Development and Validation of a Beverage and Snack Questionnaire for Use in Evaluation of School Nutrition Policies

School nutrition policies limiting access to sweetened beverages, candy, and salty snacks have the potential to improve the health of children. To effectively evaluate policy success, appropriate and validated dietary assessment instruments are needed. The objective of this study was to develop and validate a beverage and snack questionnaire suitable for use among young adolescents. A new 19-item Beverage and Snack Questionnaire (BSQ) was administered to middle school students on two occasions, 2 weeks apart, to measure test-retest reliability. The questionnaire inquired about frequency of consumption, both at school and away from school, of soft drinks, salty snacks, sweets, milk, and fruits and vegetables. Students also completed 4-day food records. To assess validity, food-record data were compared with BSQ data. Forty-six students of diverse backgrounds from metropolitan Seattle, WA, participated in this study. Participants answered the BSQ during class time and completed the food record at home. Pearson correlation coefficients assessed test-retest reliability and validity. Using frequency per week data, the test-retest reliability coefficients were r=0.85 for fruits and vegetables consumed at school and r=0.74 and r=0.72 for beverages and sweets/snacks, respectively, consumed at school. Correlations ranged from r=0.73 to 0.77 for foods consumed outside of school. Compared with the criterion food record, validity coefficients were very good: r=0.69 to 0.71 for foods consumed at school and r=0.63 to 0.70 for foods consumed away from school. The validity coefficients for the 19 individual food items ranged from r=0.56 to 0.87. This easy-to-administer 19-item questionnaire captures data on sugar-sweetened beverages, salty snacks, sweets, milk, and fruit and vegetables as well as a more lengthy and expensive food record does. The BSQ can be used by nutrition researchers and practitioners to accurately evaluate student consumption of foods that are the focus of school nutrition policies.     

Fruit and Vegetable Preparation Changes During and After Cost-Offset Community-Supported Agriculture Plus Nutrition Education

ObjectiveInadequate consumption of fruits and vegetables (FV) can negatively impact health. Cost-offset, or subsidized, community-supported agriculture (CO-CSA) may change FV preparation behaviors among caregivers in low-income households. We assessed changes in FV preparation frequency and methods during and after participation in a CO-CSA plus tailored nutrition education intervention.DesignLongitudinal comparison of outcomes at baseline, end of CO-CSA season, and 1 year later.ParticipantsCaregivers of children aged 2–12 years from households with low income in rural areas of 4 US states (n = 148).InterventionSummer season, half-price CO-CSA share plus tailored nutrition education classes. Comparison to a control group not included in this analysis.Variables MeasuredMonthly frequency of preparing 9 FV for children's snacks and 5 vegetables for dinner; use of healthy preparation methods for dinner.AnalysisRepeated measures ANCOVA including state with Bonferroni correction and 95% confidence.ResultsAt baseline, caregivers prepared fruit for children's snacks and vegetables for dinner almost daily and vegetables for children's snacks every other day. The frequency of total FV preparation and most vegetable varieties increased during the intervention. Increases in total vegetables for snacks, dinner, and leafy greens were maintained 1 year later (n = 107).Conclusions and ImplicationsCommunity-supported agriculture plus education is a promising approach to sustained increases in vegetable preparation for children's snacks and dinner meals.     

Choose Health: Food,Fun, and Fitness Youth Curriculum Promotes Positive Behaviors

Objective

Evaluate whether participation in Choose Health: Food, Fun, and Fitness (CHFFF), a hands-on, experiential curriculum aimed at third- to sixth-graders, resulted in improvements in the targeted obesity and chronic disease prevention behaviors.

Evaluating an Interactive Digital Intervention for College Weight Gain Prevention

ObjectivePilot a digital interactive intervention for weight gain prevention among college students.MethodsOne sample pre-post study reporting on initial usability and changes in theoretical constructs (ie, self-efficacy, behavioral capability, elaboration) and program acceptability. Twenty college freshmen (mean age, 18.25 ± 0.72 years) reviewed a digital program providing self-assessment and brief tailored feedback on 8 behaviors that relate to a healthy weight: physical activity, sedentary behavior, and consumption of sugary beverages, high fat snacks, breakfast, fried foods, fruits and vegetables, and pizza.ResultsAt posttest, improvements in self-efficacy were found for 5 behaviors (ie, physical activity, high fat snacks, breakfast, fried foods, fruits and vegetables); improvements in behavioral capability were found for 3 behaviors (ie, high fat snacks, fried foods, and fruits and vegetables). Acceptability benchmarks included: positive impression (60%), relevance (95%), and ease of comprehension (75%).Conclusions and ImplicationsThis program demonstrates acceptability for a digital weight gain prevention intervention, with improvements in behavioral mediators of change. Suggestions to simplify messaging and allowing for user control may enhance acceptability and comprehension. There is a need for further testing with larger more diverse populations before broader implementation by universities to address student health.     

Perceived Stress and Eating Behaviors by Sex,Obesity Status,and Stress Vulnerability: Findings from the Vitamins and Lifestyle (VITAL) Study

Stress has been associated with eating patterns in human studies with differences due to the type and duration of stressor, type of food, and individual susceptibility factors. Laboratory and smaller epidemiological studies have reported stress-associated preferences for foods high in sugar and fat; associations have been found more consistently among women and people who are obese. Larger studies are needed to sufficiently test these relationships. The aim of this study was to evaluate associations between self-reported amount of stress and dietary nutrient intakes (percentage energy from fat, carbohydrates, added sugar) and dietary behaviors (number of eating occasions and servings of fruits and vegetables, high-fat snacks, fast-food items, and sweetened drinks) by sex, obesity status, and stress vulnerability. Linear regression was used to estimate associations of perceived stress with eating patterns among 65,235 older adults while adjusting for demographic factors, body mass index, physical activity, alcohol intake, number of comorbidities, and other relevant covariates. Higher perceived stress was associated with greater intake of energy from fat, high-fat snacks, and fast-food items as well as lower intake of energy from carbohydrates (all P for trend ≤0.002). Among those with high perceived stress vulnerability, perceived stress was associated with fewer eating occasions (P for interaction <0.0001). Although associations were small, significant relationships were found for perceived stress arising from everyday experiences among an older, mostly white population. These findings have public health implications and suggest that stress may be important to consider in programs promoting healthy eating.     

Association between junk food consumption and mental health in a national sample of Iranian children and adolescents: The CASPIAN-IV study

ObjectivesThe consumption of high energy and low nutritional content foods, which are known as junk foods, has increased. The aim of this study was to evaluate the association between junk food intake and mental health in a national sample of Iranian children and adolescents.MethodData were obtained from a surveillance system entitled CASPIAN-IV (Childhood and Adolescence Surveillance and Prevention of Adult Non communicable Disease) study of school students, ages 6 to 18 y in Iran. The students and their parents completed two sets of reliable questionnaires obtained from Global School Health Survey translated to Persian. The student questionnaire comprised several questions such as psychiatric distress (worry, depression, confusion, insomnia, anxiety, aggression, and worthless) and violent behaviors (physical fighting, being a victim, and bullying). The junk foods consisted of sweets, sweetened beverages, fast foods, and salty snacks.ResultsIn the sample of 13 486 children and adolescents, the frequency of junk food consumption was significantly associated with psychiatric distress (P < 0.001). There was a significant association between violent behaviors and intake of junk foods (P < 0.001) except for sweets, whereas the association between sweetened beverages consumption and being a victim was not significant (P > 0.05). Additionally, the results of logistic regression showed that daily consumption of sweetened beverages and snacks significantly increased the odds of self-reported psychiatric distress. Also, daily consumption of salty snacks was significantly associated with violent behavior, including physical fighting (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.21–1.60), being a victim (OR, 1.19; 95% CI, 1.04–1.37), and bullying (OR, 1.55; 95% CI, 1.32–1.82).ConclusionJunk food consumption may increase the risk for psychiatric distress and violent behaviors in children and adolescents. Improvement of eating habits toward healthier diets may be an effective approach for improving mental health.     

Child Care Sites Participating in the Federal Child and Adult Care Food Program Provide More Nutritious Foods and Beverages

ObjectiveTo compare food/beverage provisions between child care sites participating and not participating in the Child and Adult Care Food Program (CACFP).DesignCross-sectional survey administered in 2016.SettingLicensed child care centers and homes.ParticipantsChild care providers (n = 2,400) randomly selected from California databases (30% responded). Respondents (n = 680) were primarily site directors (89%) at child care centers (83%) participating in CACFP (70%).Main Outcome MeasuresMeals/snacks served, and food/beverage provisions provided to children of age 1–5 years on the day before the survey.AnalysisOdds ratios unadjusted and adjusted for the number of meals/snacks using logistic regression.ResultsCompared with CACFP sites, non-CACFP sites provided fewer meals/snacks; had lower odds of providing vegetables, meats/poultry/fish, eggs, whole grains, and milk; and had higher odds of providing candy, salty snacks, and sugary drinks. After adjusting for the number of meals/snacks, differences were attenuated but remained significant for meats/poultry/fish, milk, candy, salty snacks (centers only), and sugary drinks. Differences emerged in favor of CACFP for flavored/sugar-added yogurt, sweet cereals, frozen treats, and white grains.Conclusions and ImplicationsChild care sites participating in CACFP are more likely to provide nutritious foods/beverages compared with non-CACFP sites. Child care sites are encouraged to participate in or follow CACFP program guidelines.     

Impact of a nutrition education curriculum on snack choices of children ages six and seven years

ObjectiveTo report the impact of nutrition education on snack choices of children ages 6 and 7 years.DesignIn this quasi-experimental study, students at 2 intervention schools participated in a 4-week after-school program, NutriActive Healthy Experience, that included nutrition lessons, healthy snacks, and parent education. Students at 2 comparison schools did not receive any intervention but participated in the assessment of snack choices. Intervention and comparison students were offered the choice of 3 out of 10 snack items at baseline, at the end of the 4-week program, and 4 months later.SettingAn after-school program in the school setting.Participants36 intervention and 23 comparison kindergarten and first-grade students.Main Outcome MeasuresStudents’ snack choices were coded and analyzed.Analysist test, repeated-measures analysis of variance (ANOVA).ResultsImmediately after the program, the intervention group showed a 25.7% improvement in choosing more healthful snacks, and the comparison group showed an 18.2% decline. At 4 months, the intervention group’s score was 33.3% higher than baseline and the comparison group’s score remained 18.2% lower than baseline (time by treatment interaction, P= .023).Conclusions and ImplicationsIntervention students were significantly more likely than comparison students to choose more healthful snacks when given the opportunity. The snack test may be a useful alternative for assessing snack choices of children ages six to seven years.     

Atención Primaria y promoción de la salud bucodental: evaluación de una intervención educativa en población infantil

ObjectiveTo evaluate the short and medium term effectiveness of a Primary Care-driven oral health promotion intervention.DesignA non-randomised community intervention trial.SettingThree socio-demographically similar primary schools of a deprived neighborhood in Granada, Spain.ParticipantsEighty-two intervention and 109 control students aged 5 to 6, as well as the teachers and the parent's association of the intervention school (IS) participated in the study.InterventionSchool-based health promotion activities aimed at students, and regular meetings with the teachers and parents of the IS during 2 consecutive years.Main measurementsStudents’ oral health-related knowledge and behavior, assessed via questionnaires distributed before the intervention, and 6 and 18 months afterwards.ResultsCompared to the control groups at 18 months, students belonging to the IS reported enhanced oral health knowledge (OR 3.54; 95% CI 1.46-8.58), and an increased consumption of healthy food at breakfast (OR 2.95; 95% CI 1.26-6.89) and during mid-afternoon snack (OR 3.67; 95% CI 1.49-9.05). A significant decrease was seen in the intake of pastries (OR 4.05; 95% CI 1.68-9.81) and sweetened soft drinks and juices (OR 3.79; 95% CI 1.57-9.12) amongst intervention compared to control students in the medium term (18 months). No significant improvements were observed concerning oral hygiene in the IS.ConclusionsSchool-based educational interventions, when developed through an intersectoral and participative approach and considering the socio-economic context, appear to be effective in improving students’ diet-related knowledge and behaviors.     

Food,Health, & Choices: Curriculum and Wellness Interventions to Decrease Childhood Obesity in Fifth-Graders

Objective

To evaluate Food, Health, & Choices, two 10-month interventions.

Theory‐informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross‐sectional study

Background

The eating patterns of school‐aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar‐sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

Methods

The curriculum was developed in collaboration with school teachers using self‐determination theory as a theoretical standpoint. The Health at Every Size concept and sensory‐based food education were utilised in the curriculum. Self‐reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012–2013 with 194 pupils aged 10–13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

Results

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar‐sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

Conclusions

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

     

Translating Government Policy into Recipes for Success! Nutrition Criteria Promoting Fruits and Vegetables

ObjectiveTo develop nutrition criteria consistent with Australian dietary guidelines encouraging fruit and vegetable consumption for branding recipes with the Go for 2&5 campaign message.DesignDietary policies, guidelines, food selection guides, nutrient targets, existing consumer education programs' nutrition criteria, food habits, and eating styles were reviewed to develop nutrition criteria, which were then used to assess 128 recipes.SettingPerth, Australia.AnalysisRecipes were analyzed then assessed against criteria for fat, sodium, fiber, energy, added sugar, fruit, vegetables, cereal, and dairy content/per serving.ResultsRecipe nutrition criteria were devised, and 128 contemporary industry recipes were evaluated according to developed nutrition criteria. Recipe categories included main meals; light meals (includes breakfast); soups; salads; side dishes; snacks (includes drinks); desserts; bakery; and basic ingredients (eg, stocks, dips, and sauces). Nearly three quarters failed. Excess fat (45%) and sodium (30%) and inadequate cereal (24%) were the main reasons. Only minor modifications were required to meet criteria.Conclusions and Implications“Healthful” recipes promoting fruits and vegetables were often high in fat and sodium and low in cereal content. Nutrition criteria developed for this study provided a practical way of assessing specific meals and snacks according to the dietary guidelines, making them suitable for nutrition promotions.     

The Macronutrient Content of Sodium-Modified Foods Is Unchanged Compared with Regular Counterparts: An Evaluation of Select Categories of Packaged Foods in the United States, 2018

BackgroundLowering excess sodium in packaged foods is part of a public health strategy to reduce cardiovascular disease risk. Sales of foods with labeled sodium claims increased during the past decade. Yet, it is unclear whether sugars or fats were added during the reformulation of foods that might counter the benefits of sodium reduction.ObjectiveIt was hypothesized that the nutrient content of packaged foods with lower sodium label claims (ie, sodium-modified) would differ from their regular (ie, unmodified) counterparts.DesignThis cross-sectional study compared label data of 153 sodium-modified foods and 141 regular, matched counterparts within four food categories: soups, processed meats, vegetables, and savory snacks. Foods were identified by searching manufacturer websites of the top-10 brands in each category. Sodium, calories, total carbohydrate, sugar, protein, total fat, saturated fat, and potassium (when reported) were compared by labeled serving and per 100 g food.ResultsThe average amount in milligrams of sodium per serving in regular foods ranged from 162 mg for savory snacks to 782 mg for soups. Compared with regular foods, the matched lower sodium foods had significantly less sodium per serving (–95 to –387 mg) and per 100 g (–184 to –462 mg) (P<0.01 for all comparisons), except for soups per 100 g (P = 0.166), and were similar to their regular counterparts in calories, total carbohydrate, sugar, protein, total fat, and saturated fat (P>0.05 for all comparisons). Of the soups that reported potassium on the label, potassium was 244 mg/serving (P=0.004) and 139 mg/100 g (P=0.002) higher among matched lower sodium soups.ConclusionsThe similarity in macronutrient contents on the labels for sodium-modified foods and their regular counterparts suggests that reformulation did not include the addition of significant amounts of sugars, fats, or other macronutrients among major food brands in the selected categories. Potassium content and additional food categories deserve further investigation.     

Gender Analyses of Brazilian Parental Eating and Activity With Their Adolescents’ Eating Habits

ObjectiveTo explore the associations between the eating habits of sons and daughters and the eating habits, sedentary behavior, and physical activity of their fathers and mothers.DesignA cross-sectional survey of adolescents.SettingThe 6 largest schools in Londrina, Brazil.ParticipantsA total of 842 adolescents, 842 mothers, and 842 fathers participated in this study.Main Outcomes MeasuresEating habits of adolescents and sedentary behavior, physical activity, and eating habits of their fathers and mothers, measured by questionnaire.AnalysisThe associations were identified by binary logistic regression, adjusted by adolescent's age, family's socioeconomic status, parents’ educational level, and the other parental behavior.ResultsIndependent of educational level and socioeconomic condition, mothers' eating behaviors seem to be more closely related to their adolescent children's eating behavior (vegetables, fruits, fried foods, soft drinks, and sweets [P = .001]) than fathers' behaviors (fried foods and sweets [P = .01], soft drinks [P = .001]). In addition, the behaviors of mothers were more associated to the behaviors of daughters than to the behaviors of sons (7 vs 5 associated behaviors), while behaviors of fathers were more associated with the behaviors of sons than to the behaviors of daughters (4 vs 2 associated behaviors). No associations were noted for sedentary and physical activity behavior and eating behaviors between adolescents and their parents.Conclusions And ImplicationsMany eating habits of adolescents were associated with eating habits of both fathers and mothers, emphasizing the importance of family-focused health promotion actions. Future research is needed incorporating into the analyses, among others, the nutritional statuses and the clustering of healthy and unhealthy behaviors of parents and their children.     

Creating Healthful Home Food Environments: Results of a Study with Participants in the Expanded Food and Nutrition Education Program

ObjectiveTo evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention.DesignTwo-group randomized control trial; intervention versus usual EFNEP curriculum.SettingTexas EFNEP classes.Participants1,104 EFNEP clients in 100 classes.InterventionSix short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes.Main Outcome MeasuresBody mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later.AnalysisMixed-model repeated measures analysis of variance.Results100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive.Conclusion and ImplicationsExisting EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.     

Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study

BackgroundStandard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy. In addition, important behaviors might differ for short- vs long-term weight control.ObjectiveOur aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months.DesignWe performed secondary analysis of data collected during a randomized weight-loss intervention trial with 48-month follow-up.ParticipantsWe studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study.Main outcome measuresWe measured changes in weight from baseline to 6 and 48 months.Statistical analyses performedLinear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group.ResultsAt 6 months in the combined population, weight loss was independently associated with decreased desserts (P<0.001), restaurant eating (P=0.042), sugar-sweetened beverages (P=0.009), and fried foods (P<0.001), and increased fish consumption (P=0.003). Results were similar in intervention participants; only reduced desserts and fried foods associated with weight loss in controls. At 48 months in the combined population, weight loss was again associated with decreased desserts (P=0.003) and sugar-sweetened beverages (P=0.011), but also decreased meats/cheeses (P=0.024) and increased fruits/vegetables (P<0.001). Decreased meats/cheeses predicted weight loss in intervention participants; desserts, sugar-sweetened beverages, and fruits/vegetables were independently associated in controls.ConclusionsChanges in eating behaviors were associated with weight change, although important behaviors differed for short- and long-term weight change and by randomization group. Future studies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes.     

Dietary intake among adults in Trinidad and Tobago and development of a quantitative food frequency questionnaire to highlight nutritional needs for lifestyle interventions

Primary objective To create a food list and develop a draft quantitative food frequency questionnaire (QFFQ) for Trinidad and Tobago.

Methods and procedures A mixed sampling method was used to obtain a representative sample and trained interviewers administered 24-h dietary recalls. Portion sizes were assessed and the most frequently reported foods were tabulated.

Main outcomes and results Results are from 155 men and 169 women aged 21–64 years. The most frequently reported food items were: full-cream milk (64%), rice (61%), and sweetened fruit drinks (50%). Carbonated drinks were consumed by 28%. The most frequently consumed fruits were banana (23%) and citrus (22%); < 20% consumed a vegetable food item. The final QFFQ contains 146 items: 19 breads/cakes/cereals; seven rice/pastas/noodles; 12 dairy; 26 meats/poultry/fish/soy products; 15 fruits; 34 vegetables; six legumes; 11 other; 12 drinks; four alcoholic drinks.

Conclusions A list of commonly consumed foods in Trinidad and Tobago was obtained and a draft QFFQ was prepared.     

Good Grubbin': Impact of a TV Cooking Show for College Students Living Off Campus

ObjectiveTo determine if a series of 4 15-minute, theory-driven (Social Cognitive Theory) cooking programs aimed at college students living off campus improved cooking self-efficacy, knowledge, attitudes, and behaviors regarding fruit and vegetable intake.DesignA randomized controlled trial with pre-, post- and follow-up tests.SettingUniversity campus.ParticipantsStudents (n = 101) from upper-level nonhealth courses (n = 37 male and n = 94 living off campus).InterventionThe intervention group (n = 50) watched 4 weekly episodes of the cooking show, Good Grubbin’. The control group (n = 51) watched 4 weekly episodes on sleep disorders.Main Outcome MeasuresDemographic information; knowledge, self-efficacy, motivations, barriers of eating fruits and vegetables; self-efficacy, motivations, barriers and behaviors of cooking; fruit and vegetable intake food frequency questionnaire.AnalysisRepeated-measure analysis of variance and chi-square analyses were used to compare outcome variables.ResultsThere were significant improvements in knowledge of fruit and vegetable recommendations in the intervention group compared to the control group postintervention and at 4-month follow-up (P < .05). There were no significant changes in fruit and vegetable motivators, barriers, self-efficacy or intake.Conclusions and ImplicationsA television show on nutrition and cooking may be influential in changing students’ knowledge, but it seems to have little impact on dietary behaviors. With a recent increase in popularity of cooking shows, future research should investigate the impact an extended cooking and nutrition show series might have on young adult viewers.