An effective procedure for changing food preferences in 5-7-year-old children

Efeitos da Modelação e Reforçamento Positivo no Consumo de Frutas em Crianças

Resumo Este estudo avaliou o efeito da modelação (vídeos) e das consequências sobre o consumo de frutas em oito pré-escolares. No Experimento1 foram apresentados vídeos e, posteriormente, consequências. No Experimento 2 foram programadas consequências, em seguida, vídeos e consequências conjuntamente. No Experimento 1, o consumo foi maior durante apresentação de consequências; no Experimento 2, a apresentação conjunta de vídeos e consequências produziu maior consumo que consequências isoladamente, sugerindo efeito potencializador dos vídeos. Mudança gradual na intermitência das consequências reduziu consumo de três participantes do Experimento 1, mas aumentou consumo para os dois participantes afetados pelas intervenções no Experimento 2. O consumo foi maior na LBII comparada à LBI, porém menor que durante intervenções, indicando efeito temporário dessas intervenções sobre o consumo.

Changing the behaviour of children living in Dutch disadvantaged neighbourhoods to improve breakfast quality: Comparing the efficacy of three school-based strategies

Children's breakfast habits are suboptimal. A novel school-based education programme was developed and tested with the aim of improving children's attitude, knowledge and breakfast quality. A pre- and post-test design was used with four conditions: group-based education, role modelling, tailored feedback with goal setting, and a combination of these three delivery modes. Two hundred eighty children from disadvantaged communities (9.3 ± 0.8 years) participated in three lessons at school over a two-month period. Children's attitude, knowledge and breakfast behaviour were evaluated by a pre- and post-questionnaire completed by the children. A follow-up measure was executed at 24 weeks. The data were analysed by repeated measures ANOVA. At baseline, 90% of the children ate breakfast on the measurement day; 60-76% of the children ate breakfast daily. Between pre- and post-test, a significant time effect was found for children's attitude, self-efficacy, knowledge and behaviour (all p < 0.05). Children in the feedback condition improved most favourably: correct classification of breakfast products increased by 10 products (out of 44) and breakfast quality score improved by 25 points (on a 100-point scale). The feedback condition also resulted in positive changes in the home setting. The follow-up test showed a decline in children's knowledge and their breakfast quality across conditions. To conclude, this study showed that a three-lesson school programme based on individual feedback and goal setting is most effective for changing knowledge on breakfasting and self-reported breakfast quality among children aged 8-10 years living in disadvantaged neighbourhoods. To maintain effectiveness, longer-term programmes embedded in the school curriculum are needed to enhance breakfast quality. Future research should explore the optimal duration and intensity of such programmes and should incorporate the topic of suitable portion sizes.

Preschoolers exhibit conformity to computer-simulated food portion selection behaviors of remote peers

Children have been found to rely on others for food choice and food intake cues, but it is unclear whether a similar type of social modeling occurs for food portion selection, especially among young children. Given that portion size predicts energy intake, it is important to understand the role of social influence on portion selection behavior early in life. The present study aimed to determine preschoolers' conformity to food portion selection patterns of remote peers using a computerized Portion Selection Task and examined the role of parents' feeding styles in children's susceptibility to others' food portion choices. Seventy-five 3-6 year old Singaporean children (M = 62 ± 0.72 months) were asked to make food portion selections of high-energy-density (ED) foods and low-ED foods both independently and after having viewed remote peers' portion selections of the same foods. In the unhealthy peers condition, children saw peers choose large portions of high-ED foods and small portions of low-ED foods, while in the healthy peers condition, children saw peers select large portions of low-ED foods and small portions of high-ED foods. Parents were surveyed about their child feeding practices. Results revealed that participants exhibited conformity to the portion sizes of remote peers for both high-ED and low-ED foods under the healthy peers condition, but only marginally for high-ED foods under the unhealthy peers condition. Parents' higher restriction of foods for child's health was marginally associated with lower conformity to peers' portion selections of unhealthy foods and higher conformity to peers' portion selections of healthy foods. This study provides support for social modeling of food portion selection among young children, but the extent of social modeling may be contingent on characteristics of the food.

Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study

BACKGROUND

The aim of the study was to explore the implementation of school based diet and physical activity interventions with respect to the barriers and facilitators to adoption, implementation and sustainability; supportive actions required for implementation and recommendations to overcome identified barriers. Two interventions rolled out nationally in Ireland were chosen; Food Dudes, a programme to encourage primary school children to consume more fruit and vegetables and Green Schools Travel (GST), an active travel to school programme in primary and secondary schools. Trained school coordinators (teachers) cascade the programmes to other teaching staff.

METHODS

Multiple case study design using qualitative semi-structured interviews with key stakeholders: primary and secondary school teachers, school coordinators, project coordinators/managers, funders and intermediaries. Fifteen interviews were conducted. Data were coded using a common categorization matrix. Thematic analysis was undertaken using the Adoption, Implementation and Maintenance elements of the RE-AIM implementation framework.

RESULTS

Good working relationships within and across government departments, intermediaries and schools were critical for intervention adoption, successful implementation and sustainability. Organisational and leadership ability of coordinators were essential. Provision of participation incentives acted as motivators to engage children's interest. A deep understanding of the lives of the target children was an important contextual factor. The importance of adaptation without compromising core components in enhancing intervention sustainability emerged. Successful implementation was hindered by: funding insecurity, school timetable constraints, broad rather than specific intervention core components, and lack of agreement on conduct of programme evaluation. Supportive actions for maintenance included ongoing political support, secure funding and pre-existing healthy lifestyle policies.

CONCLUSIONS

Successful implementation and scale up of public health anti-obesity interventions in schools is dependent on good contextual fit, engagement and leadership at multiple levels and secure funding. Recommendations to overcome barriers include: capacity to deliver within an already overcrowded curriculum and clear specification of intervention components within a conceptual framework to facilitate evaluation. Our findings are generalisable across different contexts and are highly relevant to those involved in the development or adaptation, organisation or execution of national public health interventions: policy makers, guidelines developers, and staff involved in local organisation and delivery.

Assessing factors that influence young children's food preferences and choices

Researchers have identified an unbalanced diet as a key risk factor in the etiology of many chronic diseases (World Health Organization, ). Although researchers have found that numerous factors influence children's food choices, no assessment exists to identify these factors. In Experiment 1, we established preliminary empirical evidence of children's preferences for healthier and less-healthy foods, and found that 16 of 21 children preferred less-healthy foods to healthier foods. In Experiment 2, we established the utility of an analogue, competing parameters assessment designed to approximate children's food choices in the natural environment. We identified either quality or immediacy as the most influential parameters governing four of four childrens' food choices. We found that effort influenced the efficacy of these reinforcer parameters in a predictable manner for one of four children.

A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood

Purpose of Review

This study aims to synthesise the body of research investigating methods for increasing vegetable consumption in 2- to 5-year-old children, while offering advice for practitioners.

Recent Findings

Repeated exposure is a well-supported method for increasing vegetable consumption in early childhood and may be enhanced with the inclusion of non-food rewards to incentivise tasting. Peer models appear particularly effective for increasing 2–5-year-olds’ vegetable consumption. There is little evidence for the effectiveness of food adaptations (e.g. flavour-nutrient learning) for increasing general vegetable intake among this age group, although they show some promise with bitter vegetables.

Summary

This review suggests that practitioners may want to focus their advice to parents around strategies such as repeated exposure, as well as the potential benefits of modelling and incentivising tasting with non-food rewards. Intervention duration varies greatly, and considerations need to be made for how this impacts on success.

Increased Classroom Consumption of Home-Provided Fruits and Vegetables for Normal and Overweight Children: Results of the Food Dudes Program in Italy

OBJECTIVE

To increase classroom consumption of home-provided fruits (F) and vegetables (V) in obese, overweight, and normal weight children.

DESIGN

Consumption evaluated within and across the baseline phase and the end of the intervention and maintenance phases.

SETTING

Three Italian primary schools.

PARTICIPANTS

The study involved 672 children (321 male and 329 female) aged 5-11 years. Body mass index measures were available for 461 children.

INTERVENTION

Intervention schools received the Food Dudes (FD) program: 16 days of repeated taste exposure (40 g of F and 40 g of V), video modeling, and rewards-based techniques. The comparison school was only repeatedly exposed to FV.

MAIN OUTCOME MEASURE

Grams of FV brought from home and eaten.

ANALYSIS

Chi-square, independent t test, repeated-measures ANOVA, and generalized estimating equation model.

RESULTS

Intervention schools show a significant increase in home-provided F (P < .001) and V (P < .001) consumption both in overweight and non-overweight children. Approximately half of children in the intervention schools ate at least 1 portion of FV at the end of the intervention and maintenance phases.

CONCLUSIONS AND IMPLICATIONS

The increase in home-provided FV intake was similar in overweight and non-overweight children in the FD intervention schools compared with the comparison school. The effect of the FD program was higher at the end of the intervention phase than the end of the maintenance phase.

Increasing primary school children’s fruit and vegetable consumption

Purpose

– The purpose of this paper is to evaluate the evidence base of the Food Dudes healthy eating programme, specifically the short- and long-term effectiveness of the intervention for consumption of fruit and vegetables both at school and at home and displacement of unhealthy snack consumption.

Design/methodology/approach

– Articles were identified using Academic Search Complete, PsycARTICLES, Medline and PubMed databases keywords for the period January 1995 to August 2013. Articles were included if they reported an empirical evaluation of the Food Dudes programme aimed at children aged between 4-11 years. Articles were included regardless of geographical location and publication type (i.e. published and “grey” literature).

Findings

– Six articles were included for review. Findings indicated that the programme was moderately effective in the short term; however, the long-term effectiveness of the programme is unknown. The ability of the programme to generalise to the home setting and to displace unhealthy snack foods also requires further investigation.

Originality/value

– This is the first independent review of the Food Dudes programme. In light of the extensive roll out of the Food Dudes programme, an appraisal of the evidence surrounding the programme is timely. The review highlights that sustaining fruit and vegetable intake cannot be achieved through behaviour-based interventions alone and the long-term maintenance of fruit and vegetable consumption requires more than the implementation of an intervention found to be effective in a controlled research environment.

Psychosocial, behavioural, pedagogical, and nutritional proposals about how to encourage eating a healthy breakfast

BACKGROUND

Even if more and more evidences have highlighted the importance of breakfast in the growth and development of children, from 10 to 30% of US and European children and adolescents regularly skip breakfast. Thus, there is still a lot to be done before breakfast becomes a daily habit. The aim of this paper is to try and understand how it is possible to overcome the real or imaginary difficulties associated with skipping breakfast by psychosocial, behavioural, pedagogical and nutritional proposals.

DISCUSSION

Schools are the best context where perform healthy interventions because it is here that children learn about the importance of good health at an age when the school still plays a major role in their education. Some school interventions, based on solid theories as the Self Determination Theory and the Behaviour Analysis, have been implemented in the last years to promote health behaviour such as intake of fruit and vegetables and physical activities. Cognitive behaviour therapy is the most closely monitored type of treatment/cure for obesity in randomised controlled trials. Moreover some associations such as the National Association of Food Science Specialists have drawn an own method to encourage food education at school and promote the importance of prevention. These projects could be used as starting point to perform interventions focus on breakfast.

SUMMARY

Increase the consumption of breakfast between children is very important. Efforts should be done to drawn new school projects based on scientific-evidences.

The effects of the Food Dudes Programme on children’s intake of unhealthy foods at lunchtime

Aims:

Although previous research has shown the Food Dudes Programme increases children’s lunchtime fruit and vegetable consumption, research has seldom evaluated whether the intervention can decrease the consumption of high-fat and high-sugar foods. This study is the first, independent evaluation of the Food Dudes Programme to explore whether the programme could change children’s lunchtime fruit and vegetable consumption and consumption of high-fat and high-sugar foods following the intervention and explore any relationship between these variables.

Methods:

The Food Dudes Programme was evaluated in 15 primary schools in the West Midlands, United Kingdom ( n = 2,433) at baseline (pre-intervention), and three months and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals).

Results:

A significant increase in the consumption of lunchtime fruit and vegetables was found at three months for children in the intervention schools, but only for those eating school-supplied lunches. For children consuming school meals, consumption of high-fat and high-sugar foods for children in the intervention and control schools increased over time. No relationship was found between increases in fruit and vegetable consumption and decrease in consumption of high-fat and high-sugar foods following the Food Dudes intervention.

Conclusions:

The Food Dudes Programme has a limited effect on decreasing consumption of high-fat and high-sugar foods at lunchtime. Targeting unhealthy food consumption in addition to increasing fruit and vegetable consumption may facilitate this. Restricted access to high-fat and high-sugar foods may also reduce intake; however, this needs to be part of a multi-faceted approach to changing children’s dietary patterns involving the whole school community.

Can a school-based intervention increase children’s fruit and vegetable consumption in the home setting?

Aims

Although previous research has shown the Food Dudes programme increases children’s fruit and vegetable consumption at school, the evidence for the effectiveness in the home setting is more equivocal. The school environment is identified as a logical setting for targeting children’s fruit and vegetable consumption; however, to produce sustainable changes in behaviour, it is equally important that interventions target consumption in the home setting. This study aimed to establish whether the Food Dudes intervention can influence home consumption of fruit and vegetables and the extent to which any changes in eating behaviour following the intervention were maintained in the long term.

Methods

A total of 34 children aged 4–11 years from eight primary schools (four intervention and four control groups) in the West Midlands, United Kingdom, completed a 7-day photographic food diary at baseline (prior to the intervention), a 3-month follow-up (post-intervention) and a 12-month follow-up.

Results

The Food Dudes programme did not influence either short- or long-term changes in children’s consumption of fruit and vegetables at home during weekdays or at the weekend.

Conclusions

The Food Dudes programme had no effect on changing children’s fruit and vegetable consumption in the home environment. Further development of the programme could consider how parental and home environmental factors may be combined with the principles of the Food Dudes programme to influence children’s fruit and vegetable consumption in this setting.

Behaviour change for better health: nutrition, hygiene and sustainability

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled ‘Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability’. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today’s environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes – particularly in developing and emerging countries – imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public–private partnerships.

Why don't they like that? And can I do anything about it? The nature and correlates of parents' attributions and self-efficacy beliefs about preschool children's food preferences

Children's food preferences influence their food intakes, which then have important effects on their health status. Presently little is understood about the aetiology of children's food preferences within families. Parental beliefs are important in many domains of socialisation although their role in the development of children's food preferences has seldom been investigated. Parents of 2-5 year old children participated in semi-structured qualitative interviews, which were analysed with content analysis. The parents either had children with healthy food preferences (i.e. closely aligned with dietary guidelines) (N=20), unhealthy food preferences (i.e. not closely aligned with dietary guidelines) (N=18), or high levels of food neophobia (N=19). Parents described their beliefs about why children like and dislike foods (their attributions) and their ability to influence children's food preferences (their self-efficacy). Children's food preferences were attributed to (a) the influence of children's characteristics (e.g. food neophobia level and personality), (b) sensory attributes of foods (e.g. texture and appearance), and (c) socialisation experiences (e.g. peer modelling and parental feeding behaviours). Results provide preliminary evidence of differences in parents' attributions and self-efficacy beliefs in the feeding domain and highlight the need for greater understanding of the ways in which parents' beliefs affect children's food preferences.

Increasing children's lunchtime consumption of fruit and vegetables: an evaluation of the Food Dudes programme

OBJECTIVES

Although previous research has shown that the Food Dudes programme increases children's fruit and vegetable consumption at school, there has been limited evaluation of the extent to which changes are maintained in the long term. Furthermore, despite knowledge that the nutritional content of home-supplied meals is lower than that of school-supplied meals, little consideration has been given to the programme's impact on meals provided from home. The present study therefore assessed the long-term effectiveness of the Food Dudes programme for both school- and home-supplied lunches.

DESIGN

Two cohorts of children participated, one receiving the Food Dudes intervention and a matched control group who did not receive any intervention. Consumption of fruit and vegetables was assessed pre-intervention, then at 3 and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals).

SETTING

Fifteen primary schools, six intervention (n 1282) and seven control schools (n 1151).

SUBJECTS

Participants were children aged 4-11 years.

RESULTS

A significant increase in the consumption of fruit and vegetables was found at 3 months for children in the intervention schools, but only for those eating school-supplied lunches. However, increases were not maintained at 12 months.

CONCLUSIONS

The Food Dudes programme has a limited effect in producing even short-term changes in children's fruit and vegetable consumption at lunchtime. Further development work is required to ensure the short- and long-term effectiveness of interventions promoting fruit and vegetable consumption in children such as the Food Dudes programme.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

BACKGROUND

Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds.

METHODS

The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes.

RESULTS

The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption.

CONCLUSIONS

While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.

Validation of food diaries as measures of dietary behaviour change

This study aimed to validate the ability of a 24-h food diary (the DIET-24) to accurately detect change in children's fruit and vegetable consumption at school snack time following implementation of the Food Dudes healthy eating intervention. Participants were 4- to 9-year-old children from two primary schools in England. There were 148 participants in the intervention school and 43 participants in the no intervention control school. For each child, snack-time fruit and vegetable consumption was measured separately by weight (grammes), and compared with teachers' estimates (to the nearest half portion) using the DIET-24. Both consumption measures were taken at T1 (pre-intervention) and T2 (post-intervention). At each time-point, Spearman rank correlations between the two measures were low to moderate, but significant. However, when compared with weighed measures, the DIET-24 did not always accurately detect significant changes in children's fruit and vegetable consumption following the intervention. To provide sensitive measures of behaviour change, it is important that dietary measures assess as accurately as possible the amount of food consumed, rather than, as is often the case, rely on all-or-none portion estimates. This issue is important for the establishment of a reliable evidence-base for healthy eating interventions.

Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis

OBJECTIVE

The consumption of fruits and vegetables (FV) may contribute to the prevention of many diseases. However, children at school age do not eat an enough amount of those foods. We have systematically reviewed the literature to assess the effectiveness of school interventions for promoting the consumption of FV.

METHODS

We performed a search in MEDLINE, EMBASE, CINAHL and CENTRAL. We pooled results and stratified the analysis according to type of intervention and study design.

RESULTS

Nineteen cluster studies were included. Most studies did not describe randomization method and did not take the cluster's effect into account. Pooled results of two randomized controlled trials (RCTs) of computer-based interventions showed effectiveness in improving consumption of FV [Standardized Mean Difference (SMD) 0.33 (95% CI 0.16, 0.50)]. No significant differences were found in pooled analysis of seven RCTs of multicomponent interventions or pooling results of two RCTs evaluating free/subsidized FV interventions.

CONCLUSIONS

Meta-analysis shows that computer-based interventions were effective in increasing FV consumption. Multicomponent interventions and free/subsidized FV interventions were not effective. Improvements in methodology are needed in future cluster studies. Although these results are preliminary, computer-based interventions could be considered in schools, given that they are effective and cheaper than other alternatives.

Kid's Choice Program improves weight management behaviors and weight status in school children

The present study examined the effectiveness of the Kid's Choice Program (KCP) for increasing children's weight management behaviors, and decreasing body mass index percentile (BMI%) for overweight and average-weight children. It also evaluated KCP characteristics relevant to long-term application in schools. Participants included 382 children assigned to two groups: a KCP group that received token rewards for three "Good Health Behaviors" including eating fruits or vegetables first at meals (FVFIRST), choosing low-fat and low-sugar healthy drinks (HDRINK), and showing 5000 exercise steps recorded on pedometers (EXERCISE), or a control group that received token rewards for three "Good Citizenship Behaviors." School lunch observations and pedometer records were completed for one month under baseline and three months under reward conditions. The school nurse calculated children's BMI% one year before baseline, at baseline, at the end of KCP application, and six months later. The KCP increased FVFIRST, HDRINK, and EXERCISE from baseline through reward conditions, with ANCOVAs demonstrating that these increases were associated with both the offer of reward and nearby peer models. Overweight (n=112) and average-weight (n=200) children showed drops in BMI% after the three-month KCP, but overweight children re-gained weight six months later, suggesting the need for more ongoing KCP application. HDRINK choice was the behavior most associated with BMI% drops for overweight children. Small teams of parent volunteers effectively delivered the KCP, and school staff endorsed parent volunteers as the best personnel to deliver the KCP, which costs approximately two U.S. dollars per child per month of application.

The Parent Mealtime Action Scale (PMAS). Development and association with children's diet and weight

A new and comprehensive Parent Mealtime Action Scale (PMAS) was developed to identify dimensions of mealtime behaviors used by parents, then examined for its usefulness to explain variance in children's diet and weight status. Exploratory factor analysis with 2008 mothers and two confirmatory factor analyses with 541 mothers and 439 fathers produced a 31-item scale with nine dimensions. Mothers reported more gentle PMAS actions like setting SNACK LIMITS, ensuring DAILY FV AVAILABILITY, and using FAT REDUCTION and POSITIVE PERSUASION during meals, whereas fathers reported more forceful PMAS actions like INSISTENCE ON EATING. Seven PMAS dimensions explained variance in children's diet and weight status even when in competition with three well-known predictors (genetic risk, exercise, television). Children with healthier diets and weight had parents who often ensured DAILY FV AVAILABILITY and used FAT REDUCTION, POSITIVE PERSUASION, and INSISTENCE ON EATING during meals, but who rarely showed SNACK MODELING, allowed children too MANY FOOD CHOICES, or made them SPECIAL MEALS different from the shared family meal. Parents also may respond to children's overweight by using more FAT REDUCTION. The PMAS offers a new research, clinical, and educational tool to guide parents in actions most associated with children's diet and weight status.

Do children's food preferences align with dietary recommendations?

Objectives

To examine how Australian children's reported everyday food preferences reflect dietary recommendations, and the impact of sociodemographic factors on these associations.

Design

Cross-sectional survey.

Setting/subjects

Three hundred and seventy-one parents of children aged 2–5 years, recruited from three socio-economic groups in two Australian cities, completed a survey on their child's liking for 176 foods and drinks on a 5-point Likert scale in addition to demographic descriptors. Preferences were compared with the recommendations of theDietary Guidelines for Children and Adolescents in Australiaand theAustralian Guide to Healthy Eating.

Results

Foods in the Extra Foods (non-nutritious foods) and Cereals groups of theAustralian Guide to Healthy Eatingwere highly liked (mean: 4.02 and 4.01, respectively), whilst foods in the Vegetables group were liked least (mean: 3.01). A large percentage of foods in the Cereals and Extra Foods groups were liked (64% and 56%, respectively) in contrast to the other food groups, especially Vegetables (7%). Children liked foods that were higher in sugar (r = 0.29,P < 0.0001) and more energy-dense (r = 0.34,P < 0.0001) but not those higher in saturated fat (r = 0.16,P = 0.03), total fat (r = 0.12,P = 0.12) or sodium (r = 0.10,P = 0.18). Sociodemographic variables (e.g. socio-economic status, parental education, children's age and sex) explained little of the variation in children's food preferences.

Conclusions

Australian pre-school children's food preferences align with dietary guidelines in some respects, but not others. Interventions are needed to shift children's preferences away from non-nutritious foods that are high in energy density and sugar, and towards vegetables and fruits.

Increasing children's physical activity: a peer modelling, rewards and pedometer-based intervention

BACKGROUND/OBJECTIVES

To evaluate a peer modelling, rewards and pedometer-feedback intervention designed to increase children's physical activity and which uses the same behaviour-change principles underlying the Food Dude Healthy Eating Programme.

SUBJECTS/METHODS

The study was conducted in two primary schools in Wales. Participants were 47 children (21 boys, 26 girls) from the experimental school and 53 children (29 boys, 24 girls) from a matched control school, aged 9-11 years. Children in the experimental school took part in the intervention; over 8 days they were introduced to fictional role models (the Fit n' Fun Dudes) via visual and audio intervention materials and received small rewards when their daily pedometer step counts increased by 1500 steps per day relative to their baselines. Pedometer measures were taken from children in both schools at baseline, intervention (baseline 2 for the control school) and 12-week follow-up.

RESULTS

Among experimental girls, steps per day were significantly higher during the intervention (14 686+/-2540) and at follow-up (13 737+/-3288) compared to baseline (10 864+/-2481, P<0.001) and control girls (P<0.005). Experimental boys showed significantly higher daily steps during the intervention compared to baseline (16 237+/-4204 cf. 13 452+/-3258, P<0.001) and control boys (P<0.005). There were no significant differences between activity levels of experimental and control boys at follow-up.

CONCLUSIONS

The intervention resulted in substantial increases in children's physical activity, which was well maintained over a 12-week period in girls.

The social facilitation of food intake

Perspective on the paper by Lumeng and Hillman (see page 384)

The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables

Objective

To assess the impact of a school-based nutrition education intervention aimed at increasing the consumption of fruits and vegetables.

Design

The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing materials, newsletters for children and parents, and teacher information. Curriculum materials at age 6–7 and 10–11 years were also developed and utilised. Evaluation was undertaken with groups of younger (aged 6–7 years) and older (aged 10–11 years) children. Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline, with follow-up at 9 months, in intervention and control schools.

Setting

The work was undertaken in primary schools in Dundee, Scotland.

Subjects

Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls.

Results

Children (n = 64) in the intervention schools had an average increase in fruit intake (133±1.9 to 183±17.0 g day-1) that was significantly (P < 0.05) greater than the increase (100±11.7 to 107±14.2 g day-1) estimated in children (n = 65) in control schools. No other changes in food or nutrient intake were detected. Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group, although taste preferences for fruits and vegetables were unchanged.

Conclusions

It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake.

“Kids Choice” School lunch program increases children's fruit and vegetable acceptance

The "Kids Choice" school lunch program used token reinforcement, food choice, and peer participation to increase children's fruit and vegetable consumption without later drops in food preference sometimes found in past research and often called 'overjustification effects.' Participants included 188 school children (92 boys, 96 girls; mean age = 8.0; 95% Caucasian). After four baseline meals, children were randomly assigned for 12 meals to receive token reinforcement for eating either fruits or vegetables. Observers recorded fruit and vegetable consumption and provided token reinforcement by punching holes into nametags each day children ate their assigned foods, then once a week children could trade these tokens for small prizes. Fruit and vegetable preference ratings were gathered with child interviews during baseline, and during follow-up conditions two weeks and seven months after the token reinforcement program. Consumption increased for fruit and for vegetables and the increases lasted throughout reinforcement conditions. Two weeks after the program, preference ratings showed increases for fruit and for vegetables. Seven months later, fruit and vegetable preferences had returned to baseline levels, suggesting the need for an ongoing school lunch program to keep preferences high, but also showing no signs of "overjustification effects" from the token reinforcement used in the "Kids Choice" school lunch program.

Sweet preferences and sugar consumption of 4- and 5-year-old children: role of parents

We investigated the relationships in children between rules that restrict consumption of mono- and disaccharides (MDS), consumption of MDS and preferences for sucrose-containing orangeade. The background ideas of restriction rules we also investigated. To this end, 44 children (5.1+/-0.5 years) performed a rank-order and paired-comparison test of preference for five orangeades, which differed in sucrose concentration (0.14, 0.20, 0.29, 0.42, 0.61 M sucrose). Parents filled out a questionnaire concerning restriction rules and their children's consumption of MDS-containing foods. Stronger restriction rules were related to a lower consumption of beverages that contained MDS and to a lower consumption of MDS-containing foods during breakfast and lunch. The most freedom to choose foods that contain MDS was given during the afternoon. Fifty-five percent of the children who were highly restricted showed a preference for the highest concentration of sucrose in orangeade. None of these children preferred the orangeade with the lowest concentration of sucrose. While 19% of the children who were little restricted preferred the beverage with the lowest concentration of sucrose, 33% preferred the beverage with the highest concentration. These parents generally believed that sugar has a bad effect on health and had similar background ideas concerning restriction rules.

Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention

OBJECTIVE

To evaluate a peer-modelling and rewards-based intervention designed to increase children's fruit and vegetable consumption.

DESIGN

Over a 5-month period, children in an experimental and a control school were presented with fruit and vegetables at lunchtime. Children aged 5-7 y also received fruit at snacktime (mid-morning). The intervention was implemented in the experimental school and levels of fruit and vegetable consumption were measured at baseline, intervention and at 4-month follow-up.

SETTING

Two inner-city London primary schools.

SUBJECTS

In total, 749 children aged 5-11 y.

INTERVENTION

Over 16 days children watched video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. After 16 days there were no videos and the rewards became more intermittent.

MAIN OUTCOME MEASURES

Consumption was measured (i) at lunchtime using a five-point observation scale; (ii) at snacktime using a weighed measure; (iii) at home using parental recall.

RESULTS

Compared to the control school, lunchtime consumption in the experimental school was substantially higher at intervention and follow-up than baseline (P<0.001), while snacktime consumption was higher at intervention than baseline (P<0.001). The lunchtime data showed particularly large increases among those who initially ate very little. There were also significant increases in fruit and vegetable consumption at home (P<0.05).

CONCLUSIONS

The intervention was effective in bringing about substantial increases in children's consumption of fruit and vegetables.

Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children

OBJECTIVE

To measure children's consumption of, and liking for, fruit and vegetables and how these are altered by a peer modelling and rewards-based intervention.

DESIGN

In this initial evaluation of the programme, children's consumption of fruit and vegetables were compared within and across baseline and intervention phases.

SETTING

Three primary schools in England and Wales.

SUBJECTS

In total, 402 children, aged from 4 to 11 y.

INTERVENTION

Over 16 days, children watched six video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves.

MAIN OUTCOME MEASURES

Fruit and vegetable consumption was measured (i) in school at lunchtime and snacktime using a five-point observation scale, with inter-rated reliability and weighed validation tests; and (ii) at home using parental recall. A questionnaire measured children's liking for fruit and vegetables before and after the intervention.

RESULTS

Consumption during the intervention was significantly higher than during baseline at lunchtime and at snacktime (P<0.001 in all instances). Consumption outside school was significantly higher during the intervention on weekdays (P<0.05) but not weekend days. Following the intervention, children's liking for fruit and vegetables also showed a significant increase (P<0.001).

CONCLUSIONS

The peer modelling and rewards-based intervention was shown to be effective in bringing about substantial increases in children's consumption of, and expressed liking for, fruit and vegetables.

SPONSORSHIP

: Horticultural Development Council, Fresh Produce Consortium, ASDA, Co-operative Group, Safeway, Sainsbury, Somerfield, Tesco and Birds Eye Wall's.

Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable

OBJECTIVE

The aim of this study was to evaluate two interventions (one reward-based and one exposure-based) for increasing children's acceptance of an unfamiliar vegetable compared with a no-treatment control. It was predicted that the exposure condition would increase liking for, and consumption of, the vegetable relative to either the reward or control group.

DESIGN

Using a randomized controlled design, participants were assigned to one of two intervention groups (exposure or reward) or to a no-treatment control condition, for a 2 week period. Liking for, and consumption of, red pepper was assessed before and after the treatment period.

SETTING

The study was conducted in three primary schools in London.

SUBJECTS

Parental consent was obtained for 49 out of a possible 72 children.

INTERVENTIONS

Interventions comprised eight daily sessions during which participants in the exposure group were offered a taste of sweet red pepper and told that they could eat as much as they liked. Participants in the reward group were shown a sheet of cartoon stickers and told that they could choose one of them on condition that they ate at least one piece of the pepper.

RESULTS

The exposure-based intervention significantly increased both liking (P=0.006) and consumption (P=0.03) compared with the control group. The outcome of the reward intervention was intermediate and did not differ significantly from the exposure or control conditions.

CONCLUSIONS

Repeated exposure to the taste of unfamiliar foods is a promising strategy for promoting liking of previously rejected foods in children.

Seeing mum drinking a 'light' product: is social learning a stronger determinant of taste preference acquisition than caloric conditioning?

OBJECTIVE

It was examined whether caloric conditioning or social learning strategies dominate in taste preference acquisition in children. The caloric learning paradigm predicts that eating or drinking artificially sweetened products, which deliver virtually no energy, will not lead to a taste preference whereas the social learning paradigm predicts that seeing important others modelling the eating and drinking of these 'light' products will induce a preference for the taste of light products in the child.

DESIGN

In a 2 x 2 between subjects factorial design, the amount of energy and social modelling was varied.

SETTING

The study was undertaken at primary schools in Maastricht, The Netherlands.

SUBJECTS

Forty-five children participated and six children dropped out. The 39 children who completed the study (14 boys and 25 girls) had a mean age of 67 months (range 51--81, s.d. 5.6).

INTERVENTIONS

Each subject took part in nine conditioning trials with an individually selected tasting yoghurt which was not preferred very much at the pre-test.

RESULTS

The children in the combined caloric and social condition showed an increase in their preference for the conditioned taste which was larger than a regression-to-the-mean effect (P=0.007), whereas children in the other groups did not.

CONCLUSION

Caloric and social learning combined, ie modelling the consumption of energy-rich foods or drinks, is the best way to establish taste preferences. Children more easily learn a preference for energy-rich food that is eaten by significant others than for food that is low in energy and eaten by significant others.