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O'Kane N, Watson S, Kehoe L, O'Sullivan E, Muldoon A, Woodside J, Walton J, Nugent A. The patterns and position of snacking in children in aged 2-12 years: A scoping review. Appetite 2023:106974. [PMID: 37421978 DOI: 10.1016/j.appet.2023.106974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Childhood obesity is associated with serious comorbidities during childhood and into adulthood. One potential risk factor for childhood obesity is consumption of unhealthy, energy-dense foods. This scoping review examines evidence on snacking in children aged 2-12years of age and presents the patterns and position of snacking in children's diets. METHODS A search of electronic databases (MEDLINE, Web of Science, PubMed, Embase) for articles published from March 2011 to November 2022 was conducted. Articles providing insight into the position of snacking (e.g., energy contribution), or patterns (e.g., location, timing), in children aged 2-12years were included. A quality assessment was conducted and data was synthesised according to data source (nationally representative or other). RESULTS Twenty-one articles were included, most (n = 13) reporting nationally representative data. The average number of daily snacks was 3, with 92.9-100.0% of children consuming snacks. Most were consumed in the afternoon (75.2-84.0%) and at home (46.5-67.3%). Snacks frequently consumed were 'fruits and vegetables', 'baked desserts', 'sweets, candy and confectionery', and 'dairy products'. Snacks contributed 231-565 kcal daily, up to a third of daily carbohydrate intake, a quarter of fat intake, and a fifth of protein intake. Snacks provided up to one third of vitamin C intake, one quarter of vitamin E, potassium and magnesium intake, and a fifth of calcium, folic acid, vitamins D and B12, iron and sodium intake. DISCUSSION This scoping review provides insight into patterns and position of snacking within children's diets. Snacking plays a significant role in children's diets with multiple snacking occasions occurring throughout a child's day, the overconsumption of which has the potential to increase risk of childhood obesity. Further research is required into the role of snacking, particularly specific foods playing a role in micronutrient intake, and clear guidance for snacking intake in children.
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Affiliation(s)
- Niamh O'Kane
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland.
| | - Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland
| | - Laura Kehoe
- Department of Biological Sciences, Munster Technological University, Cork, Ireland; School of Food & Nutritional Sciences, University College Cork, Cork, Ireland
| | - Emma O'Sullivan
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Aine Muldoon
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Jayne Woodside
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland
| | - Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - Anne Nugent
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Ireland
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Lindquist K, Mann G, Farris A, Gordon K, Misyak S. Parent Perspectives of Packing School Lunches. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1994081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kayla Lindquist
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS, USA
| | - Georgianna Mann
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS, USA
| | - Alisha Farris
- Nutrition and Foods Program, Appalachian State University, Boone, USA
| | - Kymberle Gordon
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS, USA
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Varman SD, Cliff DP, Jones RA, Hammersley ML, Zhang Z, Charlton K, Kelly B. Experiential Learning Interventions and Healthy Eating Outcomes in Children: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10824. [PMID: 34682570 PMCID: PMC8535521 DOI: 10.3390/ijerph182010824] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022]
Abstract
Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.
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Affiliation(s)
- Sumantla D. Varman
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Health & Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Dylan P. Cliff
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Rachel A. Jones
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Megan L. Hammersley
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Health & Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Zhiguang Zhang
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Karen Charlton
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
- Faculty of Science, School of Medicine, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Bridget Kelly
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Health & Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
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Broad J, Forbes L, Darlington G, Ma DWL, Haines J. Child involvement in meal preparation and grocery shopping is associated with lower levels of food fussiness among young children. Appl Physiol Nutr Metab 2021; 46:1559-1562. [PMID: 34432990 DOI: 10.1139/apnm-2021-0390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined associations between child food involvement and food fussiness. Analyses used survey data from 62 children ages 1.5 to 5.9 years who participated in the Guelph Family Health Study Pilot. Overall involvement (β = -0.51, p = 0.02), involvement in meal preparation (β = -0.42, p = 0.009), and involvement in grocery shopping (β = -0.29, p = 0.04) were inversely associated with food fussiness. Experimental research including larger, more diverse samples is needed to test whether food involvement reduces food fussiness among young children. Novelty: Our study identified significant, inverse associations between child food involvement and food fussiness.
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Affiliation(s)
- Julia Broad
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Laura Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Gerarda Darlington
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
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Maiz E, Urkia-Susin I, Urdaneta E, Allirot X. Child Involvement in Choosing a Recipe, Purchasing Ingredients, and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:279-289. [PMID: 33573994 DOI: 10.1016/j.jneb.2020.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment. DESIGN Quasi-experimental. SETTING Two schools in Bilbao, Spain. PARTICIPANTS A total of 202 children (aged 8-9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group. INTERVENTION Three 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities. MAIN OUTCOME MEASURES Food neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches. ANALYSIS Chi-square test of independence, ANCOVA, and t tests were performed. RESULTS Students from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups. CONCLUSIONS AND IMPLICATIONS Both interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.
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Affiliation(s)
- Edurne Maiz
- Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Guipúzcoa, Spain; BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain.
| | - Iratxe Urkia-Susin
- BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain; Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Álava, Spain
| | - Elena Urdaneta
- BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain; Euskampus, Cooperative Innovation, Leioa, Vizcaya, Spain
| | - Xavier Allirot
- BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain
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Saxe-Custack A, Goldsworthy M, Lofton HC, Hanna-Attisha M, Nweke O. Family Perceptions of a Cooking and Nutrition Program for Low-Income Children and Adolescents. Glob Pediatr Health 2021; 8:2333794X21989525. [PMID: 33614838 PMCID: PMC7868466 DOI: 10.1177/2333794x21989525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background. Flint Kids Cook, a nutrition and culinary program for children and adolescents, was created in October 2017 to address health concerns among youth and families in a low-income, urban community. In this study, researchers examined family experiences with the 6-week, chef-led program, which was taught in a farmers' market kitchen. Methods. At the conclusion of each session, researchers used an open-ended focus group format to assess program experiences, perceived impact on youth self-efficacy for cooking and healthy eating, and caregiver support. This qualitative study was guided by thematic analysis. Results. Between November 2017 and December 2018, 72 caregivers (n = 38) and students (n = 34) participated in separate focus groups. Caregivers were primarily female (74%) and African American (71%). Most students were African American (76%) and half were female. Recurrent themes included food acceptance, dietary modifications, confidence in the kitchen, and program design. Caregivers and students agreed that location and design of the program alongside facilitation by an experienced chef were important factors for program success. Conclusions. This study demonstrated that a chef-led healthy cooking program for youth was effective in improving perceived food acceptance, dietary habits, and confidence in the kitchen. The program could be modeled in similar communities to address diet and health of children and adolescents.
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Affiliation(s)
- Amy Saxe-Custack
- Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | - Mallory Goldsworthy
- Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | | | - Mona Hanna-Attisha
- Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI, USA
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Is it possible to obtain food consumption information through children's drawings? Comparison with the Free Listing. Appetite 2020; 160:105086. [PMID: 33385477 DOI: 10.1016/j.appet.2020.105086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/02/2020] [Accepted: 12/13/2020] [Indexed: 11/22/2022]
Abstract
The aims of this research were 1) to study the children's drawings to obtain scientific information about food consumption; 2) to compare this method with an existing one (Free Listing); and 3) to compare fruits- and vegetables-consumed by children of different cultural groups within a same country. Children (n = 105) from two Argentinian cities (Salta in the northwest and 9 de Julio in the Pampean region), reported the fruits and vegetables they consumed, with the Free Listing and the new Free Drawing methods. Contingency tables were built and cognitive saliency indexes (CSI) were calculated. Children evoked 57 fruits and 54 vegetables by both methods, which were then grouped into 31 fruit and 27 vegetable categories. The advantages and limitations of the methods are discussed. Throughout Free Drawing, each food was defined by its name, shape and colour, which allowed better discrimination between varieties. Children from Salta reported consuming more fruits (63.7%) and vegetables (68.6%) than those from 9 de Julio (p < 0.05). Differences between cultural groups were found in 10 fruits and 7 vegetables, mentioned more frequently in Salta, where regional crops arose principally by Free Listing. The CSI did not depend on the method used but, for vegetables, they were affected by the cultural group. The fruits with the greatest CSI were banana and apples followed by orange (CSI≥0.19). Tomatoes, carrot and pumpkins showed the highest CSI in 9 de Julio; while carrot, tomatoes, varieties of lettuce and potatoes had the highest CSI in Salta (0.17 ≤ CSI≤0.33). Free Drawing is a qualitative alternative to study food consumption in children populations through a fun activity without the need for assistants.
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Mindful eating: effects of a brief induction in the choice and intake of food in children. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00764-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Holley CE, Haycraft E, Farrow C. Unpacking the relationships between positive feeding practices and children's eating behaviours: The moderating role of child temperament. Appetite 2020; 147:104548. [DOI: 10.1016/j.appet.2019.104548] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
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Dumas AA, Lemieux S, Lapointe A, Provencher V, Robitaille J, Desroches S. Long-term effects of a healthy eating blog in mothers and children. MATERNAL AND CHILD NUTRITION 2020; 16:e12981. [PMID: 32141188 PMCID: PMC7296799 DOI: 10.1111/mcn.12981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
In the context of low consumption of vegetables and fruits and milk and alternatives among Canadian mothers and children, novel strategies are needed to improve maternal and child nutrition. This study evaluated the long‐term effects of an evidence‐informed healthy eating blog on dietary intakes and food‐related behaviours of mothers and their child. The study presents a secondary outcome analysis of a randomised controlled trial in which 84 mothers (mean age of 37.6 ± 6.7 years) of 2‐ to 12‐year‐old children living in Quebec City, Canada, were randomly assigned to a dietary intervention delivered through a healthy eating blog written by a registered dietitian (RD; n = 42) or a control group (n = 42) during a period of 6 months. Dietary intakes, maternal eating behaviours, food parenting practices, and body weight were measured at baseline, 3 months, at the end of the intervention (6 months), and 6‐month post‐intervention (12 months). Differences between groups were assessed with mixed linear models. Globally, this study found no evidence of long‐term differences in mean dietary intakes in mothers exposed to the blog and their children as well as other food‐related outcomes and body weight compared with the control condition. Potential predictors of adherence to dietary recommendations in mothers and children (e.g., involvement of children in household food activities) were identified. In conclusion, a healthy eating blog written by an RD did not result in evidence of any long‐term differences in dietary intakes and food‐related behaviours in mothers and their children compared with the control condition.
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Affiliation(s)
- Audrée-Anne Dumas
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Simone Lemieux
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Annie Lapointe
- Institute of Nutrition and Functional Foods, Centre de recherche Nutrition, Santé et Société (NUTRISS), Université Laval, Quebec City, Quebec, Canada
| | - Véronique Provencher
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Julie Robitaille
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Desroches
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
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Maiz E, Urkia I, Bereciartu A, Urdaneta E, Allirot X. Introducing novel fruits and vegetables: Effects of involving children in artistic plating of food. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mau G, Schramm-Klein H, Schuhen M, Steinmann S. What helps children resist distracting marketing stimuli? Implementation intentions and restrictions alter food choice. Appetite 2019; 140:159-168. [PMID: 31103444 DOI: 10.1016/j.appet.2019.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Abstract
This study analyzes the impact of implementation intentions as well as restrictions on the delay of gratification in children. We assume that both strategies impact the decision process of children in different ways: While implementation intentions activate the mental representation of specified cues that help pursuing a goal, restrictions support goal attainment because of the threatened consequence. The results of two studies support these assumptions. A correlation between the physiological arousal and the success in the delay task indicates that for children that follow implementation intentions arousal provides motivation to wait for a greater gratification. These results provide possible explanations for the heterogeneous outcomes of existing studies about the effects of parenting practices.
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Affiliation(s)
- Gunnar Mau
- Department of Business Psychology, Schloss Seeburg University, Seeburgstraße 8, 5201, Seekirchen am Wallersee, Salzburg, Austria.
| | - Hanna Schramm-Klein
- Department of Marketing, University of Siegen, Unteres Schloß 3, 57072, Siegen, Germany
| | - Michael Schuhen
- Department of Marketing, University of Siegen, Unteres Schloß 3, 57072, Siegen, Germany
| | - Sascha Steinmann
- Department of Marketing, University of Siegen, Unteres Schloß 3, 57072, Siegen, Germany
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