Fruit and vegetable intake: Few adolescent girls meet national guidelines

Factors Associated With Influential Health-Promoting Messages on Social Media: Content Analysis of Sina Weibo

Background

Social media is a powerful tool for the dissemination of health messages. However, few studies have focused on the factors that improve the influence of health messages on social media.

Objective

To explore the influence of goal-framing effects, information organizing, and the use of pictures or videos in health-promoting messages, we conducted a case study of Sina Weibo, a popular social media platform in China.

Methods

Literature review and expert discussion were used to determine the health themes of childhood obesity, smoking, and cancer. Web crawler technology was employed to capture data on health-promoting messages. We used the number of retweets, comments, and likes to evaluate the influence of a message. Statistical analysis was then conducted after manual coding. Specifically, binary logistic regression was used for the data analyses.

Results

We crawled 20,799 Sina Weibo messages and selected 389 health-promoting messages for this study. Results indicated that the use of gain-framed messages could improve the influence of messages regarding childhood obesity (P<.001), smoking (P=.03), and cancer (P<.001). Statistical expressions could improve the influence of messages about childhood obesity (P=.02), smoking (P=.002), and cancer (P<.001). However, the use of videos significantly improved the influence of health-promoting messages only for the smoking-related messages (P=.009).

Conclusions

The findings suggested that gain-framed messages and statistical expressions can be successful strategies to improve the influence of messages. Moreover, appropriate pictures and videos should be added as much as possible when generating health-promoting messages.

Change in diet in the period from adolescence to early adulthood: a systematic scoping review of longitudinal studies

BACKGROUND

Late adolescence to early adulthood is a period of lifestyle change and personal development which may influence dietary behaviour. Understanding dietary trajectories across this age range may help in targeting interventions appropriately. This scoping review aimed to assess how longitudinal change in diet is conceptualised and measured between the ages of 13 to 30.

METHODS

We searched Medline, SCOPUS, Embase, PsycInfo (EBSCO), ASSIA, Sportdiscus, and Web of Science Core Collection (January 2016) using search terms combining diet outcomes, longitudinal methods and indicators of adolescent or young adult age. Titles and abstracts were screened and data extracted following published guidelines for scoping reviews. Data were analysed to summarize key data on each study and map availability of longitudinal data on macronutrients and food groups by age of study participants.

RESULTS

We identified 98 papers reporting on 40 studies. Longitudinal dietary data were available on intake of energy, key macronutrients and several food groups, but this data had significant gaps and limitations. Most studies provided only two or three waves of data within the age range of interest and few studies reported data collected beyond the early twenties. A range of dietary assessment methods were used, with greater use of less comprehensive dietary assessment methods among studies reporting food group intakes.

CONCLUSION

Despite limited availability of longitudinal data to aid understanding of dietary trajectories across this age range, this scoping review identified areas with scope for further evidence synthesis. We identified a paucity of longitudinal data continuing into the mid and late twenties, variability in (quality of) dietary assessment methods, and a large variety of macronutrients and food groups studied. Advances in dietary assessment methodologies as well as increased use of social media may facilitate new data collection to further understanding of changing diet across this life stage.

Processed Food Contributions to Energy and Nutrient Intake Differ among US Children by Race/Ethnicity

This study determined and compared the mean daily intake of energy and nutrients from processed foods by level of processing (minimally processed; processed for preservation, nutrient enhancement, and freshness; mixtures of combined ingredients; ready-to-eat processed foods; and prepared foods/meals) among non-Hispanic white, non-Hispanic black, and Mexican American US children. Data from participants 2–18 years old (n = 10,298) of the nationally representative cross-sectional National Health and Nutrition Examination Survey 2003–2008 with a complete one day, 24-h dietary recall were used to determine mean intake of energy and nutrients recommended for increase and decrease, as per the 2010 Dietary Guidelines for Americans, among child race/ethnic groups by category of food processing. Regression analysis was used to estimate and compare covariate-adjusted (gender, age, and poverty-income-level) least square means (p < 0.05/3 race/ethnic groups). All children, regardless of race or ethnicity consumed processed foods. Approximately 66% to 84% of total daily energy, saturated fat, cholesterol, fiber, total sugar, added sugars, calcium, vitamin D, potassium, and sodium intake are contributed by one of the five categories of processed foods. Clinicians and policy should primarily advise consideration of the energy and nutrient composition of foods, rather than the processing level, when selecting a healthy diet for children.

The FIT Game: preliminary evaluation of a gamification approach to increasing fruit and vegetable consumption in school

OBJECTIVE

Incentive-based interventions designed to increase fruit and vegetable (FV) consumption tend to yield positive, short-term outcomes. Because consumption most often returns to baseline levels when incentives are removed, sustainable long-duration interventions may be needed to impact public health. Anticipating that low-cost interventions will be more appealing to schools, the present study explored a low-cost, game-based intervention.

METHOD

An alternating-treatments design was used to evaluate the effects of the FIT Game on objectively measured FV consumption in one elementary school (n=251) in Utah. During the Fall 2013 semester, game-based rewards were provided to heroic characters within a fictional narrative read by teachers on days when the school, as a whole, met a fruit or vegetable consumption goal in accord with the alternating-treatments design.

RESULTS

On intervention days, fruit and vegetable consumption increased by 39% and 33%, (p<0.01, p<0.05; binomial tests), respectively. Teacher surveys indicated that students enjoyed the game and grade 1-3 teachers recommended its use in other schools.

CONCLUSION

This game-based intervention provides a promising step towards developing a low-cost, effective, and sustainable FV intervention that schools can implement without outside assistance.

Gamification of dietary decision-making in an elementary-school cafeteria

Despite the known health benefits of doing so, most US children do not consume enough fruits and vegetables (FV). School-based interventions can be effective in increasing FV consumption, but the most effective of these require that schools allocate their time, effort, and financial resources to implementing the program: expenditures that schools may be reluctant to provide in climates of academic accountability and economic austerity. The present demonstration project used a behaviorally based gamification approach to develop an intervention designed to increase FV consumption while minimizing material and labor costs to the school. During the intervention, the school (N = 180 students in grades K-8) played a cooperative game in which school-level goals were met by consuming higher-than-normal amounts of either fruit or vegetables (alternating-treatments experimental design). School-level consumption was quantified using a weight-based waste measure in the cafeteria. Over a period of 13 school days, fruit consumption increased by 66% and vegetable consumption by 44% above baseline levels. Use of an alternating-treatment time-series design with differential levels of FV consumption on days when fruit or vegetable was targeted for improvement supported the role of the intervention in these overall consumption increases. In post-intervention surveys, teachers rated the intervention as practical in the classroom and enjoyed by their students. Parent surveys revealed that children were more willing to try new FV at home and increased their consumption of FV following the intervention. These findings suggest that a behaviorally based gamification approach may prove practically useful in addressing concerns about poor dietary decision-making by children in schools.

Semiparametric Estimation of the Impacts of Longitudinal Interventions on Adolescent Obesity using Targeted Maximum-Likelihood: Accessible Estimation with the ltmle Package

While child and adolescent obesity is a serious public health concern, few studies have utilized parameters based on the causal inference literature to examine the potential impacts of early intervention. The purpose of this analysis was to estimate the causal effects of early interventions to improve physical activity and diet during adolescence on body mass index (BMI), a measure of adiposity, using improved techniques. The most widespread statistical method in studies of child and adolescent obesity is multi-variable regression, with the parameter of interest being the coefficient on the variable of interest. This approach does not appropriately adjust for time-dependent confounding, and the modeling assumptions may not always be met. An alternative parameter to estimate is one motivated by the causal inference literature, which can be interpreted as the mean change in the outcome under interventions to set the exposure of interest. The underlying data-generating distribution, upon which the estimator is based, can be estimated via a parametric or semi-parametric approach. Using data from the National Heart, Lung, and Blood Institute Growth and Health Study, a 10-year prospective cohort study of adolescent girls, we estimated the longitudinal impact of physical activity and diet interventions on 10-year BMI z-scores via a parameter motivated by the causal inference literature, using both parametric and semi-parametric estimation approaches. The parameters of interest were estimated with a recently released R package, ltmle, for estimating means based upon general longitudinal treatment regimes. We found that early, sustained intervention on total calories had a greater impact than a physical activity intervention or non-sustained interventions. Multivariable linear regression yielded inflated effect estimates compared to estimates based on targeted maximum-likelihood estimation and data-adaptive super learning. Our analysis demonstrates that sophisticated, optimal semiparametric estimation of longitudinal treatment-specific means via ltmle provides an incredibly powerful, yet easy-to-use tool, removing impediments for putting theory into practice.

Youth dietary intake and weight status: healthful neighborhood food environments enhance the protective role of supportive family home environments

The aim of this study is to investigate individual and joint associations of the home environment and the neighborhood built environment with adolescent dietary patterns and body mass index (BMI) z-score. Racially/ethnically and socioeconomically diverse adolescents (n=2682; 53.2% girls; mean age14.4 years) participating in the EAT 2010 (Eating and Activity in Teens) study completed height and weight measurements and surveys in Minnesota middle and high schools. Neighborhood variables were measured using Geographic Information Systems data. Multiple regressions of BMI z-score, fruit and vegetable intake, and fast food consumption were fit including home and neighborhood environmental variables as predictors and also including their interactions to test for effect modification. Supportive family environments (i.e., higher family functioning, frequent family meals, and parent modeling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Associations between the built environment and adolescent outcomes were fewer. Interaction results, although not all consistent, indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighborhood was supportive of healthful behavior. Public health interventions that simultaneously improve both the home environment and the neighborhood environment of adolescents may have a greater impact on adolescent obesity prevention than interventions that address one of these environments alone.

Spatial patterning of supermarkets and fast food outlets with respect to neighborhood characteristics

A large body of literature has reported differences in exposure to environments supporting either healthy (e.g. supermarkets) or unhealthy (e.g. fast food outlets) dietary choices by neighborhood characteristics. We explored the associations of both supermarkets and fast food outlets availability with neighborhood characteristics, and clustering of these two outlet types in a largely rural state. Compared to block groups without a supermarket, those with a supermarket had a significantly higher income, higher housing value, larger population with high school education and above, lower minority population and lower population living below poverty even after controlling for urbanicity and population density of census block groups. Surprisingly, a similar relationship was found for block groups with and without fast food outlets. This was due to spatial co-occurrence and clustering of fast food outlets around supermarket locations. Hence, future studies exploring the associations of food environment with diet or diet-related health outcome should concurrently examine all aspects of food environment (healthy and unhealthy).

Social-cognitive correlates of fruit and vegetable consumption in minority and non-minority youth

OBJECTIVE

Inadequate fruit and vegetable (FV) consumption signals a need for identifying predictors and correlates of intake, particularly in diverse adolescents.

DESIGN

Participants completed an on-line assessment in early 2010.

SETTING

Computer classrooms in 4 high schools.

PARTICIPANTS

One hundred twenty-two Caucasian and 125 minority (African American and Hispanic) high school students (mean age = 15.3 years, SD = 1.0) with parental consent. Response rate was 89%.

VARIABLES MEASURED

Self-efficacy as measured by confidence in goal setting and decision making about healthful eating; perceived benefits and barriers to eating FVs; healthful eating-related social support; body esteem; and FV intake.

ANALYSIS

t tests were used to examine group differences, and binary logistic regression analyses were conducted to explore the predictors of 5-A-Day FV consumption.

RESULTS

Thirty-four percent of the non-minority group and 28% of the minority group reported eating 5 or more portions of FVs a day (P = .34). Self-efficacy and perceived benefits predicted consumption in minority participants, whereas barriers and social support were significant predictors in the non-minority group.

CONCLUSIONS AND IMPLICATIONS

These findings suggest different variables predict consumption for minority and non-minority groups and that self-efficacy is an important variable to consider in dietary change programs for minority adolescents.

Influence of body dissatisfaction on 1-year change in nutrient intake of overweight and obese inner-city African American children

This analysis aimed to examine the relationship of baseline body dissatisfaction with 1-year change in nutrient intake of inner-city, overweight and obese, African American children. This is a secondary analysis of 1-year pre-post data available for a convenience sample of 88 children. After adjusting for baseline intake of dietary variables and intervention group status, baseline body dissatisfaction was associated with 1-year increases in intake of energy, and all macronutrients in girls, but not in boys. These relationships were not substantially altered after adjusting for baseline BMIz and global self-worth. After including all adjustment factors, increasing baseline body dissatisfaction in girls was associated with 1-year increased intake of total energy, total sugars, total fat, discretionary fat, and total carbohydrates. This analysis suggests that, in girls but not necessarily in boys, body dissatisfaction might need to be targeted during interventions that aim to improve nutrient intake.

Associations of built food environment with dietary intake among youth with diabetes

OBJECTIVE

To evaluate the associations of supermarket and fast-food outlet accessibility and availability with dietary intake among youth with diabetes.

DESIGN

Subjects' residential location and dietary intake was obtained from the SEARCH for Diabetes in Youth study. Food outlet data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data were then used to construct accessibility and availability measures for each participant.

SETTING

State of South Carolina.

PARTICIPANTS

Three hundred fifty-nine youths with diabetes (10 years old and older) from the SEARCH for Diabetes in Youth study.

PHENOMENA OF INTEREST

Supermarket and fast-food outlet accessibility and availability; dietary intake represented by Dietary Approaches to Stop Hypertension (DASH) score.

ANALYSIS

Generalized estimating equations analyses.

RESULTS

Increased availability and accessibility of supermarkets were significantly associated with higher DASH score, even after adjusting for individual-level correlates, urbanicity, and fast-food outlet accessibility or availability. Fast-food accessibility, however, was associated only with specific food groups (meat, sweets, and low-fat dairy intake), not with the DASH score.

CONCLUSIONS AND IMPLICATIONS

Efforts to promote environments conducive to healthful eating may significantly improve the overall dietary intake and reduce diet-related health complications among youth with diabetes.

Antioxidant capacity, polyphenolics and pigments of broccoli-cheese powder blends

Novel products were developed by combining freeze dried and conventionally dried broccoli sprouts powder with the commercially available cheese powder. Quality assessment of the blended products during the development process and of the final product was done by sensory analysis and estimation of total antioxidant capacity, total polyphenolics, total chlorophyll and total carotenoids. Freeze drying was more efficient in preserving the original nutritional and sensory characteristics of the dried broccoli sprouts. Blending of the samples including the blend with a least weight proportion of broccoli sprouts powder showed an improved content of healthy compounds. Based on chemical data and sensory analysis, it was concluded that the blended cheese powder containing up to 20% freeze dried broccoli powder was an acceptable product.

Dietary intakes of urban, high body mass index, African American children: family and child dietary attributes predict child intakes

OBJECTIVE

To identify family and child nutrition and dietary attributes related to children's dietary intakes.

DESIGN

African American children (ages 8-11 years, n = 156), body mass index > 85th percentile, from urban, low-income neighborhoods. Baseline, cross-sectional data collected as part of an ongoing diabetes prevention intervention. Dietary intakes were collected by 3-day food diary to assess total energy, percent fat, discretionary fat, added sugar, whole grains, vegetables, fruit, meat, and dairy. Questionnaires on nutrition and dietary attributes administered to children and parents were used to develop 5 diet-related indices: child knowledge, child preferences, child snack habits, child beverage habits, and family food habits.

RESULTS

A higher child nutrition knowledge score was significantly related to a lower starchy vegetable intake. Higher scores on the child snack habits index were significantly related to higher intakes of fruit, total fruits and vegetables, total fruits and nonstarchy vegetables, and to lower intakes of added sugars. A higher score on the family food habits index was significantly related to lower intakes of total energy and discretionary fat.

CONCLUSIONS AND IMPLICATIONS

Targeting both child and family food and nutrition attributes may be used to promote more healthful eating among urban, low-income, overweight African American children.

White potatoes, including french fries, contribute shortfall nutrients to children's and adolescents' diets

To test the hypothesis that white potatoes (WP), oven-baked fries (OBF), and french fries (FF) contribute important nutrients within energy needs to children's and adolescents' diets, secondary analysis of 24-hour dietary recall data from the National Health and Nutrition Examination Survey 2003-2006 was conducted. Potato content of survey foods was determined using US Department of Agriculture recipe databases (Standard Reference (SR)-Link files). Nutrient content of potatoes was determined by linking SR codes to US Department of Agriculture food composition data. Daily nutrient intakes from potatoes were determined by applying the composition database to respondent's recall data. Sample-weighted data were analyzed; t tests assessed differences between age and sex groups. Results indicated that approximately 35% of children and adolescents consumed WP + FF + OBF; 18% consumed FF. Intakes were lower in children compared with adolescents (P < .01). Among adolescents, more boys than girls consumed FF (P < .05); boys ate larger amounts of WP + FF + OBF (134 g/d) and FF (100 g/d) (P < .01). Both WP + FF + OBF and FF provided 9% to 12% of total daily energy (but was within energy requirements in the highest consumers); 8% to 15% of daily fat (>75% monounsaturated fatty acids + polyunsaturated fatty acids); ≥ 10% dietary fiber, vitamin B(6), and potassium; 5% or greater thiamin, niacin, vitamin K, phosphorus, magnesium, and copper; and less than 5% sodium intake, for all sex -age groups. The combination WP + FF + OBF provided 5% or greater vitamin C for all sex-age groups and 5% or greater vitamin E and iron for most groups; FF provided 5% or greater vitamin E intakes for all. These cross-sectional data show that WP, including FF, provided shortfall nutrients within energy requirements to children and adolescents and, when consumed in moderate amounts, can be part of healthful diets.

The costs of food at home and away from home and consumption patterns among U.S. adolescents

PURPOSE

This study examined the associations of prices of food at home groceries, prices of fast food away from home and the availability of food stores and restaurants with the number of days over the past week that adolescents consumed fruit and fruit juices, vegetables, meat, nonmeat protein, dairy, grains, and sweets.

METHODS

Individual-level data on adolescents were drawn from the Child Development Supplement of the Panel Study of Income Dynamics combined at the zip code level with external economic contextual data. Multivariate regression analyses were used to estimate the associations between food consumption categories and the economic contextual factors. Regressions were also estimated by households' poverty status.

RESULTS

Fast food and food at home prices were not significantly associated with any of the food consumption categories in the full sample. However, among poor adolescents, higher fast food prices were associated with higher levels of nonmeat protein consumption. Food store outlet availability was found to have very small significant associations with some food consumption categories but no significant associations were found for restaurant outlets.

CONCLUSIONS

Food away from home prices, such as fast food prices and supermarket and grocery store availability, were associated with some food consumption categories among low-income youths and related policies deserve further examination.

Perceived barriers mediate the association between self-efficacy and fruit and vegetable consumption among students attending alternative high schools

Compared to students attending regular high schools, alternative high school students are more likely to be racial/ethnic minorities, have higher levels of poverty, and higher rates of risky and poor health behaviors, including weight-related behaviors like limited fruit and vegetable intake. However, little is known about fruit/vegetable intake among alternative high school students. This study examined whether perceived barriers to healthy eating mediated the association between self-efficacy to eat healthy foods and fruit/vegetable consumption among alternative high school students. The cross-sectional study population consisted of students (N=145) attending six alternative high schools in the St Paul-Minneapolis, MN, area who were participants in an obesity prevention pilot study and completed a baseline survey during fall 2006. Mixed model linear regression, adjusting for sociodemographic characteristics, was used to test a series of regression models performed according to mediation analysis procedures. Students' mean age was 17.3 years; 52% were male, 63% were low-income, and 61% were from racial/ethnic minorities. Students reported a mean fruit/vegetable intake of 3.6 servings per day, mean self-efficacy to eat healthy score of 22.2 (range 3 to 35), and mean barriers to eating healthy score of 6.9 (range 3 to 13). Perceived barriers to healthy eating fully mediated the relationship between self-efficacy and fruit/vegetable consumption (Sobel test statistic 2.7, P=0.007). Interventions targeting the dietary practices of alternative high school students should include components to decrease perceived barriers as a way to increase self-efficacy and ultimately fruit/vegetable intake.

Qualitative study to explore Prospect Theory and message framing and diet and cancer prevention-related issues among African American adolescents

BACKGROUND

There is a dearth of knowledge regarding factors that may motivate African American adolescents to consume healthier diets.

OBJECTIVE

To develop and test cancer prevention messages based on Prospect Theory on motivation to improve dietary intake in African American adolescents and to explore other salient factors that may inform dietary intervention design and implementation in this population.

METHODS

Semistructured in-person qualitative interviews were conducted with 13 African American male and female adolescents, aged 12 to 16 years, in North Carolina. Prospect Theory and message framing were used to guide the design of the 4 sets of diet-related messages related to cancer prevention: short-term, gain-framed; long-term, gain-framed; short-term, loss-framed; and long-term, loss-framed messages. Data were also collected on demographic, behavioral, and psychological factors; usual health behaviors; and preferences for intervention delivery.

RESULTS

Most respondents found the gain-framed, short-term messages most salient for both fruits/vegetables (8 [61.5%]) and fat consumption (7 [53.8%]). For fat consumption only, 2 (15.4%) found the loss-framed, short-term messages pertinent; none found the loss-framed, long-term messages relevant for either dietary variable. All indicated interest in participating in a dietary intervention/education program; most preferred the Internet as a channel for intervention delivery. Participants expressed diverse views regarding knowledge, attitudes, and beliefs regarding healthy eating.

CONCLUSION

The gain-framed, short-term messages were most salient for motivating the majority of respondents to consume a healthy diet and most expressed a strong interest in participating in programs about diet and nutrition, with the Internet as the preferred communication channel.

IMPLICATIONS FOR PRACTICE

Researchers conducting dietary interventions and education initiatives and medical professionals who counsel African American adolescents should consider using Prospect Theory as a theoretical framework, should focus on gain-framed, short-term messages regarding cancer prevention, and should use the Internet for data collection and intervention and information delivery.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents' eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12-15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents' diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

Longitudinal behavioral effects of a school-based fruit and vegetable promotion program

OBJECTIVE

This study examined the longitudinal effects of a school-based program on kindergarten and first grade children's fruit and vegetable (F&V) consumption.

METHODS

The program included lunchroom, classroom, school-wide, and family components. The primary dependent variable, F&V consumed at lunch, was assessed using weighed plate waste. Hierarchical linear models were used to analyze the differences between intervention and control groups and to account for repeated measurements.

RESULTS

Children in the experimental group consumed more F&V (F = 29 g; V = 6 g; 0.43 portions/lunch; 0.28 servings/lunch) at the end of Year 1 compared with children in the control group. At the end of Year 2, children in the experimental group consumed more fruit (21 g; 0.23 portions/lunch; 0.15 servings/lunch), but not more vegetables compared with children in the control group.

CONCLUSIONS

The intervention resulted in increased F&V consumption, with more pronounced and enduring effects for fruits than vegetables.

Motivation, self-efficacy, physical activity and nutrition in college students: randomized controlled trial of an internet-based education program

OBJECTIVE

MyStudentBody.com-Nutrition (MSB-N) is an internet-based nutrition and physical activity education program for college students.

METHOD

Students from six universities (N=476) in the U.S. were randomly assigned in the fall of 2005 to one of three groups: MSB-N (Experimental I), MSB-N plus Booster (Experimental II), or an attention placebo control group.

RESULTS

Experimental I and II group participants increased their fruit and vegetable intake by .33 and .24 servings, respectively, relative to the control group at post-test. Both experimental groups improved their motivation to change eating behaviors (p<.05) and were also more likely to increase their social support and self-efficacy for dietary change (p's<.05). Experimental groups also improved their attitude toward exercise (p<.05), but no behavioral changes in physical activity were noted.

CONCLUSION

MyStudentBody.com-Nutrition is an effective internet-based program that may have wide applicability on college campuses for nutrition education and promoting change in health behaviors.

What's love got to do with it? Family cohesion and healthy eating behaviors in adolescent girls

OBJECTIVE

To examine the association between family cohesion and behaviors linked to health or overweight in adolescents.

METHOD

Cross-sectional analyses of family cohesion and eating behaviors of 2,379 girls (followed from ages 9-19) who participated in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS). Height and weight measurements were obtained on an annual basis. Family cohesion was measured by the Family Adaptability and Cohesion Evaluation Scale (FACES) III. Food diaries were used to assess frequency of breakfast consumption and intake of milk, soda, fruits, and vegetables.

RESULTS

Family cohesion was significantly associated with less soda intake and higher rates of breakfast consumption. Ingestion of milk, fruits, and vegetables was predicted by family cohesion at the trend level.

CONCLUSION

Understanding the role of familial factors in adolescent eating behaviors is an important research priority. Strengthening family cohesion may be a valuable goal toward promoting the health of adolescents, increasing breakfast eating and decreasing soda consumption.

Preventing childhood obesity and diabetes: is it time to move out of the school?

Childhood obesity interventions in the USA and Europe have predominantly focused on the school environment for over two decades with mixed or modest success. The focus on school--while intuitive, apparently efficient, and convenient--does not address larger upstream environmental factors, which affect obesity among youth. In this article, we examine potential drawbacks and limitations of previous school-based obesity and diabetes prevention programs. The future of school-based obesity and diabetes interventions and potential strategies for improvement is explored. Increased use and reporting of diversified theoretical frameworks, formative research to inform the interventions, and process evaluations to improve programs are recommended. More importantly, addressing the broader issue of the overall food environment and its impact on children's diet with intensified involvement of key stakeholders, including families, supermarkets, and corner stores is essential. We discuss the development of healthy eating zones around schools as a potential tool in the fight to reduce childhood obesity.

Associations between access to food stores and adolescent body mass index

BACKGROUND

Environmental factors such as the availability of local-area food stores may be important contributors to the increasing rate of obesity among U.S. adolescents.

METHODS

Repeated cross-sections of individual-level data on adolescents drawn from the Monitoring the Future surveys linked by geocode identifiers to data on food store availability were used to examine associations between adolescent weight and the availability of four types of grocery food stores that include chain supermarkets, nonchain supermarkets, convenience stores, and other grocery stores, holding constant a variety of other individual- and neighborhood-level influences.

RESULTS

Increased availability of chain supermarkets was statistically significantly associated with lower adolescent Body Mass Index (BMI) and overweight and that greater availability of convenience stores was statistically significantly associated with higher BMI and overweight. The association between supermarket availability and weight was larger for African-American students compared to white or Hispanic students and larger for students in households in which the mother worked full time.

CONCLUSIONS

Economic and urban planning land use policies which increase the availability of chain supermarkets may have beneficial effects on youths' weight outcomes.

Adolescent exposure to food advertising on television

BACKGROUND

Television viewing is hypothesized to contribute to obesity among children and adolescents through several mechanisms that include the displacement of physical activity, snacking while watching TV, and the influence of food advertising.

METHODS

This study drew on television ratings to examine the distribution of food advertising exposure among adolescents aged 12 through 17 based on 170 top-rated shows across network, cable and syndicated TV stations over the 9-month period from September 2003 to May 2004. A total of 238,353 30-second equivalent advertisements on the top-rated shows were assessed. Each advertisement was weighted by its rating to measure actual exposure to advertisements.

RESULTS

The results showed that among total nonprogram content time, food-related products accounted for roughly one fifth of advertising exposure. Excluding TV promotions and public service announcements, as a proportion of all product advertising, total food-related advertising made up 26% of advertised products viewed by adolescents. By race, the proportion of advertising exposure to food products was 14% greater for African-American versus white adolescents and total exposure to food advertising would be even larger for African-American teens given that, on average, they watched more TV. Fast food was the most frequently viewed food product category comprising 23% of all food-related advertisements among adolescents.

CONCLUSIONS

Food ads made up just over one quarter of TV ads viewed by adolescents with the most commonly viewed products of fast food, sweets, and beverage products well within the reach of their own purchasing power.

Longitudinal assessment of micronutrient intake among African-American and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVE

Low intakes of micronutrients among adolescents may be linked to long-term health risks, especially in African-American girls. This report describes intake of key micronutrients relative to the Dietary Reference Intakes in a sample of African-American and white girls.

DESIGN

Longitudinal analyses used data from 3-day food records collected in the National Heart, Lung, and Blood Institute Growth and Health Study.

SUBJECTS/SETTING

Subjects included 1,166 white and 1,213 African-American girls (aged 9 to 18 years).

MAIN OUTCOME MEASURES

Estimated usual daily intakes of vitamins A, E, C, D, B-6, B-12, magnesium, folate, calcium, and zinc were compared to the Adequate Intake (for vitamin D and calcium) or the Estimated Average Requirement (EAR) (all other micronutrients).

STATISTICAL ANALYSES PERFORMED

Usual daily intake of each micronutrient was estimated. For nutrients with an EAR, the EAR cut-point method was used to assess the prevalence of low nutrient intakes. Mixed models were used to identify age and racial differences in usual daily intake of each nutrient.

RESULTS

African-American girls consumed less vitamin A and D, calcium, and magnesium compared to white girls. Regardless of race, a substantial percentage of girls had intakes below the EAR: vitamin E (81.2% to 99.0%), magnesium (24.0% to 94.5%), folate (46.0% to 87.3%). Intakes of vitamins A, D, and C; calcium; and magnesium decreased across years. As girls aged, there was an increasing proportion with intakes below the EAR for vitamins A, C, B-6, and B-12.

CONCLUSIONS

Food and nutrition professionals should continue to educate adolescent girls, especially those who are African American, about the importance of a nutrient-dense diet for optimum health.

Use of the youth risk behavior survey to monitor trends for nutrition and physical activity in a Midwest city school district

BACKGROUND

The Youth Risk Behavior Survey (YRBS) was used by a city school district (approximately 11,000 students) in the upper Midwest to monitor trends for nutrition and physical activity (PA) behaviors both within and between years and to compare with national 2003 data.

METHODS

Independent random samples were obtained in 1999 (387 middle school [MS] and 931 high school [HS]), in 2001 (322 MS and 367 HS), and in 2003 (658 MS and 1026 HS). A two-sample test of proportions was used.

RESULTS

Within each survey year, a higher proportion of MS compared to HS reported positive behaviors with some exceptions: (1) an increased proportion of HS having daily physical education (PE) and (2) a reduced proportion of HS reporting media time. Within 2003, a lower proportion of district females compared to males (MS and HS) reported participation in many measured behaviors. District trends overtime indicated a reduced proportion: (1) drinking milk (MS and HS), (2) eating breakfast (HS), and (3) watching television (MS). Trends overtime indicated an increased proportion: (1) using computers for fun (MS and HS), (2) participating in moderate PA (MS), and (3) daily PE (HS). District HS compared to national (2003) indicated a higher proportion: (1) drinking milk, (2) getting moderate PA, and (3) taking daily PE. District HS compared to national indicated a lower proportion: (1) at risk of overweight, (2) overweight, and (3) watching television.

CONCLUSIONS

Analysis of district YRBS trends provides both a database for informed decisions by the school district and an assessment model for other districts.

Nutritional content of television food advertisements seen by children and adolescents in the United States

OBJECTIVE

In light of the high rates of child and adolescent obesity, we examined the nutritional content of food advertising seen by American children and adolescents.

METHODS

We drew samples of top-rated television shows by using ratings data to examine the nutritional content for fat, saturated fat, sugar, sodium, and fiber of food-product advertisements seen on television by both children and adolescents. Food products were examined in aggregate and by 5 separate categories that included cereal, sweets, snacks, drinks, and other food products. For 2- to 11-year-olds and 12- to 17-year-olds, respectively, a sample of 50,351 and 47,955 30-second-equivalent food-product advertisements and their related nutritional content were weighted by television ratings data to provide actual exposure measures of the nutritional content of food advertising seen by children and adolescents.

RESULTS

Study results showed that 97.8% and 89.4% of food-product advertisements viewed by children 2 to 11 years old and adolescents 12 to 17 years old, respectively, were high in fat, sugar, or sodium. On average, 46.1% and 49.1% of total calories among the products advertised came from sugar in the advertisements seen by these respective age groups. A total of 97.6% of cereal advertisements seen by children 2 to 11 years old were for high-sugar cereals. No substantial differences were found in the nutritional content of advertisements seen by black and white children 2 to 11 years old. However, a slightly higher proportion of food advertisements in general and across all food-product categories seen by black versus white adolescents were for high-sugar products.

CONCLUSION

The overwhelming majority of food-product advertisements seen on television by American children and adolescents are of poor nutritional content.

Self-efficacy and norm measures for lunch fruit and vegetable consumption are reliable and valid among fifth grade students

OBJECTIVE

To determine the reliability and validity of a questionnaire measuring fruit and vegetable (FV) self-efficacy and social norms during school lunch among 5th graders.

DESIGN

In this cross-sectional study, students completed lunch food records and a psychosocial questionnaire measuring school lunch FV self-efficacy and social norms regarding consumption during the fall and spring semesters. Test-retest reliability was assessed between fall and spring semesters. The measurement model was cross-validated in the spring data.

SETTING

One middle school in Houston, Texas.

PARTICIPANTS

275 fifth graders in the 1998 fall semester and 262 of these fifth graders in the 1999 spring semester.

MAIN OUTCOME MEASURES

FV consumption and psychosocial variables.

ANALYSES

Principal components analyses, confirmatory factor analyses and bivariate correlations.

RESULTS

Three scales were identified: Fruit Self-Efficacy, Vegetable Self-Efficacy, and FV Social Norms. FV self-efficacy were positively correlated with low-fat vegetable and fruit consumption. Social norms were positively correlated with total vegetable, low-fat vegetable, fruit and total FV consumption.

CONCLUSIONS AND IMPLICATIONS

Self-efficacy and norms for eating FV at school lunch are related to lunch FV consumption. Increasing self-efficacy and social norms about consuming FV at school appears to be important targets to improve FV consumption.