Social Cognitive Model of Fruit and Vegetable Consumption in Elementary School Children

Coach Candidates' and Coaches' Nutrition Knowledge Affects Dietary Recommendations Indirectly: Mediator Effects of Self-Efficacy

Background/Objectives: The nutritional knowledge and behavior of athletes are considerably influenced by the dietary recommendations of their coaches, which, in turn, affect their health and performance. In the context of social cognitive theory, this study examines the impact of general and sports nutrition knowledge (GeSNK), nutrition self-efficacy (NSE), and nutrition counseling self-efficacy (NCSE) on the dietary recommendations (DRs) provided by coach candidates and coaches (CC&Cs). Additionally, it explores variations in GeSNK, NSE, and NCSE among CC&Cs based on their sports positions, genders, and types of sports. Methods: This study included 70 coach candidates and 102 coaches, with data collected via validated scales for GeSNK, NSE, and NCSE. Using the PROCESS macro, the serial multiple mediator model was applied, and group comparisons were conducted via the Mann-Whitney U test. Results: The results revealed that 36% of participants achieved adequate GeSNK scores, but only 6.4% abstained from providing DRs. Participants engaged in individual sports exhibited higher NSE and NCSE scores than those involved in team sports. Additionally, 22.7% of CC&Cs identified their former coaches as a primary source of nutrition information. The study findings revealed that GeSNK, NSE, and NCSE significantly influenced DRs, collectively accounting for 23% of the variance in DRs. The direct effect of NCSE on DRs was statistically significant, whereas the direct effects of GeSNK and NSE were not significant. GeSNK and NSE jointly explained only 41% of the variance in NCSE, suggesting that additional factors influencing NCSE and DRs remain unexplored. Conclusions: To address the issue of inadequate dietary recommendations stemming from insufficient information, it is crucial to identify and understand these additional factors affecting NCSE and DRs. Diversifying nutrition education programs to enhance the nutrition knowledge of CC&Cs is essential. Furthermore, fostering collaboration between CC&Cs and nutritionists can ensure that athletes receive accurate and comprehensive nutritional guidance.

Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study

BACKGROUND

Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake.

OBJECTIVE

This pilot study aimed first to translate the digital game "Veggies4myHeart" into French and to assess its influence on young children's preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms.

METHODS

During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview.

RESULTS

A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children's declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools.

CONCLUSIONS

In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake.

Importance-performance analysis of sodium reduction practices by school nutrition teachers and dietitians in the Republic of Korea

BACKGROUND/OBJECTIVES

This study investigated the importance and performance level of sodium reduction practices in school meal service by school nutrition teachers and dietitians, and compared them according to school level and placement of the school nutrition teacher.

SUBJECTS/METHODS

An online survey was conducted with 608 nutrition teachers and dietitians in schools in the Republic of Korea from September 28 to November 12, 2021 (response rate: 57%). The questionnaire comprised 11 items related to sodium reduction practices (purchasing, food preparation and serving, and education). The importance and performance level of each item was rated on a 5-point scale. The mean differences were analyzed using t-tests or one-way analyses of variance and Duncan's post-hoc tests. An importance-performance analysis was performed on sodium reduction practices.

RESULTS

Participating in sodium reduction education, sodium reduction education for cooks, and sodium reduction education for students were assessed to have high importance but low performance. Overall, the higher the school level, the lower was the importance level of sodium reduction practices. The performance in kindergartens and elementary schools was higher than that in middle and high schools. The importance in the purchasing category perceived by dietitians was lower as compared to nutrition teachers. In addition, the performance in the purchasing, food preparation and serving, and education categories perceived by dietitians was lower than those of nutrition teachers.

CONCLUSION

Sodium reduction education for nutrition teachers and dietitians, cooks, and students should prioritize practicing sodium reduction in school meal service. Specific guidelines for managing sodium reduction at all stages-purchasing, food preparation, and serving-should also be developed. The results could be used as basic data to reduce the sodium content in school meals.

Nutrition Education Intervention to Promote Nutrition Knowledge in Preschool Children at District of Leiria, Portugal

Several factors can influence children’s food choices and preferences. Food and nutrition education at school can therefore be the key to improving children’s nutrition knowledge, and consequently their eating behavior. To this end, several strategies seem effective, and the current difficulty lies in choosing the best methodology to implement. To determine which intervention has the greatest impact on preschool children’s nutrition knowledge about vegetables: serious game, children’s story, children’s story associated with stickers, or food wheel. This experimental study had the participation of 162 children, aged between 3 to 6 years, attending four public school institutions in the district of Leiria, Portugal. To increase children’s nutrition knowledge about vegetables, four interventions were carried out: digital game, children’s story, children’s story associated with stickers, and a food wheel. To assess the recognition of foods, identification of vegetables, and the functions of five vegetables (lettuce, tomato, carrot, cucumber, and red cabbage), two instruments were applied at three different times (at the start, conclusion, and 6 months after the intervention). The collected data were analyzed using IBM SPSS software. There was an increase in nutrition knowledge both post-intervention and 6 months follow-up, compared to the initial moment. This increase was statistically significant (p <0.001) when evaluated overall. The intervention with the digital game “Veggies4myheart”, compared to the children’s story associated with stickers, proved to be more effective in increasing nutrition knowledge related to the vegetable's functions, 6 months after the intervention (p = 0.028). The four interventions were effective to promote nutrition knowledge about vegetables in preschool children. The interventions with the digital game or with the child’s story with stickers seem to be the most appropriate to increase knowledge about vegetable functions.

Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers

This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.

Modeling Parental Influence on Food Consumption among Chinese Adolescents through Self-Efficacy: A Path Analysis

This study aimed to investigate the associations between perceived parental control, perceived parental modeling and parent–teen co-decision making, and fruit and vegetable (F&V) and sugar-sweetened beverage and junk food (S&J) consumption among Chinese adolescents, and examine whether self-efficacy mediates the associations. Data were collected in a cross-sectional survey of Chinese adolescents carried out in the fall of 2019. The questionnaires were adapted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Ordinary least-squares regressions and a path analysis were performed to evaluate the hypothesized associations. The final sample included 3595 Chinese adolescents (mean (SD) age, 14.67 (1.73) years; 52.82% (n = 1899) males). Perceived parental control was positively associated with adolescents’ F&V consumption, and was negatively associated with adolescents’ S&J consumption. Perceived parental modeling and parent–teen co-decision making were both positively associated with adolescents’ F&V consumption and negatively associated with their S&J consumption. Adolescents’ self-efficacy was positively associated with F&V consumption and negatively associated with S&J consumption. These results suggest that serving as a positive role model, having adolescents participate in the decision-making process, and increasing adolescents’ self-efficacy can be feasible and efficacious strategies to improve the nutritional quality of Chinese adolescents’ diets.

The Effects of Horticultural Activity Program on Vegetable Preference of Elementary School Students

This study was conducted to investigate effects of a horticultural activity program based on a mediating variable model for improving vegetable preference among elementary students. A quasi-experimental design was employed with 136 students and 136 primary carers in Seoul, South Korea. Based on the mediation model for improving children’s vegetable preference, 12 sessions were conducted, including gardening, nutrition education, and cooking activities using harvests. The program was conducted weekly for 12 weeks from March to July 2019. To investigate the effect of this program, mediating factors of the children were evaluated before and after the program. Pearson correlation analysis was used to identify the mediating factors. The nutrition index, attitude, knowledge, and eating habits of the primary carers were evaluated. Results showed children’s nutrition and gardening knowledge, dietary self-efficacy, outcome expectancies, and vegetable preference were significantly improved (p < 0.001). Primary carers showed significant improvement in the nutrition index, knowledge, and attitude (p < 0.05). The correlation analysis confirmed that most of the mediating factors had significant correlations (p < 0.05). Therefore, administering a structured program involving horticultural activities and nutrition education as mediating factors for 12 sessions was effective in improving eating behavior for vegetables elementary school students and primary carers.

A Motivational Pathway Linking Physical Activity to Body-Related Eating Cues

OBJECTIVE

To explore the motivational transfer between physical activity (PA) and body-related eating cues, through self-determined motivations to exercise (SDM Ex) and regulate eating (SDM Eat).

DESIGN

Cross-sectional.

SETTING

Participants completed an online inventory on PA and eating behaviors and motivations in 2017-2018.

PARTICIPANTS

A convenience sample of 300 adults (71% women; 34.4 ± 10.7 years; 23.2 ± 3.4 kg/m²), recruited through Facebook and cooperating Portuguese gyms.

VARIABLES MEASURED

Moderate-to-vigorous physical activity (independent), SDM Ex and SDM Eat (mediators), and body-related eating cues (dependent) variables assessed through validated self-reported measures.

ANALYSIS

Structural equation modeling and serial mediation procedures were used to test the hypothetical model.

RESULTS

Physical activity was positively associated with SDM Ex, which was, in turn, associated with SDM Eat, which in turn positively predicted reliance on hunger/satiety cues and (more strongly) body-food choice congruence. The path through exercise and eating motivations was the leading mediating path in the PA and body-food choice congruence association.

CONCLUSIONS AND IMPLICATIONS

This study lends support to the motivational transfer hypothesis between SDM Ex and SDM Eat in normal-weight adults, suggesting that more physically active individuals present higher SDM Ex and SDM Eat, and therefore, greater attentiveness to body-related eating cues and necessities. Encouraging PA might also improve individuals' eating self-regulation, especially if self-determined motivations are targeted in future interventions.

Garden-Based Integrated Intervention for Improving Children's Eating Behavior for Vegetables

This study was conducted to develop and verify the effects of a garden-based integrated intervention for improving children’s eating behavior for vegetables. A pre-post-test experimental design was employed. The participants were 202 elementary school students (average age: 11.6 ± 1.5 years). The garden-based integrated intervention program was conducted during regular school hours for a total of 12 weeks. The program, based on a mediator model for improving children’s eating behavior, included gardening, nutritional education, and cooking activities utilizing harvests. In order to examine effects of the program, the mediating factors related to children’s eating behavior were evaluated using pre-post questionnaires. As a result of the program, dietary self-efficacy, outcome expectancies, gardening knowledge, nutrition knowledge, vegetable preference, and vegetable consumption were significantly increased, and food neophobia was significantly decreased. In addition, there were positive correlations between most mediating factors. Thus, the garden-based integrated intervention developed in this study was effective in improving children’s eating behavior for vegetables.

Using Food Models to Enhance Sugar Literacy among Older Adolescents: Evaluation of a Brief Experiential Nutrition Education Intervention

Adolescent diets high in sugar are a public health concern. Sugar literacy interventions have changed intake but focused more on children, adults, and early adolescents and on sugar sweetened beverages rather than total sugar consumption. Food models are an efficacious experiential learning strategy with children. This study assessed the impact of two 45 min nutrition lessons using food models on adolescents’ sugar literacy. Classes (n = 16) were randomized to intervention or control with knowledge, label reading skills, intentions to limit sugar consumption measured at baseline and follow-up. Two hundred and three students aged 14 to 19 from six schools on Vancouver Island, BC, Canada participated in the study. Adolescents’ knowledge of added sugar in foods and beverages and servings per food group in a healthy diet was limited at baseline but improved significantly in the intervention condition (F(1, 201) = 104.84, p < 0.001) compared to controls. Intention to consume less added sugar increased significantly after intervention (F(1, 201) = 4.93, p = 0.03) as did label reading confidence (F(1, 200) = 14.94, p < 0.001). A brief experiential learning intervention using food models was efficacious for changing student’s knowledge about sugar guidelines and sugar in food, label reading confidence, and intention to change sugar consumption.

School Lunch Environmental Factors Impacting Fruit and Vegetable Consumption

OBJECTIVE

Assess impact of school lunch environmental factors on fruit and vegetable (F&V) consumption in second and third grade students.

DESIGN

Cross-sectional observations in 1 school year.

PARTICIPANTS

Students from 14 elementary schools in 4 New York City boroughs (n = 877 student-tray observations).

MAIN OUTCOME MEASURE(S)

Dependent variables were F&V consumption collected by visual observation. Independent variables included school lunch environmental factors, and individual-level and school-level demographics.

ANALYSIS

Hierarchical linear modeling was used with F&V consumption as the outcome variable, and relevant independent variables included in each model.

RESULTS

Slicing or precutting of fruits and having lunch after recess were positively associated (P < .05) with .163- and .080-cup higher fruit consumption across all students, respectively. Preplating of vegetables on lunch trays, having 2 or more vegetable options, and having lunch after recess were positively associated (P < .05) with .024-, .009-, and .007-cup higher vegetable consumption across all students, respectively.

CONCLUSIONS AND IMPLICATIONS

Although there was a small increase in intake, results of the study support that some school lunch environmental factors affect children's F&V consumption, with some factors leading to more impactful increases than others. Slicing of fruits seems most promising in leading to greater fruit consumption and should be further tested.

Modeling Parental Influence on Teenagers' Food Consumption: An Analysis Using the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey

OBJECTIVE

To investigate (1) how perceived parental control, perceived parental modeling, and parent-teen co-decision making are associated with teenagers' consumption of fruits and vegetables as well as sugary drinks and less healthful food; and (2) whether self-efficacy mediates this relationship.

DESIGN

Cross-sectional survey.

PARTICIPANTS

A total of 1,657 adolescents aged 12-17years.

MAIN OUTCOME MEASURE(S)

Perceived parental control, perceived parental modeling, parent-teen co-decision making, self-efficacy, and consumption of fruits and vegetables as well as sugary drinks and less healthful food.

ANALYSIS

Ordinary least-squares regressions and mediation analyses.

RESULTS

After controlling for teenagers' self-efficacy, perceived parental control was not significantly associated with teenagers' fruit and vegetable consumption but it was negatively related to teenagers' consumption of sugary drinks and less nutrient-dense food. Perceived parental modeling had a positive correlation to teenagers' fruit and vegetable consumption and a negative relationship to their consumption of sugary drinks and less healthful food. Parent-teen co-decision making regarding teenagers' food consumption emerged as a positive predictor for teenagers' fruit and vegetable consumption but not for that of sugary drinks and foods with little nutritional value after controlling for self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Findings from this study demonstrated that perceived parental behaviors were related to teenagers' nutrition intakes. Not exerting too much control and having teenagers participate in the decision-making process could help teenagers eat more healthily. Furthermore, providing a positive role model for teenagers can be an effective strategy to encourage teenagers to eat better.

Understanding fruit and vegetable consumption in children and adolescents. The contributions of affect, self-concept and habit strength

Affective processes and the role of automaticity are increasingly recognised as critical in determining food choice. This study investigated the association of affective attitude, self-identity and habit with fruit and vegetable (FV) intentions and intake in children. Previous studies have not fully explored their implications for children of different age groups and have not considered their independent contribution as part of a coherent model of behaviour that also controls for other psychosocial and environmental determinants of intake. Data was collected through face-to-face interviews with 362 children, 9-15 years old. Children were asked to report on measures of affective attitude, cognitive attitude, self-concept, social norms and facilitating factors following Triandis' Theory of Interpersonal Behaviour (TIB). Three stage least squares was used to estimate the independent association of affective attitude and self-concept with intentions and of intentions and habit with intake. Self-concept had the most prominent role in explaining intentions irrespective of age for both fruit and vegetables. The importance of affective attitude varied by age and with fruit and vegetables, with greater importance for vegetables and for children aged 11-13 years. Cognitive attitude was more relevant than affective attitude for 14 to 15 year-olds' fruit intentions. Intake was more strongly associated with habit than intentions, with stronger associations for 14 to 15 year-olds. The current findings support the importance of self-concept for FV motivations and provide further evidence on the importance of habit to FV intake in young and older children and adolescents. Results also support a targeted usefulness of affective attitude for fruit and vegetable intentions. The discussion considers potential ways in which these constructs can be incorporated into interventions to increase FV intake in children.

Prevalence and determinants of sufficient fruit and vegetable consumption among primary school children in Nakhon Pathom, Thailand

BACKGROUND/OBJECTIVES

Low consumption of fruit and vegetable is frequently viewed as an important contributor to obesity risk. With increasing childhood obesity and relatively low fruit and vegetable consumption among Thai children, there is a need to identify the determinants of the intake to promote fruit and vegetable consumption effectively.

SUBJECTS/METHODS

This cross-sectional study was conducted at two conveniently selected primary schools in Nakhon Pathom. A total of 609 students (grade 4-6) completed questionnaires on personal and environmental factors. Adequate fruit and vegetable intakes were defined as a minimum of three servings of fruit or vegetable daily, and adequate total intake as at least 6 serves of fruit and vegetable daily. Data were analyzed using descriptive statistics, the chi-square test, and multiple logistic regression.

RESULTS

The proportion of children with a sufficient fruit and/or vegetable intakes was low. Covariates of child's personal and environmental factors showed significant associations with sufficient intakes of fruit and/or vegetable (P < 0.05). Logistic regression analyses showed that the following factors were positively related to sufficient intake of vegetable; lower grade, a positive attitude toward vegetable, and fruit availability at home; and that greater maternal education, a positive child's attitude toward vegetable, and fruit availability at home were significantly associated with sufficient consumption of fruits and total fruit and vegetable intake.

CONCLUSIONS

The present study showed that personal factors like attitude toward vegetables and socio-environmental factors, such as, greater availability of fruits were significantly associated with sufficient fruit and vegetable consumption. The importance of environmental and personal factors to successful nutrition highlights the importance of involving parents and schools.

Validity and Reliability of General Nutrition Knowledge Questionnaire for Adults in Uganda

This study sought to develop and validate a general nutrition knowledge questionnaire (GNKQ) for Ugandan adults. The initial draft consisted of 133 items on five constructs associated with nutrition knowledge; expert recommendations (16 items), food groups (70 items), selecting food (10 items), nutrition and disease relationship (23 items), and food fortification in Uganda (14 items). The questionnaire validity was evaluated in three studies. For the content validity (study 1), a panel of five content matter nutrition experts reviewed the GNKQ draft before and after face validity. For the face validity (study 2), head teachers and health workers (n = 27) completed the questionnaire before attending one of three focus groups to review the clarity of the items. For the construct and test-rest reliability (study 3), head teachers (n = 40) from private and public primary schools and nutrition (n = 52) and engineering (n = 49) students from Makerere University took the questionnaire twice (two weeks apart). Experts agreed (content validity index, CVI > 0.9; reliability, Gwet’s AC1 > 0.85) that all constructs were relevant to evaluate nutrition knowledge. After the focus groups, 29 items were identified as unclear, requiring major (n = 5) and minor (n = 24) reviews. The final questionnaire had acceptable internal consistency (Cronbach α > 0.95), test-retest reliability (r = 0.89), and differentiated (p < 0.001) nutrition knowledge scores between nutrition (67 ± 5) and engineering (39 ± 11) students. Only the construct on nutrition recommendations was unreliable (Cronbach α = 0.51, test-retest r = 0.55), which requires further optimization. The final questionnaire included topics on food groups (41 items), selecting food (2 items), nutrition and disease relationship (14 items), and food fortification in Uganda (22 items) and had good content, construct, and test-retest reliability to evaluate nutrition knowledge among Ugandan adults.

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial

Background

Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.

Methods

The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.

Results

Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.

Conclusions

The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

Using a mixed-methods approach to measure impact of a school-based nutrition and media education intervention study on fruit and vegetable intake of Italian children

OBJECTIVE

The purpose of the present study was to investigate the impact of a school-based nutrition and media education intervention on the promotion of fruit and vegetable consumption to help prevent childhood obesity.

DESIGN

The 10-week-long intervention included sessions on nutrition education and media literacy. It also included a health communication media-based campaign workshop during which the children created posters, newsletters and video commercials related to fruits and vegetables targeted to their parents. For evaluation purposes, the study utilized a mixed-methods approach, including a quasi-experimental study (with one intervention group and one control group) and a focus group study.

SETTING

Four different elementary schools in Treviso (Veneto Region of Italy) agreed to participate in the research.

SUBJECTS

The target population for the study included 10-year-old Italian children and their parents.

RESULTS

Data indicate that this intervention was effective for children but not for parents. Evaluation results show that the intervention was effective in significantly increasing children's fruit and vegetable intake (P<0·05) and all psychosocial determinants (P<0·05).

CONCLUSIONS

The study results confirm the efficacy of a school-based health and media education intervention to address the children's obesity issue and, in particular, to increase children's fruit and vegetable intake. The study also opens a new perspective on the theoretical constructs investigated, because the development of 'ability of expression' could be considered one of the most important factors to determine the efficacy of the intervention.

A Randomized School Trial of Environmental Strategies to Encourage Fruit and Vegetable Consumption among Children

The Cafeteria Power Plus project examined whether a cafeteria-based intervention would increase the fruit and vegetable (FV) consumption of children. Twenty-six schools were randomly assigned to either an intervention or control condition. Baseline lunch observations of a sample ( N = 1668) of first- and third-grade students occurred in the spring of 2000; follow-up was in the spring of 2002. The intervention took place during two consecutive school years beginning in the fall of 2000 and consisted of daily activities (increasing the availability, attractiveness, and encouragement for FV) and special events (kick-offs, samplings, challenge weeks, theater production, and finale meal). Training of food-service staff and cook managers was ongoing throughout the intervention phase. Students in the intervention schools significantly increased their total fruit intake. Process measures indicated that verbal encouragement by food-service staff was associated with outcomes. The outcomes suggest that multicomponent interventions are more powerful than cafeteria programs alone with this age group.

Positive influences of home food environment on primary-school children’s diet and weight status: a structural equation model approach

Objectives

The mechanism by which the home food environment (HFE) influences childhood obesity is unclear. The present study aimed to investigate the relationship between HFE and childhood obesity as mediated by diet in primary-school children.

Design

Cross-sectional data collected from parents and primary-school children participating in the Obesity Prevention and Lifestyle Evaluation Project. Only children aged 9–11 years participated in the study. Matched parent/child data (n3323) were analysed. Exploratory factor analysis underlined components of twenty-one HFE items; these were linked to child diet (meeting guidelines for fruit, vegetable and non-core food intakes) and measured child BMI, in structural equation modelling, adjusting for confounders.

Setting

Twenty geographically bounded metropolitan and regional South Australian communities.

Subjects

School children and their parents from primary schools in selected communities.

Results

In the initial exploratory factor analysis, nineteen items remaining extracted eight factors with eigenvalues >1·0 (72·4 % of total variance). A five-factor structure incorporating ten items described HFE. After adjusting for age, gender, socio-economic status and physical activity all associations in the model were significant (P<0·05), explaining 9·3 % and 4·5 % of the variance in child diet and BMI, respectively. A more positive HFE was directly and indirectly associated with a lower BMI in children through child diet.

Conclusions

The robust statistical methodology used in the present study provides support for a model of direct and indirect dynamics between the HFE and childhood obesity. The model can be tested in future longitudinal and intervention studies to identify the most effective components of the HFE to target in childhood obesity prevention efforts.

Development and evaluation of an intervention for the prevention of childhood obesity in a multiethnic population: the Born in Bradford applied research programme

Background

There is an absence of evidence about interventions to prevent or treat obesity in early childhood and in South Asian populations, in whom risk is higher.

Objectives

To study patterns and the aetiology of childhood obesity in a multiethnic population and develop a prevention intervention.

Design

A cohort of pregnant women and their infants was recruited. Measures to compare growth and identify targets for obesity prevention, sensitive to ethnic differences, were collected. A feasibility randomised controlled trial (RCT) was undertaken.

Setting

Bradford, UK.

Participants

A total of 1735 mothers, 933 of whom were of South Asian origin.

Intervention

A feasibility trial of a group-based intervention aimed at overweight women, delivered ante- and postnatally, targeting key modifiable lifestyle behaviours to reduce infant obesity.

Main outcome measures

The feasibility and acceptability of the pilot intervention.

Data sources

Routine NHS data and additional bespoke research data.

Review methods

A systematic review of diet and physical activity interventions to prevent or treat obesity in South Asian children and adults.

Results

Routine measures of growth were accurate. The prevalence of risk factors differed between mothers of white British ethnicity and mothers of Pakistani ethnicity and weight and length growth trajectories differed between Pakistani infants and white British infants. Prediction equations for risk of childhood obesity were developed. An evidence-based intervention was evaluated in a pilot RCT and was found to be feasible and acceptable.

Limitations

This was a single-centre observational study and a pilot evaluation.

Conclusions

The programme has been successful in recruiting a unique multiethnic childhood obesity cohort, which has provided new evidence about modifiable risk factors and biethnic growth trajectories. A novel group-based behavioural change intervention has been developed and successfully piloted. A multisite cluster RCT is required to evaluate effectiveness.

Trial registration

Current Controlled Trials ISRCTN56735429.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Understanding and Changing Food Consumption Behavior Among Children: The Comprehensive Child Consumption Patterns Model

Current theoretical models attempting to explain diet-related weight status among children center around three individual-level theories. Alone, these theories fail to explain why children are engaging or not engaging in health-promoting eating behaviors. Our Comprehensive Child Consumption Patterns model takes a comprehensive approach and was developed specifically to help explain child food consumption behavior and addresses many of the theoretical gaps found in previous models, including integration of the life course trajectory, key influencers, perceived behavioral control, and self-regulation. Comprehensive Child Consumption Patterns model highlights multiple levels of the socioecological model to explain child food consumption, illustrating how negative influence at multiple levels can lead to caloric imbalance and contribute to child overweight and obesity. Recognizing the necessity for multi-level and system-based interventions, this model serves as a template for holistic, integrated interventions to improve child eating behavior, ultimately impacting life course health development.

Do specific parenting practices and related parental self-efficacy associate with physical activity and screen time among primary schoolchildren? A cross-sectional study in Belgium

OBJECTIVES

To assess the association between specific parenting practices and related parental self-efficacy with children's physical activity (PA) and screen time. Parental body mass index (BMI), family socioeconomic status (SES), and child's age and gender were examined as possible influencing factors.

DESIGN

Cross-sectional.

SETTING

January 2014, Flanders (Belgium).

PARTICIPANTS

207 parents (87.4% mothers) of children aged 6-12 years.

OUTCOME MEASURES

Specific parenting practices, related parental self-efficacy, and children's PA and screen time.

RESULTS

The majority of investigated parenting practices and related parental self-efficacy were not significantly associated with children's PA or screen time. However, children were more physically active if sports equipment was available at home (p<0.10) and if parents did not find it difficult to motivate their child to be physically active (p<0.05). Children had a lower screen time if parents limited their own gaming (p<0.01). The associations between parenting practices and related parental self-efficacy with children's PA or screen time were significant for parents with a normal BMI, for medium-high SES families and for parents of younger children. Furthermore, the association between the parenting relating factors and children's PA and screen time differed for boys and girls.

CONCLUSIONS

In contrast to what we expected, the findings of the current study show that only a very few specific parenting practices and related parental self-efficacy were associated with children's PA and screen time. It was expected that parental self-efficacy would play a more important role. This can be due to the fact that parental self-efficacy was already high in this group of parents. Therefore, it is possible that parents do not realise how difficult it is to perform certain parenting practices until they are faced with it in an intervention.

TRIAL REGISTRATION NUMBER

EC/2012/317.

Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon

BACKGROUND

In Lebanon, childhood obesity doubled during the past decade. Preventive measures should start early in life and Schools are considered an important environment to promote energy balance health behaviours. School-based programmes promoting healthy lifestyles are lacking. The purpose of this study was to evaluate the feasibility and effectiveness of a multicomponent school-based intervention to promote healthy eating and physical activity (and prevent obesity) with school children aged 9-11 years in Lebanon.

METHODS

The intervention was developed based on the constructs of the Social Cognitive Theory and adapted to the culture of Lebanese and Arab populations. It consisted of three components: class curriculum, family involvement and food service. Eight schools were purposively selected from two communities of different socioeconomic status (SES) in Beirut and, within each school type, were matched on SES, religious sect profile, and then randomly assigned to either the intervention or control group. Anthropometric measurements and questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted in intervention schools at the end of the study. Challenges encountered during the programme implementation were also identified, since Lebanon is considered a country with political unrest and no similar research projects were conducted in the area.

RESULTS

Students in the intervention group reported purchasing and consuming less chips and sweetened drinks post-intervention compared with controls (86% & 88% less respectively p < 0.001). Knowledge and self-efficacy scores increased for the intervention (+2.8 & +1.7 points respectively p < 0.001) but not for the control group. There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Interview data from focus groups showed that the programme was generally well accepted. Limitations for better outcomes include the length of the programme and the school environment.

CONCLUSION

"Health-E-PALS" intervention is a promising innovative, theory-based, culturally sensitive intervention to promote healthy eating habits and physical activity in Lebanese school children with a potential to be scaled up, replicated and sustained.

Parent-adolescent conversations about eating, physical activity and weight: prevalence across sociodemographic characteristics and associations with adolescent weight and weight-related behaviors

This paper aims to describe the prevalence of parent-adolescent conversations about eating, physical activity and weight across sociodemographic characteristics and to examine associations with adolescent body mass index (BMI), dietary intake, physical activity and sedentary behaviors. Data from two linked epidemiological studies were used for cross-sectional analysis. Parents (n = 3,424; 62% females) and adolescents (n = 2,182; 53.2% girls) were socioeconomically and racially/ethnically diverse. Fathers reported more parent-adolescent conversations about healthful eating and physical activity with their sons and mothers reported more weight-focused conversations with their daughters. Parents of Hispanic/Latino and Asian/Hmong youth and parents from lower socioeconomic status categories engaged in more conversations about weight and size. Adolescents whose mothers or fathers had weight-focused conversations with them had higher BMI percentiles. Adolescents who had two parents engaging in weight-related conversations had higher BMI percentiles. Healthcare providers may want to talk about the types of weight-related conversations parents are having with their adolescents and emphasize avoiding conversations about weight specifically.

Independent and combined associations of total sedentary time and television viewing time with food intake patterns of 9- to 11-year-old Canadian children

The relationships among sedentary time, television viewing time, and dietary patterns in children are not fully understood. The aim of this paper was to determine which of self-reported television viewing time or objectively measured sedentary time is a better correlate of the frequency of consumption of healthy and unhealthy foods. A cross-sectional study was conducted of 9- to 11-year-old children (n = 523; 57.1% female) from Ottawa, Ontario, Canada. Accelerometers were used to determine total sedentary time, and questionnaires were used to determine the number of hours of television watching and the frequency of consumption of foods per week. Television viewing was negatively associated with the frequency of consumption of fruits, vegetables, and green vegetables, and positively associated with the frequency of consumption of sweets, soft drinks, diet soft drinks, pastries, potato chips, French fries, fruit juices, ice cream, fried foods, and fast food. Except for diet soft drinks and fruit juices, these associations were independent of covariates, including sedentary time. Total sedentary time was negatively associated with the frequency of consumption of sports drinks, independent of covariates, including television viewing. In combined sedentary time and television viewing analyses, children watching >2 h of television per day consumed several unhealthy food items more frequently than did children watching ≤2 h of television, regardless of sedentary time. In conclusion, this paper provides evidence to suggest that television viewing time is more strongly associated with unhealthy dietary patterns than is total sedentary time. Future research should focus on reducing television viewing time, as a means of improving dietary patterns and potentially reducing childhood obesity.

Manga comic influences snack selection in Black and Hispanic New York City youth

OBJECTIVE

To determine whether a single exposure to a Manga comic (Japanese comic art) with multiple messages promoting fruit intake influenced snack selection in minority urban youth.

METHODS

Fifty-seven youth (mean age 10.8 y; 54% female; 74% black/African American) attending after-school programs in Brooklyn, NY participated in a pilot study in which they were randomly assigned to receive the comic or a non-health-related newsletter. After reading their media, participants were offered a snack and could choose from among healthy/unhealthy options. Secondary outcomes included knowledge, self-efficacy, and outcome expectations related to fruit intake and media transportation. Data were analyzed using regression and paired t test.

RESULTS

Comic group participants were significantly more likely to choose a healthy snack, compared to the Attention-control group (odds ratio = 3.6, 95% confidence interval: 1.1-12.1, P = .04). The Comic group reported increases in self-efficacy (P = .04) and greater transportation (immersion into media) (P = .006).

CONCLUSIONS AND IMPLICATIONS

Results suggest Manga comics may be a useful format to promote healthy snack selection in urban minority youth.

Relationships between health behaviors and weight status in American Indian and white rural children

PURPOSE

Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States.

METHODS

Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States.

FINDINGS

Multinomial logistic regression models were statistically significant for girls (χ2 [20] = 42.73, P < .01), boys (χ2 [20] = 50.44, P < .001), American Indian (χ2 [20] = 36.67, P < .05), and white children (χ2 [20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys.

CONCLUSIONS

Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.

Community food environment, home food environment, and fruit and vegetable intake of children and adolescents

OBJECTIVES

To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment.

METHODS

In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati.

RESULTS

Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment.

CONCLUSIONS AND IMPLICATIONS

A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.

Food safety is a key determinant of fruit and vegetable consumption in urban Beninese adolescents

OBJECTIVE

To identify the determinants of fruit and vegetable consumption in urban Beninese adolescents and elements to develop a school-based fruit and vegetable program.

DESIGN

Sixteen focus groups conducted with a key word guide.

SETTING AND PARTICIPANTS

Two private and 2 public secondary schools in Cotonou, Benin. One hundred fifty-three students aged 13 to 19 years, 54% girls.

ANALYSIS

The focus groups were audiotaped, transcribed, and analyzed. Three a priori categories from the Social Cognitive Theory were used for the coding: socioenvironmental, personal, and behavioral factors. Additionally, the data were checked to determine whether new categories should be created.

RESULTS

Major determinants in the school were availability and accessibility of fruits and vegetables, nutrition education, and the competition of unhealthful foods. Food safety emerged as a strong barrier to the adolescents' fruit and vegetable consumption outside home and particularly at school.

CONCLUSIONS AND IMPLICATIONS

Except for food safety, the determinants of fruit and vegetable intake in Beninese adolescents were similar to those in high-income countries. The food safety of fruits and vegetables outside home is a key issue to be studied in detail and integrated in any intervention in Benin and potentially other low- and middle-income countries.

Development and preliminary validation of the Parent Efficacy for Child Healthy Weight Behaviour Scale

This study developed a new measure of parent self-efficacy for promoting healthy weight behaviours in their children, the Parent Efficacy for Child Healthy Weight Behaviour Scale (PECHWB). In total 601 primary caregivers of children aged 4-17 completed an online survey consisting of the PECHWB, a measure of general parenting self-efficacy, measures of parental depression, anxiety and stress and demographic questions. Factor analysis identified four PECHWB subscales with high levels of internal consistency. The PECHWB showed significant small positive correlations with a measure of global parenting self-efficacy and small negative correlations with measures of parental negative affect. This study provides initial evidence for the reliability and validity of the PECHWB. Future research is required to establish further evidence of the psychometric properties of the PECHWB scale in independent samples before the scale can be used in evaluating intervention outcomes.

Measurement properties of psychosocial and environmental measures associated with fruit and vegetable intake among middle school adolescents

OBJECTIVE

To assess the measurement properties of several scales modified or created to assess factors related to fruit and vegetable intake within a young adolescent population.

DESIGN

Cross-sectional with data collected via self-report.

SETTING

Data were collected in regularly scheduled classes in the school setting.

PARTICIPANTS

African American and Caucasian middle school students (ages 11-15 years).

VARIABLES MEASURED

Self-efficacy, modeling, outcome expectations, normative beliefs, parental food management practices, and influences on food choice.

ANALYSIS

Pearson correlations, factor analysis, and Cronbach α.

RESULTS

Subscales with adequate to good internal consistencies (0.65-0.88) were established. Fruit and vegetable intake was significantly correlated with self-efficacy, parent and peer modeling, family and peer normative beliefs, and social and health outcome expectations. Fruit and vegetable intake was not significantly correlated with permissive eating, food self-preparation, or the 3 subscales measuring influences on food choice (social influence, avoiding weight-gain food, and appeal and access).

CONCLUSIONS AND IMPLICATIONS

These measures, most originally developed for children and adults and modified for this study, demonstrated adequate measurement properties for an adolescent sample.

Nutrition education intervention improves vegetable-related attitude, self-efficacy, preference, and knowledge of fourth-grade students

BACKGROUND

Impact of a classroom-based, standardized intervention to address limited vegetable consumption of fourth graders was assessed.

METHODS

A 4-lesson, vegetable-focused intervention, revised from extant materials was repurposed for Pennsylvania fourth graders with lessons aligned with state academic standards. A reliability-tested survey was modified, then examined for face and content validity and test-retest reliability. Lessons and evaluation materials were modified through an iterative testing process with educator feedback. A nonequivalent control group design was stratified by local Supplemental Nutrition Assistance Program Education (SNAP-Ed) partnering organizations with random assignment of participating elementary schools as control (N = 68) or intervention (N = 72) treatments. Independent t-tests compared control and intervention group changes. A mixed effects model was created to account for classroom effects from the nested sampling method of selecting classrooms within SNAP-Ed partnering organizations. General linear model univariate analyses of variance were conducted to assess intervention effects considering gender, and food preparation/cooking experience.

RESULTS

During a 3- to 5-week time frame, 57 intervention classrooms (N = 1047 students) and 51 control classrooms (N = 890) completed pre- and post-testing. Intervention students improved in vegetable-related attitude, self-efficacy, preference, and knowledge scores (p < .001). For example, intervention vegetable preference increased 1.56 ± 5.80 points; control group mean increase was only 0.08 ± 4.82 points. Group differences in score changes were not affected by gender or interactions between gender and food preparation/cooking experience with family.

CONCLUSIONS

A defined intervention delivered in a SNAP-Ed setting can positively impact mediators associated with vegetable intake for fourth-grade students.

Relationship between home fruit and vegetable availability and infant and maternal dietary intake in African-American families: evidence from the exhaustive home food inventory

BACKGROUND

The availability of foods in the home is likely to be related to consumption. We know of no studies that have reported this association in African-American participants, and few studies have examined home food availability using objective methods.

OBJECTIVE

This study aimed to assess the association between objective measures of fruits and vegetables in the home with reported infant and maternal diet in low-income African Americans.

DESIGN

A cross-sectional study design was used to compare food availability and dietary intake. The Exhaustive Home Food Availability Inventory used barcode scanning to measure food availability in the home. Maternal and infant diet was assessed by 24-hour recall.

SUBJECTS/SETTING

Eighty African-American first-time mother/infant dyads were recruited from Wake and Durham counties in North Carolina.

STATISTICAL ANALYSES PERFORMED

Adjusted mean dietary intake of infants and mothers was calculated within tertiles of food and nutrient availability using analysis of variance. The bootstrap method was used to estimate P values and 95% confidence intervals. Models were adjusted for mother's age, household size, shopping and eating-out behavior.

RESULTS

Infants and mothers living in homes in the highest tertile of availability of energy, nutrients, and fruits and vegetables tended to have the highest consumption, respectively; however, statistically significant associations were more likely to occur with infant diet than maternal diet. The relationship was strongest for infant consumption of fruit, with an average of 103.3 g consumed by infants who lived in homes in the highest tertile of availability, compared to 42.5 g in those living in homes in the lowest tertile (P<0.05).

CONCLUSIONS

Availability of fruits and vegetables in the home was associated with intake of those foods in a sample of African-American mothers and infants. Results support making changes in the home environment as a method of promoting changes in fruit and vegetable intake.

Child consumption of fruit and vegetables: the roles of child cognitions and parental feeding practices

OBJECTIVE

To examine the roles of child cognitions and parental feeding practices in explaining child intentions and behaviour regarding fruit and vegetable consumption.

DESIGN

Cross-sectional surveys among pre-adolescent children and their parents.

SETTING

The child questionnaire included measures of fruit and vegetable consumption and cognitions regarding fruit and vegetable consumption as postulated by the Attitude-Social Influence-Self-Efficacy (ASE) model. The parent questionnaire included measures of parental feeding practices derived from the Comprehensive Feeding Practices Questionnaire (CFPQ).

SUBJECTS

In total, 963 parents and 796 students in grades 5 and 6 from eighteen schools in the south-western part of Norway participated.

RESULTS

A large portion of child intention to eat fruit and child fruit consumption was explained by child cognitions (29 % and 25 %, respectively). This also applied to child intention to eat vegetables and child vegetable consumption (42 % and 27 %, respectively). Parent-reported feeding practices added another 3 % to the variance explained for child intention to eat fruit and 4 % to the variance explained for child vegetable consumption.

CONCLUSIONS

The results from the present study supported the application of the ASE model for explaining the variance in child intentions to eat fruit and vegetables and in child consumption of fruit and vegetables. Furthermore, our findings indicated that some parental feeding practices do have an influence on child intentions and behaviour regarding fruit and vegetable consumption. However, the role of parental feeding practices, and the pathways between feeding practices and child eating intentions and behaviour, needs to be further investigated.

Maternal self-efficacy in the home food environment: a qualitative study among low-income mothers of nutritionally at-risk children in an urban area of Jakarta, Indonesia

OBJECTIVE

To explore the factors that encompass maternal self-efficacy in providing food for the home.

METHODS

In-depth interviews were conducted with 19 mothers of nutritionally at risk children in an urban area of East Jakarta, Indonesia. This study was based on Social Cognitive Theory, Family Stress Models, and Ecological Frameworks. Data collection was coded and analyzed using the Grounded Theory Method.

RESULTS

Most mothers felt secure in providing food for their families knowing that their relatives and neighbors would support them if they lacked the money to buy food; however, most of them did not supply appropriate meals in terms of nutrient content, variety, and timing.

CONCLUSIONS AND IMPLICATIONS

Maternal self-efficacy was mainly characterized by practical issues concerning the preparation of food at home and a lack of knowledge of health and nutrition. Family-based interventions are needed to enhance competence in providing nutritious food from available resources.

Can a community-based intervention improve the home food environment? parental perspectives of the influence of the delicious and nutritious garden

OBJECTIVE

To examine changes in parental report of the home food environment during the course of a garden-based fruit and vegetable (FV) intervention for grade school children.

METHODS

Self-administered pre-post surveys were completed by parents/caregivers (n = 83). Main outcome measures included: child asking behavior, FV availability/accessibility, parental encouragement, and value of FV consumption.

RESULTS

Process evaluation results indicate children shared their garden experiences at home, and as a result, the children's home food environment became increasingly supportive of FV consumption. Parents reported an increase (P < .01) in the frequency that their child asked for FVs. Parental value for FV consumption also improved (P < .01), as did home availability of fruit (P < .05), vegetables (P < .001), and parental encouragement of FVs (P = .06).

CONCLUSIONS AND IMPLICATIONS

Community-based interventions that provide activities to engage parents may provide added benefit by improving the home food environment.

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, child's preferences for FV and AA of FV in homes of low-income Hispanic families with children 5-12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and child's preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.

The Effects of School Garden Experiences on Middle School-Aged Students’ Knowledge, Attitudes, and Behaviors Associated With Vegetable Consumption

This study describes the effects of garden-based education on children’s vegetable consumption. As part of a pre—post panel study, 236 students complete the Garden Vegetable Frequency Questionnaire and 161 complete a taste test. Results indicate that school gardening may affect children’s vegetable consumption, including improved recognition of, attitudes toward, preferences for, and willingness to taste vegetables. Gardening also increases the variety of vegetables eaten. Future research should explore whether effects persist over time and if and how changes in children’s behavior affect the behavior of their caregivers. Implications of study findings for policy and practice are discussed. Suggestions for applying results to future health promotions are provided.

Psychosocial correlates of eating behavior in children and adolescents: a review

BACKGROUND

Understanding the correlates of dietary intake is necessary in order to effectively promote healthy dietary behavior among children and adolescents. A literature review was conducted on the correlates of the following categories of dietary intake in children and adolescents: Fruit, Juice and Vegetable Consumption, Fat in Diet, Total Energy Intake, Sugar Snacking, Sweetened Beverage Consumption, Dietary Fiber, Other Healthy Dietary Consumption, and Other Less Healthy Dietary Consumption in children and adolescents.

METHODS

Cross-sectional and prospective studies were identified from PubMed, PsycINFO and PsycArticles by using a combination of search terms. Quantitative research examining determinants of dietary intake among children and adolescents aged 3-18 years were included. The selection and review process yielded information on country, study design, population, instrument used for measuring intake, and quality of research study.

RESULTS

Seventy-seven articles were included. Many potential correlates have been studied among children and adolescents. However, for many hypothesized correlates substantial evidence is lacking due to a dearth of research. The correlates best supported by the literature are: perceived modeling, dietary intentions, norms, liking and preferences. Perceived modeling and dietary intentions have the most consistent and positive associations with eating behavior. Norms, liking, and preferences were also consistently and positively related to eating behavior in children and adolescents. Availability, knowledge, outcome expectations, self-efficacy and social support did not show consistent relationships across dietary outcomes.

CONCLUSION

This review examined the correlates of various dietary intake; Fruit, Juice and Vegetable Consumption, Fat in Diet, Total Energy Intake, Sugar Snacking, Sweetened Beverage Consumption, Dietary Fiber, Other Healthy Dietary Consumption, and Other Less Healthy Dietary Consumption in cross-sectional and prospective studies for children and adolescents. The correlates most consistently supported by evidence were perceived modeling, dietary intentions, norms, liking and preferences. More prospective studies on the psychosocial determinants of eating behavior using broader theoretical perspectives should be examined in future research.

A garden pilot project enhances fruit and vegetable consumption among children

Fruit and vegetable intake among children is inadequate. Garden-based nutrition education programs may offer a strategy for increasing fruit and vegetable intake in children. A 12-week pilot intervention was designed to promote fruit and vegetable intake among 4th to 6th grade children (n=93) attending a YMCA summer camp. Children participated in garden-based activities twice per week. Weekly educational activities included fruit and vegetable taste tests, preparation of fruit and vegetable snacks, and family newsletters sent home to parents. The pilot intervention was evaluated using a pre and post survey to determine participant satisfaction and the short-term impacts of the program. The process evaluation focused on program satisfaction, whereas the short-term impact evaluation assessed fruit and vegetable exposure, preference, self-efficacy, asking behavior, and availability of fruits and vegetables in the home. Data from the impact evaluation were compared from baseline to follow-up using McNemar's test (dichotomous variables) and Wilcoxon signed rank test (scales/continuous variables). Children reported high levels of enjoyment in the intervention activities. Most children (97.8%) enjoyed taste-testing fruits and vegetables. Children also liked preparing fruit and vegetable snacks (93.4%), working in their garden (95.6%), and learning about fruits and vegetables (91.3%). Impact data suggest that the intervention led to an increase in the number of fruits and vegetables ever eaten (P<0.001), vegetable preferences (P<0.001), and fruit and vegetable asking behavior at home (P<0.002). Garden-based nutrition education programs can increase fruit and vegetable exposure and improve predictors of fruit and vegetable intake through experiential learning activities. Participation in the "seed to table" experience of eating may help promote healthful eating behaviors among youth. Food and nutrition professionals should consider garden-based nutrition education programs that connect children with healthful foods through fun, hands-on activities.