Effect of a means-end contingency on young children's food preferences

A systematic review of parenting and feeding practices, children's feeding behavior and growth stunting in Asian countries

This systematic review evaluates studies focusing on parenting and feeding practices, children's feeding behavior, and growth stunting in Asian countries. Eight electronic databases were searched to screen studies published between Jan 2015 and May 2021. There were contradictory findings related to gender differences in growth stunting and factors that reinforce/facilitate or inhibit acquisition of optimum growth in children. Theme of parenting practices showed that time spent on childcare, traditional beliefs about child-care feeding and responsive feeding were also contributing factors. Amidst economic improvement, political, social changes, and worldwide execution of various nutritional programs, stunting continues to be relentlessly persistent and widespread in Asia. Undernutrition disturbs areas of the mind involved in reasoning, reminiscence, locomotor skills and also an adverse influence on the physical and psychological growth of children and ensuing learning capabilities. Stunted children have more anxiety and depression and lower self-esteem than non-stunted children. A public health strategy is required to: (i) properly examine stunting with time through collaborated efforts of community members and various sectors, (ii) tackle malnutrition with steps to enhance maternal nutrition during pregnancy, infant feeding practices and (iii) involvement of effective multi-sectoral partnership programs for management of stunting.

Olfactory performance and odor liking are negatively associated with food neophobia in children aged between 3 and 9 years

BACKGROUND

Child food neophobia, i.e., rejection or avoidance of novel foods at a young age, is a prevalent nutrition problem that affects the quality of children's diet and impedes the development of healthy food preferences. Sensory sensitivity can relate to the degree of food neophobia, but previous studies rarely focused on the olfactory component of this problem in children.

OBJECTIVE

We aimed to thoroughly examine the relationship between various aspects of olfactory sensitivity and food neophobia in children.

METHODS

246 children aged between three and nine years took part in a food neophobia assessment as well as in a comprehensive, psychophysical olfactory testing.

RESULTS

We found that certain smell perception aspects such as lower odor liking, poorer odor identification ability as well as lower sensitivity to an unknown non-food odor all significantly predicted higher food neophobia in children. Among individual characteristics of either a child or a caregiver, only the child's age significantly and positively predicted food neophobia. The exploratory model looking into the role of family environment factors predicting self-reported food neophobia in children revealed that food neophobia was associated with lower control given to a child in this child's feeding process, as well as with a more frequent use of food as a reward in feeding.

CONCLUSIONS

We suggest that suppressed olfactory perception and performance can play a unique role in child nutritional difficulties. The study inspires further considerations of olfaction-engaging interventions to counteract food-neophobia in children.

Associations of sugar-related food parenting practices and parental feeding styles with prospective dietary behavior of children and adolescents: a systematic review of the literature from 2017 to 2023

Introduction

High consumption of sugar-rich foods and beverages has been associated with increased overweight and obesity in children and adolescents. Dietary behavior is influenced by learned mechanisms that originate in childhood and is associated with food parenting practices (FPP) and parental feeding styles (PFS). This systematic review aimed to narratively synthesize FPP and PFS concerning sugar-rich foods and beverages and their associations with the prospective dietary behavior of children and adolescents to derive evidence-based recommendations for health professionals and parents to promote healthy behaviors.

Methods

A systematic literature search was conducted using PubMed and Web of Science databases covering the publication years 2017-2023. The results were narratively synthesized, and exposure-outcome matrices were used for visual representation. The review included 15 peer-reviewed studies from different geographical regions that investigated FPP or PFS regarding the handling of sugar-rich foods and beverages in children's diets and reported the associations with the prospective dietary behavior of children and adolescents.

Results

The findings indicate that highly controlling parental practices were associated with the development of unhealthy eating behaviors and preferences for sugar-rich foods and beverages over time. Conversely, parental practices that emphasized structure and balance in dietary choices yielded more positive long-term outcomes, associated with reduced preferences for sugar-rich foods and drinks.

Discussion

The results underscore the significance of fostering a healthy home environment and active parental role modeling in promoting healthier dietary behaviors among children and adolescents.

Shaping a moral body in family dinner talk: Children's socialization to good manners concerning bodily conduct

The family meal has been extensively investigated as a site for children's acquisition of eating-related behaviors and attitudes, as well as culture-specific rules and assumptions. However, little is known about children's socialization to a constitutive dimension of commensality and even social life: good manners concerning bodily conduct. Drawing on 20th century scholarship on body governmentality and good manners, and building on recent studies on family meal as a socialization site, the article sheds light on this overlooked dimension of family commensality. Based on a corpus of more than 20 h of videorecorded family dinner interactions collected in Italy, and using discourse analysis, the article shows that family mealtime constitutes a relevant arena where parents control their children's conduct through the micro-politics of good manners. By participating in mealtime interactions, children witness and have the chance to acquire the specific cultural principles governing bodily conduct at the table, such as "sitting properly", "eating with cutlery", and "chewing with mouth closed". Yet, they are also socialized to a foundational principle of human sociality: one's own behavior must be self-monitored according to the perspective of the generalized Other. Noticing that forms and contents of contemporary family mealtime talk about good manners are surprisingly similar to those described by Elias in his seminal work on the social history of good manners, the article documents that mealtime still constitutes a privileged cultural site where children are multimodally introduced to morality concerning not only specific table manners, but also more general and overarching assumptions, namely the conception of the body as an entity that should be (self)monitored and shaped according to moral standards.

Prospective associations between early childhood parental feeding practices and eating disorder symptoms and disordered eating behaviors in adolescence

OBJECTIVE

Nonresponsive parental feeding practices are associated with poorer appetite self-regulation in children. It is unknown whether this relationship extends beyond childhood to be prospectively associated with the onset of eating disorder (ED) symptoms in adolescence. This exploratory study therefore investigated prospective associations between early childhood parental feeding practices and adolescent ED symptoms and disordered eating behaviors.

METHODS

Data were from two population-based cohorts with harmonized measures: Generation R (Netherlands; n = 4900) and Gemini (UK; n = 2094). Parents self-reported their pressure to eat, restriction and instrumental feeding (i.e., using food as a reward) at child age 4-5 years. Adolescents self-reported their compensatory behaviors (e.g., fasting, purging), binge-eating symptoms, restrained eating, uncontrolled eating, and emotional eating at 12-14 years. Associations between feeding practices and ED symptoms were examined separately in each cohort using generalized linear models.

RESULTS

In Gemini, pressure to eat in early childhood was associated with adolescents engaging in compensatory behaviors. In Generation R, parental restriction was associated with adolescents engaging in compensatory behaviors, restrained eating, uncontrolled eating, and emotional eating. Instrumental feeding was associated with uncontrolled eating and emotional eating in Generation R.

DISCUSSION

Nonresponsive parental feeding practices were associated with a greater frequency of specific ED symptoms and disordered eating in adolescence, although effect sizes were small and findings were inconsistent between cohorts. Potentially, the cultural and developmental context in which child-parent feeding interactions occur is important for ED symptoms. Further replication studies are required to better understand parents' role in the development and maintenance of ED-related symptoms.

PUBLIC SIGNIFICANCE

Prospective research examining how early childhood parental feeding practices might contribute to adolescent ED symptoms is limited. In two population-based cohorts, nonresponsive feeding practices (restriction, instrumental feeding, pressure to eat) predicted increased frequency of some ED symptoms and disordered eating behaviors in adolescence, although associations were small and further replication is required. Findings support the promotion of responsive feeding practices, which may benefit young children's developing relationship with food.

Reciprocal associations between parental feeding practices and child eating behaviours from toddlerhood to early childhood: bivariate latent change analysis in the Gemini cohort

BACKGROUND

Parental feeding practices (PFPs) are a key component of a child's food environment. Parent-child feeding relationships are hypothesised to be bidirectional; however, to date, few large prospective studies have examined this, instead focussing on unidirectional relationships. As such, the direction of relationships between PFPs and children's eating behaviours remains unclear.

METHODS

Data were from Gemini, a population-based sample of children born in England and Wales in 2007. Children's eating behaviours and PFPs were measured at 15/16 months and 5 years using validated psychometric measures (n = 1,858 children). Bivariate Latent Change Score Modelling was used to examine the nature of relationships between PFPs and children's eating behaviours at 15/16 months and 5 years. Models were adjusted to account for clustering of twins within families and for sex of the child, socioeconomic status, gestational age and age of the child at measurement time points.

RESULTS

A reciprocal relationship was observed between instrumental feeding and emotional overeating, with greater instrumental feeding predicting greater increases in emotional overeating (β = .09; 0.03-0.15; p = .004) and vice versa (β = .09; 0.03-0.15; p = .005). Reciprocity was also observed between encouragement to eat nutritious foods and children's enjoyment of food, with greater encouragement predicting greater increases in enjoyment of food (β = .08; 0.02-0.13; p = .006) and vice versa (β = .07; 0.02-0.11; p = .003). Parent-child associations and child-parent associations were also observed.

CONCLUSION

These findings are consistent with the hypothesis that certain feeding practices are used as a 'natural' response to a child expressing a greater interest in and enthusiasm for food, but at the same time, such practices impact the development of eating behaviours by nurturing and encouraging the expression of higher emotional overeating and greater enjoyment of food in preschool years. The findings provide important insights into the PFPs and eating behaviour traits that could be targeted as part of a tailored feeding intervention to support parents of children during the preschool formative years.

Controlling feeding practices moderate the relationship between emotionality and food fussiness in young children

Emotional child temperament has consistently been found to be related to food fussiness. One factor that may exacerbate or reduce the risk conferred by children's emotionality is parent feeding practices during mealtimes. Specifically, the use of controlling feeding practices aimed at increasing food consumption may particularly affect children with an emotional temperament. The primary aim of this study was to investigate whether the association between child food fussiness and higher emotionality found in previous studies is moderated by maternal use of controlling feeding practices, namely verbal pressure, physical prompts and food rewards. Sixty-seven mother-child dyads were video-recorded during a meal in their home and mothers' use of controlling feeding practices during this meal were coded. Mothers completed a questionnaire assessing child temperament. Moderation analyses revealed that maternal use of verbal pressure and physical prompts moderated the relationship between higher emotionality and food fussiness, but maternal use of food rewards did not. These results indicate that the use of verbal pressure and physical prompts may have a particularly negative influence on fussy eating for children higher in emotionality.

Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.

Utilising an integrated approach to developing liking for and consumption of vegetables in children

Children eat too few vegetables and this is attributed to disliked flavours and texture as well as low energy density. Vegetables confer selective health benefits over other foods and so children are encouraged to eat them. Parents and caregivers face a challenge in incorporating vegetables into their child's habitual diet. However, liking and intake may be increased through different forms of learning. Children learn about vegetables across development from exposure to some vegetable flavours in utero, through breastmilk, complementary feeding and transitioning to family diets. Infants aged between 5 and 7 m are most amenable to accepting vegetables. However, a range of biological, social, environmental and individual factors may act independently and in tandem to reduce the appeal of eating vegetables. By applying aspects of learning theory, including social learning, liking and intake of vegetables can be increased. We propose taking an integrated and individualised approach to child feeding in order to achieve optimal learning in the early years. Simple techniques such as repeated exposure, modelling, social praise and creating social norms for eating vegetables can contribute to positive feeding experiences which in turn, contributes to increased acceptance of vegetables. However, there is a mismatch between experimental studies and the ways that children eat vegetables in real world settings. Therefore, current knowledge of the best strategies to increase vegetable liking and intake gained from experimental studies must be adapted and integrated for application to home and care settings, while responding to individual differences.

Longitudinal Associations between Food Parenting Practices and Dietary Intake in Children: The Feel4Diabetes Study

Food parenting practices (FPPs) have an important role in shaping children’s dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children’s dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (β = 0.492 in girls and β = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children’s fruit intake (β = 0.431 in girls and β = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children’s dietary intake.

Maternal self-efficacy is associated with mother-child feeding practices in middle childhood

OBJECTIVE

Maternal self-efficacy (MSE) is a well-established correlate of health outcomes in young children, though little is known about this association in older children. The purpose of this cross-sectional study was to examine how MSE relates to mother-child feeding practices in middle childhood.

METHODS

A total of 306 children ages 8-12 (Mean age = 9.72, SD = 0.91, 52.9% female) and their mothers participated in this study. Mothers completed the New General Self-Efficacy Scale and the Child Feeding Questionnaire. A series of hierarchical regression models were used to examine how MSE related to maternal food restriction, maternal pressure to eat, and maternal food monitoring.

RESULTS

After accounting for maternal Body Mass Index (BMI), education, and age, and child Body Mass Index Percentile (BMI%ile) and age within the first step of each regression model, MSE emerged as a significant predictor for maternal restriction of foods (p = .024) and maternal food monitoring (p = .048). MSE was not significantly related to maternal pressure to eat.

CONCLUSIONS

This study is the first to establish that higher MSE is significantly related to healthier mother-child feeding practices in middle childhood, providing preliminary justification for enhancing MSE within comprehensive family interventions to support child weight-related health.

De-implementation of detrimental feeding practices: a pilot protocol

BACKGROUND

Early childhood educators (ECEs) often use detrimental feeding practices and are slow to implement positive feeding practices. Nevertheless, few studies have aimed to understand and change ECEs' feeding practices. This gap needs to be addressed because implementation (i.e., adding new, evidence-based practices) and de-implementation (i.e., stopping low-value or harmful practices) are distinct processes that require unique strategies.

METHODS

We will develop a de-implementation strategy for detrimental feeding practices using evidence-based quality improvement (EBQI) sessions to engage stakeholders and draw on the Niven process model for de-implementation. Then, we will investigate the effects of the de-implementation strategy in a proof-of-principle study. The de-implementation strategy will be evaluated in 2 partnering childcare agencies using a pre-post, within-site design. For our primary outcome, we will interview educators throughout the school year to assess the feasibility and acceptability of the intervention and survey them with standard measures for assessing feasibility and acceptability. For secondary outcomes, we will investigate its effects on the use of detrimental and evidence-based feeding practices by teachers and impacts on child BMI and diet.

DISCUSSION

The current study will establish the feasibility and acceptability of our de-implementation approach and will provide preliminary data toward 3 predicted secondary outcomes: (1) decreased detrimental feeding practices by ECEs, (2) increased adoption of and fidelity to nutrition promotion practices, and (3) improved child dietary outcomes. These results are expected to contribute to the uptake and sustainability of mealtime interventions to improve the diets of young children. Results will also apply to the field of implementation science by informing processes for developing de-implementation approaches in a community setting.

Coparenting in the feeding context: perspectives of fathers and mothers of preschoolers

PURPOSE

This study examined how fathers and mothers coparent around child feeding.

METHODS

Father-mother pairs (N = 30) of preschool-aged children (M child age = 4.1 years old) participated in joint or group interview sessions.

RESULTS

Three themes emerged from the qualitative analysis: (1) couples' division of labor regarding feeding tasks seemed to align with stereotypical gender roles; (2) couples noted that they attempted healthier family eating habits in comparison to families of origin and recognized the influence of extended family on their attempts at healthier feeding; (3) couples agreed on the importance of family mealtime, routines, and healthy meals, yet disagreed on strategies to limit unhealthy foods and achieve harmonious family meals.

CONCLUSIONS

This study identified processes of coparenting and child feeding areas that were particularly challenging to manage among parents, which could be important targets for childhood obesity interventions.

LEVEL OF EVIDENCE

V, descriptive study.

Environmentally Sustainable Food Consumption: A Review and Research Agenda From a Goal-Directed Perspective

The challenge of convincing people to change their eating habits toward more environmentally sustainable food consumption (ESFC) patterns is becoming increasingly pressing. Food preferences, choices and eating habits are notoriously hard to change as they are a central aspect of people's lifestyles and their socio-cultural environment. Many people already hold positive attitudes toward sustainable food, but the notable gap between favorable attitudes and actual purchase and consumption of more sustainable food products remains to be bridged. The current work aims to (1) present a comprehensive theoretical framework for future research on ESFC, and (2) highlight behavioral solutions for environmental challenges in the food domain from an interdisciplinary perspective. First, starting from the premise that food consumption is deliberately or unintentionally directed at attaining goals, a goal-directed framework for understanding and influencing ESFC is built. To engage in goal-directed behavior, people typically go through a series of sequential steps. The proposed theoretical framework makes explicit the sequential steps or hurdles that need to be taken for consumers to engage in ESFC. Consumers need to positively value the environment, discern a discrepancy between the desired versus the actual state of the environment, opt for action to reduce the experienced discrepancy, intend to engage in behavior that is expected to bring them closer to the desired end state, and act in accordance with their intention. Second, a critical review of the literature on mechanisms that underlie and explain ESFC (or the lack thereof) in high-income countries is presented and integrated into the goal-directed framework. This contribution thus combines a top-down conceptualization with a bottom-up literature review; it identifies and discusses factors that might hold people back from ESFC and interventions that might promote ESFC; and it reveals knowledge gaps as well as insights on how to encourage both short- and long-term ESFC by confronting extant literature with the theoretical framework. Altogether, the analysis yields a set of 33 future research questions in the interdisciplinary food domain that deserve to be addressed with the aim of fostering ESFC in the short and long term.

How information about what is "healthy" versus "unhealthy" impacts children's consumption of otherwise identical foods

Can brief messages about health influence children's consumption of identical foods? Across a series of studies, we manipulated children's consumption of identical foods (fruit sauces) by pairing those foods with brief messages about each food's health status. What initially appeared to be a preference for foods described as healthy among 5- to 6-year-old children (Studies 1-2) actually reflected a preference for alternatives to foods described as unhealthy (Studies 3-5), including comparison foods that were described with negative or neutral content. Although the 2 foods on each trial were identical, children consistently ate more of the alternative to a food described as unhealthy. Similar effects were observed among 8- to 9-year-old children (Study 6). These results demonstrate that children's eating behavior is affected by messages they receive from other people, including messages about health. Further, these studies reveal basic psychological mechanisms that contribute to children's choices among foods, which could lead to effective interventions in the food domain. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parental feeding style changes the relationships between children's food preferences and food parenting practices: The case for comprehensive food parenting interventions by pediatric healthcare professionals

PURPOSE

To determine if parental feeding styles (emotional environment of the meal) moderate the relationship between food parenting practices (goal-directed behaviors) and children's preferences for fruits, vegetables, or high fat/sugar foods.

DESIGN AND METHODS

This cross-sectional descriptive study recruited parents (n = 108) of preschool age children. The parents completed several questionnaires. Linear regressions were used to assess the relationship between food parenting practices and children's food preferences as moderated by feeding style, with the authoritative feeding style serving as the reference.

RESULTS

Parental feeding styles were found to be moderators between several food parenting practices and child food preferences. When compared with parents with the authoritative feeding style (high demands, responds to child's needs), children like vegetables significantly less if indulgent (low demands, responds to child's needs) parents allow children to control their own eating, or authoritarian (high demands, does not respond to child's needs), or uninvolved (low demands, does not respond to child's needs) parents provide a healthy food environment. The authoritative style was not always preferential. For example, children of uninvolved parents who used food as a reward liked vegetables significantly more than children of parents who had the authoritative feeding style who also used food as a reward. In addition, children of authoritarian parents who modeled healthy eating liked foods high in fat and/or sugar significantly less than children of authoritative parents.

PRACTICE IMPLICATIONS

When discussing child diet quality with parents, pediatric nurses should educate parents on both food parenting practices and feeding style, or the meal's emotional climate, as children experience both of these during mealtime interactions. In addition, for educational efforts, it may be advantageous to tailor interventions based upon the parent's feeding style.

The effect of limited availability on children’s consumption, engagement, and choice behavior

Three studies examine the effect of limited availability on the engagement, consumption, and choice behavior of four- to five-year old children. It is shown that children engage longer in an activity when the activity is presented as limited in time and consume more of a particular food when the food is presented as limited in quantity. It is also shown that the consumption ratio of a less preferred food to a more preferred one increases when the less preferred food is presented as limited in quantity. Finally, children are more likely to choose a less preferred option over a more preferred one when the less preferred option becomes less available.

About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers

BACKGROUND

Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children.

METHODS

Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted.

RESULTS

Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60).

CONCLUSIONS

The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.

Mere social knowledge impacts children's consumption and categorization of foods

How does social information affect the perception of taste early in life? Does mere knowledge of other people's food preferences impact children's own experience when eating? In Experiment 1, 5- and 6-year-old children consumed more of a food described as popular with other children than a food that was described as unpopular with other children, even though the two foods were identical. In Experiment 2, children ate more of a food described as popular with children than a food described as popular with adults. Experiment 3 tested whether different perceptual experiences of otherwise identical foods contributed to the mechanisms underlying children's consumption. After sampling both endpoints of a sweet-to-sour range (applesauce with 0 mL or 5mL of lemon juice added), children were asked to taste and categorize applesauce samples with varying amounts of lemon juice added. When classifying ambiguous samples that were near the midpoint of the range (2 mL and 3 mL), children were more likely to categorize popular foods as sweet as compared to unpopular foods. Together, these findings provide evidence that social information plays a powerful role in guiding children's consumption and perception of foods. Broader links to the sociality of food selection are discussed.

Nutrition Knowledge, Attitudes, and Fruit and Vegetable Intake as Predictors of Head Start Teachers' Classroom Mealtime Behaviors

OBJECTIVE

To examine the association between nutrition knowledge, attitudes, and fruit/vegetable intake among Head Start teachers and their classroom mealtime behaviors (self-reported and observed).

DESIGN

Cross-sectional design using observation and survey.

SETTING

Sixteen Head Start centers across Rhode Island between September, 2014 and May, 2015.

PARTICIPANTS

Teachers were e-mailed about the study by directors and were recruited during on-site visits. A total of 85 participants enrolled through phone/e-mail (19%) or in person (81%).

MAIN OUTCOME MEASURES

Independent variables were nutrition knowledge, attitudes, and fruit/vegetable intake. The dependent variable was classroom mealtime behaviors (self-reported and observed).

ANALYSIS

Regression analyses conducted on teacher mealtime behavior were examined separately for observation and self-report, with knowledge, attitudes, and fruit and vegetable intake as independent variables entered into the models, controlling for covariates.

RESULTS

Nutrition attitudes were positively associated with teacher self-reported classroom mealtime behavior total score. Neither teacher nutrition knowledge nor fruit/vegetable intake was associated with observed or self-reported classroom mealtime behavior total scores.

CONCLUSION AND IMPLICATIONS

There was limited support for associations among teacher knowledge, attitudes, and fruit/vegetable intake, and teacher classroom mealtime behavior. Findings showed that teacher mealtime behavior was significantly associated with teacher experience.

Using food as a reward: An examination of parental reward practices

Eating patterns and taste preferences are often established early in life. Many studies have examined how parental feeding practices may affect children's outcomes, including food intake and preference. The current study focused on a common food parenting practice, using food as a reward, and used Latent Profile Analysis (LPA) to examine whether mothers (n = 376) and fathers (n = 117) of children ages 2.8 to 7.5 (M = 4.7; SD = 1.1) grouped into profiles (i.e., subgroups) based on how they use of food as a reward. The 4-class model was the best-fitting LPA model, with resulting classes based on both the frequency and type of reward used. Classes were: infrequent reward (33%), tangible reward (21%), food reward (27%), and frequent reward (19%). The current study also explored whether children's eating styles (emotional overeating, rood fussiness, food responsiveness, and satiety responsiveness) and parenting style (Authoritative, Authoritarian, and Permissive) varied by reward profile. Analyses of Variance (ANOVA) revealed that the four profiles differed significantly for all outcome variables except satiety responsiveness. It appears that the use of tangible and food-based rewards have important implications in food parenting. More research is needed to better understand how the different rewarding practices affect additional child outcomes.

Table Talk: development of an observational tool to assess verbal feeding communications in early care and education settings

OBJECTIVE

Children's dietary intake impacts weight status and a range of short- and long-term health outcomes. Accurate measurement of factors that influence children's diet is critical to the development and evaluation of interventions designed to improve children's diets. The purpose of the current paper is to present the development of the Table Talk observational tool to measure early care and education teachers' (ECET) verbal feeding communications.

DESIGN

An observational tool to assess ECET verbal communication at mealtimes was deigned based on the extant literature. Trained observers conducted observations using the tool during lunch for both lead and assistant ECET. Descriptive statistics, test-retest for a subgroup, interclass correlations for each item, and comparisons between leads and assistants were conducted.

SETTING

Head Start centres, Southern USA.

SUBJECTS

Seventy-five Head Start educators.

RESULTS

On average, 17·2 total verbal feeding communications (sd 8·9) were observed per ECET. For lead ECET, the most prevalent Supportive Comment was Exploring Foods whereas for assistants Making Positive Comments was the most prevalent. Overall, lead ECET enacted more Supportive Comments than assistant ECET (F(2,72)=4·8, P=0·03). The most common Unsupportive Comment was Pressuring to Eat, with a mean of 3·8 (sd 4·3) and a maximum of 25. There was no difference in Unsupportive Comments between lead and assistant ECET.

CONCLUSIONS

Table Talk may be a useful tool to assess verbal feeding communications of ECET, with potential applications such as informing ECET training and assessing intervention efforts.

The effect of childrens' eating behaviors and parental feeding style on childhood obesity

In is important to determine the factors that affect obesity in childhood, in order to raise generations of healthy children. This study aims to determine the effect of primary school students' eating behaviors and parental feeding styles on obesity in childhood. This descriptive cross-sectional study was conducted with 1201 children and their parents between September 2014 and March 2015. The data were collected using the socio-demographic data collection form for children and parents, the Children's Eating Behavior Questionnaire and the Parental Feeding Style Questionnaire. The data were analyzed using percentage calculators, mean, Spearman's correlation analysis, Pearson's correlation analysis and multiple regression analysis. Of the children, 16.9% were found to be obese. Three models were created considering the relationships between the variables in this study and the occurrence of obesity. In the first model, the factors that affect childhood obesity were found to be enjoyment of food, emotional overeating, food responsiveness, satiety responsiveness and food fussiness. In the second model, the factors were prompting/encouragement and control over eating. Enjoyment of food, emotional overeating, food responsiveness, satiety responsiveness, emotional feeding and food fussiness were also found to be the factors in the third model (p<0.05). This study showed that children's eating behaviors and parental feeding style affect the occurrence of obesity in childhood.

Association between childcare educators' practices and preschoolers' physical activity and dietary intake: a cross-sectional analysis

INTRODUCTION

Childcare educators may be role models for healthy eating and physical activity (PA) behaviours among young children. This study aimed to identify which childcare educators' practices are associated with preschoolers' dietary intake and PA levels.

METHODS

This cross-sectional analysis included 723 preschoolers from 50 randomly selected childcare centres in two Canadian provinces. All data were collected in the fall of 2013 and 2014 and analysed in the fall of 2015. PA was assessed using Actical accelerometers during childcare hours for 5 consecutive days. Children's dietary intake was measured at lunch on 2 consecutive days using weighed plate waste and digital photography. Childcare educators' nutrition practices (modelling, nutrition education, satiety recognition, verbal encouragement and not using food as rewards) and PA practices (informal and formal PA promotion) were assessed by direct observation over the course of 2 days, using the Nutrition and Physical Activity Self-Assessment for Child Care tool. Associations between educators' practices and preschoolers' PA and dietary intake were examined using multilevel linear regressions.

RESULTS

Overall, modelling of healthy eating was positively associated with children's intake of sugar (β=0.141, 95% CI 0.03 to 0.27), while calorie (β=-0.456, 95% CI -1.46 to -0.02) and fibre intake (β=-0.066, 95% CI -0.12 to -0.01) were negatively associated with providing nutrition education. Not using food as rewards was also negatively associated with fat intake (β=-0.144, 95% CI -0.52 to -0.002). None of the educators' PA practices were associated with children's participation in PA.

CONCLUSIONS

Modelling healthy eating, providing nutrition education and not using food as rewards are associated with children's dietary intake at lunch in childcare centres, highlighting the role that educators play in shaping preschoolers' eating behaviours. Although PA practices were not associated with children's PA levels, there is a need to reduce sedentary time in childcare centres.

A Pilot Intervention Targeting Dietary Intake in School Cafeterias

Objectives

This study assessed fruit and vegetable (F&V) waste during school meals in two public elementary schools, and investigated the impact of a tasting intervention implemented in one of these schools.

Methods

F&V waste was evaluated before (baseline), immediately after (post-testing), and six weeks following (follow-up), the tasting intervention.

Results

The modal outcome at each assessment was that children ate all of the served F&Vs. During tastings, most children attempted and liked the offered F&Vs. No differences between schools in F&V waste were evident at post-testing; at follow-up, the intervention school had significantly less F&V waste than the control school.

Conclusions

Generally, students were consuming the F&Vs served. Policy impact might be enhanced via a low-intensity tasting intervention.

Changing children's eating behaviour - A review of experimental research

The interest in children's eating behaviours and how to change them has been growing in recent years. This review examines the following questions: What strategies have been used to change children's eating behaviours? Have their effects been experimentally demonstrated? And, are the effects transient or enduring? Medline and Cab abstract (Ovid) and Web of Science (Thomson Reuters) were used to identify the experimental studies. A total of 120 experimental studies were identified and they are presented grouped within these 11 topics; parental control, reward, social facilitation, cooking programs, school gardens, sensory education, availability and accessibility, choice architecture and nudging, branding and food packaging, preparation and serving style, and offering a choice. In conclusion, controlling strategies for changing children's eating behaviour in a positive direction appear to be counterproductive. Hands-on approaches such as gardening and cooking programs may encourage greater vegetable consumption and may have a larger effect compared to nutrition education. Providing children with free, accessible fruits and vegetables have been experimentally shown to positively affect long-term eating behaviour. The authors recommend future research to examine how taste and palatability can positively affect children's attitudes and eating behaviour.

Understanding Food Fussiness and Its Implications for Food Choice, Health, Weight and Interventions in Young Children: The Impact of Professor Jane Wardle

PURPOSE OF REVIEW

This review examines the concepts of fussy eating and food neophobia in the context of key determinants of the development of children's food preferences. We discuss the evidence for genetic versus parental and other environmental influences on the ontogeny of these behavioural traits and the implications of current knowledge for interventions that attempt to lessen the impact of these traits on children's diets. Finally, we consider whether these traits increase the risk of a child becoming obese, or alternatively, underweight and malnourished.

RECENT FINDINGS

Fussy eating and neophobia are related concepts with both genetic and environmental aetiologies. Parent-child correlations and heritability estimates are moderate to high for both traits, but aspects of the family environment remain influential in young children, although no longer in young adults. Parental strategies based around repeat tasting opportunities can improve acceptance of disliked foods in even the fussiest children. Fussy eating and neophobia are not risk factors for obesity but could limit growth in severe cases. Fussy eating and food neophobia are common concerns for parents, though health risks are low. Dissemination of evidence-based strategies to parents that can encourage a more varied diet in young children would be helpful.

Mealtime Structure and Responsive Feeding Practices Are Associated With Less Food Fussiness and More Food Enjoyment in Children

OBJECTIVE

To identify associations between structure-related and non-responsive feeding practices and children's eating behaviors.

DESIGN

Cross-sectional online survey design.

PARTICIPANTS

Parents (n = 413) of 1- to 10-year-old children.

MAIN OUTCOME MEASURES

Parental feeding practices and child eating behaviors were measured via the validated Feeding Practices and Structure and Children's Eating Behaviour questionnaires.

ANALYSIS

Associations between parental feeding practices and children's eating behaviors were tested using hierarchical multivariable linear regression models, adjusted for covariates.

RESULTS

Feeding practices accounted for 28% and 21% of the variance in food fussiness and enjoyment of food, respectively (P < .001). For all other eating behaviors the amount of variance explained by feeding practices was < 10% (P < .001). Key findings were that more structure and less non-responsive practices were associated with lower food fussiness and higher enjoyment of food.

CONCLUSIONS AND IMPLICATIONS

Overall, the findings suggested that mealtime structure and responsive feeding are associated with more desirable eating behaviors. Contrary to predictions, there was no evidence to indicate that these practices are associated with better self-regulation of energy intake. Longitudinal research and intervention studies are needed to confirm the importance of these feeding practices for children's eating behaviors and weight outcomes.

Incentives and children's dietary choices: A field experiment in primary schools

We conduct a field experiment in 31 primary schools in England to test the effectiveness of different temporary incentives on increasing choice and consumption of fruit and vegetables at lunchtime. In each treatment, pupils received a sticker for choosing a fruit or vegetable at lunch. They were eligible for an additional reward at the end of the week depending on the number of stickers accumulated, either individually (individual scheme) or in comparison to others (competition). Overall, we find no significant effect of the individual scheme, but positive effects of competition. For children who had margin to increase their consumption, competition increases choice of fruit and vegetables by 33% and consumption by 48%. These positive effects generally carry over to the week immediately following the treatment, but are not sustained effects six months later. We also find large differences in effectiveness across demographic characteristics such as age and gender.

Perceived effective and feasible strategies to promote healthy eating in young children: focus groups with parents, family child care providers and daycare assistants

BACKGROUND

The aim of the current study is to identify strategies to promote healthy eating in young children that can be applied by caregivers, based on their own perceptions of effectiveness and feasibility. Whereas previous research mainly focused on parental influences on children's eating behavior, the growing role of other caregivers in the upbringing of children can no longer be denied.

METHODS

Four focus groups were conducted with three types of caregivers of post-weaning children under 6 years old: parents (n = 14), family child care providers (n = 9), and daycare assistants (n = 10). The audiotaped focus group discussions were transcribed and imported into Nvivo 10.0 for thematic analysis. The behaviors put forward by the caregivers were categorized within three broad dimensions: global influences, general behaviors, and specific feeding practices.

RESULTS

Perceived effective strategies to promote healthy eating behavior in children included rewards, verbal encouragement, a taste-rule, sensory sensations, involvement, variation, modeling, repeated exposure, and a peaceful atmosphere. Participants mainly disagreed on the perceived feasibility of each strategy, which largely depended on the characteristics of the caregiving setting (e.g. infrastructure, policy).

CONCLUSIONS

Based on former research and the current results, an intervention to promote healthy eating behaviors in young children should be adapted to the caregiving setting or focus on specific feeding practices, since these involve simple behaviors that are not hindered by the limitations of the caregiving setting. Due to various misconceptions regarding health-promoting strategies, clear instructions about when and how to use these strategies are necessary.

Associated Demographic Factors of Instrumental and Emotional Feeding in Parents of Hong Kong Children

BACKGROUND

Instrumental and emotional feeding have been associated with obesogenic dietary behaviors and obesity in children. Therefore, identifying parents who are more likely to use detrimental feeding styles may be helpful for tailoring interventions.

OBJECTIVE

This study examines the demographic variation of instrumental and emotional feeding by using a sample of the Hong Kong population.

DESIGN

A cross-sectional research is presented. Instrumental and emotional feeding styles were assessed.

PARTICIPANTS

A total of 3,742 Hong Kong parents from 27 kindergartens, with children aged 2 to 7 years old, were enrolled in this study.

MAIN OUTCOME MEASURES

Instrumental and emotional feeding styles were assessed by a validated Parental Feeding Style Questionnaire.

STATISTICAL ANALYSIS

Differences among the demographic characteristics in parental feeding styles were compared by independent t test or analysis of variance. Multiple linear regressions were performed to determine the associated demographic factors.

RESULTS

A greater tendency to adopt instrumental feeding was associated with younger children (β=-.07), feeding a daughter (β=.05), and a mother having a full-time job (β=.10). By contrast, a greater tendency to adopt emotional feeding was associated with younger children (β=-.07), feeding a daughter (β=.06), a mother having a full-time job (β=.16), or a lower parental education level (β=-.11).

CONCLUSIONS

Parents with full-time jobs, lower education levels, or who were nurturing a younger child may be more likely to use unhealthy feeding styles. Researchers should consider developing intervention strategies that focus on decreasing emotional and instrumental feeding styles for full-time employed or less-educated parents of younger children, particularly daughters.

Influence of maternal feeding goals and practices on children's eating behaviors

Parents are highly influential in shaping their children's dietary habits. This study examined whether negative feeding practices mediated the relationship between feeding goals (health and convenience) and children's eating behaviors. One hundred ninety-two mothers (mean age = 34.2; mean BMI = 27.0) of 7-11 year old children participated via Amazon's Mechanical Turk. Results showed that negative feeding practices fully mediated the relationship between convenience feeding goals and children's eating behaviors (goals to healthy/unhealthy eating behaviors: β = -0.08/.09, n.s.; goals to feeding practices: β = 0.27, p < 0.01; feeding practices to healthy/unhealthy eating behaviors: β = -0.57/.48, p < 0.05). On the other hand, negative feeding practices did not fully mediate the relationship between health feeding goals and children's eating behaviors (goals to healthy/unhealthy eating behaviors: β = 0.66/-0.29, p < 0.01; goals to feeding practices: β = -0.28, p < 0.001; feeding practices to healthy/unhealthy eating behaviors: β = -0.26/.44, p < 0.05). In other words, children whose mothers emphasized health goals consumed more healthy food and less unhealthy food, above and beyond the use of negative feeding practices. Because parents are on the front lines of shaping children's eating habits, understanding the best point of intervention for parents (e.g., shaping parents' goals, changing parents' feeding practices) might be especially fruitful, considering that childhood obesity has become a global public health crisis and energy intake is one of the key factors contributing to this problem.

Desire for Sweet Taste Unchanged After Eating: Evidence of a Dessert Mentality?

BACKGROUND/OBJECTIVES

Added sugars provide calories and desirability to foods and beverages. Our aim was to test whether desire for a sweet taste would be better maintained than a desire for other tastes for 3 hours after a test meal.

METHODS

Eighty-three young adults ate 2 slices of bread on 2 separate occasions after which they were asked to rate their desire for savory, sweet, fatty, or salty tastes and to specify the number of servings of white rice, pizza, cheese and crackers, sweet biscuits, and pasta they could consume. Desirability was assessed using 100-mm visual analog scales (VAS), with 0 mm representing no desire and 100 mm great desire.

RESULTS

When participants provided a quantitative assessment of the servings of foods that they wanted to eat following the bread meal, desire decreased on average for all foods measured, χ² (3) = 2.63, p = 0.452. Mean (95% confidence interval [CI]) change in VAS taste desirability 30 minutes after eating declined for salty (14.5 mm [10.5, 18.6]), fatty (11.2 mm [7.1, 15.2]), and savory (24.1 mm [19.7, 28.5]) tastes (p < 0.001). Desirability for sweet taste did not differ from baseline (2.4 mm [-2.3, 7.1]), and this level of desire was maintained throughout the 3-hour period.

CONCLUSIONS

The data indicate a partial disconnection between appetite and desirability for sweet taste. Physiological and psychosocial reward systems may make it difficult for people to resist sweet tasting foods and beverages. Targeting familial and cultural practices that discourage the consumption of added sugar foods might be useful to combat desire-driven food intake.

Does an early socialization into a food culture condition lifelong food preferences? Evidence from a retrospective study

The influence of early formed dietary practices on food choices and preferences during adulthood has often been assumed but rarely adequately demonstrated given the difficulty of studying the subject matter with conventional laboratory or observational research designs. This article examines this assumption by analyzing the information from 31 structured interviews on the respondents' current preferences for combinations of six side dishes with bread or mămăligă (boiled cornmeal mush, similar to polenta). All the respondents had consumed mămăligă in their childhood but in their adulthood had switched to bread following the social and economic upheavals from 1960s Romania. The results show that a) for specific combinations, physiological factors and/or cultural norms that defined bread as a 'prestigious' food have been capable of overriding the effects of early socialization with mămăligă as the accompanying food and b) that consumers continue to prefer certain side dishes with mămăligă even after decades of predominant consumption of bread although confounding factors might account for such preferences. These findings qualify the expectation that an early familiarization with healthy eating habits will promote this desired lifestyle during adulthood by showing that physiological and socio-cultural factors are capable of overriding its effects on hedonic preferences.

Strategies to improve the Willingness to Taste: The moderating role of children's Reward Sensitivity

The present study investigates the effectiveness of different strategies to improve Willingness to Taste disliked vegetables and the moderating role of Reward Sensitivity. Preschool children (N = 204; age: M = 4.48, SD = 1.01) were randomly allocated to one of four different Willingness to Taste strategies. The findings indicate that first, Willingness to Taste is higher in the modelling and reward strategies compared to neutral instructions. Second, there is a differential effect of Willingness to Taste strategies dependent upon individual differences: children high in Reward Sensitivity were more likely to taste immediately when rewarded, while children low in Reward Sensitivity were more willing to taste when verbally encouraged, but with hesitation. This article thus highlights the roles of both individual differences and behavioral techniques for promoting a healthy diet in children.

Primary caregivers of young children are unaware of food neophobia and food preference development

Issues addressed: This research explored primary caregivers' awareness of food neophobia and how food preferences develop in young children aged between 1 and 2.5 years. Methods: This qualitative study used case study methodology and comprised interviews with 24 primary caregivers of young children aged between 1 and 2.5 years. Results and conclusions: Primary caregivers of young children are unaware of food neophobia and food preference development in young children. So what? Raising primary caregivers' awareness of food neophobia and how food preferences develop in young children may encourage caregivers to decrease their children's exposure to non-core foods.

Fundamental constructs in food parenting practices: a content map to guide future research

Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.

Using food as reinforcer to shape children's non-food behavior: The adverse nutritional effect doubly moderated by reward sensitivity and gender

PURPOSE

Control rules are parental practices that use food, especially those high in fat or sugar, as an instrumental reinforcer to encourage children to behave in a normative manner in non-food domains. Past laboratory experiments show that repeatedly presenting snacks as a reward or associated with adults' attention, increases children's preference for the presented food. This field study aims to examine whether control rules are associated with children's increased everyday intake of food high in sugar/fat, and whether this effect is moderated by individual differences in neurobehavioral sensitivity to reward and in gender.

DESIGN

207 six- to twelve-year-old children's parents reported the children's everyday dietary intake through a food frequency questionnaire and provided information regarding the children's sensitivity to rewards as well as the frequency of enforcing control rules.

RESULTS

Children who lived in families with a high frequency of using control rules exhibited more daily fat, carbohydrate, and total energy intake than did children whose parents use control rules less often. Furthermore, the effect of control rules on dietary pattern was particularly strong for children with high reward sensitivity, especially boys.

CONCLUSIONS

Control rules have adverse consequences on children's nutrition. The moderating effects of sensitivity to reward and gender are consistent to a reinforcement learning process--associating the high-fat/sugar food consumption with social-affective pleasure resulting from performing behavior desired by parents--through which parental control rules contribute to children's maladaptive dietary patterns.

Using Virtual Pets to Increase Fruit and Vegetable Consumption in Children: A Technology-Assisted Social Cognitive Theory Approach

A virtual pet in the form of a mid-sized dog was developed based on the framework of social cognitive theory and tested as a vehicle for promoting fruit and vegetable (F&V) consumption in children. Three groups of children (N = 68) between the ages of 7 and 13 years were studied: baseline (no treatment), computer only, and virtual dog. Children in the virtual dog condition interacted with the virtual dog for 3 days, setting F&V consumption goals and receiving evaluation and reinforcement based on whether they met their self-set goals. Children vicariously experienced future health outcomes of F&V consumption by seeing, hearing, and feeling their virtual dog's physical and mental health improve or deteriorate based on their F&V consumption in the physical world. Children in the computer only condition interacted with a computer system that presented equivalent features, but without the virtual dog. Children in the baseline condition did not receive any experimental treatment. Results indicated that children in the virtual dog condition chose to be served significantly more F&V than those in the computer only or baseline conditions did. However, children in the virtual dog condition were unable to consume significantly more F&V than those in the computer only condition, although children in those two conditions consumed more F&V than the baseline condition. Food preferences did not differ significantly across the three conditions before and after the experimental treatments. Theoretical and practical potentials of using a virtual pet to promote F&V consumption systematically in children are discussed.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Consumers' view on determinants to food satisfaction. A qualitative approach

The objective of this study was to gain a better understanding of the multiple determinants to food satisfaction from a consumer perspective. The study includes two focus groups with a total of 20 consumers varying in gender, age, employment and food interest. The results were divided into sections based on the main themes that arose from analysing the focus groups; i) sensory properties, ii) physical wellbeing, iii) expectations and desires, iv) the food context and v) comparison of the importance of the various determinants to satisfaction. Factors important for food satisfaction appear before as well as during and after intake. Before intake, the important factors are; expectations and desires based on memories about previous food experiences and the context in which the food is perceived. Physical wellbeing was mentioned important for the feeling of satisfaction, included in physical wellbeing is the experience of an appropriate energy level after intake. In general the sensory experience seems to be the primary determinant to satisfaction. The hedonic experience of eating could be enhanced by the social company and knowledge about the food inclusive health value and origin. Findings from the study will prospectively be used to develop a questionnaire. The questionnaire will be applied in case studies to measure factors influential in food satisfaction.

Maternal Attitudes and Behaviors Regarding Feeding Practices in Elementary School-Aged Latino Children: A Pilot Qualitative Study on the Impact of the Cultural Role of Mothers in the US-Mexican Border Region of San Diego, California

This study aimed to explore the attitudes and behaviors of Latino mothers around feeding their children. Using qualitative methods, we conducted four focus groups in Spanish with 41 Latino mothers of elementary school-age children in San Diego County, CA. Latino mothers' mean age was 41 years; 90% were foreign-born; and 74% had a high school education or less. We explored cultural viewpoints around feeding and cooking and feeding strategies used. Focus groups were analyzed based on a priori and emergent themes. The following themes around feeding emerged: feeding attitudes central to the maternal responsibility of having well-fed children and feeding behaviors that centered on cooking methods, supportive behaviors, and reinforcement strategies for "eating well." These findings increase our understanding of the Latino maternal role to feed children and can help to inform more culturally appropriate research to effectively address nutritional issues and obesity prevention in Latino children.

Associations between Parental Feeding Styles and Childhood Eating Habits: A Survey of Hong Kong Pre-School Children

Childhood obesity is a global public health issue, including in the Chinese setting, and its prevalence has increased dramatically throughout the last decade. Since the origins of childhood obesity may lie in the pre-school period, factors relating to very young children’s food consumption should be investigated. Parental influence, including feeding style, is the major determinant of childhood dietary behaviour through altering food provision and social environment. However, the applicability of previous research on parental feeding styles was limited by small sample size. To evaluate the influence of parental feeding styles on children's dietary patterns, a cross-sectional study was conducted among 4553 pre-schoolers in Hong Kong. Information was obtained about dietary intake and how regularly they had breakfast, using previous health surveillance surveys taken among primary school students. Parental feeding styles were assessed by a validated Parental Feeding Style Questionnaire and categorized into ‘instrumental feeding’, ‘emotional feeding’, ‘prompting and encouragement to eat’ and ‘control over eating’. Multivariable analysis was performed, adjusted for demographic information. Instrumental and/or emotional feeding was found to relate to inadequate consumption of fruit, vegetables and breakfast, and positively correlated with intake of high-energy-density food. Encouragement on eating was associated with more frequent consumption of fruits, vegetables, dairy products and breakfast. Control over eating correlated with more frequent consumption of fruits, vegetables and breakfast, and less consumption of dairy products and high-energy-density food. The present study has provided evidence on the associations between parental feeding styles and dietary patterns of Hong Kong pre-school children from a reasonably large population. Parents should avoid instrumental and emotional feeding, and implement control and encouragement to promote healthy food intake. Longitudinal studies and interventions on parental feeding style are required to confirm the research findings.