The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents

Public Procurement Practices for Cereal Products in Polish Educational Institutions: Analysis and Implications for Nutrition Policy

Public procurement of food is crucial for ensuring proper nutrition and the provision of high-quality products in public institutions like schools and kindergartens. It should be seen as an investment in health promotion, particularly for young children. Notably, when no quality criteria are specified, the cheapest and often lowest-quality products are typically selected. This study analyzed 1126 public procurement orders processed by schools and kindergartens in Poland between November 2022 and March 2023, with a focus on cereal products and their derivatives. Of these orders, 197 met the inclusion criteria, yielding a total of 5084 cereal products for detailed analysis. The study assessed the quantities ordered and the quality characteristics specified in the procurement documents. The results revealed that the most commonly described criteria pertained to product composition, especially typical characteristics and the absence of additives. Sensorial characteristics such as consistency and color were also frequently specified, while sustainable public procurement criteria were mentioned the least, indicating their marginal importance in current procurement practices. This underscores the critical importance of establishing minimum standards for describing cereal products in terms of sensorial characteristics, composition, and sustainability. Such standards are essential for improving the quality of grain products supplied to public institutions and ensuring that these institutions actively contribute to promoting healthy eating habits among children.

Patient-reported outcomes following dental implant rehabilitation according to reason for missing teeth: A survey from a Norwegian population 8 years following treatment

AIM

The aim of this study was to assess patient-reported outcomes (PROs) 8 years after dental implant rehabilitation in a sample with tooth loss due to periodontitis (TLP) and a sample with missing teeth for other reasons (MTOR).

MATERIALS AND METHODS

The Norwegian National Insurance Scheme registry of subsidized dental implant therapy was searched, and patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire. PROs were described by relative frequencies, and the TLP and MTOR subsamples were compared using chi-square test. Multiple linear regression analyses were used to investigate variables potentially predicting PROs.

RESULTS

Of the respondents (n = 1299), more than 90% were partly or fully satisfied with the treatment outcome. Complications were reported by 44.2%. Patients who lost teeth due to periodontitis (n = 784) reported greater oral function improvement and better pre-treatment information, and were more likely to experience complications when compared with patients who lost teeth for other reasons (n = 515). Age, level of education, self-funded cost, pre-treatment information, history of complications and the reason for missing teeth were found to predict PROs.

CONCLUSIONS

In a Norwegian population rehabilitated with dental implants in 2014, satisfaction with the treatment outcome and the aesthetic outcome was high, irrespective of the reason for missing teeth. Self-report of complications and lack of pre-treatment information were the strongest predictors of inferior patient satisfaction and also predicted inferior oral function.

Are exposure to health information and media health literacy associated with fruit and vegetable consumption?

BACKGROUND

Health information promotes a healthy lifestyle; however, media health literacy (MHL) is essential to personal intake, especially fruit and vegetables (F&V). This study aimed to determine how exposure to health information and MHL affect F&V consumption among Thai youth aged 10-14 years. Health behavior at this age can be an important determinant of consumption habits when transitioning into adulthood.

METHODS

A stratified two-stage sample survey was conducted to recruit 1,871 youth across regions to be nationally representative. Qualtrics offline survey application was used for data collection face-to-face with all respondents. Multiple linear regression was used to analyze the explanatory variables on fruit consumption and vegetable consumption.

RESULTS

This study found that almost 70% of Thai youth were exposed to health-related content via the Internet, and had low analytical skills to process that information. Grade Point Average (GPA), exposure to health information, various media types, frequency of exposure to health information, and MHL influenced the frequency of F&V intake. Health status related to fruit intake, age, place of residence, amount of pocket money, and body mass index (BMI) were associated with F&V consumption.

CONCLUSION

Exposure to health information and MHL are associated with F&V intake. Therefore, exposure to health information and MHL should be addressed for policy formulation in Thai schools and the health system.

Cross-sectional associations between screen time and the selected lifestyle behaviors in adolescents

Background

In adolescents, excessive screen time leads to many adverse health outcomes and is associated with a variety of lifestyle behaviors. This study was conducted to investigate the associations between the two types of screen time and a variety of lifestyle behaviors in American adolescents.

Methods

Based on the Youth Risk Behavior Surveillance System, this cross-sectional study was conducted. With the help of data collectors, participants self-reported screening time, lifestyle behaviors, and demographic data via well-validated tools.

Results

19% and 43.4% of the participants spent more than two hours a day watching television and using the computer, respectively, while the prevalence of physical inactivity and insufficient sleep was 75.1 and 74.4% respectively. Furthermore, 11.9, 7.3, 14.3, and 21.3% of the participants reported skipping fruits, vegetables, breakfast and milk, respectively. Moreover, the prevalence of alcohol and tobacco consumption and sexual activity was 26.8, 5.3, and 23.5% respectively. More than two hours of television time was significantly associated with high risks of fewer frequency for eating fruit (OR = 1.605, 95%CI: 1.308-1.970), vegetables (OR = 1.389, 95%CI: 1.029-1.873), and smoking (OR = 1.465, 95%CI: 1.088-1.972). Computer/video time for more than two hours was significantly associated with high risks of physical inactivity (OR = 1.724, 95%CI: 1.531-1.941), insufficient sleep (OR = 1.354, 95%CI: 1.151-1.592), and not eating fruit (OR = 1.434, 95%CI: 1.179-1.745).

Conclusion

Increased screen time may be associated with specific unhealthy lifestyle behaviors in adolescents. Furthermore, the associations between different types of screen time and various lifestyle behaviors varied.

Like parent, like child: a cross-sectional study of intra-household consumption patterns of non-alcoholic beverages among British households with children

OBJECTIVE

Most research investigating sugar-sweetened beverages (SSB) and health, conducted at the individual or household level, ignores potentially important intra-household dynamics. We analysed self-reported consumption relationships between children and adults, and between children of different ages, as well as the associations between intra-household consumption, BMI and sociodemographic characteristics.

DESIGN

A cross-sectional analysis of survey data from Kantar Fast Moving Consumer Goods panellists in September 2017.

SETTING

Great Britain.

PARTICIPANTS

Random sample of 603 households with children under 18 years who regularly purchase non-alcoholic beverages.

RESULTS

Low- or no-sugar/diet beverages dominate consumption across all age categories, particularly children under 12 years. SSB consumption increased as children became older. Children's reported consumption of SSB and low- or no-sugar/diet beverages was positively associated with consumption by adults; a child in adolescence had over nine times the odds of consuming SSB (adjusted OR 9·55, (95 % CI 5·38, 17·00), P < 0·001), and eight times the odds of consuming low- or no-sugar/diet drinks (adjusted OR 8·12, (95 % CI 4·71, 13·97), P < 0·001), if adults did so. In households with multiple children, consumption patterns of older siblings were associated with those of the younger; notably a perfect correlation between children aged 0 and 6 years consuming SSB if siblings 13-18 years did so, and children aged 7-12 years had 22 times the odds of consuming SSB if siblings aged 13-18 years did so (OR 22·33, (95 % CI 8·60, 58·01), P < 0·001).

CONCLUSIONS

Multiple policies, targeting children as well as adults, such as fiscal levers and advertisement restrictions, are needed to reduce and prevent the consumption of SSB.

Knowledge about caries and erosive tooth wear is confused among Norwegian high school students

OBJECTIVES

This study investigated differences in high school students' subjective and objective knowledge- and concerns about preventing caries and/or erosive tooth wear and the associations between these variables.

MATERIALS AND METHODS

A survey was conducted among students at 16 high schools in Norway. The survey included a range of fact-based questions to measure objective knowledge about caries and erosive tooth wear, as well as questions about students' perceptions of his/her own knowledge (subjective knowledge) and concerns about preventing the two conditions.

RESULTS

There were small differences in subjective knowledge about caries and erosive tooth wear among the 784 students who completed the survey (p < .01). However, students scored significantly higher on objective knowledge about caries (mean 2.99) than about erosive tooth wear (mean 1.45), p < .01, and seemed to confuse the two conditions. By contrast, students scored significantly worse on questions about beverages' potential to cause caries (mean 5.18) than to cause erosive tooth wear (mean 6.30), p < .001. Finally, objective knowledge about caries was positively associated with subjective knowledge about caries, but corresponding associations could not be found for erosive tooth wear.

CONCLUSIONS

Knowledge about caries and erosive tooth wear seemed to be confused among Norwegian high school students.

Parental perceptions of the food environment and their influence on food decisions among low-income families: a rapid review of qualitative evidence

Background

The food environment within and surrounding homes influences family dietary habits with socio-economic areas at a nutritional disadvantage. Families’ perception of the food environment and how it influences their food decisions is less clear. This rapid review aimed to synthesise qualitative evidence of parental perspectives of the food environment and their influence on food decisions among disadvantaged families.

Method

Qualitative and mixed-methods peer-reviewed journal articles published after 2000, that explored the perspectives of low-income parents in relation to their food environment and how this impacted food decisions for families with children aged 2-17 years, were included in this review. Embase, Scopus and PsycINFO were the databases chosen for this review. Search strategies included seven concepts related to family, food, perceptions, influences, environment, socio-economic status and study type. Two independent reviewers screened sixty-four studies. Thematic synthesis was employed.

Results

Two thousand one hundred and forty five results were identified through database searching and 1,650 were screened. Fourteen articles that originated from the US, Australia and the UK were included in this review. No articles were excluded following quality appraisal. Child preferences, financial and time constraints, and location and access to food outlets were barriers to accessing healthy food. Parental nutrition education and feeding approaches varied but positive outcomes from interventions to address these behaviours will be short-lived if inequities in health caused by poverty and access to affordable and healthy food are not addressed. The reliance on social support from families or government sources played an important role for families but are likely to be short-term solutions to health and nutritional inequities.

Conclusions

This qualitative evidence synthesis provides an insight into the perceptions of low-income parents on the factors influencing food decisions. Findings have implications for public health and the development of effective strategies to improve the dietary habits of children of disadvantaged families. Sustainable changes to dietary habits for families on low-income requires policy responses to low income, food access and to the high cost of healthy foods.

Increasing dietary calcium intake of children and their parents: a randomised controlled trial

OBJECTIVE

Approximately 25 % of Canadian children aged 4-8 years fail to meet the recommended dietary allowance (RDA) of calcium (Ca). Young children's food choices are primarily determined by their parents. No interventions have directly targeted parents as a medium through which to increase children's Ca consumption. This study compared the effectiveness of a Ca-specific intervention targeted towards parents, with generic dietary advice on the Ca consumption of children aged 4-10 years.

DESIGN

A parallel two-arm randomised controlled trial was conducted.

SETTING

The study was conducted across Canada. Both conditions received information on the RDA of Ca and an index of intake requirements. Material sent to the intervention condition included behavioural strategies to increase dietary Ca consumption, information on the benefits of dietary Ca intake and messages addressing perceived barriers to the consumption of Ca-rich foods.

PARTICIPANTS

A total of 239 parents (93 % mothers) of children aged 4-10 years who consumed less than the RDA of Ca were randomly assigned in a 1:1 allocation ratio.

RESULTS

There was a significant increase in total Ca intake and Ca from dairy for children at weeks 8, 34 and 52 (P ≤ 0·001) in both conditions. Parental Ca intake and amount spent on dairy products did not significantly increase following the intervention.

CONCLUSIONS

Provision of daily Ca requirements with regular reminders could impact parents' delivery of Ca-rich foods to their children. This finding is important for public health messaging as it suggests that parents are a potent medium through which to promote Ca intake in children.

Adolescent vegetable consumption: the role of socioemotional family characteristics

OBJECTIVE

To describe associations between adolescents' frequency of vegetable consumption, food parenting practices and socioemotional family characteristics, and to explore potential mediated relationships that may contribute to an understanding of the family processes involved.

DESIGN

Cross-sectional survey among adolescents aged 13-15 years.

SETTING

A survey questionnaire including self-report measures on adolescents' frequency of vegetable consumption, perceived food parenting practices (i.e. family dinner frequency, maternal/paternal healthy eating guidance (HEG), maternal/paternal social support for vegetable consumption) and socioemotional family characteristics (i.e. general family functioning and level of cohesion and conflict within the family) was distributed in a convenience sample of secondary school students.

PARTICIPANTS

Four hundred forty students from five secondary schools in eastern Norway completed the questionnaire.

RESULTS

Results from multiple linear regression analysis revealed positive and statistically significant associations between adolescents' frequency of vegetable consumption, maternal HEG and family cohesion. A partial indirect (mediated) association between family cohesion and adolescents' frequency of vegetable consumption, working through maternal HEG, was also found.

CONCLUSIONS

Results from the present study suggest that perceived family cohesion may influence adolescents' frequency of vegetable consumption both directly and indirectly. However, there is a need for continued investigation of family-related factors influencing adolescent eating. In particular, the role of socioemotional family characteristics should be further scrutinised in future studies.

The Influence of Parental Dietary Behaviors and Practices on Children's Eating Habits

Poor dietary habits established during childhood might persist into adulthood, increasing the risk of developing obesity and obesity-related complications such as Type 2 Diabetes Mellitus. It has been found that early modifications in eating habits, especially during childhood, might promote health and decrease the risk of developing diseases during later life. Various studies found a great influence of parental dietary habits on dietary behaviors of their children regardless of demographic characteristics such as gender, age, socioeconomic status and country; however, the exact mechanism is still not clear. Therefore, in this review, we aimed to investigate both parents’ and children’s dietary behaviors, and to provide evidence for the potential influence of parents’ dietary behaviors and practices on certain children’s eating habits. Family meals were found to contribute the most in modeling children’s dietary habits as they represent an important moment of control and interaction between parents and their children. The parental practices that influenced their children most were role modeling and moderate restriction, suggesting that the increase of parental encouragement and decrease of excessive pressure could have a positive impact in their children’s dietary behaviors. This narrative review highlights that parental child-feeding behaviors should receive more attention in research studies as modifiable risk factors, which could help to design future dietary interventions and policies to prevent dietary-related diseases.

Promoting water consumption among Dutch children: an evaluation of the social network intervention Share H2O

Background

There is a need to develop and improve interventions promoting healthy drinking behaviors among children. A promising method could be to stimulate peer influence within children’s social networks. In the Share H₂O social network intervention (SNI), peer influence was utilized by selecting a subset of influential children and training them as ‘influence agents’ to promote water consumption—as an alternative to SSBs. Previous research has mainly focused on the process of selecting influence agents. However, the process of motivating influence agents to promote the behavior has hardly received any research attention. Therefore, in the SNI Share H₂O SNI, this motivation process was emphasized and grounded in the self-determination theory (SDT). This study evaluated the implementation of the Share H₂O SNI, focusing on whether and how applying SDT-based techniques can motivate the influence agents and, indirectly, their peers.

Methods

This study included data collected in the Netherlands from both the influence agents (n = 37) and the peers (n = 112) in the classroom networks of the influence agents.

Self-reported measurements assessed the influence agents’ enjoyment of the training, duration and perceived autonomy support during the training, and changes in their intrinsic motivation and water consumption before and after the start of the intervention. Changes in the peers’ intrinsic motivation, perceived social support, and social norms were measured before and after the start of the intervention.

Results

The influence agents enjoyed the training, the duration was adequate, and perceived it as autonomy supportive. There was an increase in the influence agents’ intrinsic motivation to drink water and their actual water consumption. Providing personal meaningful rationales seemed to have motivated the influence agents. The intrinsic motivation and perceived descriptive norm of the peers remained stable. The peers reported an increase in their perceived social support and injunctive norm concerning water drinking after the intervention. Influence agents appeared to mainly use face-to-face strategies, such as modeling, talking to peers, and providing social support to promote the behavior.

Conclusions

The current findings provided preliminary evidence of the promising effects of using SDT-based techniques in an SNI to motivate the influence agents and, indirectly, their peers.

Trial registration

NTR, NL6905, Registered 9 January 2018, https://www.trialregister.nl/trial/6905

Consumption of acidic drinks, knowledge and concern about dental erosive wear in Norwegian high school students

OBJECTIVES

The objectives of the present study were to assess the consumption of acidic beverages, knowledge and concern about preventing dental erosive wear, and to examine potential associations between these variables, in a sample of high school students.

MATERIALS AND METHODS

A survey measuring acidic beverage consumption, knowledge and concern about erosive tooth wear was conducted at 13 high schools in Rogaland county, Norway.

RESULTS

Of the 850 students who completed the questionnaire, 26% reported that they drink acidic beverages every day. There were significant gender differences for the consumption of acidic drinks. The survey also demonstrated that a high proportion of students lacks basic knowledge of what erosive tooth wear is, and that this lack of knowledge is associated with a more frequent intake of acidic beverages. However, students who responded that they are concerned about preventing dental erosive wear reported that they drink soft drinks and energy drinks less frequently than students who are not concerned about this.

CONCLUSIONS

Results from this study support assumptions about a lack of knowledge about dental erosive wear in youth, and that this lack of knowledge is associated with a more frequent intake of acidic drinks.

How Zoomers’ Eating Habits Should be Considered in Shaping the Food System for 2030—A Case Study on the Young Generation from Romania

Is the Food System prepared for 2030? Considering that Zoomers (Generation Z) will be the largest global cohort in the world at that time, the purpose of the study is to identify what can be learned now from their eating habits to diversify and create a more resilient Food System prepared for the future. Researchers have discovered that the Food System should encourage sustainable and healthier food production by empowering a resilient local production. These changes are aligned with Zoomer preferences for local and organic food, considering their moral, ethical, and economic implications. To gather data, a quantitative investigation was performed among university students from Romania using an online survey in which 343 responses were recorded. A direct logistic regression was performed, similar to the one presented by Wilson and Lorenz (2015), to assess the impact of factors on the changing eating habits of Zoomers. The results showed significant changes in the diet of Zoomers who are facing an increased internationalization of the food consumption; they seek convenience but are also more eager to consume healthy food. For a more resilient Food System, special importance should be given to these preferences, through local and organic production, improving delivery methods, and enhancing the food experience in a responsible and ethical manner in order to prepare it for the next majoritarian cohort. These findings can be further developed by adapting the current Food System to emerging food eating habits and also by addressing how Zoomers’ food choices can improve the environmental impact of the Food System.

Associations between family and home-related factors and child's snack consumption in a multi-ethnic population

BACKGROUND

Energy-dense snacks are considered unhealthy due to their high concentrations of fat and sugar and low concentrations of micronutrients. The present study aimed to evaluate associations between family and home-related factors and children's snack consumption. We explored associations within subgroups based on ethnic background of the child.

METHODS

Cross-sectional data of 644 primary school children (mean age: 9.4 years, 53% girls) from the population-based 'Water Campaign' study conducted in the Netherlands were used. Logistic regression analyses were used to evaluate the associations between family and home-related factors and child's snack intake.

RESULTS

Of the children, 28.7% consumed more than one snack per day. Children of parents who expressed more restrictive parenting practices towards the child's snack consumption (odds ratio (OR) = 2.5, P < 0.001), and who modelled snack eating less often (OR = 2.2, P < 0.001) had lower snack intake. Restrictive parenting practices and parental modelling of healthy snacking were significant for children with a Dutch or Moroccan/Turkish ethnic background, but not for children with a Surinamese/Antillean ethnic background.

CONCLUSIONS

We observed that parenting practices and parental modelling were independently associated with the child's snack intake. Also, the relationships between these factors and the child's snack consumption differed for children with distinct ethnic backgrounds.

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review

Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar-sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.

Recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for young adults with intellectual and developmental disabilities: A systematic review

BACKGROUND

People with intellectual and developmental disabilities (IDD) are at risk of developing long term health conditions, and a preventative health agenda research is emerging. However, little is known about the recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for this population. Therefore, the aim of this review was to synthesize and evaluate these characteristics.

METHOD

A systematic review of studies identified from multiple databases on healthy lifestyle interventions for adolescents and young people with IDD was conducted. Data were synthesized and evaluated using a logic model. Quality of rigour was also assessed.

RESULTS

Sixteen geographically diverse studies were selected and evaluated. Participants were most commonly recruited from schools, with interventions typically taking place in a gym setting and involving physical activity training.

CONCLUSIONS

This review indicates that physical activity and dietary interventions in people with IDD may lead to lifestyle changes, however more robust evidence is required. Educational settings are conducive, with settings beyond schools requiring further consideration.

Parent and household influences on calcium intake among early adolescents

BACKGROUND

Calcium intake during early adolescence falls short of requirements for maximum bone accretion. Parents and the home food environment potentially influence children's calcium intakes. This study aimed to quantify parental psychosocial factors (PSF) predicting calcium intakes of Asian, Hispanic, and non-Hispanic white (NHW) early adolescent children from a parental perspective.

METHODS

This was a cross-sectional study involving the administration of a validated calcium-specific food frequency questionnaire to a convenience sample of children aged 10-13 years and the primary individual responsible for food acquisition in the child's household. Based on Social Cognitive Theory, parental factors potentially associated with children's calcium intake were also assessed via parent questionnaires. The total study sample consisted of 633 parent-child pairs (Asian = 110, Hispanic = 239, NHW = 284). Questionnaires were completed at community-based centers/sites. Outcome measures were the association between parent-child calcium (mg), milk (cups/day), and soda (cans/day) intakes and the predictive value of significant parental PSF towards calcium intakes of their children. Sex-adjusted linear regression and multivariate analyses were performed.

RESULTS

Calcium intakes of parent-child pairs were positively associated among all ethnic groups (r = 0.296; P < 0.001). Soda intakes were positively associated among Hispanic parent-child pairs only (r = 0.343; P < 0.001). Home availability of calcium-rich foods (CRF), parental rules and expectations for their child's intake of beverages, and parents' calcium intake/role modeling were positively associated with children's calcium intake and overwhelmed all other PSF in multivariate analyses. Significant cultural differences were observed. Parental role modeling was a significant factor among Hispanic dyads only. Multivariate models explained 19-21% of the variance in children's calcium intakes.

CONCLUSIONS

Nutrition interventions to improve children's calcium intakes should focus on parents and provide guidance on improving home availability of CRF and increasing rules and expectations for the consumption of CRF. Among Hispanic families, interventions promoting parental modeling of desired dietary behaviors may be most successful.

Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home

OBJECTIVES

To examine the association between sugar-sweetened beverage availability at home and sugar-sweetened beverage consumption, and to evaluate whether this association was consistent across school and school neighborhood sugar-sweetened beverage availability.

STUDY DESIGN

Secondary data analyses were performed from the 2014 cross-sectional, Internet-based Family Life, Activity, Sun, Health, and Eating (FLASHE) study of 1494 adolescents (age 12-17 years). Ordinal logistic regression analyses were conducted to examine the association between sugar-sweetened beverage availability in the home and adolescents' frequency of sugar-sweetened beverage consumption (nondaily, <1; daily, 1-<2; daily, ≥2), adjusting for adolescent age, sex, race, and body mass index and parent marital status and housing insecurity. Stratified ordinal logistic regression analyses were used to examine the associations by school and school neighborhood sugar-sweetened beverage availability.

RESULTS

One-third (32.6%) of adolescents were nondaily consumers of sugar-sweetened beverages, 33.9% consumed 1-<2 sugar-sweetened beverages daily, and 33.5% consumed ≥2 sugar-sweetened beverages daily. Almost one-half (44.4%) reported that sugar-sweetened beverages were often or always available in the home. Frequency of sugar-sweetened beverage availability at home was associated with greater sugar-sweetened beverage consumption (OR, 2.88; 95% CI, 2.86-2.89 for rarely/sometimes available at home; OR. 5.62; 95% CI, 5.60-5.64 for often/always available at home). Similar associations were found regardless of the availability of sugar-sweetened beverages in the adolescent's school or school neighborhood.

CONCLUSIONS

Sugar-sweetened beverage availability in the home was associated with adolescent sugar-sweetened beverage consumption, regardless of sugar-sweetened beverage availability in other settings, and may be a key target for obesity prevention efforts.

Comparison of school day eating behaviours of 8-11 year old children from Adelaide, South Australia, and London, England: Child eating behaviours in South Australia and England

Objective

School food intake makes a considerable contribution to children's overall diet, especially fruit and vegetable intake. Comparing differing school food provision systems can provide novel insights for intervention and improved nutrition policy. This study compared school day food in children from Australia and England.

Design

Children completed food frequency questionnaires reporting school day food intake, breakfast intake and family evening meals. Differences in food consumed over the school day between Australian and English children were evaluated. Multinomial logistic regressions compared fruit and vegetable intake, family dinner frequency and breakfast in Australian and English children adjusting for confounders: age, sex, ethnicity and parent education.

Setting

27 Primary schools in Adelaide, Australia and 32 in London, England.

Subjects

N = 772 children aged 8–11 years from the Australian REACH study (n = 347) and UK RHS School Gardening Trial in England (n = 425).

Results

Considerably more English children reported consuming vegetables at school than Australian children (recess/lunchtime Australian children 3.4%/6.1%; English children recess/lunctime 3.6/51.1%). However, Australian children were more likely to consume vegetables daily (OR = 4.1; 1.3, 12.5), and have family evening meals everyday [OR = 4.01; 1.88, 8.55], and were less likely to consume breakfast (OR = 0.26; 0.08, 0.79) than English children.

Conclusions

Findings indicate that provision of a school lunch meal, compared to a packed lunch from home, may be more supportive of children's vegetable intake. However, without a supportive home environment that encourages vegetable intake, children will not be able to consume sufficient amounts of vegetables.

Maternal feeding practices in relation to dietary intakes and BMI in 5 year-olds in a multi-ethnic Asian population

BACKGROUND

In Asia, little is known about how maternal feeding practices are associated with dietary intakes and body mass index (BMI) in preschoolers.

OBJECTIVE

To assess the relationships between maternal feeding practices with dietary intakes and BMI in preschoolers in Asia using cross-sectional analysis in the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort.

PARTICIPANT SETTINGS

Mothers (n = 511) who completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and a semi-quantitative Food Frequency Questionnaire (FFQ) when children were 5 years old.

STATISTICAL ANALYSIS

Associations between 12 maternal feeding practices (mean scores divided into tertiles) and children's dietary intakes of seven food groups and BMI z-scores were examined using the general linear regression model. Weight and height of the child were measured, and dietary intakes derived from the FFQ.

RESULTS

Compared to those in the low tertile, mothers in the high tertile of modelling healthy food intakes had children with higher intakes of vegetables[+20.0g/day (95%CI:11.6,29.5)] and wholegrains[+ 20.9g/day (9.67,31.1)] but lower intakes of sweet snacks[-10.1g/day (-16.3,-4.94)] and fast-foods[-5.84g/day (-10.2,-1.48)]. Conversely, children of mothers in the high tertile for allowing child control (lack of parental control) had lower intake of vegetables[-15.2g/day (-26.6,-5.21)] and wholegrains[-13.6g/day (-22.9,-5.27)], but higher intakes of sweet snacks[+13.7g/day (7.7, 19.8)] and fast-foods[+6.63g/day (3.55,9.72)]. In relation to BMI at 5 years, food restrictions for weight was associated with higher BMI z-scores [0.86SD (0.61,1.21)], while use of pressure was associated with lower BMI z-scores[-0.49SD(-0.78,-0.21)].

CONCLUSIONS AND IMPLICATIONS

Modelling healthy food intakes by mothers was the key feeding practice associated with higher intakes of healthy foods and lower intakes of discretionary foods. The converse was true for allowing child control. Only food restrictions for weight and use of pressure were associated with BMI z-scores.

Objectively-Measured Physical Activity and Sedentary Time are Differentially Related to Dietary Fat and Carbohydrate Intake in Children

Background: Research on the clustering of physical activity, sedentary, and dietary intake behaviors in children has relied on retrospective and parent-report measures, which may obscure true associations. The current study combined objectively-measured moderate-to-vigorous intensity physical activity (MVPA) and sedentary time (ST) data from waist-worn accelerometers, with multiple child-report 24-h dietary recalls to assess specific components of dietary intake (i.e., dietary fat, carbohydrates, protein; glycemic load, fruits and vegetables) in children.

Methods: Participants (n = 136, ages 8–12 years) wore an accelerometer for 7 days. On two of those days, children completed 24-h recall phone interviews to assess dietary intake.

Results: After adjusting for child age, sex, ethnicity, annual household income, and body mass index (BMI) percentile; ST was positively associated with percent dietary fat intake, and negatively associated with percent dietary carbohydrate intake and glycemic load (p's < 0.01). MVPA was positively associated with percent dietary carbohydrate intake and daily glycemic load, and negatively associated with percent dietary fat intake (p's < 0.05).

Conclusion: Despite its direct health benefits, physical activity may be associated with consuming greater proportion of total intake from carbohydrates, especially those with a higher glycemic index. Further research is needed to understand the differential implications of these unique behavioral interrelations for diabetes, cardiovascular, and obesity risk.

Promoting Water Consumption on a Caribbean Island: An Intervention Using Children's Social Networks at Schools

Sugar-sweetened beverage (SSB) consumption and the associated childhood obesity are major concerns in the Caribbean, creating a need for interventions promoting water consumption as a healthy alternative. A social network-based intervention (SNI) was tested among Aruban children to increase their water consumption and behavioral intention to do so and, consequently, to decrease SSB consumption and the associated behavioral intention. In this study, the moderating effects of descriptive and injunctive norms were tested. A cluster randomized controlled trial was completed in schools (mean age = 11 years ± SD = 0.98; 54% girls). Children were assigned to the intervention group (IG; n = 192) or control group (CG; n = 185). IG children were exposed to peer influencers promoting water consumption and CG children were not. Regression analyses showed that water consumption increased for IG children with a high injunctive norm score (p = 0.05); however, their intention to consume more water remained unchanged (p = 0.42). Moreover, IG children showed a decrease in SSB consumption (p = 0.04) and an increase in their intention to consume less SSB (p = 0.00). These findings indicate that SNIs are a promising instrument for health behavioral changes for Aruba and other islands in the Caribbean region.

The relationship between home- and individual-level diet quality among African American and Hispanic/Latino households with young children

Background

The quality of most Americans’ diets is far from optimal. Given that many Americans consume a significant portion of calories in the home, intervening in this setting could be beneficial. However, the relationship between the home food environment and diet quality is not well understood. This study examined the relationship between diet quality at the individual level with home-level diet quality using an index that measures compliance with federal dietary guidance.

Methods

This was a cross sectional study that enrolled 97 African American and Hispanic/Latino low-income parent-child dyads. Diet quality at the individual level was assessed through two 24-h dietary recalls collected for parents and children, respectively. Diet quality at the home level was assessed with two home food inventories conducted in participants’ homes. Diet quality scores at the home and individual levels were computed by applying the Healthy Eating Index-2010 (HEI-2010) to these data. Linear models adjusted for potential confounding factors were used to examine the relationship between diet quality at the home and individual levels.

Results

Total HEI-2010 scores from parents and children’s diets were positively associated with HEI-2010 scores based on home food inventories (parent diet: β: 0.36, 95% CI: 012–0.60; child diet: 0.38 95% CI: 013–0.62). Positive associations were also observed between individual level and home level subcomponent HEI-2010 scores for total fruit (parent: 0.55 95% CI: 0.16–0.94; child: 0.49 95% CI: 0.03–0.94), whole fruit (parent only: 0.41 95% CI: 0.07–0.74), greens and beans (parent only: 0.39 95% CI: 0.05–0.74), and whole grain (children only: 0.33 95% CI: 0.04–0.63).

Conclusion

This study demonstrated that individual level diet quality was positively associated with home-level diet quality. Findings from this study can help us to address modifiable targets of intervention in the home to improve diet quality.

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.

Children's sugar-sweetened beverages consumption: associations with family and home-related factors, differences within ethnic groups explored

Background

The consumption of sugar-sweetened beverages (SSB) may contribute to the development of overweight among children. The present study aimed to evaluate associations between family and home-related factors and children’s SSB consumption. We explored associations within ethnic background of the child.

Methods

Cross-sectional data from the population-based ‘Water Campaign’ study were used. Parents (n = 644) of primary school children (6-13 years) completed a questionnaire on socio-demographic characteristics, family and home-related factors and child’s SSB intake. The family and home-related factors under study were: cognitive variables (e.g. parental attitude, subjective norm), environmental variables (e.g. availability of SSB, parenting practices), and habitual variables (e.g. habit strength, taste preference). Regression analyses were used to evaluate the associations between family and home-related factors and child’s SSB intake (p < 0.05).

Results

Mean age of the children was 9.4 years (SD: 1.8) and 54.1% were girls. The child’s average SSB intake was 0.9 litres (SD: 0.6) per day. Child’s age, parents’ subjective norm, parenting practices, and parental modelling were positively associated with the child’s SSB intake. The availability of SSB at home and school and parental attitude were negatively associated with the child’s SSB intake. The associations under study differed according to the child’s ethnic background, with the explained variance of the full models ranging from 8.7% for children from Moroccan or Turkish ethnic background to 44.4% for children with Dutch ethnic background.

Conclusions

Our results provide support for interventions targeting children’s SSB intake focussing on the identified family and home-related factors, with active participation of parents. Also, the relationships between these factors and the child’s SSB intake differed for children with distinct ethnic backgrounds. Therefore, we would recommend to tailor interventions taking into account the ethnic background of the family.

Trial registration

Number NTR3400; date April 4th 2012; retrospectively registered.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4095-0) contains supplementary material, which is available to authorized users.

Perceived rules and accessibility: measurement and mediating role in the association between parental education and vegetable and soft drink intake

Background

The existence of socioeconomic differences in dietary behaviors is well documented. However, studies exploring the mechanisms behind these differences among adolescents using comprehensive and reliable measures of mediators are lacking. The aims of this study were (a) to assess the psychometric properties of new scales assessing the perceived rules and accessibility related to the consumption of vegetables and soft drinks and (b) to explore their mediating role in the association between parental education and the corresponding dietary behaviors.

Methods

A cross-sectional survey including 440 adolescents from three counties in Norway (mean age 14.3 years (SD = 0.6)) was conducted using a web-based questionnaire. Principal component analysis, test-retest and internal reliability analysis were conducted. The mediating role of perceived accessibility and perceived rules in the association between parental education and the dietary behaviors was explored using linear regression analyses.

Results

Factor analyses confirmed two separate subscales, named “accessibility” and “rules”, both for vegetables and soft drinks (factor loadings >0.60). The scales had good internal consistency reliability (0.70–0.87). The test–retest reliability of the scales was moderate to good (0.44–0.62). Parental education was inversely related to the consumption of soft drinks and positively related to the consumption of vegetables. Perceived accessibility and perceived rules related to soft drink consumption were found to mediate the association between parental education and soft drink consumption (47.5 and 8.5 % of total effect mediated). Accessibility of vegetables was found to mediate the association between parental education and the consumption of vegetables (51 % of total effect mediated).

Conclusion

The new scales developed in this study are comprehensive and have adequate validity and reliability; they are therefore considered appropriate for use among 13–15 year-olds. Parents, in particular those with a low educational background, should be encouraged to increase the accessibility of vegetables and to decrease the accessibility of soft drinks, in particular during dinner. Enforcing parental rules limiting soft drink intake in families with low parental education also appears relevant.

Using the Intervention Mapping Protocol to develop an online video intervention for parents to prevent childhood obesity: Movie Models

BACKGROUND

The increasing prevalence of childhood overweight/obesity caused by an unhealthy diet, insufficient physical activity (PA) and high levels of sedentary behaviour (SB) is a prominent public health concern. Parenting practices may contribute to healthy behaviour change in children, but well-researched examples are limited. The aim of this study is to describe the systematic development of an intervention for parents to prevent childhood overweight/obesity through the improvement of parenting practices.

METHODS

The six steps of the Intervention Mapping Protocol (IMP), a theory- and evidence-based tool to develop health-related interventions, were used as a framework to develop the 'Movie Models' programme.

RESULTS

In Step 1, a needs assessment was performed to better understand the health problem of overweight/obesity in children and its association with diet, PA and SB. In Step 2, the programme goal (increasing the adoption of effective parenting practices) was sub-divided into performance objectives. Change objectives, which specify explicit actions required to accomplish the performance objectives, were also identified. Step 3 included the selection of theoretical methods (e.g. 'modelling' and 'images'), which were then translated into the practical strategy of online parenting videos. Step 4 comprised the development of a final intervention framework, and Step 5 included the planning of programme adoption and implementation. The final phase, Step 6, included the development of an effect- and process-evaluation plan.

DISCUSSION

The IMP was used to structure the development of 'Movie Models', an intervention targeting specific parenting practices related to children's healthy diet, PA, SB, and parental self-efficacy. A clear framework for process analyses is offered, which aims to increase the potential effectiveness of an intervention and can be useful for those developing health promotion programmes.

A Systematic Review to Assess Sugar-Sweetened Beverage Interventions for Children and Adolescents across the Socioecological Model

Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socioecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socioecological strategy levels, is unknown. This systematic review aimed to examine the extent to which studies reported internal and external validity indicators defined by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model and assess reporting differences by socioecological level: Intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), and multilevel (Combined Level). A systematic literature review was conducted in six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, Education Research Information Center, and Arcola) to identify studies from 2004-2015 meeting inclusion criteria (children aged 3 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 years, experimental or quasiexperimental, and substantial SSB component). Interventions were categorized by socioecological level, and data were extracted using a validated RE-AIM protocol. One-way analysis of variance assessed differences between levels. There were 55 eligible studies accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six studies (65%) were conducted in the United States, 19 studies (35%) were conducted internationally, and 39 studies (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy or effectiveness=45%, adoption=26%, implementation=27%, and maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared with Level 1 (44% and 57%, respectively) or Combined Level studies (31% and 52%, respectively) (P<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Interventions to reduce SSB consumption in children and adolescents across the socioecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population influence.

What influences urban Indian secondary school students' food consumption? - A qualitative study

Indian adolescents' over reliance on foods such as nutrient-poor snacks, sugar-sweetened beverages and take-away foods puts them at significant risk of obesity and several diet-related chronic diseases. Therefore, the factors that influence their dietary behaviours need to be better understood in order to develop effective nutrition promotion strategies. The purpose of this qualitative inquiry was to investigate adolescents', parents', teachers', and school principals' perceptions of the main influences on adolescent eating behaviours. Fifteen adolescents aged 14-15 years, 15 parents, 12 teachers and 10 principals from 10 private English-speaking schools in Kolkata, India, participated in semi-structured interviews. The digitally-recorded conversations were transcribed verbatim and analysed thematically. The 52 interviews revealed a number of factors that may influence adolescents' eating habits including parent and peer influences, home and school food environments, and the mass media. Emerging evidence suggests that future health and nutrition promotion interventions need to target the different influences on Indian teenagers' food consumption.

Mediating Effects of Self-Efficacy, Benefits and Barriers on the Association between Peer and Parental Factors and Physical Activity among Adolescent Girls with a Lower Educational Level

Background

The prevalence of physical activity among lower educated adolescent girls is low, suggesting it is important to have insights into the complex processes that may underlie their physical activity levels. Therefore, this study aimed to examine the mediating effects of self-efficacy, perceived benefits and barriers on the associations between peer and parental variables and physical activity among lower educated adolescent girls.

Methods

In total, 226 girls (mean age 16.0±1.0 years; 53% technical education; 47% vocational education) from a convenience sample of 6 secondary schools in Flanders, Belgium, completed a questionnaire on their total physical activity level and related peer and parental variables (i.e. modeling of physical activity, co-participation in physical activities and encouragement to be active) and personal variables (i.e. self-efficacy to be active, and specific perceived benefits of physical activity and specific barriers to be active). Mediating effects were tested using MacKinnon’s product-of-coefficients test based on multilevel linear regression analyses.

Results

Higher peer and parental modeling, co-participation and encouragement were significantly related to a higher physical activity level among adolescent girls (p<0.05). Self-efficacy, the perceived benefits of having fun, being around friends or meeting new people, and not being bored and the perceived barrier of not liking physical activity mediated several associations between peer and parental variables and girls’ physical activity, with some of the mediated proportions exceeding 60%.

Conclusions

This study contributed to a better understanding of the complexity of how parental and peer factors work together with personal factors to influence the physical activity levels of adolescent girls with a lower educational level. Interventions should involve both peers and parents, as they may influence girls’ physical activity both directly and indirectly through the internalisation of several personal variables, such as self-efficacy to be active and the perceived benefit of having fun.

Family functioning and quality of parent-adolescent relationship: cross-sectional associations with adolescent weight-related behaviors and weight status

BACKGROUND

Little is known about how factors within the general family environment are associated with weight and related behaviors among adolescents/young adults.

METHODS

We studied 3768 females and 2614 males, 14-24 years old in 2011, participating in the Growing Up Today Study 2. We used generalized mixed models to examine cross-sectional associations of family functioning and quality of mother- and father-adolescent relationship with adolescent/young adult weight status, disordered eating, intake of fast food and sugar-sweetened beverages, screen time, physical activity, and sleep duration. In all models, we included participant's age and family structure.

RESULTS

Eighty percent of participants reported high family functioning and 60% and 50% of participants reported high-quality mother and father relationship, respectively. Among both males and females, high family functioning was associated with lower odds of disordered eating (adjusted odds ratio [AOR] females = 0.53; 95% Confidence Interval [CI] = 0.45-0.63; AOR males = 0.48; CI = 0.39-0.60), insufficient physical activity, i.e., less than 1 h/day, (AOR females = 0.74; CI = 0.61-0.89; AOR males = 0.73; CI = 0.58-0.92), and insufficient sleep, i.e., less than 7 h/day, (AOR females = 0.56; CI = 0.45-0.68; AOR males = 0.65; CI 0.5-0.85). High family functioning was also associated with lower odds of being overweight/obese (AOR = 0.73; CI = 0.60-0.88) and eating fast food one or more times/week (AOR = 0.74; CI = 0.61-0.89) among females only. Among females, high-quality mother and father relationship were both associated with lower odds of being overweight/obese and disordered eating, eating fast food, and insufficient sleep and the magnitude of associations were similar for mother and father relationship quality (AOR range 0.61-0.84). Among males, high-quality mother and father relationship were both associated with lower odds of disordered eating, insufficient physical activity and insufficient sleep, but only father relationship quality was associated with lower odds of overweight/obesity.

CONCLUSIONS

Adolescents/young adults reporting high family functioning and more positive relationships with their parents reported better weight-related behaviors. For weight status, females appear to be affected equally by the quality of their relationship with both parents, whereas males may be more affected by their relationship with fathers.

A social network-based intervention stimulating peer influence on children's self-reported water consumption: A randomized control trial

The current pilot study examined the effectiveness of a social network-based intervention using peer influence on self-reported water consumption. A total of 210 children (52% girls; M age = 10.75 ± SD = 0.80) were randomly assigned to either the intervention (n = 106; 52% girls) or control condition (n = 104; 52% girls). In the intervention condition, the most influential children in each classroom were trained to promote water consumption among their peers for eight weeks. The schools in the control condition did not receive any intervention. Water consumption, sugar-sweetened beverage (SSB) consumption, and intentions to drink more water in the near future were assessed by self-report measures before and immediately after the intervention. A repeated measure MANCOVA showed a significant multivariate interaction effect between condition and time (V = 0.07, F(3, 204) = 5.18, p = 0.002, pη(2) = 0.07) on the dependent variables. Further examination revealed significant univariate interaction effects between condition and time on water (p = 0.021) and SSB consumption (p = 0.015) as well as water drinking intentions (p = 0.049). Posthoc analyses showed that children in the intervention condition reported a significant increase in their water consumption (p = 0.018) and a decrease in their SSB consumption (p < 0.001) over time, compared to the control condition (p-values > 0.05). The children who were exposed to the intervention did not report a change in their water drinking intentions over time (p = 0.576) whereas the nonexposed children decreased their intentions (p = 0.026). These findings show promise for a social network-based intervention using peer influence to positively alter consumption behaviors.

TRIAL REGISTRATION

This RCT was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12614001179628). Study procedures were approved by the Ethics Committee of the Faculty of Social Sciences at Radboud University (ECSW2014-1003-203).

Influencing factors of children's fruit, vegetable and sugar-enriched food intake in a Finnish preschool setting - Preschool personnel's perceptions

INTRODUCTION

A large proportion of young children spend most of their weekdays at preschool in Western countries. In Finland, three meals are included in a full day at preschool. These meals have the potential to promote healthy eating. This study aimed to obtain the personnel's (preschool teachers, day-care nurses) views on the factors influencing children's fruit, vegetable, and sugar-enriched food intake at preschool.

STUDY DESIGN

Four focus groups, in all 14 preschool personnel. Two researchers independently analysed the data using a socio-ecological framework.

RESULTS

At the child level, age, peers, and the child's personality were recognized as factors influencing the fruit and vegetable (FV) and sugar-enriched food intake. At the preschool level, both the physical and social environments were discussed thoroughly, whereas at the societal level, policies of the EU, the state, and the municipality were mentioned as factors that influence what children eat in preschool. The personnel also discussed the interactions between factors both between levels and within levels.

CONCLUSIONS

In Finnish preschools, children's food intake is influenced on and within several levels of the socio-ecological model. The identification of the factors influencing food intake allows different methods of intervention at multiple levels to promote healthy eating behaviours in preschools.

Fundamental constructs in food parenting practices: a content map to guide future research

Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.

Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the "Fortaleça sua Saúde" program

Background

Interventions on adolescents’ lifestyle are important, but the main mechanisms that explain the changes (mediating variables) on lifestyle are unclear. This paper presents the rationale and methods of an intervention program focused on promoting active and healthy lifestyles (especially physical activity [PA] practice and reducing screen time) among Brazilian students-the Fortaleça sua Saúde program (Portuguese for “strengthen your health”).

Methods/Design

This is a school-based cluster-randomized controlled trial. Three intervention and three control (no intervention) full-time public schools were randomly selected in Fortaleza, northeastern Brazil. Students (n = 1,272) from classes in Grades 7–9 were eligible, and 1,085 (548 in the intervention and 537 in control schools) completed the baseline and follow-up measures. The program duration was approximately four months and took place in 2014. Intervention strategies focused on teacher training, activities on health in the curriculum, active opportunities in the school environment (the availability of equipment for PA), and health education (health materials for students and parents). Data collection was undertaken before and immediately after the intervention. The primary variables included the practice of PA (weekly PA volume, PA behavior change stage and preference for PA during leisure-time) and screen time (TV and computer/video games). Potential intrapersonal, interpersonal and environmental mediators of PA and screen time were evaluated by a standardized questionnaire. Other lifestyle components (e.g., eating habits, substance use), psychological (e.g., self-rated health, body satisfaction) and biological (general and abdominal obesity) aspects, as well as academic performance were also evaluated in the total sample. Depressive symptoms, eating disorders, sleep quality, objectively-measured PA, and sedentary time were evaluated in obese students.

Discussion

If effective, this program will contribute to the development of public policies for the promotion of active and healthy lifestyles in youth, especially those from low- and middle-income countries. The main intrapersonal, interpersonal and/or environmental mediators of PA and screen time may also be indicated. Finally, we anticipate that the proposed strategies may be adaptable to public schools and may even be extended to the entire school system.

Trial registration

ClinicalTrials.Gov: NCT02439827. Registration date: May 3, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2543-2) contains supplementary material, which is available to authorized users.

Evaluation of diet quality and its associated factors among adolescents in Kuala Lumpur, Malaysia

BACKGROUND/OBJECTIVES

This study aims to determine contribution of meal frequency, self-efficacy for healthy eating, and availability of healthy foods towards diet quality of adolescents in Kuala Lumpur, Malaysia.

SUBJECTS/METHODS

This study was conducted among 373 adolescents aged from 13 to 16 years old. Diet quality of the respondents was assessed using the Healthy Eating Index for Malaysians. Meal frequency, self-efficacy for healthy eating, and availability of healthy foods were assessed through the Eating Behaviours Questionnaire (EBQ), self-efficacy for healthy eating scale, and availability of healthy foods scale, respectively.

RESULTS

The majority of the respondents (80.7%) were at risk of poor diet quality. Males (mean = 34.2 ± 8.2%) had poorer diet quality than females (mean = 39.9 ± 9.0%) (t = -5.941, P < 0.05). Malay respondents (mean = 36.9 ± 8.7%) had poorer diet quality than Indian respondents (mean = 41.3 ± 10.0%) (F = 2.762, P < 0.05). Age (r = 0.123, P < 0.05), self-efficacy for healthy eating (r = 0.129, P < 0.05), and availability of healthy foods (r = 0.159, P < 0.05) were positively correlated with the diet quality of the respondents. However, meal frequency was not correlated with the diet quality of the respondents. Multiple linear regression analysis showed that being a male, being a Malay, low self-efficacy for healthy eating, and low availability of healthy foods contributed significantly towards poor diet quality among respondents.

CONCLUSIONS

In short, sex, ethnicity, self-efficacy for healthy eating, and availability of healthy foods were associated with diet quality among adolescents. Health practitioners should take into consideration of differences in sex and ethnicity during implementation of nutrition-related intervention programs. Self-efficacy for healthy eating and availability of healthy foods should be included as important components in improving diet quality of adolescents.

Promotion and Prevention Focused Feeding Strategies: Exploring the Effects on Healthy and Unhealthy Child Eating

There is a general lack of research addressing the motivations behind parental use of various feeding practices. Therefore, the present work aims to extend the current literature on parent-child feeding interactions by integrating the traditional developmental psychological perspective on feeding practices with elements of Regulatory Focus Theory (RFT) derived from the field of motivational psychology. In this paper, we seek to explain associations between parental feeding practices and child (un)healthy eating behaviors by categorizing parental feeding practices into promotion and prevention focused strategies, thus exploring parent-child feeding interactions within the framework of RFT. Our analyses partly supported the idea that (1) child healthy eating is positively associated with feeding practices characterized as promotion focused, and (2) child unhealthy eating is negatively associated with feeding practices characterized as prevention focused. However, a general observation following from our results suggests that parents' major driving forces behind reducing children's consumption of unhealthy food items and increasing their consumption of healthy food items are strategies that motivate rather than restrict. In particular, parents' provision of a healthy home food environment seems to be essential for child eating.

Restrictive rules of Dutch mothers regarding their children's dietary intake between meals

The use of restrictive food rules by parents has been found to be associated with dietary intake in their children. The aim of this study was to explore the use of restrictive rules of Dutch mothers regarding their child's food intake between main meals in detail, to generate necessary input for setting priorities for further research and intervention development. A cross-sectional questionnaire study on nine restrictive rules was completed by 359 mothers of primary school children aged 4-12years. Mothers reported to use an average of 4.1 (SD 2.1) out of nine restrictive food rules and all rules measured in this study were used. The rules mother's reported to use most were not eating shortly before meals, not eating certain foods too often and not eating too much of certain foods. The rules varied according to different foods, but particularly applied to the intake of potato chips, nuts and savory snacks, candy and chocolate. Mothers of a younger age, lower educated mothers and mothers with a higher BMI were less likely to use (certain) restrictive rules. This study showed that mothers use a large variety of rules, particularly to restrict the intake of unhealthy foods and reported on several subgroups that were less likely to use (certain) rules. Our results direct further research and inform the development of interventions.

Children's snack consumption: role of parents, peers and child snack-purchasing behaviour. Results from the INPACT study

BACKGROUND

Parents and peers are both likely to influence children's dietary behaviour. However, their actual influence may depend on the age and life stage of the individual child. Therefore, this study examined the influence of parents (home snack availability and consumption rules) and peers on 11-year-old children's snack consumption, and whether these associations were mediated by children's snack-purchasing behaviour. It was hypothesized that children are more likely to buy unhealthy snacks if these are not always available at home, if restrictive rules apply to their consumption and if a child is sensitive to peer influence. It was also assumed that children who buy snacks out of their pocket money would consume more snacks.

METHODS

Data were taken from 1203 parent-child dyads who completed a questionnaire in the INPACT study (IVO Physical Activity Child cohorT). Multivariable regression models were used to (i) analyze associations between children's consumption and parents' and peers' influence and (ii) determine whether these associations were mediated by children's snack-purchasing behaviour.

RESULTS

Of the parental factors, home availability of snacks was associated with higher snack consumption (B = 1.03, P < 0.05). Parental factors and children's snack-purchasing behaviour were not associated. Children who were sensitive to peer influence consumed more snacks (B = 3ċ07, P < 0.01) and bought more snacks out of their pocket money (odds ratio 3.27, P < 0.0.01). Children's snack-purchasing behaviour explained part (8.6%) of the association between peer influence and children's snack consumption.

CONCLUSION

As these findings indicate that both parents and peers influence children's snack consumption, health promotion may benefit from targeting the broader social environment.

Socio-economic position as a moderator of 9–13-year-old children’s non-core food intake

Objective

There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children’s non-core food and sweetened drink intakes and unhealthy dietary behaviours.

Design

Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income.

Setting

Twenty-six primary schools in South Australia, Australia.

Subjects

Children aged 9–13 years and their parents (n 395).

Results

Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls’ sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys’ non-core food intake with monitoring, parent’s self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents’ self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment.

Conclusions

Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake.

Mothers' child-feeding practices are associated with children's sugar-sweetened beverage intake

BACKGROUND

Sugar-sweetened beverage (SSB) intake is a substantial source of energy in the diet of US children.

OBJECTIVE

We examined the associations between mothers' child-feeding practices and SSB intake among 6-y-old children.

METHODS

We analyzed data from the Year 6 Follow-up of the Infant Feeding Practices Study II in 1350 US children aged 6 y. The outcome variable was child's SSB intake. The exposure variables were 4 child-feeding practices of mothers: setting limits on sweets or junk foods, regulating their child's favorite food intake to prevent overconsumption, pressuring their child to eat enough, and pressuring their child to "clean the plate." We used multinomial logistic regression and controlled for child and maternal characteristics. Analyses were stratified on child weight status.

RESULTS

The consumption of SSBs ≥1 time/d was observed among 17.1% of underweight/normal-weight children and in 23.2% of overweight/obese children. Adjusted ORs (aORs) of consuming SSBs ≥1 time/d (vs. no SSB consumption) were significantly lower in children whose mothers reported setting limits on sweets/junk foods (aOR: 0.29; 95% CI: 0.15, 0.58 for underweight/normal-weight children; aOR: 0.16; 95% CI: 0.03, 0.79 for overweight/obese children). SSB intake was higher among underweight/normal-weight children whose mothers reported trying to keep the child from eating too much of their favorite foods (aOR: 2.03; 95% CI: 1.25, 3.29). Mothers' tendency to pressure their children to consume more food or to "clean the plate" was not associated with child's SSB intake.

CONCLUSIONS

SSBs were commonly consumed by young children. The odds of daily SSB intake were lower among children whose mothers set limits on sweets/junk foods regardless of child's weight but were higher among underweight/normal-weight children whose mothers restricted the child's favorite food intake. Future studies can investigate the impact of alternatives to restrictive feeding practices that could reduce children's SSB intake.

Application of social cognitive theory in predicting childhood obesity prevention behaviors in overweight and obese Iranian adolescents

The aim of this cross-sectional study was to use social cognitive theory to predict overweight and obesity behaviors in adolescent girls in Iran. Valid and reliable questionnaires about nutritional and physical activity regarding social cognitive theory constructs (self-efficacy, social support, outcome expectations, and outcome expectancies), dietary habits, and physical activity were filled by 172 overweight and obese girl adolescents. The mean age and body mass index were 13.4 ± 0.6 years and 28.2 ± 3.6 kg/m(2), respectively. Body mass index was significantly related to hours of television viewing (p = .003) and grams of junk food (p = .001). None of the social cognitive theory constructs were found to be significant predictors for servings of fruits and vegetables, grams of junk foods, minutes of physical activity, and hours of sedentary behaviors. In future, more culturally appropriate models need to be developed in Iran that can explain and predict prevention behaviors of obesity in Iranian adolescents.

Environmental influences on youth eating habits: insights from parents and teachers in South Korea

Youth obesity has increased over the past two decades in South Korea. Researchers employed in-depth interviews and focus-group discussions with parents and teachers from 26 schools in metropolitan South Korea, to examine environmental factors affecting youth eating habits. Home environment and exposure to healthy foods were the most important factors influencing healthy eating habits. Families with working mothers eat out more than do families with stay-at-home mothers. Poor nutrition education is associated with low vegetable intake in elementary school lunches. A cultural emphasis on academic achievement adversely affects children's eating practices. Findings can guide future studies and inform program development.

Energy balance related behaviour: personal, home- and friend-related factors among schoolchildren in Europe studied in the ENERGY-project

Objective

To design interventions that target energy balance-related behaviours, knowledge of primary schoolchildren's perceptions regarding soft drink intake, fruit juice intake, breakfast consumption, TV viewing and physical activity (PA) is essential. The current study describes personal beliefs and attitudes, home- and friend-related variables regarding these behaviours across Europe.

Design

Cross-sectional study in which personal, family and friend -related variables were assessed by validated questionnaires, and dichotomized as favourable versus unfavourable answers. Logistic regression analyses were conducted to estimate proportions of children giving unfavourable answers and test between-country differences.

Setting

A survey in eight European countries.

Subjects

A total of 7903 10–12 year old primary schoolchildren.

Results

A majority of the children reported unfavourable attitudes, preferences and subjective norms regarding soft drink, fruit juice intake and TV viewing accompanied with high availability and accessibility at home. Few children reported unfavourable attitudes and preferences regarding breakfast consumption and PA. Many children reported unfavourable health beliefs regarding breakfast consumption and TV viewing. Substantial differences between countries were observed, especially for variables regarding soft drink intake, breakfast consumption and TV viewing.

Conclusion

The surveyed children demonstrated favourable attitudes to some healthy behaviours (PA, breakfast intake) as well as to some unhealthy behaviours (soft drink consumption, TV viewing). Additionally, many children across Europe have personal beliefs and are exposed to social environments that are not supportive to engagement in healthy behaviours. Moreover, the large differences in personal, family and friend-related variables across Europe argue for implementing different strategies in the different European countries.

Association between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents

OBJECTIVE

The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents.

MATERIALS AND METHODS

A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13-14 years, n = 195; 18-19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression.

RESULTS

Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dental erosion (both age groups) and DMFT/DMFS (18-19 years group) were significantly higher in the high consumption groups. Logistic regression showed predictive variables for high consumption of carbonated soft drinks to be mainly gender (male), unhealthy dietary habits, lesser physical activity, higher BMI and longer time spent in front of TV/computer.

CONCLUSION

High soft drink consumption was related to poorer oral health and an unhealthier lifestyle.

The home food environment of overweight gatekeepers in the Netherlands

OBJECTIVE

The aim of the present study was to gain insight into (i) processed snack-food availability, (ii) processed snack-food salience and (iii) the size of dinnerware among households with overweight gatekeepers. Moreover, associations between gatekeepers' characteristics and in-home observations were determined.

DESIGN

A cross-sectional observation of home food environments was conducted as part of a baseline measurement of a larger study.

SETTING

Home food environments of overweight and obese gatekeepers in the Netherlands.

SUBJECTS

Household gatekeepers (n 278). Mean household size of the gatekeepers was 3.0 (SD 1.3) persons. Mean age of the gatekeepers was 45.7 (SD 9.2) years, 34.9% were overweight and 65.1% were obese. Of the gatekeepers, 20.9% had a low level of education and 42.7% had a high level of education.

RESULTS

In 70% of the households, eight or more packages of processed snack foods were present. In 54% of the households, processed snack foods were stored close to non-processed food items and in 78% of households close to non-food items. In 33% of the households, processed snack foods were visible in the kitchen and in 15% of the households processed snack foods were visible in the living room. Of the dinnerware items, 14% (plates), 57% (glasses), 78% (dessert bowls), 67% (soup bowls) and 58% (mugs) were larger than the reference norms of the Netherlands Nutrition Centre Foundation. Older gatekeepers used significantly smaller dinnerware than younger gatekeepers.

CONCLUSIONS

Environmental factors endorsing overconsumption are commonly present in the home environments of overweight people and could lead to unplanned eating or passive overconsumption.

The association of sugar-sweetened beverage intake during infancy with sugar-sweetened beverage intake at 6 years of age

OBJECTIVES

To examine whether sugar-sweetened beverage (SSB) intake during infancy predicts SSB intake at 6 years of age.

METHODS

A longitudinal cohort analysis of 1333 US children was conducted by using data from the 2005-2007 Infant Feeding Practices Study II and the 2012 Follow-Up Study at 6 years of age. The exposure variables were maternal-reported SSB intakes during infancy. The outcome variable was maternal-reported SSB intake at age 6 years. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for associations of SSB intake during infancy with consuming SSBs ≥1 time/day at 6 years old after controlling for baseline child's and parent's characteristics.

RESULTS

Based on maternal recall, approximately one-fifth of children consumed SSBs at least 1 time/day at age 6 years. Adjusted odds of consuming SSBs at age 6 years ≥1 time/day was significantly associated with any SSB intake during infancy (aOR, 2.22 vs none), age at SSB introduction (aOR, 2.33 for age ≥6 months and 2.01 for age <6 months vs never), and mean SSB intake during age 10 to 12 months (aOR, 2.72 for 1 to <2 times/week and 2.57 for ≥3 times/week vs none).

CONCLUSIONS

SSB intake during infancy significantly increased the likelihood of consuming SSBs ≥1 time/day at 6 years of age. Our findings suggest that infancy may be an important time for mothers to establish healthy beverage practices for their children and these findings can be used to inform intervention efforts to reduce SSB intake among children.