Journal of Nutrition Education and Behavior

Published by Elsevier
Print ISSN: 1499-4046
To determine factors associated with the consumption of fruit and vegetables among 11-year-old schoolchildren in Belgium-Flanders and the Netherlands. In total, 2468 school children from 98 randomly selected schools participated in a cross-sectional survey. Frequency of fruit and vegetable intake and potential personal, social and environmental correlates were measured by means of self-administered, school-based, written questionnaires. Hierarchical multiple regression analyses were conducted to assess potential correlates of schoolchildren's fruit and vegetable consumption. Separate analyses were conducted for boys and girls. Bringing fruit to school, modeling behavior of parents and friends, parents demanding that their child eat fruit, knowledge about recommended intake levels, liking fruit, and self-efficacy to eat fruit were the strongest correlates of fruit intake. For vegetables, gender, parental demand, parents facilitating the consumption of vegetables by cutting them for their child, modeling behavior of parents and friends, and preferences for vegetables emerged as strongest correlates. No substantial differences in significant correlates were found according to gender. The percentage of explained variance was 33.7% for fruit and 28.4% for vegetable intake. Interventions need to be focused on personal (taste preferences), social (parental influences), and environmental factors (availability).
Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on Satter's How to Eat protocol, within a Health at Every Size framework, was successful for 36 women in improving eating attitudes and behaviors, body image, and self-esteem, regardless of initial degree of eating disturbance or weight. This practice model has the potential for ameliorating societal weight escalation and multigenerational struggles with eating and weight.
Consumption of Milk by Sociodemographic Characteristics Among US Children and Adolescents From the National Health and Nutrition Examination Survey, 2001-2004 
Observed and Modeled Energy, Nutrient Intake, and Diet Cost (SD) After Complete Replacement, 2001-2004 
Estimated Survey-Weighted Mean Energy, Nutrient Intake, and Diet Cost (SD) After Replacing Whole and Reduced-Fat Milk With Low-Fat and Skim Milk on a Proportional Basis Among Children Consuming Whole And/or Reduced-Fat Milk, 2001-2004 (n ¼ 4,413) 
Dietary guidance emphasizes plain low-fat and skim milk over whole, reduced-fat, and flavored milk (milk eligible for replacement [MER]). The objective of this study was to evaluate the population-level impact of such a change on energy, macronutrient and nutrient intakes, and diet cost. Cross-sectional modeling study. Data from the 2001-2002 and 2003-2004 National Health and Nutrition Examination Survey. A total of 8,112 children aged 2-19 years. Energy, macronutrient, and micronutrient intake before and after replacement of MER with low-fat or skim milk. Survey-weighted linear regression models. Milk eligible for replacement accounted for 46% of dairy servings. Among MER consumers, replacement with skim or low-fat milk would lead to a projected reduction in energy of 113 (95% confidence interval [CI], 107-119) and 77 (95% CI, 73-82) kcal/d and percent energy from saturated fat by an absolute value of 2.5% of total energy (95% CI, 2.4-2.6) and 1.4% (95% CI, 1.3-1.5), respectively. Replacement of MER does not change diet costs or calcium and potassium intake. Substitution of MER has the potential to reduce energy and total and saturated fat intake with no impact on diet costs or micronutrient density. The feasibility of such replacement has not been examined and there may be negative consequences if replacement is done with non-nutrient-rich beverages. Copyright © 2015. Published by Elsevier Inc.
To examine changes, between 1977-78 and 1994-96, in the quantity and quality of food Americans consumed that was prepared at home versus away from home. Data were obtained from nationwide surveys of food consumption conducted by the US Department of Agriculture (USDA) in 1977-78 and 1994-96. To maximize comparability, we used "day 1" dietary data, which both surveys collected via 24-hour recall. Individuals 2 years of age and over were selected. USDA sampling weights were used to generate nationally representative estimates. We categorized foods by preparation at home or at restaurants, fast-food establishments, schools/day care, and other non-home locations. We assessed percent calories from total fat and saturated fat, and the cholesterol, sodium, fiber, calcium, and iron densities of foods prepared at home versus those prepared away from home. T tests were calculated using accepted procedures to adjust for survey design effects. Between 1977-78 and 1994-96, consumption of food prepared away from home increased from 18% to 32% of total calories. Meals and snacks based on food prepared away from home contained more calories per eating occasion, and "away" food was higher in total fat and saturated fat on a per-calorie basis than at-home food. "Away" food contained less dietary fiber, calcium, and iron on a per-calorie basis. Among adults but not children, food prepared away from home was more sodium and cholesterol dense. When developing intervention messages and strategies, nutrition educators need to be aware of the increasing role of "away" food in Americans' diets.
The United Nations System Standing Committee on Nutrition (SCN) is a forum where United Nations (UN) agencies, bilateral partners, and nongovernmental agencies meet to harmonize and coordinate nutrition policy and programs. This report reviews the positions taken regarding nutrition education throughout SCN publications, annual sessions, and thematic working groups. The first Nutrition Policy Paper, published in 1985, was a State-of-the-Art Review that investigated 6 aspects of a nutrition education system. Later SCN publications and meetings have further addressed how to conduct effective nutrition education to maximize impact. For nutrition education to be worthwhile, it must reach significant audiences and lead to behavioral change, conditions which in turn require feasibility studies and investments in terms of personnel and resources. The SCN plays an important role to these ends through: 1) the advocacy opportunity offered by the SCN Annual Session; 2) the expertise of the working groups; and 3) the dissemination channels offered by the SCN publications and Web site.
Regulatory changes proposed by the US Department of Agriculture in 1994 promised to bring progressive changes to school meals. However, lobbying by interest groups resulted in substantial changes to the final rule. This analysis retrospectively examines the federal school meals policy-making process during 1992 to 1996. Key questions address why the policy changed and what the role of interest groups was in affecting the shape, pace, and direction of the policy. The study provides suggestions for using the experiences of 1992 to 1996 to guide future advocacy efforts and for adapting the approach for application to other food and nutrition policies.
To test the reliability and validity of scales on nutrition knowledge, social-psychological factors, and use of food labels developed from the 1995 Diet and Health Knowledge Survey (DHKS) questions. The 1995 DHKS questions within a section were pooled together as a scale and their reliability and validity were examined. US adults (> or =20 years) in the 1995 DHKS who responded to questions selected for this study (n = 1196). Nutrition knowledge about the diet-disease relationship and nutrient content of products, perceived barriers and benefits of food labels, perceived ease of understanding food labels, food label use, and importance of healthful eating. Scales validity, Cronbach alpha, item total correlation, alpha if the item was deleted, and discriminant, convergence, and correspondence validity. Scales on perceived ease of understanding the food label, benefits of using food labels, food label use, and importance of healthful eating were reliable (Cronbach alpha =.78,.82,.91, and.82, respectively) and valid. Accurate findings and interpretation of survey data depend on the use of reliable and valid instruments. This study identified the scales in the DHKS that can substantiate the conclusion on which effective nutrition education strategies should be established.
By fall 2006 each school division participating in the National School Lunch Program was mandated to establish a local wellness policy. The study objective was to assess schools' plans for the policy, including goals for food, nutrition education, and physical activity and evaluation. Surveys were administered to 132 School Health Advisory Board coordinators in Virginia in early 2006; 92 (69.7%) responded. The findings highlight gaps toward meeting minimum requirements for the policy and give guidance on how nutrition educators and researchers can provide expertise to optimize the policy and document progress and impacts on children's health related to the policy.
To compare reporting accuracy for breakfast and lunch in 2 studies. Children were observed eating school meals and interviewed the following morning about the previous day. In Study 1, 104 children were each interviewed 1 to 3 times with >or=25 days separating any 2 interviews. In Study 2, 121 children were each interviewed once in forward (morning-to-evening) and once in reverse (evening-to-morning) order, with these interviews separated by >or=29 days. 12 schools. Fourth-grade children. For each meal, food-item variables (observed number, reported number, omission rate, intrusion rate, total inaccuracy) and kcal variables (observed, reported, correspondence rate, inflation ratio). General linear mixed models. For each study, observed and reported numbers of items and kcal, and correspondence rate (reporting accuracy), were greater for lunch than for breakfast; omission rate, intrusion rate, and inflation ratio (measures of reporting error) were greater for breakfast than for lunch. In Study 1, for each meal over interviews, total inaccuracy decreased and correspondence rate increased. In Study 2, for each meal for boys for reverse and for girls for forward order, omission rate was lower and correspondence rate was higher. Breakfast was reported less accurately than lunch. Despite improvement over interviews (Study 1) and differences for order x sex (Study 2), reporting accuracy was low for breakfast and lunch.
To examine whether (1) student perceptions of parent behaviors explain variations in fruit and vegetable consumption, (2) self-efficacy mediates this relationship, and (3) perceived home fruit and vegetable availability moderates this relationship. A cross-sectional survey. Classrooms in 3 middle schools in 2 northeast Georgia counties. 366 middle school students. The response and participation rates were 59% and 56%, respectively. Perceived authoritative parenting, perceived parent control, perceived parent modeling, perceived parent support, self-efficacy, perceived fruit and vegetable availability, and fruit and vegetable consumption. Hierarchical multiple regression; P <.05. Perceived parent modeling, perceived parent support, self-efficacy, and perceived fruit and vegetable availability were significant predictors of fruit and vegetable consumption. The relationship between perceived parent support and fruit and vegetable consumption was mediated by self-efficacy. The relationship between fruit and vegetable consumption and both perceived parent modeling and support was moderated by perceived fruit and vegetable availability. Parents appear to moderately influence middle school student fruit and vegetable consumption. Educators might focus on improving home fruit and vegetable availability and student self-efficacy, as well as parent support and modeling. The level of availability might indicate where efforts should focus for enhancing parent behaviors.
The researchers evaluated the impact of a 7-month gardening and 4-month vegetable and fruit snack program on Aboriginal First Nations children's home consumption and preferences toward vegetables and fruit. The intervention was based on the Social Cognitive Theory. Children in grades 1-6 planted and tended classroom container gardens and prepared and ate what grew. At baseline and 7 months later, children tasted and rated 17 vegetables and fruit using a Likert scale and indicated whether they ate each food at home. Data were collected from 76 of 116 children (65.5%). Preference scores for vegetables, fruit, and vegetables and fruit combined increased over the 7 months (P < .017). Self-reported home consumption did not change. School interventions have the potential to increase children's preferences for vegetables and fruit. Family participation is likely required, along with increased community availability of produce, to promote home consumption. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
The goals of this study were to explore the perceptions of professionals concerning research, its different approaches, and appropriate future directions with Native American communities, particularly in relation to nutrition issues. Semistructured qualitative interviews. setting: Interviews were conducted at Native and non-Native academic institutions, at other relevant locations, and over the telephone. Participants (N = 20) were from Native and non-Native academic institutions and had experience working with research in Native American communities. Relationships between Native and non-Native academic institutions, worldviews regarding research and American Indian communities, and beneficial research within American Indian communities. Interviews were audiotaped, transcribed verbatim, and returned to the participants for review. Analysis of interview material involved eliciting themes. Some participants acknowledged different cultural worldviews in relation to research. Many participants provided insight on how to define beneficial research. Most said building trust between Native and non-Native academic institutions is an important step in developing effective research relationships. These findings are a first step toward creating a more equitable process of research that acknowledges different cultural worldviews and values community involvement within Native American communities.
To determine the status of gardens in California schools. A self-administered Internet and mailed survey was sent to all California principals (N = 9805). 4194 California school principals. School garden practices, attitudes associated with the use of gardens in schools, and perceptions of barriers to having and using school gardens in academic instruction. Descriptive statistics and chi-square; P < .05. A 43% response rate was achieved. The most frequent reason for having a garden was for enhancement of academic instruction. Gardens were most commonly used for teaching science, environmental studies, and nutrition. Principals strongly agreed that resources such as curriculum materials linked to academic instruction and lessons on teaching nutrition in the garden would assist in the school garden being used for academic instruction. Principals deemed the garden as being not to slightly effective at enhancing the school meal program. School gardens appear to be predominantly used by most schools to enhance academic instruction. There is a need for curriculum materials and teacher training for gardening and nutrition. The link between the garden and the school meal program is an area that clearly requires attention. School lunch would be a logical setting for provision of edible produce, in addition to taste-testing of fresh produce in the garden or classroom setting.
To determine the acceptability of lower glycemic index (GI) foods served at diabetes camp. Crossover design of standard and lower GI menus. Three consecutive 5-day diabetes camp sessions. 140 youth, age 7-16, with type 1 or 2 diabetes. A standard camp cycle menu was reformulated to include 2 1/2 days of standard foods and 2 1/2 days of lower GI foods. Youth provided satisfaction ratings after meals and snacks using measures designed for this study. Observations of food consumption were conducted on a random sample of youth for each meal. Descriptive analyses and t-tests were conducted to assess differences in satisfaction with and consumption of standard and lower GI foods. Lower GI foods served at dinner and for snacks received satisfaction ratings equal to standard foods (dinner: 3.68 lower GI versus 3.79 standard, P = .30; snacks: 3.74 lower GI versus 3.79 standard, P = .60). Lower GI foods served at breakfast and lunch received lower, though very acceptable, ratings (breakfast: 3.76 lower GI versus 4.04 standard, P < .01; lunch: 3.64 lower GI versus 3.88 standard, P = .01). Consumption of all meals was acceptable. No differences occurred in the frequency of high or low blood sugars between standard and lower GI days. Higher quality carbohydrates may be provided to youth in institutional settings while maintaining sufficient levels of acceptability; specific findings are instructive for designing efforts to increase their consumption.
To investigate whether children's books affect attitudes and behaviors pertaining to an unfamiliar vegetable. Nine Head Start classes were randomly assigned to a positive, negative, or control group. Data were collected through individual interviews on a pretest day and two book-reading (posttest) days. 118 children, ages 3 to 5. Interventions: Children's book with prominent positive or negative messages about kohlrabi. Main Outcome Measures: Children's familiarity with kohlrabi, willingness to taste it, and attitudes toward kohlrabi and vegetables in general. Chi-square and logistic regression. There were significantly more kohlrabi tasters in the positive-message group than in the control group during the second posttest (P <.05). Primary factors in willingness to taste kohlrabi during the second posttest were being exposed to the positive-message treatment (P =.0398) and reporting in the previous interview that they would taste kohlrabi again (P =.0026). Further study is needed to verify these findings and to determine whether the results generalize to other foods and/or other children.
To determine how and where homeless families access food, and to determine factors that influence food choice. Seven focus groups (90 minutes each) were conducted by two moderators and audio-taped. Two homeless shelters serving families. Fifty-three parents or guardians (M = 11; F = 42) with children 3-12 years of age. Most participants had completed high school or higher education. Food choice and food access among homeless families. Transcripts evaluated for consistency, coded, and evaluated for dominant themes. Limited cooking and storage space, and poor meal timing and food options at the shelters resulted in participants developing strategies to alleviate hunger. Strategies used to obtain food included using food stamps, stealing food, eating food in grocery stores, pawning personal items, using savvy shopping habits, scavenging in dumpsters (obtaining items such as food from dumpsters), and sacrificing food for children. Homeless families find strategies to prevent food insecurity. Food stamp usage is a common strategy, but it often is insufficient to meet monthly needs, indicating the need for reevaluation of program components. The shelter environment's impact on families' food choices suggests a role for nutritionists in ensuring availability of adequate, nutritious foods. Future research is needed to evaluate the impact of the shelter environment on homeless families' overall nutritional status.
To compare eating behaviors of Korean American (KA) families with mothers of different acculturation stages with those of families in Korea. Survey research using a self-report questionnaire. Settings: Field survey on convenience sample in California and in Seoul, Korea. 225 KA and 216 Korean mothers. Main Outcome Measures: Frequency of eating at home, preparation of Korean foods, favorite dishes of families, and for special occasions. Chi-square, t test, and analysis of variance. Families of the more acculturated mothers dined out more frequently and had lower preferences for Korean foods than did the families with less acculturated mothers. The more acculturated mothers prepared Korean foods, including kimchi, less at home. Fewer Korean dishes were included among the 5 favored dishes, both for family and for special occasions, in KA families than in Korean families. The acculturation stage of the mothers affected preference for Korean dishes of the families but not for special occasions. Mothers' acculturation stage influenced the family's eating habits. Changes of preference of typical Korean dishes varied by acculturation stage. Nutrition educators should be aware that dietary behaviors of KA families may differ by acculturation stage and tailor interventions appropriately.
To investigate the accuracy of children's dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews. Each child was observed eating school breakfast and school lunch and was interviewed that evening about that day's intake. Setting: Ten elementary schools. A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36). Main Outcomes Measured: Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined. Analysis of variance; chi-square. Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch. The accuracy of children's recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed.
To assess the accuracy of parents as reporters of both their own and their 2- to 5-year-old children's fruit and vegetable intake. Observational study with a 1-meal intake assessment by an independent observer, followed by a telephone survey to determine the previous day's consumption using a 29-item fruit, juice, and vegetable food frequency questionnaire. Two separate meal assessments in community-based settings. A convenience sample of 61 parent-child dyads from Eastern Missouri was recruited from a school health fair and the Parents as Teachers program. The mean age of the parents was 31.1 years, and 91% were female. The mean age for children was 39.0 months, and 60% were female. Parent and child fruit and vegetable intake. Interobserver agreement using a kappa statistic. Parents accurately reported their children's intake on most fruits and vegetables (kappa=0.59-0.61). Parents were the least accurate in recalling the consumption of raisins from oatmeal cookies (kappa=0.05) and 100% juice (kappa=0.17). Parents can serve as accurate proxies to report fruit and vegetable consumption by their preschoolers on a food frequency questionnaire used to determine intake for the previous day. This can be a helpful evaluation method for research involving young children.
A spectrum of eating-, activity-, and weight-related concerns is presented that includes 5 dimensions (weight control practices, level of physical activity, body image, eating behaviors, and weight status) and different levels of severity within each of these dimensions. Multiple interacting factors contribute to the etiology of problems within each of these dimensions in adolescents at the individual, familial, peer, school, community, and societal levels. Families have an important role to play in reinforcing the positive influences at each of these levels and in filtering out the negative influences. Parents can help their children engage in more healthful eating and physical activity behavior and feel better about themselves through (1) role modeling healthful behaviors, (2) providing an environment that makes it easy for their children to make healthful choices, (3) focusing less on weight and more on behaviors and overall health, and (4) providing a supportive environment for their children to enhance communication. Families need to be proactive within our society, which works against the development of a healthy weight and a positive body image in children and adolescents. However, families cannot do it on their own and need support from the more distal environments within which they function.
To identify the nature, strength, and relative importance of influences on intentions to consume foods that are enriched with omega-3 fatty acids using the Theory of Planned Behavior (TPB). A cross-sectional self-administered questionnaire. Community-based residents living in the Illawarra region of New South Wales, Australia. Two subsamples were surveyed via questionnaire: community members who responded to a local media advertisement (n = 79), and subjects in a dietary intervention trial for type 2 diabetes mellitus (n = 50). Using the TPB variables-intention, attitude, subjective norm, and perceived behavioral control-questionnaire items were constructed to measure intention to consume omega-3-enriched novel foods. The results from subsamples did not differ and were combined for analysis. The determinants of intention defined in the TPB were investigated using multiple linear regressions. Regression analysis showed that the model was a significant determinant of intention (R2 = .725; P < .001). Attitude was a significant determinant of intention, whereas subjective norms and control beliefs were not. With attitude having the greatest influence on intentions, immediate prospects for modifying behavior are likely to come through a change in attitude, specifically in beliefs about the effectiveness of enriched products in achieving specific health benefits. Promoters of omega-3-enriched foods would be advised to direct their promotions toward changing the attitudes of consumers about the effectiveness of the functional ingredient.
This research addresses 2 questions: What are the patterns in selected food choice behaviors across the transition to motherhood? and Do the patterns vary by mothers' social location, particularly parity, family income, and breast-feeding behavior? A prospective cohort study with healthy, adult women followed from midpregnancy until 2 years postpartum. Data were collected through mailed questionnaires for prepregnancy and pregnancy, at 6 months, at 1 and 2 years postpartum, and through an audit of the women's medical records. A hospital and primary care clinic system serving a 10-county area of rural upstate New York. 360 women of the 622 in the cohort provided data for all time points. Three food choice behaviors served as categorical dependent variables at each of the 5 time points: drinking > or = 2 cups of milk per day, consuming > or = 3 servings of fruits and vegetables per day, and eating breakfast every day. Three social location variables were used as independent variables for the second research question: parity (nulliparous vs primi- and multiparous), family income (low [< or = 185% of federal poverty level] vs higher), and breast-feeding (> or = 1 year vs less). McNemar's test was used to compare proportions of women at or above the cutoff value for each food choice behavior across time, and the Fisher exact test was used to compare proportions between groups for each social location variable at each time point. P < or = .05 was considered significant. The proportion of women drinking 2 or more cups of milk per day at 2 years postpartum was not different from prepregnancy, but the proportions consuming 3 or more fruits and vegetables and eating breakfast every day were significantly higher at 2 years postpartum than prior to pregnancy. The pattern of change varied by categories within the social location variables and differed by food choice behavior. The transition to motherhood was associated with a positive change in some food choice behaviors. Women making this transition for the first time showed the most consistent positive changes and should be a target audience for nutrition education.
To explore women's dietary actions after a breast cancer diagnosis and the factors influencing those actions. Individual interviews exploring women's perceptions. Vancouver, British Columbia, Canada. A culturally diverse convenience sample of women (N = 30) aged 40 to 60 years diagnosed with breast cancer 6 months to 15 years previously. Social and personal factors that influence dietary actions. Verbatim interview transcripts were coded and themes developed by sorting and summarizing coded transcript segments. Women held a wide range of beliefs concerning the relationship between diet and breast cancer, particularly their own cancer occurrence. Actions were not always consistent with professed beliefs. Some women believed that diet contributes to breast cancer, even their own cancer, yet made no diet changes; others did not believe in such a relationship but did change their diets postdiagnosis. Family support, employment, financial resources, cultural food patterns, and other health concerns were strong influences. Although beliefs about diet-cancer connections affect actions concerning diet change, the relationship is not consistent. Diet change is also affected by social, cultural, and economic concerns that are at least as important as a woman's beliefs. Nutrient supplements appear to be a common, although perhaps temporary, response to diagnosis. Future research should explore the possibilities for nutrition professionals to help women think critically about the range of influences on their diets.
When education majors take a nutrition course based on Fink's taxonomy of learning and are taught using techniques and activities that are relevant and support active learning, they are able to develop the knowledge, skills, and level of caring needed to teach nutrition effectively. When future teachers learn how to teach nutrition and then do, the impact on children can be tremendous.
Objective: Increasing serving sizes have been identified as contributors to the obesity epidemic. Researchers suggest that consumers are in need of cues that provide norms for the appropriate amount of food to consume. The impact of one potential cue, the provision of nutritional information for a single serving as well as the entire package ("dual-column labels") versus single-serving nutritional information only ("single-column labels"), was investigated on the consumption of a snack food for dieters and nondieters. Design: In a between-subjects experimental design, participants were provided with a snack food product and nutrition label. After the opportunity for consumption, they were provided with a survey instrument. Setting: The study took place in a classroom setting. Participants: Undergraduate students were randomly assigned to the single-column versus dual-column label treatment groups and were classified as dieters (n = 45) or nondieters (n = 67) based on self-reported dieting behavior. Intervention: Participants were exposed to either a single-column or dual-column nutrition label. Main outcome measures: Perceptions of consumption norms; use, importance, and understanding of nutrition labels; and the actual amount consumed by each individual were measured. Analysis: Analysis of variance was used to analyze data from the study. Results: Nondieting participants, but not dieting participants, ate significantly less when exposed to the dual-column label compared to the single-column label (P < .05). Although there was a significant difference in the amount consumed by dieters and nondieters in the case of the single-column label (P < .05), the presence of a dual-column label attenuated this effect. In addition, dieters reported paying greater attention to (P < .01), better perceived the necessity of (P < .01), and had better understanding of (P < .05) label information than nondieters. In addition, dieters considered the provided serving to be more adequate than nondieters (P < .05). Implications for research and practice: Compared to standard, single-column labels, dual-column nutritional labels have a greater impact on the snack food consumption of nondieters.
With the expansion of nutrition education to the World Wide Web, nutrition educators will find ways to adapt existing programs for new audiences and save time and money. The Internet allows for mass distribution, which decreases reproduction costs, easy updating, and individual tailoring. Compared to developing a new application, adapting an existing diet analysis application to fit the needs of the EatFit intervention took a quarter of the cost and a third of the time. The process of adapting the application took 5 people working part time for approximately 1 year and might have taken less time had we fully anticipated some of the issues ahead of time. The 6 steps outlined here should save others valuable time and resources.
Knowledge, Self-Efficacy, and Attitude "Scores" at Beginning of Fourth Grade by Intervention
This study adapted an urban-based school nutrition program for delivery in a rural community. Specific aims were to adapt the curriculum; expand it to include physical activity; determine effectiveness on students' attitudes, knowledge, and self-efficacy; and assess teachers' impressions. Three cohorts were established: 173 students taught by a resource teacher, 170 students taught by classroom teachers, and 187 students who did not receive the curriculum. Pre- and posttest surveys measured outcomes, and classroom teachers were observed and interviewed. The curriculum was shown to be effective in enhancing student outcomes for both the resource teacher and classroom teacher cohorts. Teachers reported that lessons needed to be simplified and that children enjoyed them. Findings support the transferability of an urban-based nutrition curriculum to a rural community and the need for students to receive health education annually.
To assess the attitudes, perceptions, and practices of staff of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in providing nutrition education on childhood overweight topics with WIC participants. Descriptive and correlational study. WIC clinics in Virginia. 106 employees working in direct contact with WIC participants. MEAN OUTCOME MEASURE(S): Demographic information; comfort level and frequency of discussing childhood overweight-related topics with participants; perception of WIC's ability to prevent and help address overweight among children and adults; body mass index (BMI); and attitudes toward personal weight. Descriptive statistics, regression, and analysis of variance. WIC staff in this study reported a lack of comfort, practice, and confidence in addressing and/or preventing childhood overweight with WIC participants, with differences existing based on job title (P < .05). Barriers to implementing programs included perceived attitudes of participants, transportation, time, cultural issues, and childcare. Staff BMIs were significantly correlated to ethnicity, age, feeling overweight, unhappiness with current weight, and comfort level discussing fruit and vegetable intake and physical activity (P < .05). Staff training, health promotion programs, and culturally relevant educational materials are warranted for WIC staff to build a strong knowledge base and promote self-efficacy about childhood overweight-related topics.
To assess food supply adequacy within 3 food store types in the Lower Mississippi Delta. Regional food store survey to determine availability and quality of 102 food items in 62 supermarkets, 77 small/medium stores, and 86 convenience stores. Lower Mississippi Delta region of the United States. 225 food stores in 18 counties. Percentage of Thrifty Food Plan (TFP) food items available and quality ratings of 6 food sections across store types. On average, supermarkets carried 96% of the items that compose the TFP. Mean percentage of TFP carried in small/medium stores was 50%. Convenience stores carried 28% of the TFP items. Supermarkets had higher overall quality ratings and quality ratings for fresh and frozen foods compared to small/medium and convenience stores (P<.01). Although supermarkets carried a large percentage of items surveyed, the number of supermarkets in this region is limited. Community residents with limited transportation to reach supermarkets may experience limited food supply adequacy. Therefore, community-based nutrition interventions should include partnerships with small/medium food retailers while trying to impact residents' food choices within those stores.
To predict, for French women, the impact of a cost constraint on the food choices required to provide a nutritionally adequate diet. Isocaloric daily diets fulfilling both palatability and nutritional constraints were modeled in linear programming, using different cost constraint levels. For each modeled diet, total departure from an observed French population's average food group pattern ("mean observed diet") was minimized. To achieve the nutritional recommendations without a cost constraint, the modeled diet provided more energy from fish, fresh fruits and green vegetables and less energy from animal fats and cheese than the "mean observed diet." Introducing and strengthening a cost constraint decreased the energy provided by meat, fresh vegetables, fresh fruits, vegetable fat, and yogurts and increased the energy from processed meat, eggs, offal, and milk. For the lowest cost diet (ie, 3.18 euros/d), marked changes from the "mean observed diet" were required, including a marked reduction in the amount of energy from fresh fruits (-85%) and green vegetables (-70%), and an increase in the amount of energy from nuts, dried fruits, roots, legumes, and fruit juices. Nutrition education for low-income French women must emphasize these affordable food choices.
Declining calcium intake among adolescents warrants attention. Our objective was to identify influences on adolescents' consumption of calcium-rich foods. Focus groups were conducted with girls representing 2 age groups (11 to 12 or 16 to 17 years) and 3 macroethnic groups (Asian, Hispanic, or white). Public schools in 10 states. A convenience sample (n = 200) was recruited through schools. Focus groups (n = 35) were audiotaped and transcribed. Influences relative to consumption of milk or other calcium-rich foods were identified. Comments were coded as motivators or barriers within each focus group. Content analysis procedures were used to compare ethnic and age groups. A barrier to milk consumption that was more common among older girls and Asian groups was the limited expectation within families for drinking milk. Many controlled their own beverage choices, and milk, even if liked, was only one option. Milk was positively associated with strength and bone health, but these attributes were viewed as being more important for boys than girls. Milk was associated with breakfast, school lunches, cereal, and desserts. White girls had the most positive reactions to milk and Hispanic girls the most negative. All groups were positive toward pizza, ice cream, and cheese. To improve calcium intake among teens, interventions should include a family component, stress the benefits of milk for girls, and focus on breakfast.
The purpose of this study was to explore the feasibility of implementing a soy intervention in female adolescents. Twenty girls, ages 8 to 14, were recruited to consume 1 daily serving of soymilk or soy nuts. They also provided 9 weekly urine samples over a 2-month period. Information about the study foods and procedures was collected through post-study questionnaires. Adherence to the intervention was successful using strategies that addressed both girls' and mothers' needs. The use of conveniently packaged soy foods, activities to maintain motivation, and frequent contact maintained participation. Future studies should also consider the maturity and sense of responsibility of participants to achieve compliance.
Evaluate the relationship between maternal concern for healthful eating and maternal and adolescent dietary intake, eating behavior, and home food environment. Mothers of a subsample of adolescents who participated in a school-based survey (Project Eating Among Teens [EAT]) completed telephone interviews. Seven hundred fourteen mother-adolescent pairs. Mothers responded to a question regarding how much they are personally concerned with eating healthfully, and adolescents responded to a question regarding perceptions of their mothers' concern about eating healthfully. Dependent variables included adolescent and parent food intake and home food environment. Multinomial cumulative logistic regression models, adjusted for maternal race/ethnicity, socioeconomic status (SES), and adolescent grade level. A positive association was found between maternal concern for healthful eating and maternal fruit and vegetable intake, maternal breakfast and lunch consumption, and serving fruits and vegetables in the home. Maternal concern for healthful eating (as reported by mothers) was not associated with adolescent behavior. Adolescent perception of maternal concern for healthful eating was positively associated with adolescent fruit and vegetable intake. Mother's concern for healthful eating is associated with maternal eating behavior and the home food environment. Adolescent perceptions of maternal attitudes are a stronger predictor than actual maternal attitudes of adolescent behavior. Parents should be encouraged to share their beliefs regarding the importance of healthful eating with their adolescents.
Demographic Characteristics of Parents (n 20)
Average Daily Consumption of Food and Beverage Items High in Calcium (n 102 adolescent girls)
To identify individual and environmental factors affecting intake of calcium-rich food and beverages by early adolescent Hmong girls. Cross-sectional survey of girls, in-depth interviews with parents. Girl Scout and 4-H programs in the Minneapolis/St. Paul metropolitan area. Convenience samples of 10-13-year-old Hmong girls (n = 102) and their parents (n = 20). Spearman correlation analysis, constant comparative method. Individual and environmental factors for girls and reported intake of calcium-rich food and beverages. Few girls observed parents drinking milk or were encouraged by parents to drink milk. Many reported low intake of milk with dinner meals and snacks. Only one third reported that calcium-rich food such as yogurt, cheese, and tofu were available at home, and intake of these food items was associated with availability. Parents accommodated child preferences and had few expectations for their child to eat certain calcium-rich food items. Parents did not commonly consume dairy products but indicated they made milk available for children. Knowledge of calcium requirements was limited, but most parents related calcium to bone health. Environmental factors may limit calcium intake by Hmong girls. Education should involve parents and children and address environmental factors that affect intake.
To investigate factors influencing rural and urban adolescents' food perceptions during a time of nutritional transition in Cameroon, Africa. Qualitative in-depth interviews. Yaoundé urban and Bandja rural areas. Fifteen adolescents 12 to 15 years old purposely selected from schools in urban and rural areas. Interviews were audiotaped, transcribed, and analyzed using Grounded Theory method. Factors influencing adolescents' food perceptions from the rural area were "to live" "health" and "poverty." Among adolescents from the urban poor area, "health," "beauty," and "not enough money" were factors. Among adolescents from the urban rich area, "pleasure" and "beauty" were factors. Rural girls liked "to be fat," whereas girls from the urban poor wanted "to be a little bit fat," and girls from the urban rich wanted "to be normal." Food behavior is changing from a diet composed of traditional food in rural areas to a more westernized diet in urban areas. The relationship between socioeconomic factors and nutrition needs to be examined with a sufficiently large number of adolescents to investigate these factors in a quantitative survey. Healthful local food should be available at home and from vendors. Nutrition education about food and diet-related diseases is needed in school.
To identify predictors of healthful dietary practices in adolescents using the Theory of Planned Behavior and determine how gender and ethnicity influence the relationship among the theoretical constructs. Initial and 1-month follow-up questionnaires, designed to measure the constructs of the Theory of Planned Behavior and select demographic items, were administered to the participants in the spring of 1997 to gather data for this descriptive research. Settings/ A sample of 780 adolescents, aged 14 to 19 years, was recruited from randomly selected science classes at 4 public high schools in San Bernardino, California. Seven hundred and fifty participants (96%) completed the initial questionnaire and 672 (86%) completed the follow-up questionnaire. A 5-step hierarchical multiple regression procedure, general linear model analysis, and Tukey's honestly significant difference post hoc test were used to analyze the data. Intention to eat a healthful diet was a predictor of healthful dietary behavior. Intention was influenced most by attitude and then by perceived behavioral control and subjective norm. Those with positive attitudes toward healthful eating believed that they would like the taste of healthful foods, feel good about themselves, tolerate giving up foods that they like to eat, and lose weight or maintain a healthful weight. Mother, siblings, and friends were identified as important predictors of subjective norm. Knowledge about how to eat a healthful diet, availability of healthful foods, motivation, and access to enough money were salient facilitating factors related to perceived behavioral control. Interesting contrasts among gender and ethnic groups also were noted. The findings indicate that multiple attitudinal, normative, and control factors influence healthful dietary behavior in adolescents. The synergistic use of these factors in the development and implementation of nutrition education interventions may assist in the promotion of healthful eating among teens from culturally diverse communities.
To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake. Self-report questionnaires administered to a convenience sample of middle school students during regular classes. Black and white adolescents, 11 to 15 years of age (N = 736). Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics. Chi-square, general linear models, and Poisson and linear regressions as appropriate. Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice. Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.
To assess the lifestyle and prevalence of overweight among 16- to 18-year-old adolescents attending 4 different types of secondary education (SE). Cross-sectional school-based survey. A community sample of 994 adolescents (body mass index [BMI]: 15-43 kg/m2). Overweight and obesity were assessed by BMI. Health-related quality of life (HRQL) was assessed using the 36-item short-form (SF-36) questionnaire. The Dutch eating behavior questionnaire was administered. Lifestyle was assessed using the Baecke questionnaire and self-reported activities. Prevalence of overweight, HRQL and lifestyle were assessed per type of education. Gender differences and differences between BMI-categories were analyzed. Students in Vocational SE were significantly more likely to be overweight (18%) or obese (7.5%) compared to students in other types of SE (chi square-27.0, P < .001). HRQL was significantly lower among obese girls compared to overweight (P = .009) or normal weight girls (P < .01). Obese and overweight adolescents scored higher in restrained eating than their normal weight peers (P < .001) but lower in externally induced eating (P = .001). Lifestyle and prevalence of overweight and obesity seems to differ between different types of education. This could be of importance when making health policy decisions. Health programs should focus on types of education with the highest prevalence of overweight and obesity and should be tailor-made to the specific needs of the targeted type of education.
The relationships among primary sources of social support in adolescents' environments (family and friends) and eating behaviors (fat and fiber consumption) were examined in a sample of rural adolescents. Cross-sectional baseline health surveys were administered in classrooms as part of a larger randomized trial evaluating a cancer education program. Data were collected in middle schools drawn from 22 rural counties in Virginia and New York. 1942 sixth graders with a modal age of 12 years, roughly equal gender distribution, and racially diverse (53% white, 37% black). Variables included a 10-item scale of social support from family and friends for healthy eating, a brief food frequency questionnaire estimating daily grams of fat and fiber intake, and demographics (age, gender, race). Hierarchical multiple regressions and analyses of variance (ANOVAs). Controlling for demographics, family and friend support were found to significantly predict fat (P < .05) and fiber (P < .01) intake. Black respondents reported higher support from friends than did white adolescents (F = 47.49, P < .01). Support for healthful eating was related to healthful dietary practices and differed among racial subgroups. Identifying and fostering sources of positive support for healthful eating is critical to developing effective health promotion programs targeting high-risk adolescents.
To assess the perceptions of rural and urban Costa Rican adolescents about their diet and the factors they consider significant to healthful eating. Data were collected in focus group discussions. The study sample included 108 male and female adolescents aged 12 to 18 years. Adolescents were recruited among 7th to 11th grade students interested in taking part in the study. Two urban and one rural high school in San José, Costa Rica. Diet perceptions and barriers to and motivators for healthful eating. Data were reviewed for emerging themes, and themes were coded applying content analysis procedures. The conceptual model for understanding adolescent eating behavior, proposed by Story and colleagues, served as the framework for this study. Factors perceived as barriers to adopting healthful eating practices included unavailability of healthful food in the school environment, inadequate food choices within the family diet, and the peer-group notion among males and females that healthful eating by males is effeminate. Factors perceived as motivators included improving the nutritional quality of foods available at school, adoption of healthful eating practices by the entire family, and healthful eating becoming a peer-group social norm. This study suggests that the family, peer group, and school environment are potential targets for nutrition interventions for Costa Rican adolescents, but further studies are needed to confirm this conclusion. Future studies should explore in depth the factors associated with the family's eating pattern and the influence of adolescent socialization patterns (particularly male) in the establishment of a healthful diet.
Top-cited authors
Nancy S Wellman
  • Tufts University
Nancy Kondracki
  • Self Employed
Joanne F Guthrie
  • United States Department of Agriculture
Biing-Hwan Lin
  • United States Department of Agriculture (retired)
Elizabeth Frazao
  • United States Department of Agriculture