Patterns in child and adolescent consumption of fruit and vegetables: effects of gender and ethnicity across four sites

Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review

BACKGROUND

Previous evidence suggests that school garden-based programmes (SGBP) may be a promising yet cost-effective intervention to improve children's knowledge, attitudes and practices (KAP) on healthy eating. This review aimed to summarise and evaluate the evidence available on the impacts of SGBP in addressing diet and nutrition-related KAP among school-aged children.

METHODS

Five databases including PubMed, Embase, Cochrane, Web of Science and Scopus were searched until February 2021. Randomised, non-randomised controlled and pre-post intervention studies investigating the impacts of SGBP on at least one of the outcomes of interest including diet and nutrition-related knowledge, attitudes towards fruits and vegetables (F&V), food diversity and dietary practice among school-aged children were included. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Quality appraisal for studies included was assessed using American Dietetic Association Quality Criteria Checklist.

RESULTS

A total of 10,836 records were identified, and 35 studies that met the inclusion and exclusion criteria were included. This includes 25,726 students from 341 schools and 8 nurseries from 12 countries. Intervention duration ranged from 6 weeks to 4 years with 18 studies involving a varied degree of parental participation. SGBP, which majorly includes school gardening activities, cooking lessons and nutrition education, demonstrated beneficial effects on children's nutritional knowledge, their attitudes and acceptability towards fruits and vegetables and children's dietary practices including the actual F&V consumption and dietary diversity. However, the impacts of SGBP on such outcomes were highly influenced by various social and environmental factors including the activities/components and duration of the intervention, parental involvement, sample size, and the age of children when interventions were first introduced.

CONCLUSION

These findings suggest that SGBP may be effective in promoting children's nutritional knowledge, attitudes and acceptability towards vegetables, however, the impacts may vary by the type, the extent, and the length of the programmes, and other factors such as parent involvement. Future SGBP is suggested to implement using a combined multidisciplinary approach targeting the children, parents, and community to effectively promote healthy eating among the children and prevent childhood obesity.

Children's Perceived Barriers to a Healthy Diet: The Influence of Child and Community-Related Factors

A healthy diet influences the promotion and maintenance of health throughout an individual’s life. Many individuals struggle to have a healthy diet, despite it being mainly under their control. The current study aims to explore children’s perceived barriers to a healthy diet. A qualitative study with the open-ended question, “Please identify the top 5 barriers to a healthy diet”, was undertaken between January–June 2019 in which 274 students from the 5–6th grades wrote down their answers to the open-ended question. Content analysis was used to analyze responses with a codebook based on the Six C’s Model. Five categories were identified: Child, Clan, Community, Country, and Culture-related barriers. Findings showed that the barriers most highlighted were in the Child sphere (e.g., dietary intake) and the Community sphere (e.g., peer food choices). Children seldom referred to barriers from the Clan sphere, i.e., related to family (e.g., food available at home). Additionally, it seems that girls emphasize more barriers from the Child sphere, while boys emphasize more barriers from the Community sphere. Due to the qualitative nature of this study, interpretation of the data should take into account the specific characteristics and context of the sample. Nevertheless, the current data are helpful in identifying implications for practice, for example, the need to empower children with tools (e.g., self-regulation-based interventions) likely to help them overcome perceived barriers. Finally, advocacy groups may help set environmental and structural changes in the community likely to facilitate children’s healthy choices.

Food Availability, Motivational-Related Factors, and Food Consumption: A Path Model Study with Children

The promotion of children’s healthy eating is a key public health priority. However, children’s food consumption is a complex phenomenon with several contributing factors, and there is a call to continue developing comprehensive models with several variables acting simultaneously. The present study aimed to examine the role different motivational-related variables (e.g., self-regulation, self-efficacy) may play in children’s consumption of healthy and unhealthy foods. To address this goal, data were collected in a sample of 242 fifth and sixth graders with access to both healthy and unhealthy foods at home. A path model was conducted to analyze networks of relationships between motivational-related variables and children’s healthy and unhealthy eating. The gender variable was included as a covariate to control its effect. The data showed that self-regulation for healthy eating mediates the relationship between the predictor variables (i.e., knowledge, attitude, and self-efficacy) and the type of food consumption (healthy and unhealthy). Current data contribute to understanding the complexity behind food consumption by providing a comprehensive model with motivational-related factors associated with both healthy and unhealthy eating. The present findings are likely to help inform the development of early preventive interventions focused on the promotion of healthy eating.

Nutrient intake and gender differences among Saudi children

Dietary surveillance is necessary to determine community needs for nutrition interventions. Yet, the nutrient intake of Saudi children has not been previously investigated. The objective of the present study is to evaluate dietary data of Saudi children and investigate gender differences in nutrient intake. In this cross-sectional study, dietary data of 424 Saudi children (6-12 years of age) were collected using telephone-administered single 24-h dietary recall. Three 24-h dietary recalls were collected from a subsample of 168 children (39⋅6 %) and compared with the Dietary Recommended Intakes (DRIs). Nutrient intakes and proportions of children meeting the DRI requirements were similar and did not vary by children's gender. Over two-thirds of the children had an adequate usual intake of vitamin B12, and over half had adequate intakes (AIs) of vitamin C and phosphorus. On the other hand, our data indicated that low proportions of children consumed adequate usual intakes of magnesium and vitamin E. Over half of the children in our sample met the AI for sodium and vitamin D. Only small proportions of children met the AI for calcium, potassium and fibre. Cholesterol and saturated fat intake exceeded the limits of 300 mg and 10 % of total energy intake by 13⋅7 % (n 23) and 80⋅4 % (n 135) of the sample, respectively. Suboptimal intake of several micronutrients was observed among children, suggesting an urgent need to identify barriers to high-quality diet and to develop evidence-based interventions to promote optimal dietary efficacy for children in Saudi Arabia.

Dental changes in humans with untreated normal occlusion throughout lifetime: A systematic scoping review

INTRODUCTION

Understanding age-related changes in normal dental occlusion is crucial for orthodontic treatment, planning, and retention, especially considering the increasing demand from adult patients. This review aimed to systematically perform a scoping literature review regarding age-related dental changes in untreated normal occlusion subjects.

METHODS

An electronic search was performed until May 2020 using the following terms: "Dental Occlusion," "Dentition," "Ageing," and "Age groups." Articles studying changes in dental occlusal traits in orthodontically untreated subjects with neutroclusion and comparing them between various age groups were included. Studies focusing on a single age group or written in languages other than English were excluded. The risk of bias of the studies was assessed with both the methodological index for nonrandomized studies and the risk of bias in nonrandomized studies of intervention tools.

RESULTS

From the initial 7681 articles, 40 were included. High methodologic heterogeneity was found among studies. Intercanine width was found to increase until 8.0 years and 15.0 years in the mandible and maxilla, respectively, whereas intermolar width increases in both arches until 26.0 years. After that, both parameters decrease into late adulthood. Crowding increases from mixed dentition until 60.0 years of age, especially in the mandible and females. Maxillary incisors procline with age while mandibular incisors retroclined.

CONCLUSIONS

The age-related evolution of occlusal traits, together with skeletal and soft tissue changes, should be considered during orthodontic planning. Well-designed prospective cohort studies are necessary for confirmatory evidence. Expectations for treatment stability should consider muscular balance and inform patients that crowding is a sign of aging that should not always be seen as a failure of orthodontic therapy. Protocol registration number: PROSPERO CRD42020138846.

Gender differences in dietary behaviors among Japanese adolescents

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Few studies assessed a variety of adolescent dietary behaviours in Japan.

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The findings suggest that gender differences existed in dietary behaviors.

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Girls tended to adopt regular dietary behaviors as compared to boys.

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Schools support modeling and reinforcing healthy dietary behaviors.

Unhealthy dietary behaviors in adolescence are an important public health problem. Gender differences in dietary behaviors have already appeared during adolescence. However, few studies have assessed a variety of adolescent dietary behaviors in Japan. We aimed to clarify gender differences in unhealthy dietary behaviors among Japanese adolescents. The participants consisted of 84,988 participants from seventh to 12th grades. Unhealthy dietary behaviors were defined according to the National Health and Nutrition Survey. Multivariable logistic regression was used to analyze a nationally representative sample of Japanese adolescents from the 2014 to 2015 Lifestyle Survey. The effective response rate was 51.4%. The prevalence of unhealthy dietary behaviors (skipping breakfast, snacking, eating out, skipping meals, eating alone at dinner, and subjectively poor diet quality) among boys and girls was 14.2% versus 12.4%, 19.6% versus 14.1%, 10.6% versus 7.0%, 7.9% versus 5.6%, 13.3% versus 12.1%, and 12.3% versus 15.8%, respectively. Compared with boys, girls were more negatively associated with skipping breakfast [OR = 0.76 (95% CI 0.73–0.79)], snacking [OR = 0.67 (95% CI 0.65–0.70)], eating out [OR = 0.62 (95% CI 0.59–0.66)], skipping meals [OR = 0.61 (95% CI 0.58–0.65)], and eating alone at dinner [OR = 0.79 (95% CI 0.76–0.83)]. However, girls were more positively associated with subjectively poor diet quality [OR = 1.19 (95% CI 1.14.1.24)]. The findings suggest that gender differences existed in dietary behaviors. Gender differences in dietary behaviors suggest opportunities for tailoring interventions related to dietary education in schools.

Gender Differences in Attitudes to Vegans/Vegetarians and Their Food Preferences, and Their Implications for Promoting Sustainable Dietary Patterns–A Systematic Review

Limiting meat consumption has recently become one of the key issues linked to public health and environmental sustainability. This is reflected in the strong emphasis on increasing promotion of plant-based nutritional styles, such as vegan and vegetarian diets. Vegan/vegetarian diets appeal to certain demographic groups more than to others. The most striking difference, however, is found between the sexes. Men and women differ in their preferences for plant products and in their attitudes to meat consumption. There are also differences between their motivations to start and/or follow a vegan/vegetarian diet. Major differences have also been observed in men’s and women’s attitudes towards people following plant-based diets. Vegetarian diets are generally considered to be less masculine than meat-based diets, and omnivores exhibit more prejudice against vegetarian men than women. This study follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) systematic literature review model. The Web of Science and PubMed databases were searched (up to January 2020) to identify studies, which analysed variables directly or indirectly related to inter-sex differences with regard to the vegan/vegetarian diet. After the screening process based on the relevance and quality criteria, 29 articles were included in the study. The purpose of this review is to raise awareness of these gender differences, not only as regards social perceptions, but also in terms of individual attitudes to vegetarian/vegan diets. Ignoring those differences hinders the promotion of plant-based diets and may explain the relatively meager success of previous efforts to promote sustainable nutritional styles.

Cumulative exposure to organic pollutants of French children assessed by hair analysis

Children represent one of the most vulnerable parts of the population regarding the effects of pollutants exposure on health. In this study, hair samples were collected between October 2013 and August 2015 from 142 French children originating from different geographical areas (urban and rural) and analysed with a GC/MS-MS method, allowing for the detection of 55 biomarkers for pesticides and metabolites both persistent and non-persistent from different families, including: organochlorines, organophosphates, pyrethroids, azoles, dinitroanilines, oxadiazines, phenylpyrazoles and carboxamidas; 4 polychlorobiphenyls (PCBs) and 5 polybromodiphenylethers (PBDEs). The number of compounds detected in each sample ranged from 9 up to 37 (21 on average), which clearly highlighted the cumulative exposure of the children. The results also showed a wide range of concentration of the pollutants in hair (often more than 100 times higher in the most exposed child compared to the less exposed), suggesting significant disparities in the exposure level, even in children living in the same area. In addition to the detection of currently used chemicals, the presence of persistent organic pollutants (POPs) in children also suggests that the French population is still exposed to POPs nowadays. PCP, DEP, PNP, 3Me4NP, trans-Cl2CA, 3PBA, fipronil and fipronil sulfone, presented statistically significant higher concentration in the hair of boys compared to girls. PCP, PNP and 3Me4NP presented statistically significant higher concentration in younger children. Finally, this study also suggests that local environmental contamination would not be the main source of exposure, and that individual specificities (habits, diet…) would be the main contributors to the exposure to the pollutants analysed here. The present study strongly supports the relevance of hair for the biomonitoring of exposure and provides the first values of organic pollutant concentration in the hair of French children.

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

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

Dietary Calcium Intake in Sample of School Age Children in City of Rabat, Morocco

Calcium is an important mineral playing a vital role to maintain bone health. Calcium intake is considered as one of the most important determinants to assess the calcium status and to evaluate the calcium deficiency in the human body. Our study aims at estimating calcium intake in a sample of children and adolescent to be used in the global strategy to reduce calcium deficiency disorders in Morocco. Thus, 131 children and adolescents were recruited from public schools at Rabat and its regions in the framework of a descriptive cross-sectional study. For each participant, anthropometric parameters were measured. Calcium status was assessed by 24 h dietary recall. Food frequency questionnaire was used to evaluate children's nutritional habits and to assess the consumption of calcium-rich food. Overall, the mean calcium intake was 522.0 ± 297.0 mg/day, and 85.5% of subjects highlighted calcium deficiency, with no significant difference between boys and girls. Calcium intake was significantly different according to age groups, and high consumption of calcium was found in subjects aged from 14 to 18 years (776.86 ±290.07 mg/day), giving evidence of the low calcium status of the studied population. Daily food intake and food frequency analysis showed that bread, vegetables, and fruits are the most consumed food and the main source of daily calcium intake. Consumption of dairy products, considered as the best source of calcium, is lower and represents only 14% of total calcium intake. Our study clearly showed that calcium status is very lower in Moroccan children and adolescents and a large proportion of this population have inadequate calcium intake. Hence, there's an urgent need of specific strategies, including children sensitisation and nutritional education, to increase calcium intake and therefore reduce calcium deficiency disorders impacting the whole body during childhood and in adult age.

What are Asian-American youth consuming? A systematic literature review

Numerous studies have explored dietary practices among children, but there are limited studies on children of Asian background in the US. This review had three aims: (a) review literature regarding Asian-American youth's dietary behaviors, (b) critically evaluate the methodological quality of such research, and (c) provide recommendations for future nutrition-related research on Asian-American youth. The authors conducted a systematic literature review through MEDLINE (EBSCO), CINAHL Plus with Full Text (EBSCO), and Embase (Ovid); extracted descriptive data; and evaluated methodological quality. Thirteen articles were included. Major findings included: (a) frequent consumption of milk, fruit, meat, unenriched white rice, vegetables, and high-fat and high-sugar items among Asian-American children and (b) acculturation's influences on diet, resulting in Asian-American youth consuming diets characterized by both Asian and American foods. Findings from this review may inform education and promotion programs and services for Asian Americans in the US.

SOCIO-DEMOGRAPHIC FACTORS ASSOCIATED WITH DIETARY BEHAVIOUR AMONG YOUNG GHANAIANS AGED 15–34 YEARS

This study used data from the 2008 Ghana Demographic and Health Survey to investigate the association between selected socio-demographic factors and dietary behaviour as measured by fruit and vegetable consumption among a sample of 6139 young people aged 15–34 years in Ghana. Overall, fruit and vegetable consumption was low in young people, but females were likely to consume more fruit and vegetables than their male counterparts. Respondents from the Mande ethnic group, those who resided in rural areas and those living in the Brong/Ahafo, Ashanti and the Eastern regions consumed more fruit and vegetables than those from other regions. Females who were Catholic/Anglican, Methodist/Presbyterian and Pentecostal/Charismatic were more likely than those of other religions to consume fruit and vegetables, while Muslim males generally consumed more fruit and vegetables. The findings point to the need for interventions to educate young people in Ghana about the health benefits of eating fruit and vegetables.

Predictors of healthy behaviours in Swedish school children

AIM

To evaluate the impact of predictors of adopting a healthy lifestyle in Swedish schoolchildren.

METHODS

A sample of 1409 Swedish schoolchildren (mean age 12.5 years) representative of different socio-economic and geographical living areas participated in a questionnaire-based survey on healthy habits and knowledge of healthy behaviour. A logistic regression analysis was performed to identify intrapersonal, social and environmental predictors of healthy habits.

RESULTS

A normal body mass index (intrapersonal determinant) was connected to refraining from tobacco (P<0.05). For children to perceive family (P<0.001), themselves (P<0.001), or someone else (P<0.01) as a source of inspiration (social determinant) to be physically active was related to a high physical activity level. Paternal (P=0.01) and maternal (P<0.001) attention to the use of tobacco (social determinant) was of importance for children to refrain from such habits. To live in a socio-economically wealthy area (environmental determinant) was of importance for healthy food choices (P<0.01) and physical activity (P<0.05). Children from rural (P<0.01) areas (environmental determinant) were more physically active than children from urban areas.

CONCLUSION

Social aspects such as parental support for physical activity and refraining from tobacco were found to be important for healthy behaviours. Moreover, environmental factors such as socio-economic and geographical living area favourably influenced food choices and physical activity. Parental attitudes and economy are therefore important for physical activity, healthy food choices and refraining from tobacco in children. Consequently, future interventions need to address the psychological and environmental influences of the home environment through the active involvement of parents, even in school-based interventions.

Dietary habits of Samoan adults in an urban Australian setting: a cross-sectional study

Objective

To describe key characteristics of the dietary habits of Samoans residing in Logan, Queensland and to compare these characteristics with comparable populations.

Design

Dietary intake was measured using a self-administered structured questionnaire between December 2012 and March 2013. Demographic characteristics included age and sex. Questionnaire results were compared with data from samples of Brisbane residents of similar social and economic characteristics and Pacific Islanders in New Zealand. The association between demographic characteristics and diet was investigated.

Setting

Logan, Queensland, Australia.

Subjects

Samoans aged 16 years and older.

Results

A total of 207 Samoans participated, ninety-six (46 %) of whom were male. Of the participants, seventy-nine (38 %) were aged 16–29 years, sixty-three (30 %) were aged 30–49 years and sixty-five (31 %) were aged ≥50 years. Younger adults were significantly more likely to eat hamburgers, pizza, cakes, savoury pastries, potato crisps, sweets and soft drinks (all variablesP<0·001). Among Samoans, 44·7 % consumed two or more pieces of fruit daily, compared with 43·8 % of comparable Brisbane residents (relative risk=1·0; 95 % CI 0·8, 1·2). Three or more servings of vegetables each day were consumed by 9·2 % of Samoans compared with 36·6 % of comparable Brisbane residents (relative risk=3·8; 95 % CI 2·5, 6·0).

Conclusions

Samoans are consuming significantly fewer vegetables and more discretionary foods than other populations. Socio-economic factors, length of stay in Australia and cultural practices may impact upon Samoans’ diets. Further comprehensive studies on Samoans’ dietary habits in Australia are recommended.

Exploring the role of gender norms in nutrition and sexual health promotion in a piloted school-based intervention: The Philadelphia Ujima™ experience

Perceptions of masculinity and femininity influence behaviors and can be identified in young children and adolescents (Brannon, 2004). Thus, adolescents' engagement in health risk or promoting behaviors is influenced by perceptions of masculinity and femininity and the differences in expectations, norms and responsibilities for girls and boys (WHO, 2007). Girls and boys have different needs, and gender-based interventions that consider similarities as well as differences are needed. A gender-based nutrition and sexual health promotion program was developed and piloted by the Philadelphia Ujima Coalition in a high school setting. To explore the gender differences in adolescents' perceptions of the influence of gender norms on weight, nutrition, physical activity, and sexual health and the implication of these differences in future gender-integrated health promotion programming for youth, a content analysis of student and facilitator debriefing forms were implemented for the participating schools. The content analysis was used to identify central themes, concepts gained, and overall impact of the intervention sessions. Overall, gender norms influence healthy eating practices and activity through influencing perceptions of body type in adolescents. Gender norms also influence sexual activity and decision making through influencing perceptions of beauty, masculinity, femininity, pressures and popular concepts related to sexual activity. Thus, interventions that address gender may more effectively promote health and wellness in adolescents.

Impact of a school-based cooking curriculum for fourth-grade students on attitudes and behaviors is influenced by gender and prior cooking experience

OBJECTIVE

To compare effects of the Cooking With Kids (CWK) cooking and tasting curriculum (CWK-CT) with a less-intense, tasting-only curriculum (CWK-T) and to conduct a non-treatment comparison on fourth graders' cooking self-efficacy (SE), cooking attitudes (AT), and fruit and vegetable preferences (FVP).

DESIGN

Pre-post, quasi-experimental, 2 cohorts.

SETTING

Eleven low-income public schools in a Southwestern city.

PARTICIPANTS

Fourth-grade students, 50% female and 84% Hispanic.

INTERVENTIONS

School-based experiential nutrition education program of 5 2-hour cooking and/or 5 1-hour fruit and vegetable tasting lessons throughout the school year.

MAIN OUTCOME MEASURES

Cooking self-efficacy, AT, and FVP were assessed with 3 tested, validated scales administered in a 37-item survey pre- and post-classroom intervention.

ANALYSIS

General linear modeling with gender and prior cooking experience were fixed factors.

RESULTS

Among 961 students, CWK positively affected FVP, especially in CWK-CT students and males (P = .045 and .033, respectively); vegetable preference drove this outcome. Independent of treatment, students without cooking experience (61% male) had more than twice the gains in cooking self-efficacy (P = .004) and an improved AT response (P = .003).

CONCLUSIONS AND IMPLICATIONS

Cooking With Kids increased FVP, especially with vegetables. Greatest gains in preferences and self-efficacy were seen in boys without prior cooking experience. For fourth graders, experiential nutrition education improved cognitive behaviors that may mediate healthful food choices.

Cooking with Kids positively affects fourth graders' vegetable preferences and attitudes and self-efficacy for food and cooking

BACKGROUND

Cooking with Kids (CWK), an experiential school-based food education program, has demonstrated modest influence on fruit and vegetable preference, food and cooking attitudes (AT), and self-efficacy (SE) among fourth-grade, mostly low-income Hispanic students in a quasiexperimental study with an inconsistent baseline. Effect was notably strong for boys and those without previous cooking experience. The aim of this project was to assess the effect of CWK with a mostly non-Hispanic white sample that assured no previous CWK exposure.

METHODS

The randomized, controlled assessment of CWK effect on fourth graders was conducted with 257 students in 12 classes in four public schools. CWK included a 1-hour introductory lesson, three 2-hour cooking classes, and three 1-hour fruit and vegetable tasting sessions led by trained food educators during the school day for one semester. Fruit preference, vegetable preference, and cooking AT and SE were assessed with a tested 35-item measure, shown to have test-retest reliability. Univariate analyses considered gender and previous cooking experience.

RESULTS

Intervention efficacy was confirmed in this mostly white sample (75%; 79% with previous cooking experience; 54% girls). Increases in vegetable preference, AT, and SE were all significantly greater in CWK students with ηp (2) of 0.03, 0.02, and 0.06, respectively. CWK most strongly improved AT and SE for boys without previous cooking experience.

CONCLUSIONS

CWK significantly improved fourth-grade students' vegetable preferences, AT, and SE toward food and cooking, which are factors important to healthful eating and obesity prevention. Noncookers, especially boys, benefitted from this intervention.

Is Healthy Eating Behaviour Common Among School Adolescents in Mauritius?

Adolescents eating behaviours have come in the limelight because of the unconventional meals, fast-food intake, and snacking. This study was therefore undertaken to appraise and understand eating behaviours of secondary school adolescents in Mauritius. Data were collected randomly from a representative sample (n=384) of adolescents via a self-administered questionnaire and analysed statistically to examine associations, if any, between socio-demographic factors and eating behaviours. Breakfast was the most frequently (68%) missed meal, attributed mainly to lack of time (79.2%). No significant difference was observed between common socio-demographic variables and breakfast skipping. Adolescents tend to consume healthy food items such as breakfast cereals, fruits and vegetables while fast food consumption was universally present but higher among low income groups. Snacking was highly prevalent (84%) and occurred more often in female teens, urban residents and middle and higher income groups. However, snacking pattern revealed a healthy trend with 76% adolescents reporting drinking water and fruits appeared to be the most popular snack (Popularity Score: 5.57). This study shows that there has been an improvement in the eating behaviour of school adolescents in Mauritius compared to previous local studies.

A qualitative study for understanding family and peer influences on obesity-related health behaviors in low-income African-American adolescents

BACKGROUND

Given the cultural and developmental relevance of family members and peers in the lives of African-American adolescents, the present study used a bioecological framework to qualitatively explore the parenting context as well as specific family factors (support, rules, monitoring) and peer factors (support) related to weight status, physical activity (PA), and healthy eating in low-income African-American boys versus girls.

METHODS

Qualitative data were obtained from African-American adolescents through focus groups. Adolescents (n = 45, 100% African American, 51% girls, 12.6 ± 1.2 years, 51% overweight/obese) were from two underserved communities in South Carolina (median income ≈$17,000-$22,000, high crime levels). Sessions were audiotaped, transcribed, and coded by independent pairs of raters (r = 0.75). QSR NVivo 8 was used to analyze data, and themes were categorized separately for boys and girls.

RESULTS

Adolescents reported themes of family warmth and control practices consistent with an authoritative style of parenting. Although adolescents wanted increased autonomy, they viewed parental monitoring as a favorable part of their relationship. Boys reported receiving more constructive feedback from parents about weight status and greater overall support for PA and diet than did girls. Girls reported more honest feedback from peers about weight status than did boys. Overall, adolescents acknowledged the unique opportunities of parents and peers in improving their health behaviors.

CONCLUSIONS

Findings suggest parents and peers interact in different ways with African-American boys and girls regarding their weight status and health behaviors. Future obesity prevention efforts in minority youth may need to target parenting skills that provide greater support to African-American girls. In addition, given peers influence PA and diet differently in boys and girls, interventions should strategically include parenting strategies that involve monitoring peer-adolescent interactions.

School lunches and lunches brought from home: a comparative analysis

BACKGROUND

Considerable effort has been put forth to improve the nutritional quality of school meals by the National School Lunch Program (NSLP). However, a large percentage of children do not obtain their meals from school and instead bring lunch from home. Little research has focused on the content of these lunches. The purpose of the current study was to examine differences between school lunch and lunch brought from home.

METHODS

Children in the 2nd grade from seven schools in a large suburban school district were observed on three separate days. A total of 2107 observations were made, with 38.5% of these being lunches brought from home. Chi-squared analyses evaluated differences in the presence of specific food items between school lunch and lunch brought from home.

RESULTS

Compared to children with a school lunch, children with a lunch brought from home were significantly less likely to have fruits (75.9% vs. 45.3%), vegetables (29.1% vs. 13.2%), and dairy (70.0% vs. 41.8%) (p < 0.001). Children with a lunch from home were more likely to have snacks high in sugar and/or fat (17.5% vs. 60.0%) and non 100% fruit juice/fruit drink (0.3% vs. 47.2%) (p < 0.001) than children with a school lunch.

CONCLUSIONS

The NSLP has been widely criticized; however, conducting a comparison in this manner demonstrates advantages to children obtaining school lunches. Although it was beyond the scope of this study to examine diet quality (e.g., actual intake and nutrient/caloric density), these results provide compelling evidence that lunches brought from home should be an area of emphasis for research and intervention.

Healthy eating behaviors and the cognitive environment are positively associated in low-income households with young children

The purpose of this research was to examine relationships between eating behaviors and the cognitive environment in primarily Hispanic low-income households with young children receiving WIC benefits in Los Angeles County. Survey data were collected from 3645 low-income families with children age 12-65 mo in Los Angeles County. Eating behaviors were measured through questions about fruit, vegetable, milk, soft drink, and fast food intake. The cognitive environment was evaluated through questions on the home literacy environment (HLE), reading frequency, and preschool enrollment. All healthy eating behaviors measured were significantly and positively associated with reading frequency and HLE scores after adjustment for confounders. HLE and reading frequency scores were 18% and 14% higher, respectively, in children eating two or more servings of fruit per day and 12% and 9% higher, respectively, in children eating three or more servings of vegetables per day. Preschool enrollment was not significantly associated with any eating behavior. Outcomes varied by language-ethnic groups and child sex. Results suggest that healthy eating behaviors are positively associated with stronger cognitive environments in low-income Hispanic families with young children. Interventions to prevent childhood obesity in this group may therefore benefit from including a home literacy component.

Determinants of fruit and vegetable availability in Hispanic head start families with preschool-aged children living in an urban midwestern area

OBJECTIVE

Determine relationships between self-efficacy, decisional balance, and processes of change and Stages of Change (SOC) related to fruit and vegetable (FV) availability among Hispanic Head Start parents.

DESIGN

A 2-phase descriptive study with mixed methodology.

SETTING

Two Head Start sites in a city in the midwestern United States.

PARTICIPANTS

Convenience sample of Hispanic Head Start parents/guardians recruited to complete a FV survey and focus groups.

MAIN OUTCOME MEASURES

Amount of FV served; distribution of participants between SOC; level of self-efficacy, decisional balance, and use of cognitive and behavioral processes.

ANALYSIS

Analysis of variance was conducted using the SOC as the independent variable and Transtheoretical Model construct scales as dependent variables. Significance was set at P < .05. Focus groups were analyzed using content analysis.

RESULTS

Of the 113 participants, 60% were in pre-action stages. Compared to those of parents in higher stages, intentions of parents in lower stages to serve more FV were impeded by cost and preparation time (P = .028). Focus groups confirmed low self-efficacy as the common barrier to serving more FV.

CONCLUSIONS AND IMPLICATIONS

Nutrition education for low-income Hispanic parents should include components focused on increasing self-efficacy and minimizing perceived barriers; quick and tasty FV recipes; shopping for economical FV; and promoting parental role modeling.

Focus groups inform a web-based program to increase fruit and vegetable intake

OBJECTIVE

To use focus groups to inform a web-based educational intervention for increased fruit and vegetable (FV) consumption.

METHODS

Twelve groups (participants=137, aged 21-65) were recruited from four geographically diverse health systems. Four groups were stratified by gender and eight by race (white and African American) and gender. Questions included perceptions of healthy eating, factors that encourage or serve as barriers to FV consumption and features preferred for a web-based educational intervention.

RESULTS

Though knowledgeable about healthy eating, participants did not know how to achieve or always care about healthy nutritional choices. Motivators for FV consumption included being role models and health concerns. Barriers included: lack of time, expense and FV availability. Website preferences included: visuals, links, tailored materials, menu suggestions, goal setting assistance, printable summaries and built in motivation. The developers incorporated nearly all suggestions.

CONCLUSION

Focus groups provided needs-based tactical strategies for an online, education intervention targeting factors to improve FV consumption.

PRACTICE IMPLICATIONS

Focus groups can provide valuable input to inform interventions. Further, web-based programs' abilities to offer information without time or geographic constraints, with capacity for tailoring and tracking progress makes them a valuable addition in the arsenal of efforts to promote healthy behaviors.

Examining elementary school--aged children's self-efficacy and proxy efficacy for fruit and vegetable consumption

Children's self-efficacy for fruit and vegetable consumption (FVC) and proxy efficacy to influence others to make fruit and vegetables (FV) available may influence their FVC. A previous investigation has demonstrated that self-efficacy for fruit consumption, self-efficacy for vegetable consumption, proxy efficacy to influence parents to make FV available, and proxy efficacy to influence after-school staff to make FV available can be measured with four independent but related scales. The purpose of the present investigation is to confirm this factor structure and determine if the scales were invariant across gender, ethnicity, and socioeconomic status (SES) subgroups of children attending after-school programs. Results provide further validity evidence for the four correlated scales. In addition, results confirm measurement invariance across gender, SES, and ethnicity, confirming the unbiased generalizability of the current measure to these demographic groups. Lastly, tests of population heterogeneity reveal no meaningful differences in self- and proxy efficacy among gender, SES, and ethnicity subgroups.

Parenting practices are associated with fruit and vegetable consumption in pre-school children

OBJECTIVE

Parents may influence children's fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children.

DESIGN

An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004-5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children's consumption of F&V, after controlling for potential confounding factors.

RESULTS

A three-cluster solution provided the best fit (R2 = 0.62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments' practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized beta = 0.09, P < 0.1; final model R2 = 0.17) after controlling for confounders, including parental feeding styles.

CONCLUSIONS

Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children's F&V intake.

Grains are similarly categorized by 8- to 13-year-old children

This study assessed how 8- to 13-year-old children categorized and labeled grain foods and how these categories and labels were influenced by child characteristics. The main hypotheses were that children categorized foods in consistent ways and these food categories differed from the professional food categories. A set of 71 cards with pictures and names of grain foods from eight professionally defined food groups was sorted by each child into piles of similar foods. There were 149 8- to 13-year-old children (133 English-speaking, 16 Spanish-speaking) in this exploratory study. One-way analysis of variance and Robinson matrices for identification of clusters of food items were calculated. Children created a mean (+/-standard deviation) of 8.3+/-3.8 piles with 8.6+/-9.1 cards per pile. No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics. For the majority of the piles, children provided "taxonomic-professional" (34.5%) labels, such as bread for the professional category of breads, rolls, and tortillas, or "script" (26.1%) labels, such as breakfast for the professional category of pancakes, waffles, and flapjacks. These categories may be used to facilitate food search in a computerized 24-hour dietary recall for children in this age group.

Digital photography as a tool to measure school cafeteria consumption

BACKGROUND

Assessing actual consumption of school cafeteria meals presents challenges, given recall problems of children, the cost of direct observation, and the time constraints in the school cafeteria setting. This study assesses the use of digital photography as a technique to measure what elementary-aged students select and actually consume from school cafeteria meals.

METHODS

Before and after still digital photographs were taken of labeled trays for every lunch served to elementary students over 4 lunch periods. Two analysts visually estimated the amount of each item consumed from every tray, and those estimates were compared to evaluate interrater reliability.

RESULTS

Collection of photographic data was rapid and did not disrupt the busy elementary cafeteria setting. Analysts' estimates of consumption levels of meal components (main and side dishes) were within 10% of each other in 92% of the cases. Only 0.2% of items could not be analyzed due to children playing with food or otherwise obstructed photographs.

CONCLUSIONS

Digital photography offers researchers and school food service personnel a highly accurate and cost-effective tool to measure actual consumption of school cafeteria meals. Data collected through this method can be evaluated by simple counts of servings of produce or other food groups or by more detailed analyses of nutritional composition.

Fruit and vegetables are similarly categorised by 8-13-year-old children

OBJECTIVE

This exploratory study assessed how 8-13-year-old children categorised and labelled fruit and vegetables (FaV), and how these were influenced by child characteristics, to specify second-level categories in a hierarchical food search system for a computerised 24 h dietary recall (hdr).

DESIGN

Two sets of food cards, sixty-seven for fruit (F) and sixty-four for vegetables (V), with pictures and names of FaV from ten professionally defined food categories were sorted, separately, by each child into piles of similar foods. Demographic data, BMI and 6-n-propylthiouracil (PROP) taster status were obtained.

SETTING

Participants attended the Children's Nutrition Research Center in the summer of 2006.

SUBJECTS

In all, 152 8-13-year-old children, predominantly English-speaking, of whom sixteen were predominantly Spanish-speaking.

RESULTS

Children created an average of 8.5 (5.3) piles with 7.9 (11.4) cards per pile for the F, and an average of 10.1 (4.8) piles with 6.2 (7.9) cards per pile for the V. No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics, BMI or PROP sensitivity. Children provided clusters names that were mostly 'Taxonomic - Professional' labels, such as salads, berries, peppers, for both F (51.8 %) and V (52.1 %).

CONCLUSIONS

These categories should be tested to assess their ability to facilitate search of FaV items in a computerised 24 hdr for children in this age group.

Diverse food items are similarly categorized by 8- to 13-year-old children

OBJECTIVE

Assess how 8- to 13-year-old children categorized and labeled food items for possible use as part of a food search strategy in a computerized 24-hour dietary recall.

DESIGN

A set of 62 cards with pictures and names of food items from 18 professionally defined food groups was sorted by each child into piles of similar food items.

SETTING

Participants attended the Children's Nutrition Research Center in the summer 2006.

PARTICIPANTS

148 8- to 13-year-old children (132 English speaking, 16 primarily Spanish speaking).

MAIN OUTCOME MEASURES

Sorting of food items into common groupings and their names.

ANALYSES

Robinson matrices for identification of clusters of food items.

RESULTS

Children created on average 11.1 (+/- 4.4) piles with 5.4 (+/- 4.9) cards per pile. Robinson matrix clusters captured 92.4% of the variance in the sorting of food cards. No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics. The label names provided by the children were most frequently categorized as "Taxonomic-Professional" (42.5%), such as meat, fruit, and drinks; or "Script" (26.4%), such as breakfast food, desserts, and snacks.

CONCLUSION AND IMPLICATIONS

Children categorized food items into similar clusters but used diverse names to label them. These categories may be used to facilitate food search for researchers in a computerized 24-hour dietary recall for children in this age group.

Mediation of adult fruit and vegetable consumption in the National 5 A Day for Better Health community studies

BACKGROUND

The 5 A Day for Better Health community studies demonstrated in randomized trials the efficacy of population-based strategies to increase fruit and vegetable consumption in diverse geographic areas and settings.

PURPOSE

Mediation analysis can help to elucidate the theoretical basis of changing dietary habits. This is important for informing more powerful cancer prevention and control interventions to achieve broad public health impact.

METHODS

Five sites that focused on adults were included in mediation analyses to determine whether theoretically derived constructs assessed at baseline and follow-up contributed to explaining change in fruit and vegetable (F&V) consumption. These variables were knowledge, self-efficacy, and autonomy/responsibility. Stage of change also was considered as a potential moderating variable.

RESULTS

Self-efficacy and knowledge of the 5 A Day recommendation increased in those who received the interventions and were positively associated with higher F&V. Mediation of intervention effect was demonstrated for these variables. Autonomy/responsibility did not meet the criteria for mediation. There was no evidence of differential effect of mediators according to baseline stage.

CONCLUSIONS

The present study findings provide strong support for mediation of F&V consumption by two variables: self-efficacy and knowledge. The authors discuss the findings in relation to study limitations and future research directions.

Psychosocial and demographic predictors of fruit, juice and vegetable consumption among 11–14-year-old Boy Scouts

Objective

Psychosocial and demographic correlates of fruit, juice and vegetable (FJV) consumption were investigated to guide how to increase FJV intake.

Design

Hierarchical multiple regression analysis of FJV consumption on demographics and psychosocial variables.

Setting

Houston, Texas, USA.

Subjects

Boys aged 11–14 years (n= 473).

Results

FJV preference and availability were both significant predictors of FJV consumption, controlling for demographics and clustering of Boy Scout troops. Vegetable self-efficacy was associated with vegetable consumption. The interaction of preference by home availability was a significant predictor of FJV. The interaction of self-efficacy by home availability showed a trend towards significantly predicting vegetable consumption. No significant interactions were found between body mass index and the psychosocial variables.

Conclusions

Findings suggest that future interventions emphasising an increase in preference, availability and efficacy may increase consumption of FJV in similar populations.

Daily calcium intake in male children and adolescents obtained from the rapid assessment method and the 24-hour recall method

BACKGROUND

In order to rapidly assess nutrient intake, Food Frequency Questionnaires (FFQ) have been developed and proven to be reliable for quick, user friendly analysis in adults. However, the accuracy of these questionnaires in children has been studied to a limited extent. The aim of this study was to compare the daily calcium intake values obtained from the Rapid Assessment Method (RAM), an FFQ, for assessing daily calcium intake in child and adolescent males with the values obtained from the 24-hour recall method.

METHODS

Subjects included 162 child and adolescent males, aged 9-16 years, subdivided into elementary school (ES, 9-12 years) and high school (HS, 14-16 years) age groups.

RESULTS

Daily calcium intake was significantly lower in ES compared with HS, using both methods. The intra-class correlation coefficients (ICC) between RAM values and those obtained using the 24-hour recall questionnaire were significant yet moderate (ICC = 0.46 and 0.43 for ES and HS, respectively). However, daily calcium intake obtained using RAM was significantly higher when compared with the 24-hour recall values in both ES (1576 +/- 1101 vs. 1003 +/- 543 mg, in RAM and 24-hour, respectively) and in HS males (1873 +/- 739 vs. 1159 +/- 515 mg, in RAM and 24-hour, respectively).

CONCLUSION

RAM overestimates daily calcium intake as compared with the 24-hour recall method in both child and adolescent males.

Mixed foods are similarly categorized by 8-13 year old children

Food search in a computerized 24h dietary recall (24hdr) for children should be easiest when the categories reflect children's categorization of foods, in contrast to professional categories. This study assessed how 8-13 year old children categorized and labeled mixed foods (e.g. fried rice, lasagna), and how these were influenced by child characteristics. A set of 48 cards with pictures and names of mixed foods from 14 professionally defined food groups was sorted by each child into piles of similar foods. Participants (n=146), including 8-13 year old 130 English speaking, and 16 Spanish speaking children, attended data collection in the summer, 2006. One way ANOVA, pairwise comparisons and Robinson matrices for identification of clusters were used. Children created an average of 10.5 (+/-5.5) piles with 6.0 (+/-4.1) cards per pile. No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics, body mass index, or 6-n-propylthiouracil sensitivity. For the majority of the piles, children provided "taxonomic-professional" (26.0%) labels, such as vegetables, sandwiches and drinks, or "specific-food item" (23.0%) labels, i.e. the name of the food. These categories may be used to facilitate mixed food search in a computerized 24hdr for children in this age group.

Fourth-grade children are less accurate in reporting school breakfast than school lunch during 24-hour dietary recalls

OBJECTIVE

To compare reporting accuracy for breakfast and lunch in 2 studies.

DESIGN

Children were observed eating school meals and interviewed the following morning about the previous day. In Study 1, 104 children were each interviewed 1 to 3 times with >or=25 days separating any 2 interviews. In Study 2, 121 children were each interviewed once in forward (morning-to-evening) and once in reverse (evening-to-morning) order, with these interviews separated by >or=29 days.

SETTING

12 schools.

PARTICIPANTS

Fourth-grade children.

MAIN OUTCOME MEASURES

For each meal, food-item variables (observed number, reported number, omission rate, intrusion rate, total inaccuracy) and kcal variables (observed, reported, correspondence rate, inflation ratio).

ANALYSIS

General linear mixed models.

RESULTS

For each study, observed and reported numbers of items and kcal, and correspondence rate (reporting accuracy), were greater for lunch than for breakfast; omission rate, intrusion rate, and inflation ratio (measures of reporting error) were greater for breakfast than for lunch. In Study 1, for each meal over interviews, total inaccuracy decreased and correspondence rate increased. In Study 2, for each meal for boys for reverse and for girls for forward order, omission rate was lower and correspondence rate was higher.

CONCLUSIONS AND IMPLICATIONS

Breakfast was reported less accurately than lunch. Despite improvement over interviews (Study 1) and differences for order x sex (Study 2), reporting accuracy was low for breakfast and lunch.

Age and gender differences in children's food preferences

The present study was conducted to examine the developmental patterning of food preferences in a large sample of British schoolchildren and to investigate possible gender differences. Using a cross-sectional survey design, the study was carried out in three primary and three secondary schools in West London, UK. A total of 1291 children aged from 4 to 16 years completed a 115-item food preference questionnaire in class time, supervised by class teachers and assistants. Children indicated whether they had ever tried each item and, if so, how much they liked it. We observed age-related increases in the number of foods tried (P<0·001), liked (P<0·005) and disliked (P<0·05). Controlling for the number of foods tried rendered the increase in dislikes non-significant and reversed the age effect on the number liked. Girls liked fruit (P<0·05) and vegetables (P<0·001) more than boys did; boys liked fatty and sugary foods (P<0·005), meat (P<0·001), processed meat products (P<0·001) and eggs (P<0·05) more than girls did. Some age differences were apparent in liking for categories of food, although the effects were not linear. Across ages and genders, children rated fatty and sugary foods most highly, although ratings for fruit were also high. Children's food preferences overall are not consistent with a healthy diet. Interventions should focus on increasing the familiarity, availability and accessibility of healthy foods and should be mindful of the need to target messages appropriately for boys who have less healthful food preferences than girls at all ages.

Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods

Objective:

This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.

Design:

Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.

Subjects/setting:

The study sample included 902 adolescents and their parent or guardian.

Results:

Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend= 2.70,P< 0.01) and soft drink availability was inversely associated with dairy intake (ttrend= 2.08,P= 0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend= 3.65,P< 0.01). Parental intakes were positively associated with dairy intake for boys (ttrend= 2.04,P= 0.04), and with dairy (ttrend= 2.43,P= 0.01), vegetable (ttrend= 3.72,P< 0.01) and fruit (ttrend= 3.17,P< 0.01) intakes for girls.

Conclusions/applications:

Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.

The method of delivery of nutrition and physical activity information may play a role in eliciting behavior changes in adolescents

OBJECTIVES

Motivating adolescents to adopt proper nutrition and physical activity behaviors is important in this nation's fight to prevent obesity and chronic diseases. This study was conducted to determine which health education delivery method would elicit a greater behavior change.

METHOD

The intervention was conducted in three schools (control, computer-based, and traditional education).

RESULTS

Students who received the computer-based intervention showed increased knowledge (p<0.001), physical activity (p=0.001), self-efficacy (p<0.001), and social support (p<0.001), and decreased meals skipped (p<0.001).

CONCLUSION

The computer-based group showed more positive behavior changes. However, future programs may be enhanced by including group discussion and individual feedback.

Personal, social and environmental correlates of vegetable intake in normal weight and overweight 9 to 13-year old boys

BACKGROUND

The first aim of the present study was to investigate differences in correlates of vegetable intake between the normal weight and the overweight boys in the Pro Children Cross Sectional Study. The second aim was to explore whether the association between vegetable intake and potential correlates is different in overweight boys compared with normal weight boys.

METHODS

Random samples of mainly 11-year old children were recruited in 9 European countries. The total sample size consisted of 3960 boys (16.5% overweight). A validated self-report questionnaire was used to measure vegetable intake, and personal, social and environmental factors related to vegetable intake in the classroom. Weight and height were reported by the parents of the children in parents' questionnaires.

RESULTS

Regression analyses explained 23% to 28% of the variance in vegetable intake by potential correlates. Liking, self-efficacy and bringing vegetables to school were related to intake in both normal weight and overweight boys (beta's>0.10). Active parental encouragement and availability at home was only related to intake in overweight boys (beta's>0.10), whereas knowledge about recommendations was only related to vegetable consumption in normal weight boys (beta>0.10)

CONCLUSION

Intervention strategies to increase vegetable intake should focus on increase in liking and preferences, increase in self-efficacy, and increase in bringing vegetables to school in both normal weight and overweight boys. Further research should investigate whether advising parents of overweight boys to encourage their child to eat vegetables every day, to insist as far as possible that their child eats vegetables regularly and to make vegetables easily available at home is effective in changing vegetable intake.

Differences in fruit and vegetable intake and determinants of intakes between children of Dutch origin and non-Western ethnic minority children in the Netherlands - a cross sectional study

BACKGROUND

Fruit and vegetable consumption is low in the Netherlands and a key target in healthy diet promotion. However, hardly any information is available on differences in fruit and vegetable consumption between Dutch children and ethnic minority children. Therefore, the aim of present study was to determine differences in usual fruit and vegetable intake between native Dutch and non-Western ethnic minority children and to study differences in and mediating effects of potential psychosocial and environmental determinants.

METHODS

Ethnicity, usual fruit and vegetable consumption, psychosocial and environmental determinants and mothers' educational level were measured with a self-administered questionnaire during school hours in primary schools in Rotterdam, the Netherlands. Complete data was available for 521 10-11 year-old-children, of which 50.5% of non-Western origin. Differences between the groups regarding potential determinants and fruit and vegetable intake were assessed with Mann Whitney tests or multiple regression analyses. Multiple regression analyses were also conducted to assess mediating effects.

RESULTS

Ethnic minority girls ate fruit more frequently (1.41 +/- 1.0 times/day) than Dutch girls (1.03 +/- 0.82 times/day); no differences in frequency of intake were found for vegetables or among boys. Ethnic differences were found for almost all potential determinants. The Dutch children reported lower scores on these determinants than the ethnic minority children, except for perceived self-efficacy and barriers to eat fruit and vegetables. Knowledge of recommendations and facilitating behaviors of the parents mediated the association between ethnicity and fruit consumption among girls.

CONCLUSION

Ethnic minority girls in the Netherlands appear to have more favorable fruit intakes than Dutch girls, and ethnic minority children in general show more positive prerequisites for fruit and vegetable consumption. Interventions addressing multi-ethnic populations of children must take such differences into account.

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: Quantitative studies

BACKGROUND

In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents.

METHODS

Papers were identified from Medline and PsycINFO by using all combinations of the search terms: "fruit(s) or vegetable(s)" and "children or adolescents". Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6-18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes.

RESULTS

Ninety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-economic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake.

CONCLUSION

The determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account. This paper is published as part of the special Pro Children series in the International Journal of Behavioral Nutrition and Physical Activity. Please see [http://www.ijbnpa.org/content/3/1/26] for the relevant editorial.

Fruit and vegetable intake: Few adolescent girls meet national guidelines

OBJECTIVE

To examine longitudinal changes in daily fruit and vegetable consumption among black and white adolescent girls and calculate the percent of girls who met the Healthy People 2010 recommendations.

METHODS

Girls (1186 black and 1126 white) who participated in the National Heart, Lung, and Blood Institute Growth Health Study (NGHS) were included if they had completed a 3-day food diary for at least one of six annual assessments visits, beginning at ages 11 or 12. Mixed models estimated the association of visit and race with (a) average daily consumption of fruits and vegetables and (b) the probability of meeting intake recommendations on one or more out of 3 days.

RESULTS

For girls of both races, fruit and vegetable consumption increased with age; white girls showed a greater increase in fruit and nutrient-rich vegetable intake than black girls. Across visits, girls consumed considerably fewer than the recommended daily servings of fruits (1.0-1.5), vegetables (1.7-2.5), or nutrient-rich vegetables (0.25). Most girls (95%) failed to meet Healthy People 2010 recommendations.

CONCLUSIONS

Public health efforts are needed to meet Healthy People 2010 objectives.

Fruit, Vegetable, and Fat Intake among Non-Hispanic Black and Non-Hispanic White Adolescents: Associations with Home Availability and Food Consumption Settings

OBJECTIVE

This study sought to explore home food availability and common settings of food consumption as correlates of fruit, vegetable, and fat intake among a sample of non-Hispanic black and non-Hispanic white adolescents.

PARTICIPANTS AND DESIGN

Adolescents (n=144 black, 84 white) and their parents completed a cross-sectional survey in an urban adolescent health clinic. The adolescent survey included screening measures for fruit, vegetable, and fat intake and items on frequency of eating meals with family, while watching television, and at three types of restaurants. Parents provided information on home availability of foods.

MAIN OUTCOMES

Correlates of fruit, vegetable, and fat consumption.

STATISTICAL ANALYSIS

Spearman correlations for associations among variables, t tests for mean comparisons, and multiple stepwise regression conducted separately for black and white adolescents.

RESULTS

In multiple regression, home availability was not significantly associated with fruit, vegetable, or fat intake except for fruit intake among white adolescents only. Use of non-fast-food restaurants was the strongest positive predictor of vegetable intake. For both black and white adolescents, fast-food and buffet restaurant use and eating while watching television were the strongest predictors of fat intake.

CONCLUSIONS

Compared with restaurant use and eating while watching television, home availability had a relatively small impact on fruit, vegetable, and fat consumption for both black and white adolescents. Intervention programs on adolescent nutrition should target not just availability of healthful foods, but also ease of access, such as the preparation of fruits and vegetables so that they are flavorful and ready to eat.

Improving the dietary patterns of adolescents using a computer-based approach

The Centers for Disease Control and Prevention (CDC) recently reported that 16-33% of children and adolescents in the United States are overweight or obese, making this the number one nutritional disease of this group. The prevalence appears to be increasing annually, as are the associated consequences. Moreover, the CDC estimates that less than 50% of adolescents are physically active on a regular basis. In order to improve the health of these individuals, an intervention must be focused to modify these behaviors. Facilitating the understanding of proper nutrition and need for physical activity among adolescents will likely prevent health problems such as overweight and obesity and the development of chronic diseases later in life. Despite these concerns, adolescents remain one of the most underserved populations in terms of preventive services. In the past, health education interventions have shown increases in knowledge; however, the ultimate goal of these programs is to positively impact behavior. To accomplish this, we must focus on the learning styles of "today's" adolescents. Computer-based interventions allow for individualized strategies to promote healthy lifestyles. A computer-based intervention program has the potential to elicit a greater behavior change in comparison to a traditional didactic intervention program.

Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods

OBJECTIVE

This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.

DESIGN

Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.

SUBJECTS/SETTING

The study sample included 902 adolescents and their parent or guardian.

RESULTS

Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P<0.01) and soft drink availability was inversely associated with dairy intake (ttrend=2.08, P=0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend=3.65, P<0.01). Parental intakes were positively associated with dairy intake for boys (ttrend=2.04, P=0.04), and with dairy (ttrend=2.43, P=0.01), vegetable (ttrend=3.72, P<0.01) and fruit (ttrend=3.17, P<0.01) intakes for girls.

CONCLUSIONS/APPLICATIONS

Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.