The patterns and position of snacking in children in aged 2-12 years: A scoping review

BACKGROUND

Childhood obesity is associated with serious comorbidities during childhood and into adulthood. One potential risk factor for childhood obesity is consumption of unhealthy, energy-dense foods. This scoping review examines evidence on snacking in children aged 2-12years of age and presents the patterns and position of snacking in children's diets.

METHODS

A search of electronic databases (MEDLINE, Web of Science, PubMed, Embase) for articles published from March 2011 to November 2022 was conducted. Articles providing insight into the position of snacking (e.g., energy contribution), or patterns (e.g., location, timing), in children aged 2-12years were included. A quality assessment was conducted and data was synthesised according to data source (nationally representative or other).

RESULTS

Twenty-one articles were included, most (n = 13) reporting nationally representative data. The average number of daily snacks was 3, with 92.9-100.0% of children consuming snacks. Most were consumed in the afternoon (75.2-84.0%) and at home (46.5-67.3%). Snacks frequently consumed were 'fruits and vegetables', 'baked desserts', 'sweets, candy and confectionery', and 'dairy products'. Snacks contributed 231-565 kcal daily, up to a third of daily carbohydrate intake, a quarter of fat intake, and a fifth of protein intake. Snacks provided up to one third of vitamin C intake, one quarter of vitamin E, potassium and magnesium intake, and a fifth of calcium, folic acid, vitamins D and B12, iron and sodium intake.

DISCUSSION

This scoping review provides insight into patterns and position of snacking within children's diets. Snacking plays a significant role in children's diets with multiple snacking occasions occurring throughout a child's day, the overconsumption of which has the potential to increase risk of childhood obesity. Further research is required into the role of snacking, particularly specific foods playing a role in micronutrient intake, and clear guidance for snacking intake in children.

Using the theory of planned behavior to predict factors influencing fast-food consumption among college students

PURPOSE

The purpose of this research is to examine the behavioral factors that impact fast food consumption (FFC) among college students in Pakistan by applying the theory of planned behavior (TPB).

METHODS

Cross-sectional survey was distributed to college students in Pakistan. The questionnaire examines the factors associated with six categories: demographics, FFC pattern, intention for FFC, attitudes toward FFC, Subjective Norms (SN), and Perceived Behavioral Control (PBC). Data analysis was conducted using SPSS and SPSS AMOS software using descriptive statistics, inferential statistics (chi-square, t-test, Pearson correlation, and multiple regression analysis), and structural equation modeling (SEM) Analysis.

RESULTS

A total of 220 questionnaires were completed (97 males and 123 females). There were significant differences in FFC association with gender. Among the constructs of TPB, behavioral intention (BI) and SN are the strongest predictors of the FFC (p < .05). TPB has significantly predicted FFC behavior with a variance of R² 0.603. The SEM analysis shows that the data collected were incompatible with the theoretical TPB model, making it unfeasible to test our five hypotheses or interpret the results due to the poor fit of the model with the data.

CONCLUSIONS

To ensure a good fit of the data with the specified TPB model in SEM analysis, the number of indicators should be limited (≤ 30), or the sample size should be greater (N ≥ 500). Pakistani college students' FFC is mainly influenced by friends and the increased popularity of fast food, despite their knowledge of its negative health effects. Educational programs should target specific harmful effects of fast food, and SN and BI are the strongest predictors of FFC among TPB constructs. These findings can be useful for developing targeted interventional health strategies and future research.

Children's Daily Negative Affect Patterns and Food Consumption on Weekends: An Ecological Momentary Assessment Study

OBJECTIVE

This study evaluated the association between children's daily negative affect (NA) trajectories and unhealthy food consumption during weekends using ecological momentary assessment (EMA).

DESIGN

Children answered mobile phone-based EMA surveys 7 times a day for 2 weekend days per wave, with each survey assessing current NA and past 2-hour consumption of fried foods (chips or fries), sweets (pastries or sweets), and sugary beverages (drank soda or energy drinks).

SETTING

Los Angeles, California.

PARTICIPANTS

The sample consisted of 195 children (51% female; mean age, 9.65 years; SD, 0.93) from the Mothers and Their Children's Health cohort study.

MAIN OUTCOMES MEASURES

Negative affect trajectory (independent variable), unhealthy food consumption (dependent variable).

ANALYSIS

Latent growth mixture modeling classified NA trajectories across days and examined their association with unhealthy food consumption.

RESULTS

The latent growth mixture modeling identified 3 classes of daily NA trajectories: (1) stable low, (2) early increasing and late decreasing and (3) early decreasing and late increasing. Fried food consumption was higher on early increasing and late decreasing and early decreasing and late increasing NA trajectories than days with stable low NA.

CONCLUSIONS AND IMPLICATIONS

By better understanding day-to-day variability in children's affect and eating, we can individually tailor obesity interventions to account for the emotional contexts in which unhealthy eating occurs.

Determining intention, fast food consumption and their related factors among university students by using a behavior change theory

Background

Today, with the advancement of science, technology and industry, people’s lifestyles such as the pattern of people’s food, have changed from traditional foods to fast foods. The aim of this survey was to examine and identify factors influencing intent to use fast foods and behavior of fast food intake among students based on the theory of planned behavior (TPB).

Methods

A cross-sectional study was conducted among 229 university students. The study sample was selected and entered to the study using stratified random sampling method. Data were collected using a four-part questionnaire including Participants’ characteristics, knowledge, the TPB variables, and fast food consumption behavior. The study data were analyzed in SPSS software (version 16.0) using descriptive statistics (frequencies, Means, and Standard Deviation) and inferential statistics (t-test, Chi-square, correlation coefficient and multiple regressions).

Results

The monthly frequency of fast food consumption among students was reported 2.7 times. The TPB explained 35, 23% variance of intent to use fast food and behavior of fast food intake, respectively. Among the TPB variables, knowledge (r = .340, p < 0.001) and subjective norm (r = .318, p < 0.001) were known as important predictors of intention to consume fast foods - In addition, based on regression analyses, intention (r = .215, p < 0.05), perceived behavioral control (r = .205, p < 0.05), and knowledge (r = .127, p < 0.05) were related to fast food consumption, and these relationships were statistically significant.

Conclusions

The current study showed that the TPB is a good theory in predicting intent to use fast food and the actual behavior. It is supposed that health educators use from the present study results in designing appropriate interventions to improve nutritional status of students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12696-x.

Measuring university students' beliefs toward healthy snack selection

Objectives: Understanding university students' beliefs toward selecting healthy snacks is important in developing effective programs targeting healthy eating behaviors. The purpose of this research was to assess students' beliefs toward healthy snack selection and consumption. Participants: In November 2017, a convenience sample of 779 undergraduate students living on campus completed an online survey. Methods: A survey was developed to measure students' beliefs about eating healthy snacks. Paired t-tests were used to compare differences in beliefs and their importance. Independent t-tests were used to compare differences in belief responses by gender. Results: Students believed that healthy snacks were good for health and assisting with weight management. However, time management, motivation, preparation needs, and poor taste were reported as barriers to selection and consumption of healthy snacks. Conclusions: Increasing students' awareness of available food preparation facilities, developing food preparation skills, and motivation for consumption of healthy-good tasting snacks may increase healthier snacking.

Children's conformity to social norms to eat healthy: A developmental perspective

RATIONALE

Previous studies suggest injunctive norms (prompts of what people ought to do) are stronger predictors of healthy eating intentions, whereas descriptive norms (prompts of what people are doing) are stronger predictors of healthy eating behaviors. However, previous research provides little insight into why different norms influence children's health intentions and behaviors differently. In addition, no research has explored developmental differences in children's conformity to, or rejection of, different types of social normative influence. Thus, this paper adopts a developmental perspective to understand why children conform differently to descriptive and injunctive norm messaging on healthy eating.

METHOD

An experiment was done with 405 children in Germany aged 7 to 16. The research design was a 4 (social norms: descriptive vs. injunctive peer vs. injunctive authority vs. control) × 2 (developmental stage: middle childhood vs. adolescence) between-subject design. Children's healthy eating intentions and behaviors were collected as key dependent variables.

RESULTS

and conclusions: The experimental results suggest that children mainly use a descriptive norm as an information shortcut to behaving "appropriately". This should have a stronger impact on younger children than older ones, although both young and old children consider it easier to understand than an injunctive norm. The experimental results further suggest that an injunctive norm mainly influences children via activation of a motive for maintaining a positive self-image in public, rather than one of affiliation. These results are very important for social research on health, because they can explain why different social norms influence health intentions and behaviors differently. In addition, our finding that injunctive norm conformity is mainly used for impression management purposes can reconcile existing contradictory results on the impact of social norms on children.

Using the Theory of Planned Behavior to Explore Pediatric Heart Transplant Recipients’ Dietary Behavior

Abstract. Heart transplantation is the treatment of choice for children with end-stage heart disease. Coronary artery vasculopathy is, however, a significant morbidity and leading cause of late graft loss, and hyperlipidemia a risk factor for its development. Improving diet in this population could have important benefits for patients. We wanted to understand what influences decisions about food intake in this patient group. Dietary intentions and behavior were examined using a questionnaire based on the Theory of Planned Behavior (TPB) with 67 children who had undergone heart transplantation at least 12 months previously. The TPB model was significant for both healthy and unhealthy dietary behaviors, explaining 55% and 38% of the variance, respectively. Ten percent of children reported not eating any fruit and/or vegetables in the previous week and only 29% reported eating fruit and/or vegetables every day. The Theory of Planned Behavior provides a framework for explaining some specific dietary behaviors related to individual food groups in children who have undergone heart transplantation. These preliminary data support using this approach to inform the development of interventions to improve fruit and vegetable consumption but the approach may be less useful for explaining and developing interventions to reduce the consumption of unhealthy foods.

The association between environmental and psychosocial factors towards physical activity and screen time of children: an application of the Integrative Behavioural Model

Physical activity is beneficial at all stages of life, and has been linked as a protective factor from obesity, and other chronic health conditions. Despite the benefits of physical activity, less than half of US children meet the current recommendations, and activity levels decline with age. When planning physical activity interventions, behavioural theories should be utilised, given the inherent benefits theory-based approaches possess. The purpose of this study was to investigate how constructs of the Integrative Theoretical Model (IM) are associated with physical activity and screen time among children (9 years ±1.2; n = 264). Using structural equation modeling, a final model proved to have a good fit (CFI = 0.989; TLI = 0.975; RMSEA = 0.043), and results indicated intentions and perceived behavioural control (PBC) explained 19.4% of the variance for physical activity, and attitudes, perceived norms, and PBC accounted for 62% of the variance of intentions. Furthermore, attitudes and perceived norms were negatively associated with total screen time, and accounted for 10% of the variance. Results suggest that IM is a useful framework for explaining physical activity and screen time among children.

From perceived autonomy support to intentional behaviour: Testing an integrated model in three healthy-eating behaviours

A motivational model integrating self-determination theory, the theory of planned behaviour, and the health action process approach was tested in three samples in three behavioural contexts: fruit and vegetable, breakfast, and snack consumption. Perceived support for autonomous (self-determined) forms of motivation from parents and autonomous motivation from self-determination theory were hypothesised to predict intention and behaviour indirectly via the mediation of attitude and perceived behavioural control from the theory of planned behaviour. It was also expected that planning strategies would mediate the effect of intention on behaviour. Relations in the proposed models were expected to be similar across the behaviours. A two-wave prospective design was adopted. Three samples of high-school students (total N = 1041; 59.60% female; M age = 17.13 years ± 1.57) completed measures of perceived autonomy support, autonomous motivation, theory of planned behaviour constructs, planning strategies and behaviour for each of the three behavioural contexts. Three months later, 816 participants (62,24% female; M age: 17.13 years, SD = 1.58) of the initial sample self-reported their behaviour referred to the previous three months. Structural equation models provided support for the key hypothesised effects of the proposed model for the three health-related behaviours. Two direct effects were significantly different across the three behaviours: the effect of perceived autonomy support on perceived behavioural control and the effect of attitude on intention. In addition, planning strategies mediated the effect of intention on behaviour in fruit and vegetable sample only. Findings extend knowledge of the processes by which psychological antecedents from the theories affect energy-balance related behaviours.

A systematic literature review and meta-analysis: The Theory of Planned Behavior's application to understand and predict nutrition-related behaviors in youth

BACKGROUND

Efforts to reduce unhealthy dietary intake behaviors in youth are urgently needed. Theory-based interventions can be effective in promoting behavior change; one promising model is the Theory of Planned Behavior (TPB).

PURPOSE

The aim of this study was to determine, using a systematic literature review, how the TPB has been applied to investigate dietary behaviors, and to evaluate which constructs are associated with dietary behavioral intentions and behaviors in youth.

METHODS

Publications were identified by searching electronic databases, contacting experts in the field, and examining an evolving Internet-based TPB-specific bibliography. Studies including participants aged 2-18years, all TPB constructs discernible and measured with a description of how the variables were assessed and analyzed, were published in English and peer-reviewed journals, and focused on nutrition-related behaviors in youth were identified. Accompanying a descriptive statistical analysis was the calculation of effect sizes where possible, a two-stage meta-analysis, and a quality assessment using tenants from the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statements.

RESULTS

Thirty-four articles, including three intervention studies, were reviewed. The TPB was most often used to evaluate healthy eating and sugary snack and beverage consumption. Attitude had the strongest relationship with dietary behavioral intention (mean r=0.52), while intention was the most common predictor of behavior performance (mean r=0.38; both p<0.001). All three interventions revealed beneficial outcomes when using the TPB (e.g. η(2)=0.51 and ds=0.91, 0.89, and 0.79); extending the Theory with implementation intentions may enhance its effectiveness (e.g. η(2)=0.76).

CONCLUSIONS

Overall, the TPB may be an effective framework to identify and understand child and adolescent nutrition-related behaviors, allowing for the development of tailored initiatives targeting poor dietary practices in youth. However, support from the literature is primarily from observational studies and a greater effort towards examining these relationships within intervention studies is needed.

Comparing the Utility of the Theory of Planned Behavior Between Boys and Girls for Predicting Snack Food Consumption

The purpose of this study was to use the theory of planned behavior to explain two types of snack food consumption among boys and girls (girls n = 98; boys n = 69), which may have implications for future theory-based health promotion interventions. Between genders, there was a significant difference for calorie-dense/nutrient-poor snacks ( p = .002), but no difference for fruit and vegetable snacks. Using stepwise multiple regression, attitudes, perceived behavioral control, and subjective norms accounted for a large amount of the variance of intentions (girls = 43.3%; boys = 55.9%); however, for girls, subjective norms accounted for the most variance, whereas for boys, attitudes accounted for the most variance. Calories from calorie-dense/nutrient-poor snacks and fruit and vegetable snacks were also predicted by intentions. For boys, intentions predicted 6.4% of the variance for fruit and vegetable snacks ( p = .03) but was not significant for calorie-dense/nutrient-poor snacks, whereas for girls, intentions predicted 6.0% of the variance for fruit and vegetable snacks ( p = .007), and 7.2% of the variance for calorie-dense/nutrient-poor snacks ( p = .004). Results suggest that the theory of planned behavior is a useful framework for predicting snack foods among children; however, there are important differences between genders that should be considered in future health promotion interventions.

Determinants of fast food consumption among Iranian high school students based on planned behavior theory

OBJECTIVE

This study was conducted to identify some factors (beliefs and norms) which are related to fast food consumption among high school students in Isfahan, Iran. We used the framework of the theory planned behavior (TPB) to predict this behavior.

SUBJECTS & METHODS

Cross-sectional data were available from high school students (n = 521) who were recruited by cluster randomized sampling. All of the students completed a questionnaire assessing variables of standard TPB model including attitude, subjective norms, perceived behavior control (PBC), and the additional variables past behavior, actual behavior control (ABC).

RESULTS

The TPB variables explained 25.7% of the variance in intentions with positive attitude as the strongest (β = 0.31, P < 0.001) and subjective norms as the weakest (β = 0.29, P < 0.001) determinant. Concurrently, intentions accounted for 6% of the variance for fast food consumption. Past behavior and ABC accounted for an additional amount of 20.4% of the variance in fast food consumption.

CONCLUSION

Overall, the present study suggests that the TPB model is useful in predicting related beliefs and norms to the fast food consumption among adolescents. Subjective norms in TPB model and past behavior in TPB model with additional variables (past behavior and actual behavior control) were the most powerful predictors of fast food consumption. Therefore, TPB model may be a useful framework for planning intervention programs to reduce fast food consumption by students.