The influence of peers′ and siblings′ on children’s and adolescents′ healthy eating behavior. A systematic literature review

Moderating effects of socioeconomic status and geographical location on the Health4Life school-based intervention

Objective

This study evaluated the moderating effects of socioeconomic status (SES) and geographical location on the efficacy of an eHealth school-based multiple health behaviour change intervention - Health4Life - in targeting alcohol and tobacco use, dietary intake, knowledge, behavioural intentions, and psychological distress over 24-months.

Methods

Data from the Health4Life cluster-randomised controlled trial conducted from 2019 to 2021 in 71 Australian secondary schools were analysed (N=6639; baseline age 11-14yrs). Schools were from metropolitan (89%) and regional (11%) areas, and participants' SES was classified as low (15%), mid (37%), and high (48%) relative to the study population. Primary outcomes included alcohol and tobacco use, and a composite indicator of poor diet. Secondary outcomes were knowledge, behavioural intentions, and psychological distress. Latent growth models assessed moderating effects of SES and geographical location on between-group change over 24-months.

Results

Geographical location moderated the intervention's effect on odds of reporting a poor diet (OR = 1.79, 95% CI = 1.32-2.43, p < 0.001) and diet-related behavioural intentions (OR = 0.71, 95% CI = 0.56-0.89, p = 0.024) over time. Subset analyses indicated that intervention participants in regional areas had higher odds of reporting a poor diet (OR = 1.61, 95% CI = 1.13-2.29, p = 0.008), while those in metropolitan areas had higher odds of improving diet-related behavioural intentions (OR = 1.13, 95% CI = 1.01-1.27, p = 0.041), compared to the control group. No other significant moderation effects were observed.

Conclusions

While significant disparities were generally not observed, the geographical differences in intervention effects on diet and diet-related intentions suggest that co-designed and tailored approaches may benefit disadvantaged adolescents to address the disproportionately high rates of lifestyle risk behaviours among these priority populations.

Socioeconomic and household framework influences in school-aged children's eating habits: Understanding the parental roles

Maternal influences on children's diet have been widely studied, while paternal and household frameworks require further research. This study aimed to evaluate how individual, socioeconomic and household characteristics at birth and 7 years (y) impact children's fruit and vegetable (FV) and energy-dense foods (EDF) intake at 10y, distinguishing maternal and paternal effects. The sample included 2750 children evaluated at 7 and 10y in the Portuguese birth cohort Generation XXI. The children's food intake was assessed through a Food Frequency Questionnaire at both ages, where 4 food groups were defined: FV, 'Sweet foods', 'Salty snacks', and 'Soft drinks'. The associations between food intake at 7y, parents' and children's characteristics, and food intake at 10y were evaluated via binary logistic regression models. Offspring of older mothers with higher age and education, who live with siblings and had higher family income were likelier to have 5 servings of FV daily at 10y. Children eating 5 portions/day of FV at 7y had higher odds of keeping this pattern at 10y. Higher maternal age and education, and father's education decreased the odds of having soft drinks daily at 10y. Higher family income was linked with lower odds of weekly salty snacks and daily sweet foods at 10y. In conclusion, parental education, maternal age, living with siblings, and higher family income influenced children's FV and EDF intake at 10y. Mothers' effects appear to impact children's food intake more than fathers'.

Screen Time Use and Ultra-Processed Food Consumption in Adolescents: A Focus Group Qualitative Study

BACKGROUND

Sedentary lifestyles and ultra-processed food (UPF) consumption contribute to a high prevalence of overweight and obesity among adolescents. Screen time may be associated with higher UPF consumption and affect eating behaviors substantially.

OBJECTIVE

The aim of this study was to explore adolescents' perceptions, attitudes, and motivations concerning the consumption of UPF when using screens; investigate their perceived educational needs regarding nutrition; and explore their knowledge about UPF.

DESIGN

This was a qualitative study using focus groups.

PARTICIPANTS/SETTING

Four focus groups with 30 adolescents aged 12 to 16 years at a Spanish high school were recruited in May 2022. Participants were chosen using purposive sampling based on a theoretical saturation criterion.

ANALYSES

Focus group discussions were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Three themes emerged from the thematic analysis. Participants explained that most of their meals were eaten in front of screens. They confirmed more consumption of UPF at breakfast, as mid-afternoon snacks, on weekends, and during their main meals when alone. Participants reported that the high consumption of UPF during social gatherings was related to its easy availability, convenience, and palatability. Adolescents expressed that eating in front of screens and exposure to UPF advertising led to compulsive and impulsive consumption of these products. They described UPF as addictive and unhealthy. Although participants had little awareness of UPF health effects, they expressed interest in learning about healthy eating habits. Parental attitudes toward food were considered by the participants as relevant in establishing their eating behaviors.

CONCLUSIONS

Loneliness, social gatherings, and parental attitudes toward UPF consumption emerged as important influences on adolescents' dietary behaviors in front of screens. In addition, availability, palatability, and exposure to advertising were key factors reported to influence adolescents' UPF consumption in front of screens. Addressing these influences through nutritional and educational interventions, as well as regulating the adolescent obesogenic environment and managing screen time could help modulate these effects.

Relationship Between Food Insecurity and Healthy Eating Behavior for Gestational Diabetes Risk Reduction Among American Indian and Alaska Native Adolescent and Young Adult Females: A Qualitative Exploration

OBJECTIVE

To understand the perspectives of key informant experts regarding the relationship between food insecurity and gestational diabetes mellitus risk reduction behaviors among young American Indian and Alaska Native females.

METHODS

Participants were adult key informants with expertise in food/nutrition and health within Tribal communities (N = 58) across the US. Data were collected through 1:1 interviews using a semistructured moderator guide and analyzed using thematic content analysis methods.

RESULTS

Three themes included (1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; (2) young people are influenced by what their peers eat and the food environment, including outside of the home; and (3) the methods used to understand household food insecurity and nutrition habits in the parent study were likely limited.

CONCLUSIONS AND IMPLICATIONS

Findings provide guidance as to where nutrition education and interventions may best support young Native females.

Facilitators and barriers to healthful eating among adolescents in high-income countries: A mixed-methods systematic review

Adolescent obesity continues to be a public health challenge with poor quality diets contributing to its etiology. As part of the process to plan health promotion and policy interventions, understanding adolescents perceived facilitators and barriers to healthful eating is important. An integrative convergent mixed-methods systematic review was used to synthesize qualitative and quantitative evidence from studies among adolescents aged 10-19 years in high-income countries. Medline, Embase, PsycInfo, and Scopus were searched for peer-reviewed articles published between 2010 and 2023 and exploring adolescents' perspectives on healthful eating and contemporary contextual factors. Transformed quantitative data were integrated with qualitative data. Text was coded into subthemes and themes using an inductive approach. Key facilitators included health and physical appearance; motivation; taste; nutrition knowledge, awareness, and skills; nutrition education access; availability and accessibility of healthful foods; family; and social influences and digital media. Key barriers included taste and cravings for unhealthful foods; mood; lack of motivation, awareness, knowledge, and skills; high availability and low cost of unhealthful foods; peers and social influences; ineffective school policies; high density of fast-food outlets; unhealthful food advertising; digital influences; and time constraints. Social, behavioral, digital, and food environmental factors should be considered from an adolescent perspective in the design of education, health promotion, and policy interventions.

Correlates of lifestyle patterns among children in Singapore aged 10 years: the growing up in Singapore towards healthy outcomes (GUSTO) study

OBJECTIVE

To characterise lifestyle patterns (comprising dietary and movement behaviour aspects) of children in Singapore and examine the correlates of these patterns.

DESIGN

An observational study approach was used. Children recorded their diet and activities over two weekdays and two weekend days on a validated web-based assessment, My E-Diary for Activities and Lifestyle (MEDAL). Lifestyle patterns were derived using principal component analysis, and the correlations of these with multiple known determinants organised by distal, intermediate, and proximal levels of influence were studied.

SETTING

Children of the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort.

PARTICIPANTS

Ten-year-old children (n = 397).

RESULTS

Three lifestyle patterns, "high snacks and processed food", "balanced" and "mixed", were identified. We focused on the more health-promoting "balanced" pattern, characterised by lower screen-viewing and higher consumption of fruits, vegetables, wholegrains, and dairy. Among the distal factors, girls were more adherent to the "balanced" pattern compared to boys, and children of parents with lower education levels were less adherent to this pattern. Among intermediate factors, children of mothers with higher diet quality were more adherent to the "balanced" pattern. Among the proximal factors, engagement in active transport, leisure sports, and educational activities outside of school were positively associated with the "balanced" pattern, whereas screen-viewing while travelling was negatively associated with this pattern. Having siblings, pet ownership, mother's physical activity, parenting style, parental bonding, child's outdoor time, and breakfast consumption were not associated with children's lifestyle patterns.

CONCLUSIONS

These findings provide direction for future interventions by identifying vulnerable groups and contexts that should be prioritised.

Dietary Patterns Among US Children: A Cluster Analysis

BACKGROUND

Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions.

OBJECTIVE

This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics.

DESIGN

Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns.

PARTICIPANTS AND SETTING

Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall.

MAIN OUTCOME MEASURES

The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores.

STATISTICAL ANALYSES PERFORMED

A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership.

RESULTS

Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster.

CONCLUSIONS

Children in this study displayed different dietary patterns, with key sociodemographic variation.

Longitudinal tracking of diet quality from childhood to adolescence: The Interplay of individual and sociodemographic factors

This study aimed to examine diet tracking from childhood to adolescence, using 4 time-points, and the influence of socioeconomic and individual characteristics in this transition. The sample included 6893 children from the Portuguese birth cohort Generation XXI with complete information on Food Frequency Questionnaire in at least one of the considered follow-ups. A Healthy Eating Index (HEI), previously developed to assess adherence to WHO's dietary recommendations, was applied at all ages (4, 7, 10 and 13y). The intraclass correlation coefficient (ICC) was used to analyse the tracking of diet quality. Linear mixed-effect models were performed to estimate the association of the child's socioeconomic and individual characteristics with the HEI score and respective trajectories over time. The overall diet quality decreased from childhood (22.2 ± 3.6 at 4y) to adolescence (18.2 ± 3.9 at 13y), with moderate tracking (ICC = 0.53), showing that children who start a healthy diet earlier might have a better diet quality as time goes by. Children of older mothers (β = 0.079, 95%CI = 0.061-0.097) and with higher education (β = 0.203, 95%CI = 0.178-0.229) and a higher household monthly income (β = 0.024,95%CI = 0.007-0.041) had a higher diet quality over time. Besides family characteristics, the child's sedentary activities (β = -0.009, 95%CI = -0.014--0.003) negatively influence diet quality throughout life. In contrast, being a girl (β = -0.094, 95%CI = -0.132--0.056) and having higher sleep duration (β = 0.039, 95%CI = 0.015-0.064) are associated with a higher diet quality over time. The presence of dietary tracking from childhood to adolescence implies that promoting healthy eating habits during the first years of life is crucial for a healthier diet quality during late childhood and early adolescence, focusing on maternal and individual child characteristics.

Youth Perspectives on the Effects of a Family-centered Media Literacy Intervention to Encourage Healthier Eating

A pretest-posttest field test with control group (N = 189 parent-child dyads) tested a structural model representing youths' (ages 9-14) perspectives to examine the efficacy of a family-centered, media literacy-oriented intervention promoting fruit and vegetable consumption. The intervention facilitated critical discussion about nutrition and media, mentored by the parent. Results showed that youths' increases in fruit and vegetable consumption flowed from parent-child discussion of nutrition labels, which was predicted by child-initiated discussion, critical thinking about media sources, and critical thinking about media content. Multivariate analyses revealed that the intervention was productive for all participating age groups and for all dependent variables. The results suggest that a developmental progression from critical thinking about source to critical thinking about content affects behavior change and can be catalyzed through media literacy education and encouragement to discuss media messages (i.e. practice) with parents.

Family Meals and Social Eating Behavior and Their Association with Disordered Eating among Spanish Adolescents: The EHDLA Study

PURPOSE

The aim of this study was to examine the association of family meals and social eating behavior with disordered eating behavior in Spanish adolescents.

METHODS

This was a cross-sectional study that included 706 adolescents (43.9% boys) from the Eating Habits and Daily Life Activities (EHDLA) study (aged 12 to 17) from Valle de Ricote, Region of Murcia, Spain. The frequency of family meals was assessed by asking participants to report how often their family, or most household members, had shared meals in the past week. Social eating behavior was evaluated using three statements: "I enjoy sitting down with family or friends for a meal", "Having at least one meal a day with others (family or friends) is important to me", and "I usually have dinner with others". To evaluate disordered eating, two psychologists administered the Sick, Control, One, Fat and Food (SCOFF) questionnaire.

RESULTS

After adjusting for several covariates, for each additional family meal, the likelihood of having disordered eating behavior was lower (odds ratio (OR) = 0.96; 95% confidence interval (CI) 0.93 to 0.9997, p = 0.049). On the other hand, a lower likelihood of having disordered eating behavior was observed for each additional point in the social eating behavior scale (OR = 0.85; 95% CI 0.77 to 0.93, p = 0.001). The likelihood of having disordered eating behavior was 0.7% lower for each additional family meal (95% CI 0.01% to 1.4%, p = 0.046). Furthermore, for each additional point in the social eating behavior scale, a lower probability of having disordered eating behavior was observed (3.2%; 95% CI 1.4% to 5.0%, p < 0.001).

CONCLUSIONS

While disordered eating behavior is complex and can be shaped by various factors, both family meals and social eating behavior emerge as significant factors inversely associated with this condition among adolescents. Promoting regular engagement in family meals and fostering positive social eating experiences could serve as effective strategies in public health initiatives aimed at mitigating the incidence of disordered eating behavior among the young population.

Determinants of obesity in Latin America

Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.

A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Is it all due to peers? The influence of peers on children's snack purchase decisions

The objective of this study is to examine whether the presence of peers has an impact on children's snack purchasing decisions. In particular, the research analyzes whether the company of a classmate or friend influences children's brand awareness and price perception, and how these factors affect their snack purchases. An incentive-based discrete choice experiment was conducted with snacks varying in price, brand, and healthiness, using the presence or absence of peers as a between-subject treatment. The data was analyzed using mixed logit models and a multinomial logit model. A total of 128 primary school children aged 8 to 10 years were included in the final data analysis. The findings show that the presence of peers strongly influences children's snack purchase decisions, particularly with respect to product type and price. The results highlight that children tend to conform to the group's decision, highlighting that social influence plays a crucial role in shaping children's decision-making processes. This study is the first to investigate the influence of peers on children's actual purchase decisions, thereby extending previous knowledge of the impact of peers on primary school children to the market domain.

Validation of the adult eating behavior questionnaire in a Norwegian sample of adolescents

Eating behaviors are related to health and well-being. To examine stability and change in eating behaviors throughout life, developmentally appropriate measures capturing the same eating behavior dimensions are needed. The newly developed Adult Eating Behavior Questionnaire (AEBQ) builds on the well-established parent-reported Children's Eating Behavior Questionnaire (CEBQ), and together with the corresponding Baby Eating Behavior Questionnaire (BEBQ), these questionnaires cover all ages. However, validation studies on adolescents are relatively sparse and have yielded somewhat conflicting results. The present study adds to existing research by testing the psychometric properties of the AEBQ in a sample of 14-year-olds and examining its construct validity by means of the parent-reported CEBQ. The current study uses age 14 data (analysis sample: n = 636) from the ongoing Trondheim Early Secure Study, a longitudinal study of a representative birth cohort of Norwegian children (baseline: n = 1007). Confirmatory factor analysis (CFA) was conducted to test the factorial validity of AEBQ. Construct validity was examined by bivariate correlations between AEBQ subscales and CEBQ subscales. CFAs revealed that a 7-factor solution of the AEBQ, with the Hunger scale removed, was a better-fitting model than the original 8-factor structure. The 7-factor model was respecified based on theory and model fit indices, resulting in overall adequate model fit (χ2 = 896.86; CFI = 0.924; TLI = 0.912; RMSEA = 0.05 (90% CI: 0.043, 0.051); SRMR = 0.06). Furthermore, small-to-moderate correlations were found between corresponding AEBQ and CEBQ scales. This study supports a 7-factor solution of the AEBQ without the Hunger scale and provide evidence of its construct validity in adolescents. Several of the CEBQ subscales were significantly associated with weight status, whereas this was the case for only one of the AEBQ scales.

How Can We Increase the Nutrition-Related Knowledge in Children Aged 7-12 Years: Results of Focus Groups Interviews with Parents-Junior-Edu-Żywienie (JEŻ) Project

Nutrition education is a long-term process that should cover various population groups. A special focus should be placed on children, adolescents and their parents. The aim of this research was to find out the opinions of parents of primary school pupils aged 7-12 on their expectations towards school education in the areas of food and nutrition, addressed to both pupils and their parents. The research was conducted among 101 parents of primary school pupils with the use of the Focus Group Interview (FGI) method. It demonstrated that what is most needed are hands-on activities relating to basic theoretical issues. While parents see the need for nutrition education for their children, educating pupils in this area is of interest to only some of the respondents for whom nutrition aspects are quite important. All parents would like formal nutrition education at school, but at the same time, they do not want classes to take up too much of their children's time, due to the already excessive number of school subjects. It seems appropriate to include everyone in regard to nutrition education, regardless of their declared interest in this issue. The need for consistent presentation of educational content addressed to teachers and parents is very important, so that they can, in a uniform way, shape the attitudes towards food and nutrition of children and adolescents.

Adherence to Mediterranean Diet and Food Neophobia Occurrence in Children: A Study Carried out in Italy

Food Neophobia (FN), defined as the reluctance to eat new or unfamiliar foods, mainly concerns fruit, vegetables, and legumes, typical of the Mediterranean Diet (MD). Considering these premises, this study aimed to clarify the relationship between FN and AMD in a sample of Italian children and their association with some socio-demographic factors and children's nutritional status. A sample of 288 children aged 3-11 years participated in an assessment carried out with a questionnaire evaluating FN and AMD, respectively, with the Child Food Neophobia Scale (CFNS) and the KIDMED test. Most of the sample showed an intermediate (67.3%) or high level of FN (18.1%), with high rates among 6-11-year-old children (63.9%) and especially in those who were the only child (50%). The AMD was mostly low (29.5%) or medium (54.8%) and reached lower levels among higher neophobic children (51.9%; p value < 0.05). The present results confirm the study hypothesis that FN is a driver of MD abandonment and shows the positive effects on children's eating habits and siblings. Finally, this study proves the relevance of adopting effective feeding strategies against FN to avoid its maintenance in adulthood and the detrimental effects on future overall health and well-being.

Food consumption and adherence to dietary guidelines among Jordanian children and adolescents

Background

Early-life food consumption patterns may affect children's health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood.

Aims

To evaluate Jordanian children and adolescents' energy and macronutrient intake and how closely they adhere to dietary recommendations.

Methods

This cross-sectional study used data from Jordan's Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines.

Results

The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake.

Conclusion

The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Caregiver Influences on Eating Behaviors in Children: An Opportunity for Preventing Obesity

PURPOSE OF REVIEW

This review seeks to define caregiver practices that impact childhood eating behaviors and identify ways to utilize these relationships to prevent childhood obesity.

RECENT FINDINGS

Childhood obesity, which correlates with adult obesity and increased cardiovascular risk, is increasing in prevalence and severity. Caregivers play a significant role in shaping a child's eating behaviors and their predisposition to obesity. Maternal influences during pregnancy and infancy impact a child's future food preferences. Caregiver feeding styles (authoritarian, authoritative, indulgent, and uninvolved) are associated with distinct effects on children's eating behaviors and self-regulation. Authoritative feeding styles promote child autonomy while setting boundaries in the feeding environment. Early caregiver education and coaching regarding nutrition and feeding practices is beneficial to establishing healthy eating behaviors for children. Various caregivers, including parents, grandparents, siblings, teachers, and others, influence a child's eating habits at different stages of development. These caregivers can both positively and negatively impact a child's diet. Comprehensive interventions involving these various caregivers to promote healthy eating practices in children is ideal. Such interventions should be sensitive to cultural and environmental factors. Childhood obesity is a complex issue with long-term health effects. Early intervention using comprehensive approaches including all caregivers, community support, and public policies to address the social determinants of health will be beneficial. Future research should focus on valid outcome measures and equitable interventions that encompass all aspects of a child's life.

Examining the New Zealand school food environment: what needs to change?

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

Diet-Related Attitudes, Beliefs, and Well-Being in Adolescents with a Vegetarian Lifestyle

Vegetarianism can meet healthy, ethical, or ecological values (such as equality and protection of animals or the environment). At the same time, it can represent a response to the need for self-determination in adolescence. Furthermore, some studies show vegetarians have greater depressive risk and a lower sense of body satisfaction. Considering the spread of non-meat diets in the Western world, researchers have investigated the benefits and risks to physical and psychological health. Despite this, few studies have been conducted on factors influencing adolescent's vegetarian diet-related attitudes. Through self-administered loosely structured interviews, this research investigated factors potentially associated with vegetarian choices in adolescence. It checked (a) gender differences in vegetarian choices; (b) religious, familial, ethical, or health factors implied in vegetarian choices; and (c) indicators of well-being among young vegetarians. The findings suggest that for our sample, non-vegetarians have lower scores on health-related questions than others, while for vegetarian adolescents, the benefits of vegetarianism mainly depend on their ethical stances, beliefs, and values. Conversely, it is unrelated to factors such as the desire to lose weight, dissatisfaction about one's body shape, or depressive feelings.

Investigation of the relationships between mindfulness, emotional eating, weight control self-efficacy, and obesity in adolescents

PURPOSE

This research was conducted to examine the relationships between mindfulness, emotional eating, weight control self-efficacy, and obesity in adolescents.

DESIGN AND METHODS

The research was conducted with 198 adolescents aged 13-18 years in three high schools in the central county of a province in Türkiye. Data were collected using a sociodemographic information form, the Mindful Attention Awareness Scale-Adolescents, the Emotional Eating Scale for Children and Adolescents, and the Weight-Efficacy Lifestyle Questionnaire for Adolescents-Short Form. In this study, adolescents' height and weight were measured to determine the effects of the study variables on their body mass indexes (BMIs).

RESULTS

The variables were analyzed according to BMI. The mean age of the adolescents participating in the research was 15.25 ± 1.01 years; 52% were female, and 85% were ninth-grade high school students. Their mean height was 170.33 ± 8.59 cm, and their mean weight was 62.24 ± 12.84 kg. The adolescents' BMI was found to have a low-level, significant negative correlation with their mindfulness, a low-level, significant positive correlation with their emotional eating, and a low-level significant negative correlation with their weight control self-efficacy. Adolescents' mindfulness, emotional eating, and weight control self-efficacy scores significantly predicted their BMI and explained 14.1% of the variance in their BMI levels.

CONCLUSIONS

Mindfulness, emotional eating, and weight control self-efficacy in adolescents have a facilitating effect on the management of obesity.

IMPLICATIONS TO PRACTICE

Multidimensional programs should be developed that take into account the interaction of parents, children, and the environment, which will pave the way for the development of healthy nutrition behaviors and contribute to the prevention of obesity.

A qualitative evaluation of the specific carbohydrate diet for juvenile idiopathic arthritis based on children's and parents' experiences

BACKGROUND

Insights into the immunological role of the gastrointestinal tract in autoimmune conditions have led to the investigation of diet as a potential adjunctive treatment option for juvenile idiopathic arthritis (JIA). The specific carbohydrate diet (SCD) has shown promising results. However, studies on participants' experiences of dietary interventions in JIA are rare. In this study we investigated the experiences of children and parents' who had participated in a four-week intervention with SCD aiming to examine the potential anti-inflammatory effects.

OBJECTIVES

To conduct a qualitative evaluation exploring children's and parents' experiences of the dietary intervention, how they navigated challenges, and their support requirements.

METHODS

Semi-structured interviews were conducted with 12 children and 15 parents from 13 families, who were interviewed individually and together. The transcripts were analysed using systematic text condensation.

RESULTS

Most participants interviewed found the intervention beneficial, with 12 out of 13 reporting positive effects, such as reduced pain and morning stiffness, and improved gastrointestinal function. Many participants reported being willing to repeat the intervention in the current form. Despite facing challenges, all children followed the diet for one to three months, with some continuing to follow a modified version. Facing the socio-emotional consequences of adhering to the diet was challenging for children. These were handled by focusing on the positive aspects and by relying on the supportive environment available. Parents struggled with practical issues since the diet required hard work, time, and money. Areas identified as requiring additional support include finding simple, quick, and child-friendly solutions, strengthening organizational food skills such as meal planning, and preparation prior to starting the intervention regarding socio-emotional aspects.

CONCLUSION

Navigating the dietary treatment was considered challenging, practically for the parents and socio-emotionally for the children. Based on the reported challenges and participants' suggestions the intervention could be optimised by providing support and solutions in relation to the practical issues and better preparation regarding dealing with the socio-emotional consequences. Despite the difficulties, the participants reported overall positive experiences of, and attitudes towards, the current setup. Consequently, dietary interventions, such as the SCD, may be regarded as suitable targets for further research.

Rethinking Adolescent School Nutrition Education Through a Food Systems Lens

BACKGROUND

Obesity-driven nutrition education in schools does not appear to result in healthier adolescent food choices. This study explored food systems as an alternative pedagogical approach to engage students in nutrition education.

METHODS

After playing a food systems computer game, 250 13- to 16-year-old students in 5 Western Australian secondary schools, participated in group discussions to distinguish learning and interests in food systems. Discussion records were thematically coded using constant comparative analysis.

RESULTS

Students reported crop growth, food production and food waste, healthier food choices, and food systems as knowledge outcomes of game play. They requested additional content on food production, costing, handling, processing, and accessing local produce. Experiential activities were preferred pedagogical approaches.

CONCLUSIONS

Cross-curricular pedagogy which embraces human and planetary health through a food systems lens, can engage adolescents in nutrition education. Transformational computer games are effective to engage, educate and stimulate inquiry in food systems education.

Parents' Thoughts Regarding Their Normal-Weight Children's Food and Physical Activity as Expressed During Health Conversations With the School Nurse: A Qualitative Analysis Informing Health-Promoting Practices

Parents are key to promoting children's healthy growth and development. However, school nurses need knowledge about how to best support parents' health-promoting activities. This study aimed to explore parents' thoughts regarding their normal-weight 6-year-old children's food and physical activity behaviors as expressed during health conversations with the school nurse. Qualitative content analysis of audio-recorded conversations (n = 30) showed that parents think of their children's behaviors in terms of: (a) children's personality in relation to food and physical activity; (b) recognizing children's food and physical activity behaviors; (c) parenting in relation to food and physical activity; (d) interaction with children in situations around food and physical activity; and (e) contextual circumstances to promote children's healthy food and physical activity behaviors. The study contributes with novel knowledge regarding clinical work in health promotion, with suggestions for how school nurses can engage parents in promoting and sustaining healthy food and physical activity behaviors.

Weighing poor immunometabolic health in relatives for severity of affective symptoms: A study of patients with depressive and anxiety disorders and their siblings

BACKGROUND

Affective (i.e. depressive and anxiety) disorders often co-occur with immunometabolic diseases and related biological pathways. Although many large population-based and meta-analytic studies have confirmed this link in community and clinical samples, studies in at-risk samples of siblings of persons with affective disorders are lacking. Furthermore, this somatic-mental co-occurrence may be partially explained by familial clustering of the conditions. First, we examined whether the association between a wide range of immunometabolic diseases and related biomarker based risk-profiles with psychological symptoms replicates in at-risk siblings of probands with affective disorders. Second, leveraging on a sibling-pair design, we disentangled and quantified the effect of probands' immunometabolic health on siblings' psychological symptoms and on the association between immunometabolic health and these symptoms in siblings.

METHODS

The sample included 636 participants (Mage = 49.7; 62.4% female) from 256 families, each including a proband with lifetime depressive and/or anxiety disorders and at least one of their sibling(s) (N = 380 proband-sibling pairs). Immunometabolic health included cardiometabolic and inflammatory diseases, body mass index (BMI), and composite metabolic (based on the five metabolic syndrome components) and inflammatory (based on interleukin-6 and C-reactive protein) biomarker indices. Overall affective symptoms and specific atypical, energy-related depressive symptoms were derived from self-report questionnaires. Mixed-effects analyses were used to model familial clustering.

RESULTS

In siblings, inflammatory disease (γ = 0.25, p = 0.013), higher BMI (γ = 0.10, p = 0.033) and metabolic index (γ = 0.28, p < 0.001) were associated with higher affective symptoms, with stronger associations for atypical, energy-related depressive symptoms (additionally associated with cardiometabolic disease; γ = 0.56, p = 0.048). Immunometabolic health in probands was not independently associated with psychological symptoms in siblings nor did it moderate the association between immunometabolic health and psychological symptoms estimated in siblings.

CONCLUSIONS

Our findings demonstrate that the link between later life immunometabolic health and psychological symptoms is consistently present also in adult siblings at high risk for affective disorders. Familial clustering did not appear to have a substantial impact on this association. Instead, individual lifestyle, rather than familial factors, may have a relatively higher impact in the clustering of later life immunometabolic conditions with psychological symptoms in at-risk adult individuals. Furthermore, results highlighted the importance of focusing on specific depression profiles when investigating the overlap with immunometabolic health.

Longitudinal changes in home food availability across the first 3 years of life and associations with family context predictors

Background

There is limited research tracking changes in home food availability during the first 3 years of life and whether the family context influences these changes.

Objective

This study examined changes in and predictors of home food availability across the first 3 years of life.

Design

This study utilized longitudinal data from the STRONG Kids2 birth cohort from the target child at 6 weeks to 36 months postpartum.

Participants

Mothers of 468 children were surveyed at 6 weeks, 3, 12, 24, and 36 months postpartum.

Methods

Home observations were completed by trained research assistants to complete the presence of foods in the home. The primary outcomes were the availability of 10 food groups and scores from the Home Food Inventory (HFI), including dairy (regular fat), dairy (reduced fat), processed meats, other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and three obesogenic scores. Repeated measures ANOVA were used to examine changes in the HFI food groups and obesogenic scores over time. Multilevel regressions were conducted to examine whether the presence of an older sibling, entry into childcare, and mother's return to full-time work were associated with the HFI.

Results

Significant changes were detected for dairy (regular fat), other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and all obesogenic scores across time. A linear trend occurred for most HFI groups, however, the third obesogenic score (without milk and cheese) was highest at 3 months, declined at 12 months, and then slowly increased from 12 to 36 months years. The presence of an older sibling was a consistent predictor of the HFI groups over time. Entry into childcare was only associated with the availability of processed meats.

Conclusion

The availability of food types shift as children age and their dietary needs alter. It is important to consider the whole family context such as the presence of older siblings whose dietary needs may differ from younger children. Future efforts are warranted to consider changes in food availability among diverse samples and different family structures.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese

BACKGROUND

Parents from urban, lower social economic classes often encounter unique challenges in their lives, which shape how they work with their children who are overweight or obese to change their exercise and eating behaviors at home. The present study took an initial step to address a gap in the literature by describing the challenges that parents from lower social economic classes in an urban city encountered in changing exercise and eating behaviors of their children who are overweight or obese.

METHODS

A conversational style semi-structured interview with prompts and probes was conducted to 44 parents whose child is overweight or obese. Inductive content analysis and constant comparison was used to analyze the data. Data trustworthiness was established by using a variety of strategies.

RESULTS

Two major themes with eight sub-themes emerged from the data: Challenges to promote a healthy active lifestyle, and challenges from their child's development and lifestyle behavior. Eight sub-themes were: (1) Need for effective strategies for a lifestyle behavior change, (2) monitor and promote healthy choices, (3) money, time, and dangerous neighborhood, (4) scientific knowledge to promote a healthy active lifestyle, (5) developmental changes of adolescence, (6) unmotivated and lack of persistence, (7) sneaking eating, and (8) peer pressure.

CONCLUSION

The challenges, from economic to parenting, are certainly of importance, and understanding these challenges will be crucial to help school-based professionals develop interventions. Those identified challenges should be clearly placed within family-school collaboration practices.

Social Network, Food Patterns, Physical Activity and Associations with Overweight and Obesity in Adolescents from a School in Rural Brazil

The objective of this study was to evaluate the social network, food patterns, physical activity, and their associations with overweight/obesity in adolescents from a school in rural Brazil. Students from a rural school in Northeast Brazil (n = 90) completed questionnaires on sociodemographic characteristics, food consumption, physical activity, and a name generator. Social networks were constructed using students' social proximity ties. Principal component analysis was performed to determine food patterns, and logistic models were used to investigate variables associated with overweight/obesity. Most participants were girls (62.9%), and the proportion of overweight/obesity was 30% among adolescents. Students cited 2070 people from their networks (family, friends at school, friends outside of school, and others). Among them, the family had the highest degree of influence (61%) in the network and had the most shared meals with adolescents (47%). Adolescents' perception of their family members' body size as obese, compared to normal or underweight, was prevalent (51%). Adolescents with unhealthy food patterns were 72% more likely to be categorized as overweight/obese, and eigenvector centrality was also associated with overweight/obesity (OR = 5.88, 95% CI = 1.08-32.03). Adolescents presented a social network with strong family influence, in which a high percentage of overweight/obesity was observed. Adolescents with high eigenvector centrality were more likely to be in the overweight/obesity category. Additionally, overweight/obesity was associated with unhealthy food patterns in the family network.

Age-related differences in eating location, food source location, and timing of snack intake among U.S. children 1-19 years

BACKGROUND

Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1-19 years (y).

METHODS

A cross-sectional analysis of snacking among 14,666 children in the 2007-2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1-2 y, preschooler 3-5 y, school-age 6-11 y, adolescent 12-19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am).

RESULTS

On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001).

CONCLUSION

Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1-19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns.

Students' consumption of high and low nutrition foods and reduced plate waste by schools' wellness-related policies and garden program participation

BACKGROUND

Participation in school-based programs that may support children's nutritious dietary behaviours varies across schools. We examined school participation in wellness-related policies, school-based garden programs and students' dietary behaviours.

METHODS

Among matching schools who did and did not participate in school-based garden programs, we analysed the lunches of 80 Pittsburgh Public Schools (PPS) students in 1st, 2nd, 6th and 7th grades during Autumn 2019 using digital food photography. We also acquired school wellness policy data. Using cross-sectional linear regression, we estimated the association between school-based garden programming, wellness-related policies and dietary outcomes, adjusting for grade.

RESULTS

School's implementation of nutrition services policies was negatively associated with energy wasted from lunch (β = - 44.7 , p = 0.01 ${\rm{\beta }}=-44.7,{p}=0.01$ ). The number of semesters the students' school had participated in the garden program was positively associated with students' whole grain consumption (β = 0.07 , p < 0.001 ${\rm{\beta }}=0.07,{p}\lt 0.001$ ).

CONCLUSIONS

Cross-sectional associations suggest that schools that are more engaged in wellness policies and garden programs may provide environments that are more supportive of students' nutrition than in other schools.

A bibliometric analysis of emerging adulthood in the context of higher education institutions: A psychological perspectives

In recent years, there has been a rise in studies aimed at better understanding the needs and traits of emerging adults and the role that higher education institutions play in their development and success. Despite the relevance of higher education institutions to the emerging adulthood development, there has been scant work done to synthesise the literature on this topic. A bibliometric method was utilised to retrieve 2484 journal articles from Web of Science (WoS). Utilizing co-citation analysis and co-word analysis, we determined the most influential publications, mapped the knowledge structure, and predicted future trends. The results of the co-citation analysis indicate five clusters, while the co-word analysis indicates four. The results could be used as a roadmap for the future of research on emerging adults by a variety of interested parties, including policymakers, university administrators, funders, and academics.

Effect of school-based nutrition interventions among primary school children in sub-Saharan Africa: a systematic review protocol

INTRODUCTION

Preadolescents are passing through an intensive growth and development period that will benefit from healthy eating practices. For those attending school, school environments offer several potential benefits and have been demonstrated to influence the quality of dietary intakes and consequentially, nutritional status of school-aged children (SAC). Considering the amount of time children spend in school and the enormous potential of evidence-based interventions, the purpose of this review is to critically appraise peer-reviewed literature addressing the impact of school-based interventions on the nutritional status of SAC aged 6-12 years in sub-Saharan Africa.

METHODS AND ANALYSIS

A systematic search will be conducted in the following databases and online search records: Medline, CINAHL, Web of Science, Embase, Global health, Global Index Medicus, Cochrane library, Hinari and Google Scholar using search terms and keywords codeveloped with two librarians. An additional search will also be conducted from the reference list of identified literature. Search results of titles and abstracts will be initially screened for eligibility criteria by two independent reviewers and where there is disagreement, a third reviewer will be consulted. Articles meeting these criteria will then undergo a full-text review for the eligibility and exclusion criteria. The Joanna Briggs Institute critical appraisal tool will be used to assess the risk of bias. Data from articles meeting all study criteria will be extracted, analysed and synthesised. A meta-analysis will also be conducted if sufficient data are available.

ETHICS AND DISSEMINATION

This systematic review is limited to publicly accessible data bases not requiring prior ethical approval to access. The results of the systematic review will be disseminated through publications in peer-reviewed journals as well as conference and stakeholder presentations.

PROSPERO REGISTRATION NUMBER

CRD42022334829.

'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families

Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.

Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers

Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.

The role of mothers' involvement in their daughters' self-esteem and dieting behaviors

This study presents an initial effort to develop disordered eating pathology (DEP) prevention program with an emphasis on maternal involvement. Disordered eating pathology representing a range of behaviors and attitudes, from negative body image to full-blown eating disorder. It appears mainly in adolescent females and related to psychological and familial factors, including maternal modeling of thinness. A sample of 118 Israeli girls (11-12) was divided into three groups: participants in the program in parallel with their mothers, participants without their mothers, and control. Participants completed self-report questionnaires. Groups were tested three times: pre-intervention, post-intervention, and follow-up. For those girls who participated in parallel with their mothers, higher self-esteem was associated with fewer pathological diet behaviors. Findings deepen understanding of the risk factors involved in the development of DEP. The main study contribution is the important role mothers play in preventing DEP among their daughters.

Factors Associated with Diet Quality among Adolescents in a Post-Disaster Area: A Cross-Sectional Study in Indonesia

The diet quality of adolescents in low-middle-income countries is low. Especially in post-disaster areas, adolescents are not a priority target for handling nutritional cases compared with other vulnerable groups. The aim of this study was to examine the factors associated with diet quality among adolescents in post-disaster areas in Indonesia. A cross-sectional study was performed with 375 adolescents aged 15-17 years, representing adolescents living close to the areas most affected by a significant disaster in 2018. The variables obtained include adolescent and household characteristics, nutritional literacy, healthy eating behavior constructs, food intake, nutritional status, physical activity, food security, and diet quality. The diet quality score was low, with only 23% of the total maximum score. Vegetables, fruits, and dairy scored the lowest, whereas animal protein sources scored the highest. Higher eating habits of animal protein sources; being healthy; normal nutritional status of adolescents; higher vegetable and sweet beverage norms of mothers; and lower eating habits of sweet snacks; animal protein sources; and carbohydrate norms of mothers are associated with higher diet quality scores in adolescents (p < 0.05). Improving the quality of adolescent diets in post-disaster areas needs to target adolescent eating behavior and changes in mothers' eating behavior.

Improving adolescents' dietary behaviours in the school-setting: challenges and opportunities

Adolescence is a critical time of physical, psychological and social development, and thus, optimal nutritional intakes are required during this life stage. Despite this, adolescence is recognised as a period of nutritional vulnerability, with many reportedly failing to meet current dietary guidelines. The school-setting presents a favourable environment to intervene and promote positive dietary behaviours and is also inclusive regardless of socio-economic status. However, a lack of consensus exists on how best to utilise schools to facilitate improvements in dietary behaviours among this age group. Whilst previous research has focused on identifying the factors motivating dietary choices within the school-setting, less is known on the optimum strategies to enhance these dietary choices which could positively contribute to the design of future interventions. It is reported that adolescents have good nutritional knowledge, although this does not appear to be a central consideration when making their dietary choices. Alternative factors at the individual (taste, visual appeal, familiarity, food quality, price, portion size, value for money, time/ convenience), social (peer influence), physical (product placement) and macro environment (food availability) levels have been frequently cited as important influences on adolescents' dietary choices in school. Although school-based interventions have shown potential in achieving positive dietary change among adolescents, more research is needed to determine the most effective methods in improving dietary behaviours in schools. This review summarises the key factors which influence adolescents' school-based dietary choices and the effectiveness of previously conducted interventions, identifying promising components for consideration when developing future dietary interventions within the school-setting.

Siblings, shopping, and sustainability: Birth-order differences in green consumption

Several studies have examined the role of birth order in shaping human personality, but fewer have tested this variable in relation to other pressing issues. We conducted a birth-order study on green consumption, which enabled us to detect a small-to-moderate effect size equivalent to r = 0.15 or d = 0.30 with sufficient statistical power (N = 335). To capture green consumption, participants indicated their tendency to express the value of environmental protection through purchases and consumption behaviors. Firstborns (vs. laterborns) consistently expressed lower concerns linked to environmental protection in their purchase patterns. While the effect size of this finding was small-to-moderate by conventional standards and in direct contrast to the findings from a recent article on the same topic, these results could still be informative to address challenges associated with climate change considering the number of individuals with siblings in the world and the ease with which birth-order data can be collected.

Meat, myself, and I: The role of multiple identities in meat consumption

Excessive consumption of meat challenges global food security and environmental sustainability. In the mounting literature on identity as a motivator of behaviour, meat consumption has been associated with a handful of identities. Identity theory suggests that people hold multiple identities on different levels of abstraction, but how identities at different levels of abstraction interact and possibly co-determine intentions and behaviour remains largely unanswered. Inspired by research on attitudes and goal hierarchies, this study investigates a hierarchical model of meat-related identities and their relation to intentions to consume red meat. By means of a survey of Danish consumers (N = 1001), we identified identities related to the consumption of red meat (e.g., flexitarian identity), using confirmatory factor analysis and structural equation modelling. We also controlled for the most important additional antecedents identified in prior research. Evidence was found that more abstract identities (e.g., national identity, environmental identity) mostly influence intentions to eat meat indirectly, meditated through more behaviour-specific identities (e.g., flexitarian identity). However, some higher-order identities also appear to have a direct impact on intentions to eat meat after controlling for more behaviour-specific identities, which suggests a less hierarchical structure manifesting itself, possibly due to the behaviour being instrumental at reaching different, functionally unrelated goals that are related to different identities. Policy recommendations towards reducing meat consumption are proposed.

Prospective association of family members' sugar-sweetened beverages intake with children's sugar-sweetened beverages consumption in China

PURPOSE

We aimed to investigate whether parental and siblings' sugar-sweetened beverage (SSB) intake had prospective impact on children's SSB consumption, and the potential sex difference in these associations.

METHODS

This study included a total of 904 children and their parents enrolled from 2004 to 2011 China Health and Nutrition Survey (CHNS) cohort study. SSB consumption information was estimated using a short dietary questionnaire and total energy intake was assessed with three-day 24-h dietary assessments at recruitment and follow-up surveys. Multivariate logistic or linear regression analyses were used to assess the association for SSB consumption between parents, siblings and children after adjusting for age, body mass index (BMI) z-score, household income and parental educational level.

RESULTS

In this study, a majority (87.6%) of children consumed SSB. Among them, the median consumption of SSB was 70.3 ml/day per capita and 205.4 ml/day per consumer. Parental SSB consumption was relevant to children's SSB consumption, and this association was more pronounced in boys than in girls. Meanwhile, fathers seemed to have a stronger impact on whether children consume SSB than mothers which was reflected by lower P and higher OR. Additionally, children's SSB intake was prospectively associated with their older siblings' SSB consumption (P _{for trend} < 0.03).

CONCLUSIONS

Parental and older siblings' SSB consumption was relevant to children's SSB intake. Particularly, boys were more susceptible to parental impact than girls, and fathers seemed to have a greater influence on children than mothers.

The Association of Junk Food Consumption with Preadolescents' Environmental Influences: A School-Based Epidemiological Study in Greece

The aim of the present study was to evaluate the impact of environmental influences on Greek preadolescents' junk food consumption. A cross-sectional study, was conducted among 1718 preadolescents (mean (standard deviation(SD)) age: 11.2(0.8) years old; 54% girls) and their parents, during the school years 2014-2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, junk food consumption was recorded, classifying children as low, moderate, and high consumers. The majority of the preadolescents were classified as at least moderate junk food consumers, while almost 3/10 children were classified as high junk food consumers. A significantly lower junk food consumption was observed among preadolescents with a healthier family environment, consisting of normal-weight parents who consume junk foods less frequently, prefer home-cooked meals and adhere more to the Mediterranean diet, while more frequent family meals were also associated with lower junk food consumption. In addition, influence from teachers and participation in extracurricular sports activities were significantly associated with lower junk food consumption, while advertisements were found to have a significant negative impact on preadolescents' eating habits. Notwithstanding, peers were not found to influence their dietary choices in terms of junk food consumption. Both parents and teachers seem to be positive influencers on preadolescents' low junk food consumption. The detrimental role of advertisements on junk food consumption is reconfirmed, while peers' influence is not significant on junk food consumption. The need for urgent public health initiatives for the promotion of healthy dietary habits among preadolescents is warranted.

Self-efficacy and Social Settings Matter for Fostering Healthy Eating in Mexican Schoolchildren

OBJECTIVE

To identify differences in schoolchildren's self-efficacy for eating behaviors across social settings and self-efficacy sources favoring healthy and unhealthy eating.

DESIGN

A cross-sectional, mixed-methods study using self-efficacy and demographic surveys, focus groups, and school environment semistructured observations.

SETTING

Morelos, Mexico, Cuernavaca City school district, public elementary schools in the National School Lunch Program.

PARTICIPANTS AND RECRUITMENT

We studied 274 fifth- and sixth-grade children from 8 elementary schools during the 2016-2017 school year.

VARIABLES MEASURED

Children's self-efficacy for healthy and unhealthy eating across 3 settings (school cafeteria, recess, and home). Children's perceptions about sources of self-efficacy, which favor their healthy or unhealthy eating (performance accomplishments, behavior modeling, verbal persuasion, and emotional or physiological states). Sociodemographic information was obtained from parents.

ANALYSIS

We performed a variance components analysis with school and students within schools as random effects with paired t tests (quantitative data) and content analysis on the basis of the Social Cognitive Theory (qualitative data).

RESULTS

Schoolchildren's self-efficacy for healthy eating differed across social settings, being greater in the school cafeteria than at recess or home, except for drinking water. On average, self-efficacy for unhealthy eating was lower in the cafeteria than in other studied settings. Performance achievements and behavior modeling were key sources of self-efficacy for healthy and unhealthy eating.

CONCLUSION AND IMPLICATIONS

Sources of self-efficacy and social settings matter to understanding schoolchildren's healthy and unhealthy eating. Future interventions might consider developing collective efficacy among the school community and boosting children's participation in home meal planning. Further research could explore locus of control and other intrapersonal dimensions influencing self-efficacy.

Barriers and Facilitators of Weight Management among School Children with Obesity: A Qualitative Investigation of Parents' Perceptions

Parents play a critical role in influencing the eating habits of their children. This study examined parents' perceptions of factors that contributed to childhood obesity and sought their suggestions on various modalities for overcoming the barriers to healthy eating. Semi-structured in-depth interviews were undertaken with 26 parents of 9-13 years old school children with obesity from the United Arab Emirates. Three main topics covered in the interviews were: (1) Parents' perceptions of their children's weight and eating habits; (2) Attitudes towards healthy eating and weight management; and (3) Suggestions on how their children can adopt a healthy lifestyle. Interview transcripts were thematically analyzed using the NVIVO software to identify the emerging main themes and sub-themes. Parents identified individual/intrapersonal (child), interpersonal (peers, family, nannies), and institutional/school environment barriers and facilitators to a healthier lifestyle. The three major themes that emerged were: (1) Negative effects of obesity on children's lives; (2) Barriers to weight management and healthy lifestyle; and (3) Facilitators to healthy eating. Nutritional education and a supportive home and school environment were suggested for the adoption of a healthy lifestyle by children.

Why context matters when changing the diet: A narrative review of placebo, nocebo, and psychosocial context effects and implications for outcome research and nutrition counselling

Placebo (PE) and nocebo effects (NE) have been subjects of systematic research in medicine and psychotherapy for many decades to distinguish between the (specific) pharmacological effect of medication and the (unspecific) effect of the context. Despite this significant research, the awareness, operationalisation, and reflection of the multiplicity of PE, NE, and psychosocial context effects (PSCE) is currently limited when researching outcomes of diet changes in studies without randomisation and placebo control. This neglection is critical as it could systematically influence outcomes by moderating and mediating them and thus reducing the validity and evidence base of these studies. Therefore, we performed a (non-systematic) narrative review (NR) on the following objectives: (1) present a concise overview about the relevance of PE, NE, and PSCE in medicine and nutrition research; (2) review the current state of research on reflecting context effects when studying diet changes; (3) provide useful theoretical foundations via consideration and integration of micro- and macro context effects; (4) operationalise as hypotheses the potential PE, NE, and PSCE which are specific for researching diet changes; and (5) derive their impact for future research as well as for nutrition counselling. The electronic search in this NR for objective (2) identified N = 5 publications and for objective (4) we found N = 61 articles retrieved in the first round of search, additional references were identified by a manual and snowball search among the cited references resulting finally in N = 37. This NR offers a synoptical basis to foster awareness and operationalisation of a variety of PE, NE, and PSCE. Interdisciplinary research teams should monitor these factors using, e.g., qualitative, mixed-method studies, process evaluation, item bank approaches, moderator and mediator analysis that might reveal substantially new insights, and outcomes of relevance to science and nutrition counselling. Nevertheless, the present NR has several limitations, especially as it is non-systematic, because it is a very heterogeneous field of research, in which the topic we are investigating is usually regarded as marginal and subordinate. Therefore, future research should conduct systematic reviews and particularly theory-based primary studies (experimental research) on hypotheses of PE, NE, and PSCE in outcome research in diet changes.

Analysis of Association between Adolescents' Food Habits and Body Mass Change in a Population-Based Sample: Diet and Activity of Youth during COVID-19 (DAY-19) Study

The COVID-19 pandemic may have contributed to food habit changes, including some negative ones that may increase the risk of overweight and obesity. The aim of the study was to analyze the association between adolescents' food habits, body mass change, as well as physical activity level in a population-based sample within the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in a cohort of 1333 students (aged 10-16 years) recruited in schools after stratified random quota sampling of primary schools (sampling counties within voivodeships and schools within counties) in June 2020. The food habits were assessed for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Adolescent Food Habits Checklist (AFHC). The body mass changes were assessed based on body weight and height for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Polish growth reference values. The physical activity changes were assessed based on the subjective assessment of adolescents. It was stated that for female adolescents declaring body mass gain during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) (p < 0.0001) were accompanied by the lowest AFHC consumption score (unhealthy consumption habits) (p < 0.0001), as well as for female adolescents declaring physical activity decrease during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) were observed (p = 0.0333). It was stated that for male adolescents declaring physical activity increased during the COVID-19 pandemic, the highest AFHC consumption scores (healthy consumption habits) were observed (p = 0.0003). In the case of a majority of participants, the general food habits were unchanged, which was observed mainly for food habits associated with food preparation. More food habits changes associated with the COVID-19 pandemic resulting in body mass changes were observed in females than in male adolescents. Body mass gain during the COVID-19 pandemic in adolescents may have resulted from unhealthy consumption habits, accompanied by decreased physical activity, in spite of the fact that this sub-group presented healthy purchase habits, which was observed especially for female adolescents.

Sex-Related Differences in the Relationship between Sugar-Sweetened Beverage Consumption and Cardiorespiratory Fitness: Results from Chinese Cross-Sectional Study on Children

Sugar-sweetened beverage (SSB) consumption continues to increase among children, with adverse health effects, and China is no exception. Our study investigates the association between SSB consumption and cardiopulmonary fitness. We used stratified whole group sampling to investigate and test SSB consumption and cardiopulmonary fitness in 21,055 children aged 13−15 years in China. A chi-square test and one-way ANOVA were used to compare different categories of SSB consumption. General linear regression analysis and logistic regression analysis were used to analyze the relationship between different SSB consumption and cardiopulmonary fitness in Chinese children. Our research results show the proportions of Chinese children with SSB consumption ≤ 1 time/week, 2−4 times/week, and ≥5 times/week were 33.3%, 52.8%, and 13.9%, respectively. VO2max in children consuming ≥ 5 times/week was lower than those consuming 2−4 times/week and ≤2 times/week of SSB by 0.15 and 0.301 mL·kg−1·min−1, with statistically significant differences (F-value 18.807, p < 0.001). After relevant confounders were adjusted, children in the SSB consumption ≥ 5 times/week group had a higher risk of developing poorer cardiopulmonary fitness than those in the SSB consumption ≤ 1 time/week group (OR: 1.336, 95% CI: 1.181, 1.511) (p < 0.001). In conclusion, the consumption of SSBs among children aged 13−15 in China is higher than the recommended intake by the World Health Organization, and boys are higher than girls. In addition, after adjusting for relevant confounders, the association between SSB consumption and an increased risk of poor cardiorespiratory fitness remained. The relationship between SSB consumption and cardiopulmonary fitness was higher in girls compared with boys.

Use of Focus Groups to Inform a New Community-Based Youth Diabetes Prevention Program

There have been few youth-led diabetes prevention programs. Our objective was to conduct focus groups to explore peer influences on adolescent lifestyle behaviors and strategies for implementing a youth peer education model for diabetes prevention. We conducted six focus groups with 52 youth (ages 13-22; 62% male, 38% female; 64% Hispanic, 36% non-Hispanic Black) from East Harlem, NYC. We used a Thematic Analysis approach to identify major themes, compared findings, and resolved differences through discussion and consensus. Three dominant themes arose: (1) Adolescents generally encounter more unhealthy peer influences on diet and more healthy peer influences on physical activity; (2) Adolescents endorse youth-led diabetes prevention strategies and describe ideal qualities for peer leaders and methods to support and evaluate leaders; (3) Adolescents prefer text messaging to monitor behaviors, track goals, and receive personalized guidance. Using study findings, our Community Action Board developed a peer-led diabetes prevention program for prediabetic adolescents.

“I Like the One With Minions”: The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices

Objective

This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups.

Design

The study design involved free lists and semi-structured focus group interviews.

Setting

São Paulo, Brazil.

Participants

A total of 69 children were involved in this study.

Phenomenon of Interest

Children's perceptions of food labels.

Analysis

Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis.

Results

Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels.

Conclusions and Implications

Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.

Family Social Support and Weight-Related Behaviors of School-Age Children: An Exploratory Analysis

Families are a key provider of support that may encourage positive weight-related behaviors. Yet little is known about the relation of family support to children’s performance of weight-related behaviors. Mothers (N = 524) who completed an online survey were categorized as having low, moderate, or high family support for fruit/vegetable intake, breakfast intake, limiting sugar-sweetened beverage intake, physical activity, limiting sedentary screentime, and sleep. ANOVA revealed that children in families with high support for breakfast ate this meal significantly more often. Additionally, children in families with low support for limiting sugar-sweetened beverages had significantly greater intake. Surprisingly, families with moderate support for physical activity and sleep tended to have children with lower physical activity level, sleep duration, and sleep quality, and fewer days/week with set bedtimes than those with low and high support. Binomial logistic regression revealed that high family support for eating breakfast, limiting sugar-sweetened beverages, and getting sufficient sleep had greater odds of meeting recommendations for these behaviors. Findings suggest that greater family support for healthy weight-related behaviors tends to be associated with children’s performance of these behaviors. Future interventions should further examine the impact of different types of family support on weight-related behaviors to better understand this complex interplay.