Interactive computerized fruit and vegetable preference measure for African-American and Hispanic preschoolers

Measurement is the foundation of research and theory on children's eating behaviours: Current issues and directions for progress

Eating behaviours affect food intakes and are involved in the aetiology of obesity. There has been impetus to translate findings about children's eating behaviour into intervention and policy programs. However, measurement limitations have hindered our capacity to understand and influence children's eating behaviours. In the present paper we provide an overview of some of the key methodological and measurement issues facing the field of children's eating behaviours and highlight implications for research and health promotion. Drawing on insight from parallel issues that occur in the measurement of early social and emotional development, we examine two overlapping themes in children's (aged 0-∼12 years) eating behaviours (Somaraki et al., 2021) measurement issues related to validity and reliability, and (Steinsbekk & Wichstrøm, 2015) associated methodological challenges, such as contextual influences and the importance of designing studies that use multiple informants and multiple methods. We then suggest insights and strategies aimed at advancing approaches to measurement of children's eating behaviours. To progress our understanding of children's eating behaviours, we conclude that a range of psychometrically sound, fit-for-purpose measurement instruments and procedures are needed for use in multi-trait, multi-method, multi-informant studies in a range of populations and contexts.

'Read for Nutrition' programme improves preschool children's liking and consumption of target vegetable

OBJECTIVE

To determine whether the 'Read for Nutrition' programme would increase liking and consumption of broccoli (a target vegetable) in preschool children and test acceptability and practicality of the programme.

DESIGN

Pilot pre-post intervention study, where childcare teachers received training and coaching followed by reading the book 'Monsters Don't Eat Broccoli' multiple times with the children during a three-week intervention.

SETTING

Five classrooms of Educare, Lincoln, Nebraska in 2018.

PARTICIPANTS

Sixty-nine (11 to 16 children per classroom) preschool-aged children and sixteen teachers (minimum, three per classroom).

RESULTS

Average total consumption of broccoli increased 35 % (0·14 ounces or 0·05th cup) after the 'Read for Nutrition' programme (t = 2·66; P = 0·01; 95 % CIs (0·035, 0·246)) for all children. Proportional consumption increased for children who received ≥ five exposures to the book (t46 = 2·77; P = 0·008). Exposures to the book predicted proportional consumption (β = 0·365; P = 0·002). Liking of broccoli increased (W69 = 2·2, P = 0·03) as well. Teachers rated the programme as acceptable, practical and enjoyable to children and to themselves.

CONCLUSIONS

Programmes such as 'Read for Nutrition' have the potential to improve children's vegetable liking and consumption in early care and education settings with only book readings and no exposure to a real vegetable.

Do children favor snacks and dislike vegetables? Exploring children's food preferences using drawing as a projective technique. A cross-cultural study

OBJECTIVE

To avoid the rising spread of childhood obesity and preserve resources within planetary boundaries, healthy and sustainable eating habits and the consumption of adequate amounts of fruits and vegetables should be encouraged. Children's food preference was found to be an important determinant for food choice and consumption. The aim of this study was to explore children's food preferences using drawing as a projective technique in terms of healthy and sustainable eating and compare food preference patterns in Denmark and Lithuania.

METHOD

In total 484 children, aged between 8 and 13 years old, participated in the study (147 in Denmark and 337 in Lithuania). Participants were asked to fill the food preference questionnaire and answer questions about their daily intake of fruits, vegetables, and snacks and draw their favorite meal afterward. Sociodemographic questions about children's age, gender, parents' employment, and family composition were also included in the questionnaire.

RESULTS

Fruits, vegetables, highly-processed and animal-based foods were not included in a large part of children's most preferred meal composition. Favorite meals' composition varied among children in both countries and included different products from separate food groups. Vegetables were more likely to be present in the children's favorite meals together with meat products. Girls in both countries had more expressed vegetable preferences than boys. Boys in Lithuania had a relatively more expressed preference for highly-processed foods, while Danish girls had a more expressed preference for animal-based products.

CONCLUSIONS

Children's preferences for foods such as meat and animal-based products expressed in children's drawings, might be considered as relatively positive in terms of sustainable eating. However, children's preferences and intake of fruits and vegetables should still be encouraged among young consumers. Cultural and gender differences in children's food preferences should be considered while creating interventions and marketing strategies for promoting healthy and sustainable eating among young consumers.

Evaluation of Preferences Among Students Participating in the US Department of Agriculture Fresh Fruit and Vegetable Program

BACKGROUND

Improving children's fruit and vegetable (FV) preferences may be important as preferences can predict FV consumption. The purpose of this study was to evaluate FV preferences over time, with repeated experience, as part of the Fresh Fruit and Vegetable Program (FFVP).

METHODS

Fruits (F; N = 28) and vegetables (V; N = 29) were distributed twice a week, over 35 weeks, at a participating FFVP school (N = 236 students, 12 teachers, K-2nd grade). Preference ratings using 3-point Likert scale were analyzed over 35 weeks.

RESULTS

For 57 FVs rated for preference, ratings revealed that F had higher frequency of children choosing "I like it" than for V (78% F; 38.2% V; p < .05) and liking distribution was different between F and V (p < .001). Significant relations were found between liking and: (1) grade (r = -0.02, p = .02), and (2) time (r = -0.09, p < .001). Models indicated that V served (β = -0.40), timepoint (β = -0.07), and grade level (β = -0.02) accounted for significant variance for preference ratings (R²  = 0.17, p < .001), indicating that preference ratings declined over time.

CONCLUSIONS

Fruits were preferred over vegetables. Overall preference ratings were negatively impacted by time, grade level, and vegetables served. Being exposed one time to a variety of FVs did not improve ratings for vegetables.

Association between food availability and young people's fruits and vegetables consumption: understanding the mediation role of the theory of planned behaviour

OBJECTIVE

To evaluate the relationship between fruits and vegetables (F&V) availability at home and young people's F&V consumption behaviour, and how the theory of planned behaviour (TPB) constructs could potentially mediate the relationship.

DESIGN

Cross-sectional face-to-face survey questionnaire to assess the TPB constructs and home food availability assessed using open inventories method. F&V availability was categorised into low and high levels based on median split.

SETTING

Singapore.

PARTICIPANTS

Two hundred and ten households (each consisting one parent-child pair) recruited via stratified cluster sampling with child participants ranging from 9 to 16 years of age.

RESULTS

Mediation analyses were conducted using structural equation modelling. The relationship between home F&V availability and F&V consumption behaviour did not have a significant direct association, but there were significant indirect effects through the routes of perceived behavioural control (PBC) and intention as well as attitude and intention. Specifically, higher level of F&V availability at home was related to more positive PBC and attitude towards F&V, and subsequently greater intention to consume F&V and higher consumption of F&V.

CONCLUSIONS

Parents should make F&V more readily available at home as increased exposure to F&V could be related to enhanced liking, sense of control and intention to consume F&V and facilitate children's healthy diet.

Effects of a School Based Intervention on Children's Physical Activity and Healthy Eating: A Mixed-Methods Study

Combined diet and physical activity school-based interventions (rather than only diet or physical activity interventions) are more likely to help prevent children from becoming overweight in the long term. However, such interventions are less prevalent, and therefore, this pilot study aimed to assess the feasibility of a gardening intervention coupled with awareness about plant-based meals among 9−10 year old children in a London primary school. We recruited 60 children from two Year 5 classes, one class participated as an intervention group, and results were compared against another class who acted as the control group. Children’s physical activity (PA) was measured using GENEActiv wrist-worn accelerometers. Their fruit and vegetable intake and attitudes to and preferences in eating fruits and vegetables were measured using a self-report questionnaire. Furthermore, three focus groups were held with children in the intervention group to understand the reasons behind any change as a result of the intervention. Results are inconclusive; however, they indicate some impact on reduction of sedentary behaviour, increase of moderate to vigorous PA, knowledge of nutrition and some level of acceptance in trying new vegetables. School-based interventions involving gardening show some promise to increase children’s PA and improve their attitudes to eating fruits and vegetables.

CHAMP: A cluster randomized-control trial to prevent obesity in child care centers

Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.

Building Blocks for Healthy Children: Evaluation of a Child Care Center-Based Obesity Prevention Pilot Among Low-Income Children

OBJECTIVE

To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children.

DESIGN

A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted.

SETTING

A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).

PARTICIPANTS

Children aged 18-71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff).

INTERVENTION(S)

A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers.

MAIN OUTCOME MEASURE(S)

Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns.

ANALYSIS

Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers.

RESULTS

Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.

CONCLUSIONS AND IMPLICATIONS

Curriculum-driven training and implementation support improved nutritional policies and practices and staff-child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.

Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program

BACKGROUND

One in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, "¡Míranos! Look at Us, We Are Healthy!" (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children.

METHODS

Using a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected.

DISCUSSION

With endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children.

TRIAL REGISTRATION

ClinicalTrials.Gov ( NCT03590834 ) July 18, 2018.

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Comparison of Parent and Child Ratings of Fruit and Vegetable Liking to Assess Parent Accuracy as Proxy Reporters

This study examined the accuracy of parent-report child fruit/vegetable (FV) liking. Child/parent dyads (n = 24) were recruited from six Head Start preschools in North Carolina. Liking for 10 FVs was assessed using a validated pictorial tool for children; a similar scale was used for parents. Negative relationships were observed between parent/child for one fruit (grapes) and one vegetable (broccoli). Positive relationships were observed among oranges, grapes, and overall fruit rankings. Parents tended to rank children's liking of fruits higher than their children, while children ranked liking vegetables higher. Findings suggest parents may not be accurate respondents for preschool children's FV liking.

Fruit and Vegetable Preferences and Identification by Kindergarteners through 2nd-Graders With or Without the US Department of Agriculture Fresh Fruit and Vegetable Program

OBJECTIVE

The US Department of Agriculture Fresh Fruit and Vegetable Program (FFVP) allows schools to increase fruit and vegetable (FV) exposure by distributing FV as snacks. The objective of this study was to compare kindergarten through second (K-2nd)-graders who were exposed or not to FFVP for preferences and identification.

DESIGN, SETTING, PARTICIPANTS

The FV Preference Survey for K-2nd-graders contained 12 fruits and 12 vegetables, a 3-Likert scale (liked it, okay, don't like it), and an I don't know option. Data were collected from K-2nd-graders at 2 elementary schools near Chicago, IL (n = 435, FFVP school, n = 235 with 12 teachers; non-FFVP school, n = 200 with 10 teachers).

MAIN OUTCOME MEASURE(S)

Mean preference scores.

ANALYSIS

Chi-square, Mann-Whitney U, and multiple linear regression analyses compared school data (P < .05).

RESULTS

There were significant differences in mean preference scores, with higher fruit scores at the FFVP school (1.8 ± 0.6) than at the non-FFVP school (1.7 ± 0.6). In contrast, there was a higher vegetable score for the non-FFVP school (1.3 ± 0.9) than for the FFVP school (1.2 ± 0.9). The school variable had weak impact on fruit ranking (multivariate coefficient = 0.01; P < .05). For fruits and vegetables and combined, there were fewer I don't know responses in the FFVP (χ² = 149.080; P < .01).

CONCLUSIONS AND IMPLICATIONS

At the FFVP school, fewer I don't know responses suggested better FV identification. Non-FFVP students had higher vegetable preferences than did FFVP students. Tasting a variety of FV may help with identifying FV, but more research is needed to determine the impact on preferences.

Development of food lists as a first step to develop a food frequency questionnaire for toddlers in a multi-ethnic population

AIM

Toddlerhood is an important stage of growth, thus understanding the food intake of children in this age group is important. In Singapore, there is currently no simple tool, such as Food Frequency Questionnaire (FFQ), to collect dietary information from this ethnically diverse age group. Generating an appropriate food list is a crucial step in the development of a FFQ and this step is not clearly documented in the literature. The purpose of this study is to generate food lists and portion sizes for toddlers from three major ethnic groups in Singapore and document the processes involved in this first stage.

METHODS

A total of 30 mothers (equal number of Malays, Indians and Chinese) of 11-24-month-old children completed three-day food records and participated in the focus group discussion. The reported food items were then categorised into food groups.

RESULTS

The food lists varied by ethnic groups with the longest list obtained from Chinese toddlers. There were also other foods that were then classified as common foods for all ethnicities. Commonly used utensils among the three ethnic groups were small-sized bowls, plates, cups and spoons. For portion sizes, these utensils were typically half-filled for the toddlers.

CONCLUSIONS

As all Singaporeans have access to the same foods, the ethnic-specific food lists generated in this study could be combined into one list. Together with portion sizes, this information can be used for developing a semi-quantitative FFQ.

Validation of an iPad activity to measure preschool children's food and physical activity knowledge and preferences

Background

Preschool children’s knowledge of, and preference for food and physical activity play an important role in the development of lifestyle behaviors throughout childhood. Valid and reliable instruments that are interactive and appealing to preschool children are needed, to obtain quality information in a way that actively engages children and encourages willing participation. The purpose of the current research is to assess the reliability and validity of an adapted computerized (iPad) version of the photo-pair food and exercise questionnaire (PPFEQ).

Methods

The adaptation of the PPFEQ involved generating the questionnaire as an iPad-based tool, updating the photo-pairs within the questionnaire and testing for validity and reliability. This involved four phases of investigation to assess test-retest reliability, internal consistency, sensitivity to change and percent agreement of the questionnaire.

Results

The adaption of the PPFEQ resulted in an 18-item questionnaire, titled the preschool food and play questionnaire (Pre-FPQ). The Pre-FPQ demonstrated acceptable reliability and sensitivity to change. Test-retest reliability and internal consistency improved with age, however, it was evident that the tool was not suitable for children younger than 4 years of age.

Conclusions

Children encounter a dynamic world that shapes their knowledge, preferences, choices and behaviors. The Pre-FPQ is an innovative tool to measure preschool children’s knowledge of and preference for food and physical activity. The questionnaire offers the advantage of being presented in a well-received modality for preschool children as well as being easy and inexpensive to administer. This new tool is likely to be useful for the assessment of the effectiveness of healthy lifestyle programs implemented in the childcare setting. Future work is needed to refine and improve measures of physical activity preference in preschool children.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0469-z) contains supplementary material, which is available to authorized users.

Influence of Screen-Based Peer Modeling on Preschool Children's Vegetable Consumption and Preferences

OBJECTIVE

To determine the influence of screen-based peer modeling on children's vegetable consumption and preference.

METHODS

A total of 42 children aged 3-5 years were randomly assigned to view individually a video segment of peers consuming a modeled vegetable (bell pepper), vs a nonfood video segment or no video. Analysis of covariance models examined bell pepper preference and consumption during initial video exposure (day 1) and without video exposure (days 2 and 7), adjusted for age, sex, body mass index, and initial bell pepper consumption.

RESULTS

Children in the vegetable condition ate more bell peppers (15.5 g) than did those in the control condition (5.9 g; P = .04; model η(2) = 0.85) on day 7, with no differences on days 1 or 2. Among children who ate the modeled vegetable, those in the vegetable DVD condition reported greater preference for eating the vegetable again (P = .01).

CONCLUSIONS AND IMPLICATIONS

Screen-based peer modeling is a promising tool to influence children's vegetable consumption.

Evaluation of a pictorial method to assess liking of familiar fruits and vegetables among preschool children

Research suggests fruit and vegetable (FV) preferences greatly influence on FV intake. Methods for assessing children's FV preference in a reliable and valid manner are needed. The purpose of this study was to develop a practical, reliable, and valid method for evaluating FV liking among preschool-aged children using photographs. Authors formatively assessed a series of digital FV photographs and hedonic scales to develop content for the liking measure. The measure for assessment included 20 high-quality, digital photographs presenting 13 FVs. A non-gendered 5-point face scale (super yummy to super yucky) was chosen to determine level of liking. We used this measure to establish reliability (i.e., test re-test) and concurrent validity (i.e., photograph versus tasting experience) of the pictorial method. Data were analyzed using Spearman's Rho Correlation Coefficients and Wilcoxon signed-rank tests. The measure demonstrated varying levels of reliability/validity for individual FV items and the fruit scale; however, the vegetable scale and collapsed FV scale were determined to be valid measures. Authors recommended the removal of one weak pictorial fruit item (halved peach) from the fruit and FV scales to improve validity. The final recommended measure included 19 high-quality, digital photographs presenting 12 FVs. The pictorial FV measure and subscales may be useful for assessing FV liking among groups of preschool-aged children within the studied population. Additional research is needed to further validate the use of the pictorial FV measures in a larger, more generalizable sample.

Healthy families study: design of a childhood obesity prevention trial for Hispanic families

BACKGROUND

The childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach.

METHODS

The study will enroll 272 Hispanic families with children ages 5-7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in children's body mass index. Secondary outcomes are changes in children's waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time.

RESULTS

Enrollment and data collection are in progress.

CONCLUSION

This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities.

How to engage children in self-administered dietary assessment programmes

Effectively assessing children's dietary intake is essential for understanding the complex relationships among dietary behaviours and obesity. Dietary assessment accuracy decreases when children are unable or unmotivated to complete accurate self-reports. Technology-based assessment instruments for children's self-report of diet can be enhanced in light of developments in media psychology and communication science. To motivate children to complete a dietary assessment, researchers could use animated, customisable agents; embed the assessment process into a video game; or add narratives to encourage self-reporting behaviour. To improve accuracy, the intake environment could be recreated virtually; training sessions could be interspersed to improve portion estimation; and implicit attitudinal measures could be incorporated as a control or to increase validity. Research is needed to evaluate possible methods of enhancing children's self-reporting motivation and accuracy. The main challenge remains how to engage children without biasing their reporting.

Test-retest reliability and agreement between children's and parents' reports of a computerized food preferences tool

OBJECTIVE

To investigate test-retest reliability of primary-school children's reports of food preferences and to investigate agreement with parental reports.

DESIGN

Children completed an online test and retest, one to two weeks later, during school hours; parents completed a paper-and-pencil or an online questionnaire at home. The children's preferences questionnaire contained 148 food items, reduced to twelve scales; the parental questionnaire contained seventy-eight items reduced to nine scales.

SETTING

Children of fourteen primary schools in Belgium-Flanders.

SUBJECTS

In total 572 children participated; test-retest data were available for 354 children, children's tests could be matched to 362 parental reports.

RESULTS

Test-retest intraclass correlations were on average 0.73, ranging between 0.62 and 0.86; correlations between children's and parents' reports were on average 0.50, ranging between 0.32 and 0.62. Retest preferences were significantly higher for more than half of the scales. Children reported higher preferences than their parents for milk & milk products, fruit and soft drinks, while parents reported higher preferences for bread & breakfast cereals, meat, snacks and sauces.

CONCLUSIONS

The results indicate that the test-retest stability was good; however, agreement between parents and children was rather low to moderate.

Family ties to health program: a randomized intervention to improve vegetable intake in children

OBJECTIVE

Evaluate a home-based intervention targeted toward parents to improve vegetable intake in preschool-aged children.

METHODS

Four-month feasibility study of home-based intervention consisting of 4 tailored newsletters and 2 motivational phone calls compared to control; 4 children's books for the control group; and measured pre and post parent-reported physical and social home environment and child vegetable intake in 22 intervention and 21 control homes with a child 2-5 years old assessed with linear regression of group predicting home environment and diet characteristics post-intervention, adjusting for baseline (P < .05 significant).

RESULTS

Intervention increased availability of vegetables (+1.5 ± 2.5 vegetable types vs -0.3 ± 2.7 vegetable types, P = .02), offering fruits and vegetables for snacks (+0.95 ± 1.5 d/wk vs -0.05 ± 1.9 d/wk, P = .04), and self-efficacy (+2.4 ± 4.1 vs -0.3 ± 2.0, P = .02).

CONCLUSIONS AND IMPLICATIONS

The data suggest potential for home-based interventions to alter parent behaviors such as feeding practices and the home physical environment, which may be steps toward increasing vegetable intake in children.

Otitis media exposure associates with dietary preference and adiposity: a community-based observational study of at-risk preschoolers

Chronic exposure to otitis media (OM) has been linked to risk of overweight/obesity. Here we tested if dietary behaviors explained some of the OM-adiposity relationship among 485 racially-diverse, low-income preschoolers (253 girls, mean age=45±7 months) enrolled in government-supported urban preschool programs. From measured weight/height, 4% were underweight, 17% were overweight and 13% were obese. OM exposure according to parent report varied across nearly equal quartiles-low (never, once) to high (3-5 times, 6+ times) exposure categories. Boys were more likely to be in the high exposure categories. Parents rated their child's liking/disliking of foods (high-fat/added sugar, fruits/juice, vegetables) and non-food activities. In analysis of covariance (ANCOVA), mean liking for vegetables and fruits/juice fell as OM exposure increased, with significant differences between lowest and highest exposure categories (p<.05). Food neophobic versus non-neophobic preschoolers also liked vegetables and fruits less (p<.001). In a two-way ANCOVA, main effects of OM and food neophobia independently predicted vegetable and fruit liking; preschoolers with more OM exposure and neophobia had the lowest liking. Although ANCOVA failed to reveal OM effects on mean liking for fat/sugar foods, the relative ranking of liking for these foods differed by OM category. Fat/sugar foods were ranked as most preferred for the high OM children, particularly the boys, surpassing the ranking of pleasurable non-food items. Conversely, low OM children ranked pleasurable non-food items and fruits/juice as more pleasurable than high OM children. BMI percentile varied with OM exposure, but not neophobia: preschoolers with the greatest exposure averaged the highest percentiles. In multiple regression analyses, liking for vegetables or fruits failed to associate significantly with BMI percentile. There was a small but significant association between greater fat/sugar liking and higher BMI percentile. Overall these findings confirm associations between high OM exposure and elevated adiposity in preschoolers. They also suggest this relationship is explained through lower affinity for vegetables and fruits and greater affinity for fat/sugar foods.

Preferences predict food intake from 5 to 11 years, but not in girls with higher weight concerns, dietary restraint, and %body fat

Food preferences (FP) predict food intake in childhood; however, the predictive power of FP may decline among girls as weight concerns (WC) and dietary restraint (DR) increase during preadolescence. To examine longitudinal change in the preference-intake (P-I) relation and assess whether this relation weakens among non-Hispanic white girls (n = 197) with a history of WC and DR from age 5 to 11. Girls' preferences for and intake (kcal) of 10 palatable snack foods were assessed biennially. Height, weight, percent body fat (%BF), WC, and DR were measured. Individual correlation coefficients were calculated per girl to capture within-person P-I correlations at each time of measurement. Overall, FP predicted girls' snack food calorie intakes between 5 and 11 years, but latent profile analysis (LPA) revealed three distinct patterns of change in P-I correlations over time: "strong/stable" P-I correlations were relatively high and became stronger with age; "increasing/later null" P-I correlations were initially weak and became stronger between 5 and 9 years, but dropped to near 0 at 11 years; "initially weak/later strong" P-I correlations were initially null and increased with age. Mixed models revealed that the "increasing/later null" group had greater increases in %BF, and higher WC, DR, and BMI percentiles from 5 to 11 years, compared to the other groups. In summary, FP predicted snack food calorie intake among most girls during childhood, but waned as a predictor of calorie intake at age 11 for a subset of girls with increasing %BF, and higher WC, DR, and BMIs.

Impact of commercials on food preferences of low-income, minority preschoolers

OBJECTIVE

To determine whether fruit and vegetable (FV) commercials have an impact on preschool children's preferences for specific FV.

DESIGN

A year of extensive formative assessment was conducted to develop 2 30-second commercials: "Judy Fruity" promoted apples and bananas and "Reggie Veggie" promoted broccoli and carrots. The commercials were embedded into a 15-minute TV program. Fruit and vegetable preferences were assessed before and after 4 exposures to each of the commercials.

SETTING

Four Head Start centers in Houston, Texas.

PARTICIPANTS

One hundred eighty-three preschool children (39% African American; 61% Hispanic American).

MAIN OUTCOME MEASURES

Assessment of whether FV preferences were significantly higher in the treatment group than the control group, controlling for baseline FV preferences, age, race, and intervention dose in the model.

ANALYSIS

A general linear model was used.

RESULTS

There was a significantly higher preference for broccoli and carrots (P = .02) in the intervention group compared to the control group after multiple exposures to the vegetable commercial.

CONCLUSIONS AND IMPLICATIONS

Data suggest that commercials promoting vegetables may be an effective strategy to influence young children's preferences for vegetables. This may not be the case with fruit preferences, which are already high in this age group.

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

OBJECTIVES

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

DESIGN

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

STATISTICAL METHODS

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

RESULTS

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

CONCLUSIONS

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

Measures of self-efficacy and norms for low-fat milk consumption are reliable and related to beverage consumption among 5th graders at school lunch

OBJECTIVE

To determine the reliability and validity of scales measuring low-fat milk consumption self-efficacy and norms during school lunch among a cohort of 5th graders.

DESIGN

Two hundred and seventy-five students completed lunch food records and a psychosocial questionnaire measuring self-efficacy and norms for school lunch low-fat milk consumption during the fall and spring semesters of the 1998-1999 academic year. Test-retest reliability was assessed in participants who also completed the questionnaire in the spring semester (n = 262). Principal component analyses identified and confirmatory factor analyses confirmed latent variables. Bivariate correlations measured construct validity.

SETTING

Houston-area middle school.

SUBJECTS

Fifth graders (n = 275) from one middle school in southeast Texas.

RESULTS

Two scales measuring psychosocial influences of low-fat milk consumption were identified and proved reliable in this population: milk self-efficacy and milk norms. Milk self-efficacy and norms were positively correlated with milk consumption and negatively correlated with consumption of sweetened beverages.

CONCLUSIONS

These questionnaires can be used in similar interventions to measure the impact of self-efficacy and norms for drinking low-fat milk during school lunch.