Comparison of 4 questionnaires for assessment of fruit and vegetable intake

Comprando Rico y Sano: Increasing Latino nutrition knowledge, healthful diets, and food access through a national community-based intervention

PURPOSE

Evaluation findings from "X" a culturally relevant, community-based intervention addressing nutrition knowledge and food access are presented.

DESIGN

No-control quasi-experimental intervention with pre, post, and follow-up assessments.

SETTING

"X" was promotores-led through "X" community-based partners.

SAMPLE

Low-income Latino adults (N=966) receiving services at 25 partner sites.

INTERVENTION

"X" was a six-hour intervention focused on nutrition knowledge and consumption of fruits, vegetables, and home-prepared meals. It also provided guidance for health-conscious grocery shopping, Supplemental Nutrition Assistance Program (SNAP) information, and enrollment assistance.

MEASURES

Self-report surveys assessed nutrition knowledge; intention to change; and frequency of fruit, vegetable, and home-prepared meal consumption. Sites reported monthly SNAP enrollment data.

ANALYSIS

Paired-samples t-tests and repeated-measures ANOVAs assessed changes in knowledge, intentions, and behavior from pre-to-post (n=960) and pre-to-follow-up (n=115).

RESULTS

Pre-to-follow-up increases in nutrition knowledge (p<.001) were observed. Intention to consume more vegetables (p=.027) and home-prepared meals (p<.001) also improved between pre and follow-up. Increases from pre-to-follow-up were observed for frequency of consuming fruits (p=.007), vegetables (p=.001), and home-prepared meals (p<.001). Across 16 months, 24,359 Latinos enrolled for SNAP.

CONCLUSION

Large-scale community collaborations to deliver culturally relevant nutrition education and SNAP enrollment assistance can increase food access, health literacy, and promote healthful diets for Latinos.

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for the Chinese lactating mothers

Background

The dietary nutritional status of the lactating mothers is related to maternal health and has a significant impact on the growth and development of infants through the secretion of breast milk. The food frequency questionnaire (FFQ) is the most cost-effective dietary assessment method that can help obtain information on the usual dietary pattern of participants. Until now, the FFQs have been used for different populations in China, but there are few FFQs available for the lactating mothers. We aimed to develop a semi-quantitative, 156-item FFQ for the Chinese lactating mothers, and evaluate its reproducibility and relative validity.

Methods

A total of 112 lactating mothers completed two FFQs and one 3-d dietary record (3DR). The first FFQ (FFQ1) was conducted during postpartum at 60–65 days and the second FFQ (FFQ2) during subsequent follow-up at 5 weeks. The 3DR was completed with portion sizes assessed using photographs taken by the respondent before and after eating (instant photography) 1 week after FFQ1.

Results

For reproducibility, the Spearman’s correlation coefficients for food ranged from 0.34 to 0.68, and for nutrients from 0.25 to 0.61. Meanwhile, the intra-class correlation coefficients for food ranged from 0.48 to 0.87, and for nutrients from 0.27 to 0.70. For relative validity, the Spearman’s correlation coefficients for food ranged from 0.32 to 0.56, and for nutrients from 0.23 to 0.72. The energy-adjusted coefficients for food ranged from 0.26 to 0.55, and for nutrients from 0.22 to 0.47. Moreover, the de-attenuation coefficients for food ranged from 0.34 to 0.67, and for nutrients from 0.28 to 0.77. The Bland-Altman plots also showed reasonably acceptable agreement between the two methods.

Conclusions

This FFQ is a reasonably reproducible and a relative valid tool for assessing dietary intake of the Chinese lactating mothers.

Feasibility of a Family Meal Intervention to Address Nutrition, Emotional Wellbeing, and Food Insecurity of Families With Adolescents

OBJECTIVE

To assess the feasibility of a family meal intervention to address indicators of parent and adolescent nutrition and well-being and household food security.

METHODS

Nine adolescents and a parent/caregiver were recruited from a youth health clinic. Families were provided with meal plans, recipes, and ingredients for 5 meals weekly for 4 weeks. Participants completed baseline and follow-up surveys and open-ended interviews.

RESULTS

Overall, fidelity to the intervention was high among families; the frequency of family meals increased by approximately 2 meals/wk. Both parent/caregivers and adolescents reported improvements to nutrition (4 of 9 increased vegetable consumption for both) and most reported improvements to mental well-being. Household food insecurity also reduced during the intervention (means of 8.2 and 0.2 at baseline and follow-up, respectively).

CONCLUSIONS AND IMPLICATIONS

Providing families with meal plans, recipes, and ingredients is an acceptable way to increase weekly frequency of family meals. Future research may consider the family meal as a way to engage with families about broader concerns.

Community Forum Identifies Opportunities to Engage with Eastern Kentucky Community Leaders about Chronic Disease and Environmental Pollution

The NIEHS-sponsored Appalachian Health & Well-Being Community Forum held in Eastern Kentucky brought various community members together to communicate and establish better coordination of efforts to improve health and address regional environmental issues. The two-hour forum discussion provided bi-directional feedback about the needs and interests of community members. Top concerns of community members included obesity and obesity-related diseases and environmental pollution. Healthful lifestyles were identified as part of the remedy to protect health from potential adverse health effects associated with environmental pollution. This study highlights opportunities to engage with Appalachian communities around topics related to health and environmental pollution.

School-based secondary prevention of overweight and obesity among 8- to 12-year old children: Design and sample characteristics of the SNAPSHOT trial

Rising levels of severe obesity among children, worsening disparities by race and ethnicity and reluctance of primary care clinicians' to provide obesity management to children are compelling reasons to consider alternatives to primary care management of childhood obesity. The Students Nurses and Parents Seeking Healthy Options Together (SNAPSHOT) trial will test the efficacy of an elementary school-based, school nurse-led, healthy weight management program to reduce excess weight gain among children, 8- to 12-years old with a body mass index (BMI) ≥75th percentile, by increasing healthy dietary practices and physical activity and decreasing sedentary behaviors. SNAPSHOT has enrolled and randomized 132 child/parent dyads to either the: (1) 9-month SNAPSHOT intervention that includes four home visits, 14 kid groups held during out-of-school time and five parent groups or (2) a newsletter program consisting of monthly mailings and family-focused healthy lifestyle information. Outcomes are assessed at baseline, 12-months (post intervention) and 24-months (follow-up) post randomization. The primary outcome is child age- and gender-adjusted BMI z-score. Secondary outcomes include child dietary intake assessed with 24-h dietary recall interviews and accelerometer-measured activity levels. The SNAPSHOT intervention is a model of secondary obesity prevention for children that addresses the urgent need for theory-informed, evidence-based and safe weight management programs, delivered by skilled health professionals in accessible settings. This report describes development of the SNAPSHOT trial, including recruitment and randomization procedures, assessments, intervention and implementation plans, and baseline characteristics of the study sample.

Social networks for improving healthy weight loss behaviors for overweight and obese adults: A randomized clinical trial of the social pounds off digitally (Social POD) mobile app

OBJECTIVE

To test the efficacy of a weight loss mobile app based on recommender systems and developed by experts in health promotion and computer science to target social support and self-monitoring of diet, physical activity (PA), and weight (Social POD app), compared to a commercially available diet and PA tracking app (standard).

MATERIALS AND METHODS

Overweight adults [N=51] were recruited and randomly assigned to either the experimental group [n=26; theory-based podcasts (TBP)+Social POD app] or the comparison group (n=25; TBP+standard app). The Social POD app issued notifications to encourage users to self-monitor and send theory-based messages to support users who had not self-monitored in the previous 48h. Independent samples t-test were used to examine group differences in kilograms lost and change in BMI. Analysis of covariance was used to analyze secondary outcomes while controlling for baseline values.

RESULTS

Participant attrition was 12% (n=3 experimental and n=3 comparison). Experimental group participants lost significantly more weight (-5.3kg, CI: -7.5, -3.0) than comparison group (-2.23kg, CI: -3.6, -1.0; d=0.8, r=0.4, p=0.02) and had a greater reduction in BMI (p=0.02). While there were significant differences in positive outcome expectations between groups (p=0.04) other secondary outcomes (e.g., caloric intake and social support) were not significant.

DISCUSSION

Use of the Social POD app resulted in significantly greater weight loss than use of a commercially available tracking app. This mobile health intervention has the potential to be widely disseminated to reduce the risk of chronic disease associated with overweight and obesity.

Assessing Intervention Effects in a School-Based Nutrition Intervention Trial: Which Analytic Model Is Most Powerful?

This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and posttest. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs addressing dietary outcomes. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect (σΔ) from adjustments for both fixed and time-varying covariates and correlations over time. These estimates will allow other researchers using these variables to plan their studies by estimating a priori detectable differences and sample size requirements for any of the four analytic options. These methods are demonstrated using data from the Teens Eating for Energy and Nutrition at School study. Mixed-model analyses of covariance proved to be the most powerful analysis in that data set. The formulae may be applied to any dependent variable in any GRT given corresponding information for those variables on the parameters that define the formulae.

Fruit and vegetable consumption in Vietnam, and the use of a ‘standard serving’ size to measure intake

The aims of the present study were to provide nationally representative data on fruit and vegetable consumption in Vietnam, and to assess the accuracy of the reported numbers of ‘standard servings’ consumed. Data analysed were from a multi-stage stratified cluster survey of 14 706 participants (46·5 % males, response proportion 64·1 %) aged 25−64 years in Vietnam. Measurements were made in accordance with the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) protocols. Approximately 80 % of Vietnamese people reported having less than five servings of fruit and vegetables daily in a typical week. Fruit and vegetable intake reported in ‘standard serving’ sizes was positively correlated with levels of education completed and household income (P<0·001 for trend). The correlations between summary values for each province reflect some known demographic, geographical and climatic characteristics of the country. For example, provinces at higher latitude had higher mean servings of vegetables (r 0·90), and provinces with higher proportions of urban population had higher mean servings of fruit (r 0·40). In conclusion, about eight in ten Vietnamese people aged 25–64 years did not meet WHO recommendations for daily consumption of at least five servings of fruit and vegetables. On the basis of the consistency of the data collected with other estimates and with physical and demographic characteristics of the country, the WHO STEPS instrument has construct validity for measuring fruit and vegetable intake, but with two issues identified. The issues were seasonal variation in reporting and a limitation on the usefulness of the information for associative analyses.

The role of diet in children's exposure to organophosphate pesticides

BACKGROUND

Studies suggest that some of the greatest exposure to OPs in children occurs in agricultural communities and various pathways of exposure including the take-home pathway, proximity to orchards, and diet have been explored. However, the importance of the dietary pathway of exposure for children in agricultural communities is not well understood.

OBJECTIVES

Our goal was to ascertain whether there were associations between measures of OP exposure and apple juice, fruit, and vegetable consumption across growing seasons by children of farmworkers and non-farmworkers in a rural agricultural setting.

METHODS

Study participants were children of farmworker (N=100) or non-farmworker (N=100) households from a longitudinal cohort study. Dietary intake of fruits and vegetables was assessed using a "5-A-Day" abbreviated food frequency questionnaire, and exposure to OPs was characterized using three urinary di-methyl and three di-ethyl metabolite measurements per child for each of three growing seasons. We used generalized estimating equations to examine data.

RESULTS

Consumption frequency of fruits and vegetables was similar between children of farmworkers and non-farmworkers and across seasons. There were a few significant trends between dimethyl metabolites (DMAP) and fruit, vegetable or apple juice consumption; however, no clear pattern held across seasons or occupation. One difference was found in vegetable consumption during the harvest season, where the farmworker families showed a significant relationship between vegetable consumption and dimethyl metabolite levels (p=0.002). We also found a significant difference in this relationship between farmworkers and non-farmworkers (p=0.001). No significant trends between fruit and vegetable consumption and diethyl (DEAP) metabolites were found.

CONCLUSIONS

Our study shows the importance of considering season and parents' occupation in understanding OP exposure routes among children in an agricultural community. The impact of these factors on dietary OP exposure requires a more thorough analysis of the availability and consumption of produce from different sources including farms using pesticides where parents worked.

Fruit and vegetable intake as a moderator of the association between depressive symptoms and cigarette smoking

BACKGROUND

Studies have consistently reported associations among depression, cigarette smoking, and fruit and vegetable intake (FVI). This study evaluated FVI as a moderator of the association between depressive symptoms and smoking.

METHODS

The authors analyzed data from the National Longitudinal Survey of Youth 1979: Child and Young Adult. The study sample was adults aged 19-33 years at baseline in the year 2004 from the Young Adult Survey portion. Moderation analyses were performed using the Johnson-Neyman technique to assess whether baseline FVI moderated the association between depressive symptoms and smoking status cross-sectionally and as a predictor of smoking cessation longitudinally at 4-year follow-up.

RESULTS

Cross-sectionally, at lower levels of FVI (<4.9 times/day), there was a significant association between smoking and depressive symptoms (P < .05), but not at higher levels of FVI (≥4.9 times/day; P > .05). Longitudinally, there was an inverse association between depressive symptoms and quitting smoking at FVI <1.2 times/day (P < .05), but there was not a significant association at FVI ≥1.2 times/day (P ≥ .05).

CONCLUSIONS

FVI moderated the association between depressive symptoms and cigarette smoking cross-sectionally and longitudinally. The cross-sectional findings might be partially explained by the longitudinal findings paired with prior research; there might be fewer smokers with high FVI because depressive symptoms are removed as an impediment to cessation. Further experimental research is warranted to test the efficacy of increased FVI as an adjunct to smoking cessation, with a possible mechanism of action being reduced depressive symptoms during quit attempts.

Associations among Nine Family Dinner Frequency Measures and Child Weight, Dietary, and Psychosocial Outcomes

BACKGROUND

Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes, but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation might impact relationships with youth weight, dietary, and psychosocial outcomes.

OBJECTIVE

This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes.

DESIGN/PARTICIPANTS

This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8- to 12-year-old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011 to 2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys.

OUTCOME MEASURES

Outcomes included child body mass index z scores (BMIz); fruit, vegetable, and sugar-sweetened beverage intake; dietary quality (Healthy Eating Index-2010); family connectedness; and meal conversations.

STATISTICAL ANALYSES PERFORMED

Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes.

RESULTS

All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver and child reporters (r=0.17 to 0.94; P<0.01). In unadjusted analyses, 78% of family dinner frequency measures were significantly associated with BMIz and 100% were significantly associated with fruit and vegetable intake and Healthy Eating Index-2010. In adjusted models, most significant associations with dietary and psychosocial outcomes remained, but associations with child BMIz remained significant only for parent/caregiver- (β±standard error=-.07±.03; P<0.05) and child-reported (β±standard error=-.06±.02; P<0.01) family dinner frequency measures asking about "sitting and eating" dinner.

CONCLUSIONS

Despite phrasing variations in family dinner frequency measures (eg, which family members were present and how meals were occurring), few differences were found in associations with dietary and psychosocial outcomes, but differences were apparent for child BMIz, which suggests that phrasing of family dinner frequency measures can influence associations found with weight outcomes.

Dietary adherence and acceptability of five different diets, including vegan and vegetarian diets, for weight loss: The New DIETs study

The goal of the present study was to examine dietary adherence and acceptability among participants from the New DIETs study who were randomized to one of four plant-based diets (vegan, vegetarian, pesco-vegetarian, semi-vegetarian) or an omnivore diet. Primary outcomes at two- and six months included dietary adherence (24-hour dietary recalls), weight loss and changes in animal product intake (mg cholesterol) by adherence status, Three-Factor Eating Questionnaire (TFEQ), Power of Food Scale (PFS), dietary acceptability (Food Acceptability Questionnaire), and impact of diet preference on adherence. No differences were found in dietary adherence or changes in FAQ, TFEQ, or PFS among the groups. At six months, non-adherent vegan and vegetarian participants (n=16) had a significantly greater decrease in cholesterol intake (-190.2 ± 199.2 mg) than non-adherent pesco-vegetarian/semi-vegetarian (n=15, -2.3 ± 200.3 mg, P=0.02) or omnivore participants (n=7, 17.0 ± 36.0, P=0.04). Non-adherent vegan/vegetarian participants lost significantly more weight at six months (-6.0 ± 6.7%) than non-adherent omnivore participants (-0.4 ± 0.6%, P=0.04). Dietary preference had no impact on adherence at six months. Due to equal rates of adherence and acceptability among the diet groups, instructing participants to follow vegan or vegetarian diets may have a greater impact on weight loss and animal product intake than providing instruction in more moderate approaches even among non-adherent participants.

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for Chinese pregnant women

BACKGROUND

Food frequency questionnaire (FFQ) is a reliable tool to estimate dietary intake in large nutritional epidemiological studies, but there is lack of a current and validated FFQ for use in urban Chinese pregnant women. This study aimed to evaluate the reproducibility and validity of a semi-quantitative FFQ designed to estimate dietary intake among urban pregnant women in a cohort study conducted in central China.

METHODS

In the reproducibility study, a sample of 123 healthy pregnant women completed the first FFQ at 12-13 weeks gestation and the second FFQ 3-4 weeks later. To validate the FFQ, the pregnant women completed three 24-h recalls (24HRs) between the intervals of two FFQs.

RESULTS

The intraclass correlation coefficients of two administrations of FFQ for foods ranged from 0.23 (nuts) to 0.49 (fruits) and for nutrients from 0.24 (iodine) to 0.58 (selenium) and coefficients were all statistically significant. The unadjusted Pearson correlation coefficients between two methods ranged from 0.28 (beans) to 0.53 (fruits) for foods and from 0.15 (iodine) to 0.59 (protein) for nutrients. Energy-adjusted and de-attenuated correlation coefficients for foods ranged from 0.35 (beans) to 0.56 (fruits) and for nutrients from 0.11 (iodine) to 0.63 (protein), and all correlations being statistically significant except for iodine, sodium and riboflavin. On average, 67.0% (51.2%-80.5%) of women were classified by both methods into the same or adjacent quintiles based on their food intakes, while 68.5% (56.1%-77.2%) of women were classified as such based on nutrient intakes. Extreme misclassifications were very low for both foods (average of 2.0%) and nutrients (average of 2.2%). Bland-Altman Plots also showed reasonably acceptable agreement between two methods.

CONCLUSION

This FFQ is a reasonably reliable and valid tool for assessing most food and nutrient intakes of urban pregnant women in central China.

Randomization to plant-based dietary approaches leads to larger short-term improvements in Dietary Inflammatory Index scores and macronutrient intake compared with diets that contain meat

Studies have examined nutrient differences among people following different plant-based diets. However, all of these studies have been observational. The aim of the present study was to examine differences in nutrient intake and Dietary Inflammatory Index (DII) scores among overweight and obese (body mass index 25.0-49.9 kg/m(2)) adults randomized to receive dietary instruction on a vegan (n = 12), vegetarian (n = 13), pescovegetarian (n = 13), semivegetarian (n = 13), or omnivorous (n = 12) diet during a 6-month randomized controlled trial. Nutrient intake, nutrient adequacy, and DII score were assessed via two 24-hour dietary recalls (Automated Self-Administered 24-Hour Dietary Recall) at baseline and at 2 and 6 months. Differences in nutrient intake and the DII were examined using general linear models with follow-up tests at each time point. We hypothesized that individuals randomized to the vegan diet would have lower DII scores and greater improvements in fiber, carbohydrate, fat, saturated fat, and cholesterol at both 2 and 6 months as compared with the other 4 diets. Participants randomized to the vegan diet had significantly greater changes in most macronutrients at both time points, including fat and saturated fat, as well as cholesterol and, at 2 months, fiber, as compared with most of the other diet groups (Ps < .05). Vegan, vegetarian, and pescovegetarian participants all saw significant improvements in the DII score as compared with semivegetarian participants at 2 months (Ps < .05) with no differences at 6 months. Given the greater impact on macronutrients and the DII during the short term, finding ways to provide support for adoption and maintenance of plant-based dietary approaches, such as vegan and vegetarian diets, should be given consideration.

Dietary patterns of Brazilian adolescents: results of the Brazilian National School-Based Health Survey (PeNSE)

The objectives of this study were to identify dietary patterns in Brazilian adolescents, describe their distributions in Brazil's State capitals and Federal District, and analyze the correlations with the Municipal Human Development Index (HDI-M). The study analyzed a sample of 60,954 ninth-graders from public and private schools who participated in the National School-Based Health Survey (PeNSE) in 2009. Cluster analysis was used to characterize dietary patterns. Three patterns were identified: healthy (27.7%), unhealthy (34.6%), and mixed (37.7%). Adolescents in the country's Southeast, South, and Central West regions showed a higher proportion of the healthy eating pattern. HDI-M showed a positive correlation with the healthy pattern and a negative correlation with the mixed pattern. The identification of different dietary patterns within and between regions and according to HDI-M highlights the need for better knowledge of each local context in terms of both the magnitude of events and the examination of determinants within these different realities.

Relative validation of fruit and vegetable intake and fat intake among overweight and obese African-American women

OBJECTIVE

To compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women.

DESIGN

Three telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System's (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute's (NCI) Percentage Energy from Fat Screener.

SETTING

Participants were recruited from three federally qualified health centres in south-west Georgia, USA.

SUBJECTS

Participants (n 260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49.6%) and 58.7% had a high-school education or less. Most were obese (88.5%), with 39.6% reporting a BMI ≥ 40.0 kg/m(2).

RESULTS

Mean fruit and vegetable intake reported from the 24 h dietary recall was 2.66 servings/d compared with 2.79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0.22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35.5% as reported from the 24 h dietary recall, compared with 33.0% as measured by the NCI fat screener. The deattenuated Pearson correlation was 0.38, also with notable variation by weight status, education level and age.

CONCLUSIONS

Validity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets

OBJECTIVE

The aim of this study was to determine the effect of plant-based diets on weight loss.

METHODS

Participants were enrolled in a 6-mo, five-arm, randomized controlled trial in 2013 in South Carolina. Participants attended weekly group meetings, with the exception of the omnivorous group, which served as the control and attended monthly meetings augmented with weekly e-mail lessons. All groups attended monthly meetings for the last 4 mo of the study. Diets did not emphasize caloric restriction.

RESULTS

Overweight adults (body mass index 25-49.9 kg/m(2); age 18-65 y, 19% non-white, and 27% men) were randomized to a low-fat, low-glycemic index diet: vegan (n = 12), vegetarian (n = 13), pesco-vegetarian (n = 13), semi-vegetarian (n = 13), or omnivorous (n = 12). Fifty (79%) participants completed the study. In intention-to-treat analysis, the linear trend for weight loss across the five groups was significant at both 2 (P < 0.01) and 6 mo (P < 0.01). At 6 mo, the weight loss in the vegan group (-7.5% ± 4.5%) was significantly different from the omnivorous (-3.1% ± 3.6%; P = 0.03), semi-vegetarian (-3.2% ± 3.8%; P = 0.03), and pesco-vegetarian (-3.2% ± 3.4%; P = 0.03) groups. Vegan participants decreased their fat and saturated fat more than the pesco-vegetarian, semi-vegetarian, and omnivorous groups at both 2 and 6 mo (P < 0.05).

CONCLUSIONS

Vegan diets may result in greater weight loss than more modest recommendations.

Parental role modeling of fruits and vegetables at meals and snacks is associated with children's adequate consumption

Research has shown that parental role modeling of healthful eating behaviors is positively correlated to children's dietary intake and fruit and vegetable (F&V) preferences. The purpose of this study is to (1) examine associations between parent and child report of parental role modeling of F&V consumption at snacks and dinner and (2) determine whether parental role modeling is associated with children meeting daily F&V recommendations. Parent-child dyads (N = 160) participating in the HOME Plus study completed baseline surveys on parental role modeling of F&V at snacks and dinner. Children also completed 24-hour dietary recalls. Spearman correlations and chi-square/Fisher's exact tests were used to examine relationships between parent and child report of parental role modeling of F&V at snacks and dinner and whether children met daily recommendations. On average, children consumed less than three daily servings of F&V with only 23% consuming the recommended servings. Statistically significant correlations were seen between parent and child report of parental role modeling fruit at dinner and green salad at dinner. Children who reported parental role modeling of vegetables at snack and salad at dinner were significantly more likely, than those who did not, to meet daily F&V recommendations. Parents who reported role modeling fruit at snack were significantly more likely to have children who met daily F&V recommendations. Results indicate that children are aware of their parents' eating behaviors and on occasion report this behavior similarly to their parents. Parents should be encouraged to utilize the opportunity to role model healthful dietary intake, especially at snacks, where consumption of F&V appears low.

The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: design and methods

BACKGROUND

Informed and engaged parents and healthful home environments are essential for the health of youth. Although research has shown health benefits associated with family meals, to date, no randomized controlled trial (RCT) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes.

METHODS/DESIGN

The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study is a two-arm (intervention versus attention-only control) RCT being conducted in Minneapolis/St. Paul. Built on previous pilot research, HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children's sedentary behavior, particularly screen time, to promote healthier eating and activity behaviors and prevent obesity. HOME Plus is delivered to families in community settings. The program includes 10 monthly sessions focused on nutrition and activity education, meal planning and preparation skill development. In addition, five motivational goal-setting phone calls are conducted with parents. The primary outcome measure is age- and gender-adjusted child BMI-z score at post-intervention by treatment group. Secondary household-level outcomes include family meal frequency, home availability of healthful foods (fruits/vegetables) and unhealthful foods (high-fat/sugary snacks) and beverages (sugar-sweetened beverages), and the quality of foods served at meals and snacks. Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time.

CONCLUSIONS

The HOME Plus RCT actively engages whole families of 8-12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use.

Validade relativa de indicadores de práticas alimentares da Pesquisa Nacional de Saúde do Escolar entre adolescentes do Rio de Janeiro, Brasil

Avaliou-se a validade relativa dos indicadores de práticas alimentares do questionário utilizado na Pesquisa Nacional de Saúde do Escolar (PeNSE) entre adolescentes da cidade do Rio de Janeiro, Brasil. Foram estudados 174 alunos. Foram avaliados os indicadores: a ingestão regular (≥ 5 vezes/semana) dos alimentos marcadores de alimentação saudável, marcadores de alimentação não saudável e as rotinas alimentares: realizar refeição com responsável (REFEIÇÃO), realizar o desjejum (DESJEJUM) e comer enquanto estuda ou assiste à TV. Foram comparados os resultados do questionário e dos três recordatórios de 24 horas. Para todos os marcadores de alimentação saudável, não houve diferença na proporção de ingestão regular de acordo com os dois métodos. As frequências geradas pelo questionário foram superiores para os indicadores salgadinhos de pacote e biscoitos salgados e mais baixas para embutidos e REFEIÇÃO. Os indicadores de consumo regular de marcadores de alimentação saudável e aquele referente a DESJEJUM foram os que apresentaram maior acurácia. Os indicadores de práticas alimentares utilizados pela PeNSE apresentaram validade satisfatória.

Energy drinks, soft drinks, and substance use among United States secondary school students

OBJECTIVES

Examine energy drink/shot and regular and diet soft drink use among United States secondary school students in 2010-2011, and associations between such use and substance use.

METHODS

We used self-reported data from cross-sectional surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students and conducted multivariate analyses examining associations between beverage and substance use, controlling for individual and school characteristics.

RESULTS

Approximately 30% of students reported consuming energy drinks or shots; more than 40% reported daily regular soft drink use, and about 20% reported daily diet soft drink use. Beverage consumption was strongly and positively associated with past 30-day alcohol, cigarette, and illicit drug use. The observed associations between energy drinks and substance use were significantly stronger than those between regular or diet soft drinks and substance use.

CONCLUSIONS

This correlational study indicates that adolescent consumption of energy drinks/shots is widespread and that energy drink users report heightened risk for substance use. This study does not establish causation between the behaviors. Education for parents and prevention efforts among adolescents should include education on the masking effects of caffeine in energy drinks on alcohol- and other substance-related impairments, and recognition that some groups (such as high sensation-seeking youth) may be particularly likely to consume energy drinks and to be substance users.

Does the type of weight loss diet affect who participates in a behavioral weight loss intervention? A comparison of participants for a plant-based diet versus a standard diet trial

Studies have found that people following plant-based eating styles, such as vegan or vegetarian diets, often have different demographic characteristics, eating styles, and physical activity (PA) levels than individuals following an omnivorous dietary pattern. There has been no research examining if there are differences in these characteristics among people who are willing to participate in a weight loss intervention using plant-based dietary approaches as compared to a standard reduced calorie approach, which does not exclude food groups. The present study compared baseline characteristics (demographics, dietary intake, eating behaviors (Eating Behavior Inventory), and PA (Paffenbarger Physical Activity Questionnaire)) of participants enrolling in two different 6-month behavioral weight loss studies: the mobile Pounds Off Digitally (mPOD) study, which used a standard reduced calorie dietary approach and the New Dietary Interventions to Enhance the Treatments for weight loss (New DIETs) study, which randomized participants to follow one of five different dietary approaches (vegan, vegetarian, pesco-vegetarian, semi-vegetarian, or omnivorous diets). There were no differences in baseline demographics with the exception of New DIETs participants being older (48.5±8.3years versus 42.9±11.2, P=0.001) and having a higher Body Mass Index (BMI, 35.2±5.3kg/m(2) versus 32.6±4.7kg/m(2), P=0.001) than mPOD participants. In age- and BMI-adjusted models, there were no differences in EBI scores or in any dietary variables, with the exception of vitamin C (85.6±5.9mg/d mPOD versus 63.4±7.4mg/d New DIETs, P=0.02). New DIETs participants reported higher levels of intentional PA/day (180.0±18.1kcal/d) than mPOD participants (108.8±14.4kcal/d, P=0.003), which may have been the result of New DIETs study recommendations to avoid increasing or decreasing PA during the study. The findings of this study demonstrate that using plant-based dietary approaches for weight loss intervention studies does not lead to a population which is significantly different from who enrolls in a standard, behavioral weight loss study using a reduced calorie dietary approach.

A comparison of fruit and vegetable intake estimates from three survey question sets to estimates from 24-hour dietary recall interviews

BACKGROUND

Fruit and vegetable (F/V) intake surveillance can provide information critical to the design and evaluation of interventions and the assessment of progress toward national intake objectives. The CDC's Youth Risk Behavior Surveillance System (YRBSS) assesses F/V intake among high school students using six questions about the frequency of intake in times per day. It is not known whether F/V intake frequency in times per day can be used as a proxy for intake in servings per day.

OBJECTIVE

To compare F/V intake estimates based on responses to three sets of survey questions, including the standard set of six YRBSS questions, with criterion F/V intake in servings per day based on data from 24-hour dietary recall interviews.

PARTICIPANTS/SETTING

Study participants were 610 high school students who completed an in-class questionnaire and three telephone-administered 24-hour dietary recall interviews. The questionnaire asked students how many times they consumed 100% fruit juice and ate fruit, carrots, potatoes, green salad, and other vegetables during the "past 7 days" (set 1), the number of times they did so "yesterday" (set 2), and the number of cup-equivalents of fruits and vegetables they consumed per day (set 3).

MAIN OUTCOME MEASURE

Mean estimated F/V intake either as "times/day" or "servings/day" and the percentage of students whose estimated F/V intake was ≥1, ≥2, and ≥3 times/day or servings/day.

STATISTICAL ANALYSES PERFORMED

t tests and corrected Pearson correlations were used to compare F/V intake estimates based on survey question responses with estimates based on responses to the 24-hour dietary recall interviews.

RESULTS

Mean F/V intake estimates (in times/day or servings/day) based on responses to all sets of survey questions were significantly more than servings/day estimates based on responses to the 24-hour dietary recall interviews, and the percentages of students meeting each intake cutpoint were also more. Of the three sets of survey questions, the standard YRBSS questions produced estimates and percentages that were most consistently closest to 24-hour dietary recall interview estimates.

CONCLUSIONS

For brief self-administered questionnaires of high school students, the current YRBSS questions are recommended for monitoring F/V intake even though mean intake estimates in times/day will likely be higher than, and are not a proxy for, mean intake estimates in servings/day.

Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program

OBJECTIVE

Self-monitoring of physical activity (PA) and diet are key components of behavioral weight loss programs. The purpose of this study was to assess the relationship between diet (mobile app, website, or paper journal) and PA (mobile app vs no mobile app) self-monitoring and dietary and PA behaviors.

MATERIALS AND METHODS

This study is a post hoc analysis of a 6-month randomized weight loss trial among 96 overweight men and women (body mass index (BMI) 25-45 kg/m(2)) conducted from 2010 to 2011. Participants in both randomized groups were collapsed and categorized by their chosen self-monitoring method for diet and PA. All participants received a behavioral weight loss intervention delivered via podcast and were encouraged to self-monitor dietary intake and PA.

RESULTS

Adjusting for randomized group and demographics, PA app users self-monitored exercise more frequently over the 6-month study (2.6±0.5 days/week) and reported greater intentional PA (196.4±45.9 kcal/day) than non-app users (1.2±0.5 days/week PA self-monitoring, p<0.01; 100.9±45.1 kcal/day intentional PA, p=0.02). PA app users also had a significantly lower BMI at 6 months (31.5±0.5 kg/m(2)) than non-users (32.5±0.5 kg/m(2); p=0.02). Frequency of self-monitoring did not differ by diet self-monitoring method (p=0.63); however, app users consumed less energy (1437±188 kcal/day) than paper journal users (2049±175 kcal/day; p=0.01) at 6 months. BMI did not differ among the three diet monitoring methods (p=0.20).

CONCLUSIONS

These findings point to potential benefits of mobile monitoring methods during behavioral weight loss trials. Future studies should examine ways to predict which self-monitoring method works best for an individual to increase adherence.

Fruit and vegetable purchasing patterns and preferences in South Delhi

This study examines associations between consumer characteristics, beliefs, and preferences and fruit and vegetable (FV) purchasing and intake in South Delhi, India. Home interviews were conducted with 245 households, using a structured questionnaire to assess FV consumption and purchasing frequency, spending, place of purchase, mode of travel, knowledge and attitudes toward organics, and beliefs about barriers to FV consumption. In-depth interviews with 62 experts and key informants validated survey findings that street vendors and markets are currently the dominant source of FV in South Delhi and that affordability, not accessibility, is the main barrier to increasing FV intake.

Validity and reliability of a dietary stages of change measure among economically disadvantaged African-American adolescents

PURPOSE

To examine the construct validity and 2-month test-retest reliability of a staging measure for assessing readiness to consume five or more daily servings of fruits and vegetables among economically disadvantaged African-American adolescents.

DESIGN

Longitudinal survey.

SETTING

Youth services agencies serving low-income communities in New York, New Jersey, and Pennsylvania.

SUBJECTS

African-American adolescents (N  =  390) aged 11 to 14 years.

MEASURES

Self-report measures of stage of change and fruit and vegetable consumption.

ANALYSIS

Correlation analysis and analysis of covariance were used to examine, cross-sectionally, whether fruit and vegetable consumption differed by stage of change (validity assessment). Correlation analysis and Cohen's kappa (κ) were used to assess the degree of association and level of agreement between stages longitudinally (test-retest reliability assessment).

RESULTS

Fruit and vegetable consumption was moderately correlated with stage of change (r ≥ .54, p  =  .000). Consistent with the transtheoretical model, youths' consumption increased from earlier to later stages (p  =  .000). Forty-six percent of youths were in the same stage at both measurements. The correlation between stages was .26, and Cohen's κ was .20 (p  =  .000).

CONCLUSIONS

Despite preliminary evidence of construct validity, the low test-retest reliability found suggests that further research and testing are needed to improve the stability of the measure.

Social cognitive theory as a framework for considering Farm to School programming

BACKGROUND

Farm to School (FTS) programs are designed, in part, to improve childhood health and nutrition and may be implemented as a strategy to prevent childhood obesity. FTS programs have largely emerged out of grassroots efforts, and theory has not explicitly guided program development or implementation. This research considers the effectiveness of social cognitive theory (SCT) as a framework for FTS programming.

METHODS

In 2010, a survey was administered to 632 elementary schoolchildren in Vermont. Six indices were developed from 46 variables that measured personal characteristics and experiences with regard to fruits and vegetables, as described in the SCT.

RESULTS

These indices were the basis for cluster analysis, which identified three distinct clusters. Bivariate analysis showed significant differences among the clusters in the children’s likelihood of meeting the Dietary Guidelines for Americans (DGA). The significant differences observed among the clusters suggest that SCT is an appropriate framework within which FTS interventions may be considered.

CONCLUSIONS

The findings show that there are distinct food-related attitudes and behaviors that differ widely by the SCT informed clusters and that can be used to inform FTS programs.

Relationships between food consumption and living arrangements among university students in four European countries - a cross-sectional study

BACKGROUND

The transition of young people from school to university has many health implications. Food choice at the university can differ because of childhood food consumption patterns, sex and the living arrangements. Food consumption may change especially if students are living away from home. We aimed to assess food consumption patterns among university students from four European countries and how they differ by their living arrangements.

METHODS

We analysed data from a cross-country survey assessing health and health behaviours of students. The sample comprised a total of 2402 first year undergraduate students from one university in each of the countries of Germany, Denmark, Poland and Bulgaria. Food consumption was assessed by means of a food frequency questionnaire with 9 food groups (indicators).

RESULTS

Students' food consumption patterns differed across the countries. Frequent consumption of unhealthy items was common. Bulgarian students reported most often frequent consumption of sweets and cakes and snacks (e.g. chips and fast food). Polish students reported the least frequent consumption of vegetables and a low consumption of fruits. Across all countries except Bulgaria, men reported substantially more often frequent consumption of snacks than women. Students living at parental home consumed more fruit, vegetables, and meat than those who resided outside of their family home in all studied countries. There was more variation with regard to cakes and salads with more frequent consumption of cakes among Bulgarian female students and Danish male students and more frequent consumption of salads among Danish female students not living at parental home, compared to students from other countries.

CONCLUSIONS

Nutrition habits of university students differed across countries and by sex. Students living at parental home displayed more healthy nutrition habits, with some exceptions.

Rapid increases in overweight and obesity among South African adolescents: comparison of data from the South African National Youth Risk Behaviour Survey in 2002 and 2008

OBJECTIVES

To aid future policy and intervention initiatives, we studied the prevalence and correlates of overweight and obesity among participants in the South African National Youth Risk Behaviour Survey in 2002 and 2008.

METHODS

The survey collected data from nationally representative cross-sectional samples of students in grades 8 through 11 (n = 9491 in 2002 and 9442 in 2008) by questionnaire and measurement of height and weight. We stratified data on overweight and obesity rates by age, socioeconomic status, and race/ethnicity.

RESULTS

Among male adolescents, overweight rates increased from 6.3% in 2002 to 11.0% in 2008 (P < .01); among female adolescents, overweight rates increased from 24.3% in 2002 to 29.0% in 2008 (P < .01). Obesity rates more than doubled among male adolescents from 1.6% in 2002 to 3.3% in 2008 (P < .01) and rose from 5.0% to 7.5% among female adolescents (P < .01). We observed a dose-response relationship in overweight and obesity rates across socioeconomic categories. Rates of overweight and obesity were significantly higher among urban youths than among rural youths (P < .01).

CONCLUSIONS

South Africa is experiencing a chronic disease risk transition. Further research is needed to better understand and effectively address this rapid change.

Substance use and dietary practices among students attending alternative high schools: results from a pilot study

Background

Substance use and poor dietary practices are prevalent among adolescents. The purpose of this study was to examine frequency of substance use and associations between cigarette, alcohol and marijuana use and selected dietary practices, such as sugar-sweetened beverages, high-fat foods, fruits and vegetables, and frequency of fast food restaurant use among alternative high school students. Associations between multi-substance use and the same dietary practices were also examined.

Methods

A convenience sample of adolescents (n = 145; 61% minority, 52% male) attending six alternative high schools in the St Paul/Minneapolis metropolitan area completed baseline surveys. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention pilot trial. Mixed model multivariate analyses procedures were used to assess associations of interest.

Results

Daily cigarette smoking was reported by 36% of students. Cigarette smoking was positively associated with consumption of regular soda (p = 0.019), high-fat foods (p = 0.037), and fast food restaurant use (p = 0.002). Alcohol (p = 0.005) and marijuana use (p = 0.035) were positively associated with high-fat food intake. With increasing numbers of substances, a positive trend was observed in high-fat food intake (p = 0.0003). There were no significant associations between substance use and fruit and vegetable intake.

Conclusions

Alternative high school students who use individual substances as well as multiple substances may be at high risk of unhealthful dietary practices. Comprehensive health interventions in alternative high schools have the potential of reducing health-compromising behaviors that are prevalent among this group of students. This study adds to the limited research examining substance use and diet among at-risk youth.

Trial registration number

ClinicalTrials.gov: NCT01315743

Association between food opportunities during the school day and selected dietary behaviors of alternative high school students, Minneapolis/Saint Paul, Minnesota, 2006

INTRODUCTION

Availability of competitive foods in schools has been linked to unhealthful dietary behaviors of students. Little is known about the food environment of alternative high schools, schools that enroll students at risk of academic failure. We examined correlations between food opportunities during the school day and selected dietary behaviors of students attending alternative high schools.

METHODS

Baseline data were collected in fall 2006 as part of the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. Students (n = 145) attending 6 alternative high schools in Minneapolis/Saint Paul, Minnesota, completed a survey on food opportunities during the school day and selected dietary behaviors. We used mixed-model multivariate cross-sectional analysis and adjusted for demographic characteristics to examine associations of interest.

RESULTS

Food opportunities during the school day were positively associated with overall consumption of sugar-sweetened beverages, high-fat foods, and fast-food restaurant use.

CONCLUSION

Having many food opportunities during the school day at alternative high schools was linked to the consumption of foods and beverages high in sugar and fat and low in nutrients. School-based interventions should focus on changing the food environment in alternative high schools to decrease less healthful eating opportunities and to increase the availability of healthful foods and beverages.

Perceived barriers mediate the association between self-efficacy and fruit and vegetable consumption among students attending alternative high schools

Compared to students attending regular high schools, alternative high school students are more likely to be racial/ethnic minorities, have higher levels of poverty, and higher rates of risky and poor health behaviors, including weight-related behaviors like limited fruit and vegetable intake. However, little is known about fruit/vegetable intake among alternative high school students. This study examined whether perceived barriers to healthy eating mediated the association between self-efficacy to eat healthy foods and fruit/vegetable consumption among alternative high school students. The cross-sectional study population consisted of students (N=145) attending six alternative high schools in the St Paul-Minneapolis, MN, area who were participants in an obesity prevention pilot study and completed a baseline survey during fall 2006. Mixed model linear regression, adjusting for sociodemographic characteristics, was used to test a series of regression models performed according to mediation analysis procedures. Students' mean age was 17.3 years; 52% were male, 63% were low-income, and 61% were from racial/ethnic minorities. Students reported a mean fruit/vegetable intake of 3.6 servings per day, mean self-efficacy to eat healthy score of 22.2 (range 3 to 35), and mean barriers to eating healthy score of 6.9 (range 3 to 13). Perceived barriers to healthy eating fully mediated the relationship between self-efficacy and fruit/vegetable consumption (Sobel test statistic 2.7, P=0.007). Interventions targeting the dietary practices of alternative high school students should include components to decrease perceived barriers as a way to increase self-efficacy and ultimately fruit/vegetable intake.

The reliability and validity of a short FFQ among Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children

OBJECTIVE

To determine the reproducibility and validity of a short FFQ (SFFQ) for Australian rural children aged 10 to 12 years, particularly Aboriginal and Torres Strait Islander children.

DESIGN

In this cross-sectional study participants completed the SFFQ on two occasions and three 24 h recalls. Concurrent validity was established by comparing results of the first SFFQ against food recalls; reproducibility was established by comparing the two SFFQ.

SETTING

The north coast of New South Wales in the Australian summer of late 2005.

SUBJECTS

Two hundred and forty-one children (ninety-two Aboriginal and Torres Strait Islander children and 100 boys) completed two SFFQ and were included in the reproducibility study; of these, 205 participants with a mean age of 10·8 (sd 0·7) years took part in the validity study.

RESULTS

The SFFQ showed moderate to good reproducibility among all children with kappa coefficients for repeated measures between 0·41 and 0·80. Eighteen of twenty-three questions demonstrated good validity against the mean of the 24 h recalls, with statistically significant increasing trends (P ≤ 0·05) for mean daily weight and/or frequency as survey response categories increased. A similar number of short questions showed good validity for Aboriginal and Torres Strait Islander children as for their non-Indigenous counterparts.

CONCLUSIONS

Many short questions in this SFFQ are able to discriminate between different categories of food intake and provide information on relative intake within the given population. They can be used to monitor and/or evaluate population-wide health programmes, including those with rural Aboriginal and Torres Strait Islander children.

Fruit and Vegetable Intake In Canadian Ethnic Populations

Purpose: We explored whether Canada's diverse ethnic population consumes an adequate daily amount of fruit and vegetables. We also examined the association between fruit and vegetable consumption and long-term diseases.

Methods: The Canadian Community Health Survey, Cycle 2.2 (CCHS 2.2), was used to determine the fruit and vegetable intake (FVI) of 13 racial groups, as well as of the entire population. Specifically, we determined median intake and proportions of the group consuming five or more daily servings. Multiple pairwise comparisons among the proportions were performed to detect ethnic groups with significantly low FVI. Logistic regression was also used to describe the risk of longterm diseases associated with FVI and ethnicity.

Results: The percentages of Southeast Asian, Aboriginal (offreserve), and Chinese people who consumed five or more daily servings of fruit and vegetables were significantly lower than percentages in all other ethnic groups surveyed. Aboriginal people with the lowest FVI demonstrated the highest propensity for developing most of the long-term diseases.

Conclusions: The majority of Canada's ethnic groups identified in the CCHS 2.2 fell short of the recommended FVI target. This low-intake status might be a risk factor for common long-term diseases.

An examination of the psychometric properties of the Antiretroviral General Adherence Scale (AGAS) in two samples of HIV-infected individuals

This article reports on the development and psychometric properties of the Antiretroviral General Adherence Scale (AGAS) in two National Institutes of Health-funded projects: the Get Busy Living Project, a behavioral clinical trial to promote consistent use of antiretroviral therapy, and the KHARMA (Keeping Healthy and Active with Risk Reduction and Medication Adherence) Project, which addressed issues of adherence and risk reduction behavior in women. AGAS assesses the ease and ability of participants to take antiretroviral therapy according to a health care provider's recommendations. Data were analyzed from completed baseline assessments of the two studies. The AGAS was internally consistent in both samples. Content, construct, and criterion validity were established using factor analysis and correlations of total AGAS scores with two measures of adherence: electronic drug monitoring and an Adult AIDS Clinical Trials Group adherence scale. Viral load, CD4 cell counts, and depression scores were also examined. Reliability and validity of the AGAS were supported in both samples.

Food-frequency questionnaires: a review of their design, validation and utilisation

A review of the literature concerning the design, utilisation and validation of food-frequency questionnaires (FFQ) has been carried out using a semi-systematic approach to obtaining, reviewing and extracting data from articles. Databases were searched from 1980 to 1999. The present review identified 227 validation (from 1980 to September 1999) and 164 utilisation (for 1998 only) studies. A number of design issues have been evaluated through the present review. These include: the need to consider how portion sizes have been described, self-defined giving higher mean correlations; how an FFQ was administered, interviewer-administered giving higher mean correlations for some nutrients; how many items to include on an FFQ, those with the largest number of items having higher correlations. Validation techniques were described. Most validation studies involved comparing an FFQ against another dietary assessment method; only 19 % compared an FFQ to a biomarker. Measurement differences were most commonly assessed by correlation coefficients as opposed to other more appropriate methods. Mean correlation coefficients were highest for Ca and fat, and lowest for vitamin A and vegetables. The utilisation studies showed that FFQ were most commonly used in cross-sectional surveys, with ninety-three of the FFQ being designed to be disease-specific. The present review results were presented to a group of experts and a consensus arrived at concerning the development, validation and use of FFQ. Recommendations derived from the consensus arising from the literature review are presented as an appendix to the present paper.

Are there nutritional and other benefits associated with family meals among at-risk youth?

PURPOSE

The literature suggests positive associations between family dinner frequency and dietary practices and psychosocial well-being, and inverse associations between family dinner frequency and overweight status among general adolescent populations. The present study aims to examine these associations among a population of adolescents at-risk of academic failure.

METHODS

A racially diverse sample of adolescents (n = 145, 52% male, 61% nonwhite) from six alternative high schools (AHS) completed surveys and had their heights and weights measured by trained research staff. Mixed-model logistic regression analyses assessed associations between family dinner frequency and overweight status, healthy and unhealthy weight management, and food insecurity, whereas mixed linear models assessed associations with breakfast consumption, fruit and vegetable consumption, high-fat food intake, fast food intake, substance use, and depressive symptoms. Analyses adjusted for race/ethnicity, age, gender, socioeconomic status, and the random effect of school.

RESULTS

Family dinner frequency was positively associated with breakfast consumption and fruit intake (p < .01 and p < .05, respectively), and inversely associated with depressive symptoms (p < .05). Adolescents who reported never eating family dinner were significantly more likely to be overweight (odds ratio [OR] = 2.8, confidence interval [CI] = 1.1-6.9) and food insecure (OR = 6.0, CI = 2.2-16.4) than adolescents who reported five to seven family meals per week.

CONCLUSIONS

In this at-risk sample of youth, some, but not all of the benefits of family meals found in other studies were apparent. Intervention programs to increase the availability and affordability of healthful foods and promote family meals for families of AHS students may be beneficial.

Relative validity of a self-completion 24 h recall questionnaire to assess beverage consumption among schoolchildren aged 7 to 9 years

OBJECTIVE

Drinking habits in children are associated with diet quality, but validated assessment tools for large-scale studies in young children are lacking. Therefore, we validated a self-completion 24 h recall questionnaire (RQ) focusing on beverage consumption with a 24 h weighed record (WR).

DESIGN

Thirty-five voluntary participants from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study cohort aged 7-9 years completed the RQ. The illustrated RQ required ticking the number of glasses of seven beverage categories consumed in five time intervals in the previous 24 h. As a reference, parents completed weighed records of their child's diet. Agreement between the RQ and WR was tested by classification into consumers and non-consumers (kappa coefficients, kappa), by the children's ability to estimate the exact beverage and total volume consumed (Wilcoxon signed-rank test, Spearman rank correlation), and by ranking children according to reported beverage volumes.

RESULTS

The RQ and WR showed a good level of agreement for classifying participants into consumers and non-consumers of the single beverage categories (kappa values between 0.78 and 0.94). Correlation coefficients for the volume of the single categories ranged between 0.81 and 0.91. The total beverage volume was overestimated in the RQ, on average, by 114 ml (P = 0.015). Agreement in ranking into tertiles by beverage volume was moderate to good for juice/soft drinks (kappa = 0.44), milk (kappa = 0.57) and water (kappa = 0.70), but fair for the total beverage volume (kappa = 0.23).

CONCLUSIONS

Our self-completion 24 h RQ could estimate the consumption of several beverage categories among young children at the group level, but quantification of total beverage volume was flawed.

Assessing diet in longitudinal birth cohort studies

Diet is an important component of a person's environment. It is important for adults and particularly for mothers during pregnancy and while breast feeding, and for children in utero and during later growth and development. Measurement of the type and amount of foods consumed is complex. Here we describe the different methods that can be used, when and when not to use each one, and the importance of validation studies.

Sociodemographic differences in selected eating practices among alternative high school students

BACKGROUND

Students attending alternative high schools are an at-risk group of youth for poor health behaviors and obesity. However, little is known about their dietary practices.

OBJECTIVE

To examine associations between sex, race/ethnicity, and socioeconomic status and selected dietary practices, including consumption of sugar-sweetened beverages, high-fat foods, and fruits and vegetables and fast-food restaurant use, among students attending alternative high schools.

DESIGN

Population-based, cross-sectional study.

SUBJECTS/SETTING

A convenience sample of adolescents (n=145; 52% men; 63% aged <18 years; and 39% white, 32% African American, and 29% other/multiracial) attending six alternative high schools in the St Paul/Minneapolis, MN, metropolitan area completed a survey. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics were used to describe dietary practices. Mixed model multivariate analyses were used to assess differences in dietary practices by sex, race/ethnicity, and socioeconomic status.

RESULTS

Regular soda was consumed at least five to six times per week by more than half of students. One half of students reported eating or drinking something from a fast-food restaurant at least three to four times a week. African-American students had the highest consumption of sugar-sweetened beverages (P=0.025), high-fat foods (P=0.002), and highest frequency of fast-food restaurant use (P<0.025). Mean fruit/vegetable intake was 3.6 servings/day; there were no sociodemographic differences in fruit/vegetable consumption. Higher socioeconomic status was associated with a higher consumption of regular soda (P=0.027).

CONCLUSIONS

Racial/ethnic and sex differences in the consumption of regular soda, high-fat foods, and fast-food restaurant use among alternative high school students underscores the importance of implementing health promotion programs in alternative high schools.

Affective associations mediate the influence of cost-benefit beliefs on fruit and vegetable consumption

Consumption of fruits and vegetables is far lower than recommended. The behavioral affective associations model posits that affective associations influence behavior and mediate the influence of perceived benefits and barriers on behavioral choices. The purpose of this study was to test the model's predictions about the influence of affective associations and benefits/barriers on fruit and vegetable consumption. Community adults (N=446) reported perceived benefits and barriers to fruit and vegetable consumption, affective associations with fruits and vegetables, and current fruit and vegetable intake. Affective associations predicted behavior and mediated the influence of benefits and barriers on behavior, supporting predictions made by the behavioral affective associations model. This highlights the need to incorporate affective factors in decision-making models and intervention strategies.

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.

Changes in knowledge, beliefs, and behaviors related to fruit and vegetable consumption among Western Australian adults from 1995 to 2004

OBJECTIVES

We monitored changes in self-reported knowledge, attitudes, and behaviors regarding fruit and vegetable consumption in Western Australia prior to and after a healthful-eating campaign.

METHODS

We obtained telephone survey data from 2854 adults in Perth from Nutrition Monitoring Surveys conducted in 1995, 1998, 2001, and 2004. The "Go for 2&5" fruit and vegetable campaign was implemented from 2002 to 2005.

RESULTS

We observed changes in knowledge, attitudes, and behaviors regarding fruit and vegetable intake. In 2004, respondents were more likely than in 1995 to report 2 servings of fruit (odds ratio [OR] = 3.66; 95% confidence interval [CI] = 2.85, 4.70) and 5 servings of vegetables (OR = 4.50; 95% CI = 3.49, 5.80) per day as optimal. Despite this, vegetable consumption in 2004 was less than in 1995 (rate ratio = 0.88; 95% CI = 0.82, 0.96; P = .003). Perceived adequacy of vegetable (59.3%) or fruit (34.5%) intake and insufficient time for vegetable preparation (14.3%) were the main barriers.

CONCLUSIONS

Knowledge of the recommended fruit and vegetable intake increased following the Go for 2&5 campaign. Perceptions of the adequacy of current intake and time scarcity should be considered when designing nutrition interventions.

Consumer perceptions of fruit and vegetables serving sizes

OBJECTIVE

To assess consumer understanding of fruit and vegetable serving sizes.

DESIGN

The Western Australian Health Department launched the Go for 2&5(R) campaign to promote fruit and vegetables in March 2002. The Health & Wellbeing Surveillance System surveyed 1108 adults, aged 16 years and over, between September and November 2002 about what constituted a serving of fruit and of vegetables, their usual daily fruit and vegetables intake, and their recall of the campaign.

SETTING

The study was undertaken as a part of a public health intervention - social marketing campaign in Western Australia, which had a population of 1 927 000 in 2002.

RESULTS

Forty-two per cent of respondents knew that the fruit serving size was one piece and only 14.5 % reported the (1/2) cup vegetable serving size. The mean fruit intake was 1.8 (95 % CI 1.7, 1.8) servings/d and the mean vegetable intake was 2.8 (95 % CI 2.7, 3.0) servings/d. Vegetable intake was associated with being female (P = 0.006), increasing age (P < 0.0001), awareness of the campaign (P = 0.031) and knowledge of standard serving size (P = 0.006). Fruit consumption was associated with being female (P = 0.007). Fruit and vegetable intakes were not associated with educational attainment or household income.

CONCLUSIONS

The Go for 2&5(R) campaign uses a prescriptive message to promote increased consumption of fruit and vegetables. Respondent's knowledge of the standard of serving sizes for fruit and vegetables suggests there is value in separating fruit and vegetable recommendations in messages to encourage increased consumption.

Development of a Planning and Evaluation Methodology for Assessing the Contribution of Theory to a Diabetes Prevention Lifestyle Intervention

The benefits of utilizing and measuring application of theory for behavior change programs are numerous, including the emergence of new theories and theoretically bound strategies. Despite recent attempts to make theory use more salient, there remains a dearth of practical frameworks for the development and evaluation of theory-based programs. Without literature documenting how theories have been specifically applied to interventions and their evaluation, health educators may not be well prepared to utilize theory for the design, implementation, or as a focus of the evaluation. Using a case study example of a diabetes prevention program, this article describes how theory was used for the program design and the evaluation and provides a framework for using theory in other programs. Issues discussed include: the challenges in successfully utilizing theory for intervention development and the processes of developing theoretically based instruments.