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Effectiveness of a child-only and a child-plus-parent nutritional education program.

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Children in the United States are on a pathway to live shorter lives due to the increased prevalence of lifestyle factors associated with obesity. Intervention programs implemented to reduce this trend do not adequately address the importance of parental involvement. Therefore, the purpose of this study was to examine the effectiveness of a child-only (i.e., control) versus a child-plus-parent (i.e., experimental) nutritional education program in reducing risk factors associated with childhood obesity. Four risk factors associated with childhood obesity were examined: knowledge of nutrition, dietary behavior, physical activity behavior, and sense of self-efficacy. Participants (N = 176) were second and third grade low-income students from a school in the Western United States. A self-reported survey was conducted in the participants’ classrooms one week prior to the intervention (pretest) and one week after the intervention (posttest). Findings indicated that nutrition knowledge and self-reported dietary habits significantly improved in both control and experimental groups. Physical activity behaviors did not change from pretest to posttest for participants in either groups. However, parental education improved participant self-efficacy, where a child's willingness to ask their primary caregivers to buy fruits and vegetables increased significantly. Nutritional education within school programs positively impacts nutritional choices irrespective of parental input. Furthermore, programs designed to increase youth self-efficacy could play a role in attenuating childhood obesity and its attendant societal costs.
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Int J Child Adolesc Health 2014;7(3):229-237 ISSN: 1939-5930
© Nova Science Publishers, Inc.
Effectiveness of a child-only and a child-plus-parent
nutritional education program
Timothy Baghurst, PhD
and Kelly Eichmann PhD, RDN
Health and Human Performance, Oklahoma State
University, Stillwater, Oklahoma and School of
Advanced Studies, University of Phoenix, Phoenix,
Arizona, United States of America
Correspondence: Timothy Baghurst, PhD, 189 Colvin,
Oklahoma State University, Stillwater, OK 74078, USA.
E-mail tbaghurst@live.com
Abstract
Children in the United States are on a pathway to live
shorter lives due to the increased prevalence of lifestyle
factors associated with obesity. Intervention programs
implemented to reduce this trend do not adequately address
the importance of parental involvement. Therefore, the
purpose of this study was to examine the effectiveness of a
child-only (i.e., control) versus a child-plus-parent (i.e.,
experimental) nutritional education program in reducing
risk factors associated with childhood obesity. Four risk
factors associated with childhood obesity were examined:
knowledge of nutrition, dietary behavior, physical activity
behavior, and sense of self-efficacy. Participants (N = 176)
were second and third grade low-income students from a
school in the Western United States. A self-reported survey
was conducted in the participants’ classrooms one week
prior to the intervention (pretest) and one week after the
intervention (posttest). Findings indicated that nutrition
knowledge and self-reported dietary habits significantly
improved in both control and experimental groups. Physical
activity behaviors did not change from pretest to posttest
for participants in either groups. However, parental
education improved participant self-efficacy, where a
child's willingness to ask their primary caregivers to buy
fruits and vegetables increased significantly. Nutritional
education within school programs positively impacts
nutritional choices irrespective of parental input.
Furthermore, programs designed to increase youth self-
efficacy could play a role in attenuating childhood obesity
and its attendant societal costs.
Keywords: Obesity, adolescents, self-efficacy, prevention,
nutrition
Introduction
Childhood obesity is a costly public health issue. It is
linked to the onset of many chronic diseases (1) and
results in an expected decrease in longevity (2).
Childhood obesity rates have steadily risen over the
past 25 years, from 5% in 1976 to 15.5% in 2000 (3).
Timothy Baghurst and Kelly Eichmann
230
This trend continues to worsen; in 2003- 2004, 37.2%
of children age 6-11 years, and 34.3% of adolescents
age 12-19 years were considered overweight or at risk
for becoming obese (4).
Numerous factors have been linked with the trend
for increasing weight in the American population;
however, poor dietary and physical activity habits
remain primary. With respect to children, such
decisions are often made by the parents, guardians, or
others responsible for the child’s welfare (from hereto
forth referred to as parents) who exert control over the
environment (5).
Many child-only focused school-based obesity
prevention programs are ineffective in altering weight
status (6). Summerbell and colleagues (6) suggest that
nutrition education and physical activity interventions
are successful in promoting healthful lifestyle choices
such as fruit and vegetable intake and regular physical
activity. However, future studies and programs should
focus on the child’s environment including the types
of foods available at home, as this is the primary
source of nutrition for most pre-adolescents (7-9).
Thus, the first steps to evoke a permanent healthful
lifestyle change are to increase awareness and
knowledge and then to encourage and support an
overt behavioral change through environmental
support. When planning nutritional interventions
among children and youth, it is important that parents
are involved.
Dietary choices develop early (10-11); therefore,
a school-based nutrition education intervention may
be an effective way to prevent childhood obesity by
lowering obesity risk factors. Children spend at least
six hours each day in school, so school-based
nutrition education interventions may help in
reversing these trends.
Current school-based nutrition education
interventions focus primarily on increasing nutrition
knowledge, promoting dietary changes, and
increasing physical activity. Few researchers who
have conducted initial study interventions designed to
address childhood obesity are evaluating their
programs, and even fewer are reporting their findings
(6). Moreover, those that do show only mild and
short-term improvements in changing behaviors
associated with obesity risks. Only a few intervention
studies have included a direct focus on educating
parents, considered the most influential individuals in
a child’s environment (6). Townsend et al (9) have
suggested that future studies and programs should
focus on the child’s environment, including the types
of foods available at home. Continual education and
promotion are expected to alter health habits on an
individual basis, leading to a societal change.
The concept of social change begins with an
understanding of how a change in the environment
can affect an individual’s behavior and thus, in time,
impact our society as a whole. It is therefore crucial to
understand the history and process of change in
societal environments such as families, communities,
and social relationships if there is to be a chance to
evoke a change in individual behaviors. Finally, the
awareness and importance to health and nutrition
professionals as a change agent is essential to promote
this societal shift.
A number of peer-reviewed articles have revealed
and confirmed the need to investigate a variety of
possible solutions to this potentially devastating
problem (12-13). This study explored one possible
solution addressing the need to reduce obesity risk
factors. For example providing targeted nutrition
education in a child's classroom. Variables selected to
be assessed for this study included: (a) increasing
nutrition knowledge, (b) improving dietary behaviors,
(c) increasing physical activity, and (d) improving
self-efficacy. Two behavioral change models were
used to structure this study: the health belief model
(HBM)(14) and the social ecological model
(SEM)(14). The HBM includes Bandura’s (10)
concept of self-efficacy, which is a key component
that was assessed through pre/post test questions. The
SEM includes valuable constructs relating to
environmental influences associated with weight
maintenance.
Finally, social change, suggesting that individual
change and social change are not mutually exclusive.
A blending of simultaneous individual,
environmental, and social changes are needed to
evoke, foster, and support the elements necessary to
reduce obesity risks among Americans.
Current evidence suggests that child-only
nutrition education increases nutrition knowledge, but
education alone has been ineffective in initiating and
sustaining behavioral change. Therefore, the purpose
of this study was to compare the relative effectiveness
of two education approaches to changing children’s
Child nutrition program
231
knowledge of nutrition, dietary behavior, physical
activity behavior, and sense of self-efficacy. It was
hypothesized that simultaneous parental nutrition
education would improve a child’s willingness to
adopt a more healthful lifestyle and strengthen the
child’s self-efficacy score regarding ability or
willingness to ask for fruits and vegetables, as
compared with a child only nutrition education
intervention.
This study examined the effects of intervention
on obesity risk factors among low-income children,
not by measuring anthropometrics, but by comparing
the relative effectiveness of two educational
approaches. The goal of the two educational
approaches was to positively affect known obesity
risk factors among low-income second and third grade
elementary school children through nutrition
education designed to initiate healthful lifestyle
changes.
Methods
Participants were 176 students (male: 99, 56.2%;
female: 77, 43.8%) attending a low-income school
site in a rural area of the Western United States. The
school was a title one school, determined high risk for
obesity and obesity related diseases based on weight
status. Low-income is defined by qualification for a
free or reduced breakfast and lunch. Just less than half
of participants (87, 49.4%) were enrolled in third
grade, and the remaining participants (89, 50.6%)
were enrolled in second grade (see table 1).
Table 1. Sample characteristics
Variable Child Only Child-Plus-Parent Total
# % # % # %
Female 37 44.6 40 43 77 43.8
Male 46 55.4 53 57 99 56.2
2n
d
grade 43 51.8 46 49.5 89 50.6
3r
d
grade 40 48.2 47 50.5 87 49.4
Instruments
Based on a comprehensive review of the literature,
four existing validated instruments were selected to
measure the four major outcomes (knowledge of
nutrition, dietary behavior, physical activity behavior
and self-efficacy) of the intervention study. To
measure knowledge of nutrition, the Reading Across
MyPyramid (RAMP) quiz was selected (15). This
quiz is part of the RAMP curriculum designed and
utilized by the University of California Cooperative
Extension (UCCE) Division of Agriculture and
National Resources. The RAMP curriculum is used to
educate lower level elementary school children on the
Dietary Guidelines for Americans (i.e.,
MyPyramid/MyPlate). Only selected portions of the
RAMP education were chosen to measure change due
to the time design of the study and classroom time
availability. The RAMP lessons have been designed
to be used independently from one another. The
design allows for greater flexibility for the classroom
teachers to incorporate the RAMP lessons into their
existing teaching material. A total of 23 multiple
choice questions were used to assess knowledge of
nutrition.
RAMP questions typically used both word and
picture choices to assess respondent’s knowledge in
food guide pyramid (MyPlate), vegetables, fruit,
snacks and exercise. Sample questions included:
“Which food should you eat more of?”; “Which
beverage should you drink less of?”; “Which food
belongs in the vegetable group?”; “What is the
healthiest drink when you exercise?”. This RAMP
quiz has been shown to be valid and reliable and was
designed for low-income kindergarten through third
grade students (15). Based on the work of Heneman et
al. (15), a score on the RAMP quiz indicated a
participant’s knowledge of nutrition by using the
number of correct answers.
To measure dietary behaviors, the A Day In the
Life (DILQ) 17-item instrument was used (16). The
DILQ instrument measures the number of times a
child eats fruits or vegetables during the course of a
Timothy Baghurst and Kelly Eichmann
232
day. This 17-item instrument has been shown to have
good reliability and validity and was designed for
children of age seven to nine years (16). The
questions utilize a 24-hour recall method of obtaining
dietary intake. Sample questions are: “Did you have
something to eat and drink for breakfast,” “Did you
eat or drink anything on the way to school,” “Did you
have anything to eat or drink at morning break,” and
“Did you have anything else to eat or drink between
your evening meal and before you went to bed.” The
questionnaire does not measure other dietary
behaviors that may lead to obesity, such as eating
empty calories and eating between meals. The study
used fruit and vegetable intake as an indicator of
healthy eating. Following the work of Edmunds and
Zeibland (16), a study participant’s dietary behavior
was represented by the score of the DILQ, which is
the number of times the participant eats fruits or
vegetables during the course of a day.
Physical activity behavior was measured using
the GEMS Activity Questionnaire, developed by
Baranowski and colleagues (17) to measure physical
activity behaviors for a nutritional education
intervention. It has been shown to be valid and
reliable for middle childhood age (age 8 to 10 years)
respondents in measuring physical activity behaviors
(18).
The GEMS Activity Questionnaire lists 28
activities typically performed by children, along with
pictures of the activities. For each activity,
respondents were asked to check off whether they
engaged in that activity yesterday, and duration was
ascertained by none, less than 15 minutes, or 15
minutes or more. They also were asked whether they
usually take part in the activity, which was
ascertained by none, a little, or a lot. Based on the
work of Treuth et al. (19), a study participant’s
physical activity behavior was represented by two
scores: 1) a score of activities performed yesterday,
and 2) a score of usual activities. Scores were
weighted according to intensity level of the activity
using appropriate Metabolic Equivalent of Task
(MET) values for children for each of the 28 physical
activities (19-20).
To measure self-efficacy, the self-efficacy survey
of “Asking and Shopping for Fruits and Vegetables”
was selected (17), as it was developed to measure
self-efficacy in the area of whether the child will be
more likely to ask for fruits and vegetables and to put
them on the family’s shopping list (17). It consists of
eight five-point Likert-scale items. The respondent’s
self-efficacy is assessed through an overall question
“How sure are you that you can” in each of the eight
items, such as “write my favorite fruit or vegetable on
the family’s shopping list,” “ask someone in my
family to buy my favorite fruit or vegetable,” “go
shopping with my family for my favorite fruit or
vegetable,” and “pick out my favorite fruit or
vegetable at the store and put it in the shopping
basket.” The responses were coded as 1: I’m sure I
cannot; 2: I don’t think so; 3: I am not sure; 4: I think
so; or 5: I’m sure I can. The reliability coefficient
(Cronbach’s alpha) of the self-efficacy “Asking and
Shopping for Fruits and Vegetables” measure for the
current sample was 0.87 at pre-test and 0.82 at post-
test. As reliability for all the other measures was
established in previous studies, no reliability
assessment on these other measures were reported in
this study. Results from a small scale pilot study
indicated that the testing instrument could be used to
assess self-efficacy among the study population.
Therefore, this served as an appropriate measurement
in determining a child self-efficacy concerning how
confident the child is about asking for fruits and
vegetables to be included on his or her family’s
shopping list (17).
Procedure
In an effort to protect the identity of the participants
and ensure confidentiality, identification codes were
assigned during the pre-testing period. In addition, no
invasive or direct physical measuring or weighing was
necessary for this type of study design. Furthermore,
the study curriculum was administered by the
classroom teacher and was incorporated as part of the
school’s curriculum.
Following IRB approval, permission from school
principal, parental consent, and student assent forms
were collected respectively before any data collection
began. First, a small-scale pilot study using 20
students was conducted to determine if the selected
data collection instruments could be completed by the
target age group study participants. Because not all
instruments have been administered to second grade
Child nutrition program
233
students, the pilot study assisted in determining
whether questions could be understood and be
completed through a self-administered survey
approach.
Following the pilot study, eight classrooms (four
second grade and four third grade) were recruited for
the intervention study. After all recruited classroom
teachers attended the required training and orientation
meeting, all potential student participants were asked
to take part in the nutrition education intervention. All
potential student participants’ parent(s) were sent an
informational package to inform them of the
intervention study and asked to take part in the adult
educational component.
After parental consent forms were collected, child
study participants were randomly placed in to one of
two study groups (child-only or child-plus-parent
education groups). Because the selected RAMP
curriculum had been adopted by the participating
school’s principal, the RAMP material was
administered to all students by the classroom teachers.
Given that children in both the control and the
experimental group received the same intervention
(RAMP curriculum), having children in both groups
in the same classroom was not a concern. Parents of
the experimental group received the adult nutrition
education material while parents of the control group
did not receive the curriculum.
For both the child-only education and child-plus-
parent education groups, data collection was
conducted one week prior (pretest) and one week
following the intervention (posttest). Data collection
took place in the students’ individual classrooms,
during class time, with the help of the classroom
teachers.
All teachers recruited for this study were required
to attend a one day teacher training workshop to
review the study and data collection procedures. This
workshop was designed to introduce the teachers to
the RAMP curriculum and to review the educational
material.
Participants in both groups were asked to
complete a questionnaire that included items about the
four outcome measures during the pretest and
posttest. As an intervention, children in both the
control and experimental groups received five lessons
from the RAMP curriculum over an eight week period
which allowed teachers some flexibility to incorporate
the content into their existing lesson plans. Lessons
included selected portions from the chapters covering
the Food Guide Pyramid (lesson 1), vegetables
(lesson 3), fruits (lesson 4), snacks (lesson 7), and
physical activity (lesson 9) (15). Parents in the
experimental group received additional nutritional
education information packets similar in content to
the students lesson based on the USDA Dietary
Guidelines for Americans.
Results
The main focus of this study was to determine and
compare the relative effectiveness of two education
approaches to changing children’s knowledge of
nutrition, dietary behavior, physical activity behavior,
and self-efficacy.
Knowledge of nutrition (RAMP)
To determine differences between groups and
knowledge of nutrition, measured using RAMP, a 2
(pretest/posttest) x 2 (child-only/child-plus-parent)
repeated-measures ANOVA was conducted, using the
knowledge of nutrition scores as the dependent
variable and the educational approach as the
independent variable.
Group variances were homogenous for both
pretest scores and posttest scores, and Levene’s
statistic was not significant for pre or posttests. For
pretest scores, the Levene statistic was 1.60 with df1 =
1, df2 = 174, p > .05. For posttest scores, the Levene
statistic was 3.70 with df1 = 1, df2 = 174, p > .05. The
ANOVA results revealed a non-significant main
effect for Group [F (1, 174) = 0.30, p > .05, η2 = .59].
That is, there was no significant difference in
knowledge scores between the child-only group and
the child-plus-parent group. However, there was a
significant main effect for Time [F (1, 174) = 65.68, p
< .001, η2 = .27] where knowledge scores at the
posttest (M = 20.65) were significantly higher than
the pretest (M = 18.97). There was no significant
interaction effect between Time and Group [F (1, 174)
= 0.05, p > .05, η2 = .00].
Timothy Baghurst and Kelly Eichmann
234
Dietary Behavior (DILQ)
To determine whether children receiving child-plus-
parent nutritional education demonstrated a
significantly greater improvement in dietary behavior
than children receiving the child-only nutritional
education, a 2 (pretest/posttest) x 2 (child-only/child-
plus-parent) repeated-measures ANOVA was
conducted, using dietary behavior scores as the
dependent variable and the education approach as the
independent variable.
Results from the test of homogeneity of variances
show that group variances were homogenous for both
pretest scores and posttest scores, where Levene’s
statistic was non-significant for both pre and posttest.
There was no significant main effect for Group [F
(1, 174) = 3.27, p > .05, η2 = .02] where there was no
significant difference in dietary behavior scores
between the child-only group and the child-plus-
parent group. However, there was a significant main
effect for Time [F (1, 174) = 41.45, p < .001, η2 = .19]
where posttest dietary behavior scores (M = 2.35)
were significantly higher than pretest (M = 1.44). The
interaction (Time x Group) effect was not significant
[F (1, 174) = 2.28, p > .05, η2 = .01].
Physical activity
To determine whether children receiving child-plus-
parent nutritional education would be significantly
more physically active than children receiving child-
only nutritional education, a 2 (pretest/posttest) x 2
(child-only/child-plus-parent) repeated-measures
ANOVA was conducted, using physical activity
scores as the dependent variable and the education
approach as the independent variable. Group
variances were homogenous for both pretest scores
and posttest scores and Levene’s statistic was non-
significant for pre and posttests. There was a non-
significant main effect for Group [F (1, 174) = 0.48, p
> .05, η2 = .00]. That is, there was no significant
difference in physical activity (yesterday) scores
between the child-only group and the child-plus-
parent group. Main effect for Time and the interaction
effect between Time and Group were both non-
significant, respectively [F (1, 174) = 0.19, p > .05, η2
= .00; F (1, 174) = 1.79, p > .05, η2 = .01].
Self-efficacy
To determine whether children receiving child-plus-
parent nutritional education showed significantly
greater improvement in self-efficacy than children
receiving child-only nutritional education, a 2
(pretest/posttest) x 2 (child-only/child-plus-parent)
repeated-measures ANOVA was conducted, using the
self-efficacy scores as the dependent variable and the
education approach as the independent variable.
Group variances were homogenous and Levene’s
statistics for both pretest scores and posttest scores
was non-significant. The main effect for Group was
not significant [F (1, 174) = 1.08, p > .05, η2 = .30],
where self-efficacy scores did not differ between the
child-only group and the child-plus-parent group.
There was a significant main effect for Time [F (1,
174) = 28.29, p < .001, η2 = .14] whereby self-
efficacy scores at the posttest (M = 32.22) were
significantly higher than the pretest (M = 28.87).
Furthermore, there was a significant interaction
between Time and Group [F (1, 174) = 4.69, p < .05,
η2 = .03]. A post-hoc comparison indicated a
significantly larger increase in the self-efficacy scores
for the child-plus-parent group than for the child-only
group.
Results from the intervention study show that
nutrition knowledge, self-reported dietary habits, and
self-efficacy all improved for both the child-only and
child-plus-parent education groups. Physical
activities, however, did not change from pretest to
posttest for either group. There was no significant
difference in the improvement of nutrition knowledge
and self-reported dietary habits between the child-
only group and the child-plus-parent group. However,
self-efficacy increased significantly greater for the
child-plus-parent group than the child-only group.
Discussion
This study examined the relative effectiveness of a
child-only approach compared to a child-plus-parent
approach to teaching nutrition principles that might
reduce risk factors associated with childhood obesity
among low-income second and third grade children.
The focus of this study was to explore the potential
differences in the effect of a child-only education
Child nutrition program
235
intervention versus a child-plus-parent education
intervention on four primary factors associated with
weight status: knowledge of nutrition, dietary
behavior, physical activity behavior, and sense of self-
efficacy.
The study confirmed two assumptions, unverified
one conjecture, and affirmed one new phenomenon.
Knowledge increased with education and self-
reported dietary habits improved with the
intervention. Physical activity improvements were not
confirmed with this intervention. However, self-
efficacy scores centered on healthful dietary intake
increased with environmental family support.
Although there were no significant differences in the
improvement of nutrition knowledge and self-reported
dietary habits between the study groups, self-efficacy
scores increased significantly in the intervention
group which perhaps suggests that parental
involvement can empower a child to seek out
healthful foods.
It remains unclear whether educating a child at
school, in his or her own educational environment,
helps to prevent the child from becoming overweight
or obese. Furthermore, it remains to be seen whether
educating the child’s parents to support a healthful
lifestyle evokes a positive outward behavioral change
that favors a healthful lifestyle in time to prevent
these children from becoming obese, post-pubescent
adults. What is now clear is that outward behavioral
change begins with knowledge and a belief in one’s
ability to make change. The outcome of this study did
support Bandura’s (10) belief that after knowledge,
self-efficacy is the next step to evoking a positive
outward behavioral change.
Obesity trends and the associated diminished
quality and duration of life have reached epidemic
proportions, according to the Centers for Disease
Control and Prevention (21). In order to establish life-
long healthful dietary and physical activity habits,
early health education and intervention are essential.
Bandura (10) established that “lifelong health habits
are formed during childhood and adolescence” (p.
28). This study was designed to measure whether
parental education improves a child’s outward
behaviors to foster a more healthful lifestyle. The
overarching outcome of this study suggests that of the
four tested variables, only a child’s self-efficacy score
significantly improved with informed parental
influence. Age and cognitive ability posed the greatest
limitations for the study given the selected population.
This outcome should encourage future researchers to
incorporate an element of self-efficacy in studies
centering on obesity prevention. Self-efficacy can
now be seen as the initial step to empower children to
change their environment and to evoke outward
behavioral changes under their own autonomy.
Next steps for possible resolutions
School-based interventions continue to be an ideal
environment to educate and promote healthful
lifestyles considering the number of hours a child
spends at school per week. Incorporating a nutrition
curricula into the structure of elementary teaching
plans, is one way to influence children's food choices.
However, interventions that aim at altering a child's
whole environment must also include the family.
Although teachers may act as role models in
educating and developing healthful dietary habits, this
study in conjunction with other related studies,
suggests that parental involvement is necessary to
initiate and sustain an outward behavioral change
(12).
Recommendations for future study
The health risks facing our nations' obese and
overweight children are debilitating and lifelong. The
results of this study confirm what has been previously
reported, yet reveals what this means for future
researchers. There appears to be a fine-line between
parental involvement and parental over-control with
regards to establishing and fostering a healthful
dietary habit among children. Children must maintain
a sense of autonomy with regards to eating freedoms
in childhood in order to develop an appropriate
relationship with healthful foods. Future researchers
may consider the effect of early parental education on
overall eating patterns beyond fruit and vegetable
consumption.
Parents continue to have the most influence
regarding a child's risk for obesity and supporting
positive behavioral changes (22). Because a
significant amount of a child's learning about
Timothy Baghurst and Kelly Eichmann
236
healthful dietary practices come directly from their
parents, early parental education remains a focal point
for impacting a child's overall health status. The
results of this study and other studies indicate the
need for future studies on parental influence and
control over environmental factors associated with
obesity (7,17). More investigation is needed to
determine whether the type and depth of a parental
education will evoke a greater impact on a child's
outward behavioral change to foster desirable trends
toward a more lean health status.
Self-reporting data is historically unreliable
particularly with children; in an effort to strengthen
the present findings, future researchers would benefit
from collecting and comparing feeding observations
at home using the Child Feeding Questionnaire (23).
This questionnaire is a parental validated measure
used to assess the parents' beliefs, attitudes, and
practices' regarding their child's eating patterns.
Assessing the parent's perception of their child's
eating habits may give future researchers a clearer
indication on the reality of their child's weight status.
There exists ample evidence that childhood
obesity is a significant health concern (4). Evidence
also indicates that in order to slow, stop, and reverse
this trend more social ecological levels influencing a
child's life must be investigated simultaneously.
Therefore, individual, families, government agencies,
community groups, educators, health care providers,
registered dietitians and other components of
American society must get involved. Future research
in this area should consider a triangulation approach
to initiate and foster a healthful holistic anti-obesity
approach. A whole environment approach might
include foods being offered at school and at home
simultaneously. Moreover, determining whether
healthful individual food choices would be consumed,
if available, needs to be ascertained. This type of
assessment would best be determined through an
observations study design. Education and assessment
could also target specific food purchases practices to
determine a change in food availability.
Considering the complexity of all the inter-related
dimensions surrounding child-hood obesity, steps to
increase awareness, improve nutrition education,
initiate and foster healthful dietary practices, and
create environments to increase physical activity must
be seen as a shared community responsibility.
Saturating a child’s internal and external environment
to evoke and then sustain a healthful lifestyle are
essential to reverse childhood obesity trends in the
United States. This shared responsibility will need to
include the individual, their family, schools, the
community, health professionals, registered dietitians,
and policymakers, all coming together simultaneously
and collectively with one targeted focus to increase
the quality of life for our nation’s children.
What does this paper add?
Based on the findings of this study, and consistent
with a myriad of research conducted on nutritional
education programming, only part of the overall
hypothesis of this study can be supported. Nutrition
knowledge and diet behaviors increase with nutrition
education, as indicated in both groups. Thus, from a
practical perspective those designing health curricula
in schools should recognize that nutritional programs
designed specifically for this age group can be
effective in changing health habits and should be
encouraged. However, results of the study do not
support a change in physical activity behaviors in
either group; thus, learning more about nutrition is
unlikely to encourage more physical activity. In
identifying the effect on self-efficacy, the child-plus-
parental education group did show a significantly
greater improvement over the child-only education
group. Therefore, while nutritional programming for
children-only can improve nutritional outcomes, this
study recognizes the meaningful importance of
including parents in this process by empowering
children to make healthful nutritional choices.
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Submitted: August 20, 2013.Revised: September 20,
2013. Accepted: October 01, 2013.
... Since dietary choices develop early, a school-based nutrition education program may be an effective way to prevent childhood obesity by lowering modifiable obesity risk factors [14]. Interestingly, the changes in dietary habits and PA were more pronounced among teenagers with reduced body weight than with those normal body weight [15]. ...
... Verloigne et al. [23] showed that an important role is attributed to parents, suggesting that parents should be involved in education programs. However, Baghurst et al. [14] showed that nutrition education within school programs positively impacts dietary choices, irrespective of parental input. Furthermore, programs designed to increase youth self-efficacy could play a role in preventing childhood obesity [14]. ...
... However, Baghurst et al. [14] showed that nutrition education within school programs positively impacts dietary choices, irrespective of parental input. Furthermore, programs designed to increase youth self-efficacy could play a role in preventing childhood obesity [14]. A review of 14 dietary programs found that only 6 of them revealed significant changes in adiposity indices or could be considered successful in affecting childhood obesity [6]. ...
Article
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The sustainability of education focused on improving the dietary and lifestyle behaviours of teenagers has not been extensively studied. The aim of this study was to determine the sustainability of diet-related and lifestyle-related school-based education on sedentary and active lifestyle, diet quality and body composition of Polish pre-teenagers in a medium-term follow-up study. An education-based intervention study was carried out on 464 students aged 11–12 years (educated/control group: 319/145). Anthropometric measurements were taken and body mass index (BMI) and waist-to-height ratios (WHtR) were calculated, both at the baseline and after nine months. Dietary data from a short-form food frequency questionnaire (SF-FFQ4PolishChildren) were collected. Two measures of lifestyle (screen time, physical activity) and two diet quality scores (pro-healthy, pHDI, and non-healthy, nHDI) were established. After nine months, in the educated group (vs. control) a significantly higher increase was found in nutrition knowledge score (mean difference of the change: 1.8 points) with a significantly higher decrease in physical activity (mean difference of the change: −0.20 points), nHDI (−2.3% points), the z-WHtR (−0.18 SD), and the z-waist circumference (−0.13 SD). Logistic regression modelling with an adjustment for confounders revealed that after nine months in the educated group (referent: control), the chance of adherence to a nutrition knowledge score of at least the median was over 2 times higher, and that of the nHDI category of at least the median was significantly lower (by 35%). In conclusion, diet-related and lifestyle-related school-based education from an almost one-year perspective can reduce central adiposity in pre-teenagers, despite a decrease in physical activity and the tendency to increase screen time. Central adiposity reduction can be attributed to the improvement of nutrition knowledge in pre-teenagers subjected to the provided education and to stopping the increase in unhealthy dietary habits.
... Lastly, interventions addressing the influence of clan related factors on healthy eating have been focusing on parental involvement. Research showed that child-plus-parent interventions were more effective in promoting children's self-efficacy towards healthy eating than child-only interventions (Baghurst & Eichmann, 2014). For example, a child-plusparental education program (e.g., conveying knowledge about the food guide pyramid, vegetables, fruits, and snacks) improved children's willingness to ask their parents to buy fruits and vegetables, due to the perception of environmental family support (Baghurst & Eichmann, 2014). ...
... Research showed that child-plus-parent interventions were more effective in promoting children's self-efficacy towards healthy eating than child-only interventions (Baghurst & Eichmann, 2014). For example, a child-plusparental education program (e.g., conveying knowledge about the food guide pyramid, vegetables, fruits, and snacks) improved children's willingness to ask their parents to buy fruits and vegetables, due to the perception of environmental family support (Baghurst & Eichmann, 2014). ...
Chapter
Throughout our lifes we are exposed to different stressors that can make us more vulnerable to suffer from mental disorders, such as depression or anxiety. However, resilient individuals are characterized by their ability to achieve a positive outcome when they are in the face of adversity. Interestingly, both clinical and pre-clinical studies have provided us information about different behavioural interventions that can make us more resilient to challenging situations. These include the aerobic exercise which, at moderate doses, has been shown to be beneficial at all stages of life by promoting a range of physiological and neuroplastic adaptations that reduce the anxiety response. Due to the benefit effects of the exercise on the cognition and brain functionality, the exercise programs have been proposed as a promoter of resilience and neuroplasticity. How to understand the relationship between exercise, neuroplasticity and resilience is one of the objective that will be developed in our chapter. Thus, we will summarize the potential effect of moderate exercise to induce a more successful response toward stressful situations, as well as to describe its neurobiological underlying basis (morphofunctional modifications in HPA axe, neurogenesis, specific neuron types, glia, neurotrophic factors, among others) in different periods of life (adolescence, adulthood and old age).
... The extent to which long-term nutrition education programs for children can improve parental nutrition knowledge and promote positive changes in families' dietary behaviors should also be evaluated. A limited number of dietary intervention studies have demonstrated that nutrition knowledge and dietary habits can be improved by educational programs targeting only children as well as programs that address both children and their parents [28,29]. According to Kozłowska-Wojciechowska et al. [30], educational programs designed for children and youths are an effective indirect tool for improving parental knowledge about nutrition. ...
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Background: Effective strategies for improving eating habits and dietary intake in preschoolers are essential for reducing the risk of chronic non-infectious diseases in later life. The aim of this study was to evaluate the effect of long-term nutrition education for 3- to 6-year-olds on parental nutrition knowledge. Methods: The study was conducted as part of the "Colorful Eating is Healthy Eating" nutrition education program that has been implemented in kindergartens in Lublin since 2016. A total of 11 kindergartens were involved in this stage of the program, and 733 parents consented to participate in the project. The study was divided into three stages. In the first stage all parents completed a questionnaire containing 54 items. In the next stage, 211 children from four randomly selected kindergartens participated in the "Colorful Eating Is Healthy Eating" educational program that lasted 7 months. In the third stage of the study, the parents of children who had completed the 7-month educational program and the parents of control group children once again completed the questionnaire. Results: A positive outcome of the educational program was that it contributed to a decrease in the consumption of sweetened hot beverages (p = 0.005) and an increase in water intake (p = 0.001). The nutrition education program was also successful in reducing the consumption of sweets. Children's education improved the parents' knowledge about dietary sources of fiber and the recommended fiber intake, and it contributed to the awareness that breakfast is the most important meal of the day. The program did not enhance the parents' knowledge about snacking between meals or the role of sweetened beverages in dental caries, overweight and obesity. Conclusions: Long-term multi-stage nutrition education for children aged 3 to 6 years can be helpful in shaping families' eating habits and improving parental nutrition knowledge. However, the program was less effective in eliminating the respondents' preference for sweet-tasting foods.
... Parents who received the books demonstrated increased knowledge of five servings of fruits and vegetables a day and children were eating additional servings of fruit and vegetables per day compared with children in the control group (Blom-Hoffman et al., 2008). In a more recent study, Baghurst and Eichmann (2014) examined the effectiveness of a child-only (i.e. control) versus a child-plus-parent (i.e. ...
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This book critically assesses the role of agrobiodiversity in school gardens and its contribution to diversifying diets, promoting healthy eating habits and improving nutrition among schoolchildren as well as other benefits relating to climate change adaptation, ecoliteracy and greening school spaces. Many schoolchildren suffer from various forms of malnutrition and it is important to address their nutritional status given the effects it has on their health, cognition, and subsequently their educational achievement. Schools are recognized as excellent platforms for promoting lifelong healthy eating and improving long-term, sustainable nutrition security required for optimum educational outcomes. This book reveals the multiple benefits of school gardens for improving nutrition and education for children and their families. It examines issues such as school feeding, community food production, school gardening, nutritional education and the promotion of agrobiodiversity, and draws on international case studies, from both developed and developing nations, to provide a comprehensive global assessment. This book will be essential reading for those interested in promoting agrobiodiversity, sustainable nutrition and healthy eating habits in schools and public institutions more generally. It identifies recurring and emerging issues, establishes best practices, identifies key criteria for success and advises on strategies for scaling up and scaling out elements to improve the uptake of school gardens.
... Parents who received the books demonstrated increased knowledge of five servings of fruits and vegetables a day and children were eating additional servings of fruit and vegetables per day compared with children in the control group (Blom-Hoffman et al., 2008). In a more recent study, Baghurst and Eichmann (2014) examined the effectiveness of a child-only (i.e. control) versus a child-plus-parent (i.e. ...
... This concept should also be applied when a coach is providing food for athletes. Additionally, Baghurst and Eichmann (2014) found that nutrition education had little value if parents were not educated also. Parents may lack adequate knowledge about preparation techniques for healthy food, and if a coach takes time to educate them, parents can help foster a healthy environment for their children. ...
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Coaches are often focused on the physical training and the x's and o's associated with their sport, but there are clear benefits associated with teaching and encouraging proper nutrition and hydration for optimal performance. Certainly, the benefits can be seen, but how can coaches become more educated in nutrition and pass on this information to their athletes and parents? This article highlights 10 practical strategies coaches can use to promote nutrition and suggests ways in which coaches can incorporate nutritional information into team and parent meetings, training and competition education sessions, and travel itineraries. Further, strategies to educate on daily nutritional choices are addressed. A goal of coaches is to facilitate an environment where their athletes can achieve optimal performance on a consistent basis. Therefore, this article provides both essential information and practical strategies to help achieve this goal by improving coaches' knowledge about nutrition.
... It emphasizes the importance of providing education and interventions, especially in early childhood (Baghurst & Eichmann, 2014) due to the fact that health problems that occur during adolescence usually continue in adulthood (Fennoy, 2010). However, unfortunately, especially in schools, the decreasing level of physical activity of the students in the physical education lesson cause the increase of childhood obesity. ...
... Bildiri No: 791 -Bildiri Sunum Şekli: Sözlü Sunum Ergenlik döneminde meydana gelen sağlık sorunlarının genellikle yetişkinlikte de devam ettiği (Fennoy, 2010) bu sebepten dolayı özellikle erken çocukluk döneminde eğitim ve müdahalelerin sağlanmasının önemini vurgulamaktadır (Baghurst & Eichmann, 2014). Ancak maalesef özellikle okullarda beden eğitimi derslerinde öğrencilerin azalan fiziksel aktivite düzeyleri çocukluk çağı obesitesinin artmasına neden olmaktadır. ...
Article
Background: Poor diet and insufficient physical activity are major risk factors for non-communicable diseases. Developing healthy diet and physical activity behaviors early in life is important as these behaviors track between childhood and adulthood. Parents and other adult caregivers have important influences on children's health behaviors, but whether their involvement in children's nutrition and physical activity interventions contributes to intervention effectiveness is not known. Objectives: • To assess effects of caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors, including those intended to prevent overweight and obesity • To describe intervention content and behavior change techniques employed, drawing from a behavior change technique taxonomy developed and advanced by Abraham, Michie, and colleagues (Abraham 2008; Michie 2011; Michie 2013; Michie 2015) • To identify content and techniques related to reported outcomes when such information was reported in included studies SEARCH METHODS: In January 2019, we searched CENTRAL, MEDLINE, Embase, 11 other databases, and three trials registers. We also searched the references lists of relevant reports and systematic reviews. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of interventions to improve children's dietary intake or physical activity behavior, or both, with children aged 2 to 18 years as active participants and at least one component involving caregivers versus the same interventions but without the caregiver component(s). We excluded interventions meant as treatment or targeting children with pre-existing conditions, as well as caregiver-child units residing in orphanages and school hostel environments. Data collection and analysis: We used standard methodological procedures outlined by Cochrane. Main results: We included 23 trials with approximately 12,192 children in eligible intervention arms. With the exception of two studies, all were conducted in high-income countries, with more than half performed in North America. Most studies were school-based and involved the addition of healthy eating or physical education classes, or both, sometimes in tandem with other changes to the school environment. The specific intervention strategies used were not always reported completely. However, based on available reports, the behavior change techniques used most commonly in the child-only arm were "shaping knowledge," "comparison of behavior," "feedback and monitoring," and "repetition and substitution." In the child + caregiver arm, the strategies used most commonly included additional "shaping knowledge" or "feedback and monitoring" techniques, as well as "social support" and "natural consequences." We considered all trials to be at high risk of bias for at least one design factor. Seven trials did not contribute any data to analyses. The quality of reporting of intervention content varied between studies, and there was limited scope for meta-analysis. Both validated and non-validated instruments were used to measure outcomes of interest. Outcomes measured and reported differed between studies, with 16 studies contributing data to the meta-analyses. About three-quarters of studies reported their funding sources; no studies reported industry funding. We assessed the quality of evidence to be low or very low. Dietary behavior change interventions with a caregiver component versus interventions without a caregiver component Seven studies compared dietary behavior change interventions with and without a caregiver component. At the end of the intervention, we did not detect a difference between intervention arms in children's percentage of total energy intake from saturated fat (mean difference [MD] -0.42%, 95% confidence interval [CI] -1.25 to 0.41, 1 study, n = 207; low-quality evidence) or from sodium intake (MD -0.12 g/d, 95% CI -0.36 to 0.12, 1 study, n = 207; low-quality evidence). No trial in this comparison reported data for children's combined fruit and vegetable intake, sugar-sweetened beverage (SSB) intake, or physical activity levels, nor for adverse effects of interventions. Physical activity interventions with a caregiver component versus interventions without a caregiver component Six studies compared physical activity interventions with and without a caregiver component. At the end of the intervention, we did not detect a difference between intervention arms in children's total physical activity (MD 0.20 min/h, 95% CI -1.19 to 1.59, 1 study, n = 54; low-quality evidence) or moderate to vigorous physical activity (MVPA) (standard mean difference [SMD] 0.04, 95% CI -0.41 to 0.49, 2 studies, n = 80; moderate-quality evidence). No trial in this comparison reported data for percentage of children's total energy intake from saturated fat, sodium intake, fruit and vegetable intake, or SSB intake, nor for adverse effects of interventions. Combined dietary and physical activity interventions with a caregiver component versus interventions without a caregiver component Ten studies compared dietary and physical activity interventions with and without a caregiver component. At the end of the intervention, we detected a small positive impact of a caregiver component on children's SSB intake (SMD -0.28, 95% CI -0.44 to -0.12, 3 studies, n = 651; moderate-quality evidence). We did not detect a difference between intervention arms in children's percentage of total energy intake from saturated fat (MD 0.06%, 95% CI -0.67 to 0.80, 2 studies, n = 216; very low-quality evidence), sodium intake (MD 35.94 mg/d, 95% CI -322.60 to 394.47, 2 studies, n = 315; very low-quality evidence), fruit and vegetable intake (MD 0.38 servings/d, 95% CI -0.51 to 1.27, 1 study, n = 134; very low-quality evidence), total physical activity (MD 1.81 min/d, 95% CI -15.18 to 18.80, 2 studies, n = 573; low-quality evidence), or MVPA (MD -0.05 min/d, 95% CI -18.57 to 18.47, 1 study, n = 622; very low-quality evidence). One trial indicated that no adverse events were reported by study participants but did not provide data. Authors' conclusions: Current evidence is insufficient to support the inclusion of caregiver involvement in interventions to improve children's dietary intake or physical activity behavior, or both. For most outcomes, the quality of the evidence is adversely impacted by the small number of studies with available data, limited effective sample sizes, risk of bias, and imprecision. To establish the value of caregiver involvement, additional studies measuring clinically important outcomes using valid and reliable measures, employing appropriate design and power, and following established reporting guidelines are needed, as is evidence on how such interventions might contribute to health equity.
Article
The purpose of this article is to describe a tested teaching idea that can be implemented in elementary schools to introduce young children to fruits and vegetables that they may not be familiar with.
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Objective: To assess if a school based intervention was effective in reducing risk factors for obesity. Design: Group randomised controlled trial. Setting: 10 primary schools in Leeds. Participants: 634 children aged 7-11 years. Intervention: Teacher training, modification of school meals, and the development of school action plans targeting the curriculum, physical education, tuck shops, and playground activities. Main outcome measures: Body mass index, diet, physical activity, and psychological state. Results: Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group (weighted mean difference 0.3 portions/day, 95% confidence interval 0.2 to 0.4), representing a difference equivalent to 50% of baseline consumption. Fruit consumption was lower in obese children in the intervention group (-1.0, -1.8 to -0.2) than those in the control group. The three day diary showed higher consumption of high sugar foods (0.8, 0.1 to 1.6)) among overweight children in the intervention group than the control group. Sedentary behaviour was higher in overweight children in the intervention group (0.3, 0.0 to 0.7). Global self worth was higher in obese children in the intervention group (0.3, 0.3 to 0.6). There was no difference in body mass index, other psychological measures, or dieting behaviour between the groups. Focus groups indicated higher levels of self reported behaviour change, understanding, and knowledge among children who had received the intervention. Conclusion: Although it was successful in producing changes at school level, the programme had little effect on children's behaviour other than a modest increase in consumption of vegetables.
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This report describes the development and use of two self-report methods and an objective measure to assess longitudinal changes in physical activity in a large biethnic cohort of young girls from childhood through adolescence. The NHLBI Growth and Health Study (NGHS) is a multicenter study of obesity development in 2379 black and white girls followed from ages 9-10 yr to 18-19 yr (NGHS years 1-10). A Caltrac activity monitor was used to objectively quantify activity levels in years 3-5. A 3-d diary (AD) and a habitual patterns questionnaire (HAQ) were administered annually and biannually, respectively, to subjectively quantify physical activity levels. The changing pattern of activities as the girls matured during the 10-yr study period necessitated periodic form changes. Empirical analytic approaches were developed to help distinguish between true longitudinal changes in activity levels from potential numerical artifacts resulting from modifications in forms. The longitudinal activity data indicate a steep decline in the level of reported activity from baseline to year 10 as indicated by AD scores (446.8 to 292.1 MET-min x d(-1), 35%) as well as by HAQ scores (29.3 to 4.9 MET-times x wk(-1), 83%). This parallel trend in the pattern of the decline in activity among the two self-report methods was mirrored by a similar decline using the Caltrac method of physical activity assessment. From years 3 to 5, the AD decreased by 22%, whereas both the HAQ and Caltrac declined by 21%. The longitudinal data on physical activity collected in the NGHS cohort further confirm a dramatic decrease in the overall level of physical activity during the transition from childhood to adolescence. The consistency among the three methods indicate that both the AD and HAQ are useful tools for the assessment of activity levels in adolescent girls.
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The Child Feeding Questionnaire (CFQ) is a self-report measure to assess parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children. Confirmatory factor analysis tested a 7-factor model, which included four factors measuring parental beliefs related to child's obesity proneness, and three factors measuring parental control practices and attitudes regarding child feeding. Using a sample of 394 mothers and fathers, three models were tested, and the third model confirmed an acceptable fit, including correlated factors. Internal consistencies for the seven factors were above 0.70. With minor changes, this same 7-factor model was also confirmed in a second sample of 148 mothers and fathers, and a third sample of 126 Hispanic mothers and fathers. As predicted, four of the seven factors were related to an independent measure of children's weight status, providing initial support for the validity of the instrument. The CFQ can be used to assess aspects of child-feeding perceptions, attitudes, and practices and their relationships to children's developing food acceptance patterns, the controls of food intake, and obesity. The CFQ is designed for use with parents of children ranging in age from about 2 to 11 years of age.
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The Day in the Life Questionnaire (DILQ) was developed as a supervised classroom exercise to measure children's consumption of fruit and vegetables. The DILQ uses words and pictures to encourage the child to recall and describe a range of activities from the previous day, including their entire food intake. This study tested the validity and reliability of the DILQ for children aged 7-9 years (n = 255) in four English schools. Reliability, validity and sensitivity to change were assessed through repeated rounds of data collection. Comparisons were made of observations during school breaks and classroom completion of the DILQ. Children enjoyed completing the DILQ and teachers thought it appropriate for the age group. The questionnaire performed either well or acceptably on all validity, reliability and sensitivity tests. The DILQ can be recommended as a method of collecting data for fruit and vegetable consumption from children aged 7-9 in the classroom. The validation study included comparison of schools with and without 'fruit only' breaktime policies, and sensitivity to a brief intervention in which free fruit was distributed at morning break. The results suggest that it would be a sensitive measure for descriptive studies, before and after studies and controlled trials.
Article
The American Dietetic Association (ADA), recognizing that overweight is a significant problem for children and adolescents in the United States, takes the position that pediatric overweight intervention requires a combination of family-based and school-based multi-component programs that include the promotion of physical activity, parent training/modeling, behavioral counseling, and nutrition education. Furthermore, although not yet evidence-based, community-based and environmental interventions are recommended as among the most feasible ways to support healthful lifestyles for the greatest numbers of children and their families. ADA supports the commitment of resources for programs, policy development, and research for the efficacious promotion of healthful eating habits and increased physical activity in all children and adolescents, regardless of weight status. This is the first position paper of ADA to be based on a rigorous systematic evidence-based analysis of the pediatric overweight literature on intervention programs. The research showed positive effects of two specific kinds of overweight interventions: a) multicomponent, family-based programs for children between the ages of 5 and 12 years, and b) multicomponent, school-based programs for adolescents. Multicomponent programs include behavioral counseling, promotion of physical activity, parent training/modeling, dietary counseling, and nutrition education. Analysis of the literature to date points to the need for further investigation of promising strategies not yet adequately evaluated. Furthermore, this review highlights the need for research to develop effective and innovative overweight prevention programs for various sectors of the population, including those of varying ethnicities, young children, and adolescents. To support and enhance the efficacy of family- and school-based weight interventions, community-wide interventions should be undertaken; few such interventions have been conducted and even fewer evaluated.
Book
1. Exercise of personal and collective efficacy in changing societies Albert Bandura 2. Life trajectories in changing societies Glen Elder 3. Developmental analysis of control beliefs August Flammer 4. Impact of family processes on self-efficacy Klaus A. Schneewind 5. Cross-cultural perspectives on self-efficacy beliefs Gabriele Oettingen 6. Self-efficacy in educational development Barry Zimmerman 7. Self-efficacy in career choice and development Gail Hackett 8. Self efficacy and health Ralf Schwarzer and Reinhard Fuchs 9. Self-efficacy and alcohol and drug abuse Alan Marlatt, John S. Baer and Lori A. Quigley.
Article
It is the position of the American Dietetic Association (ADA) that schools and communities have a shared responsibility to provide students with access to high-quality, affordable, nutritious foods and beverages. School-based nutrition services, including the provision of meals through the National School Lunch Program and the School Breakfast Program, are an integral part of the total education program. Strong wellness policies promote environments that enhance nutrition integrity and help students to develop lifelong healthy behaviors. ADA actively supported the 2004 and proposed 2010 Child Nutrition reauthorization which determines school nutrition policy. ADA believes that the Dietary Guidelines for Americans should serve as the foundation for all food and nutrition assistance programs and should apply to all foods and beverages sold or served to students during the school day. Local wellness policies are mandated by federal legislation for all school districts participating in the National School Lunch Program. These policies support nutrition integrity,including a healthy school environment. Nutrition integrity also requires coordinating nutrition education and promotion and funding research on program outcomes. Registered dietitians and dietetic technicians, registered, and other credentialed staff, are essential for nutrition integrity in schools to perform in policy-making, management, education, and community building roles. A healthy school environment can be achieved through adequate funding of school meals programs and through implementation and evaluation of strong local wellness policies.
Article
Controlling maternal feeding practices have been linked to increased caloric intake, disinhibited eating, and obesity in children. Its relationship to child dieting behavior, however, is unknown. Using the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, this study examined whether controlling feeding practices are associated with increased or decreased dieting behavior in children. Controlling maternal feeding practices were assessed in third grade with the question, "Do you let your child eat what he/she feels like eating?" Answers ranged from 1 to 4; higher scores were reverse-coded to indicate greater control. Child dieting behavior was assessed in sixth grade and dichotomized into "any dieting behaviors" vs "none." Multiple logistic regression was used to investigate the relationship between controlling maternal feeding practices and dieting behavior and included the covariates of sex, race, maternal education, maternal weight status, child weight status in third grade, and change in body mass index z score between third and sixth grade. In sixth grade (n=776), 41.5% of children engaged in dieting behavior. In the multivariate analysis, greater maternal control over child eating predicted lower odds of child dieting in sixth grade (odds ratio=0.79; 95% confidence interval: 0.64 to 0.97). There was no interaction between controlling maternal feeding practices and child's sex or baseline obesity status. Exerting more control over what a child eats in third grade may protect against future dieting behavior in children, independent of child's weight status or rate of weight gain. Further work is needed to better define which controlling feeding practices are beneficial for the child.