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The objective of this cross-sectional study is to compare the dietary behaviors of children from low food secure (LFS) households with children from very low food secure (VLFS) households over an entire day, and during meals specifically consumed at home --breakfast, snack, and dinner. Parents of the recruited children completed a demographic questionnaire, along with USDA's 6-item short form food security questionnaire. Children completed 24-hour dietary recalls in person. Complete data from 102 children 9 to 12 years old were used. Using ANOVA to assess the differences among groups in intakes over an entire day and during meals consumed at home, no significant differences were found, except for vitamin C intake during breakfast. Based on the definitions of LFS and VLFS, it was hypothesized that children from VLFS group would have lower dietary intakes compared to children from the LFS group. However, this study found little difference. Speculations have been made for these findings and implications for research have been presented.

BackgroundFamily conflict can reduce adolescent adherence to type 1 diabetes management tasks. The Family Teamwork in-person intervention was shown to be efficacious in reducing conflict and low adherence to diabetes-related tasks. Its reach and potential impact, however, were limited by the need to deliver the intervention sessions in person. Relational agents (ie, computerized versions of humans) have been shown to appeal to diverse audiences and may be an acceptable replacement for a human in technology-based behavior change interventions. ObjectiveThe purpose of this paper is to present the results of a pilot study assessing feasibility and acceptability of Diabetes Family Teamwork Online, an adapted version of the Family Teamwork intervention, delivered over the internet and guided by a relational agent. MethodsParent-adolescent dyads were recruited through a diabetes care clinic at a large tertiary care hospital in the southwestern United States. A one-group design, with assessments at baseline, immediate postintervention, and 3 months later, was used to assess feasibility. A priori feasibility criteria included an assessment of recruitment, completion, attrition, program satisfaction, therapeutic alliance, attitudes toward the relational agent, and data collection. The institutional review board at Baylor College of Medicine approved the protocol (H-37245). ResultsTwenty-seven adolescents aged 10 to 15 years with type 1 diabetes and their parents were enrolled. Criteria used to assess feasibility were (1) recruitment goals were met (n=20), (2) families completed ≥75% of the modules, (3) attrition rate was ≤10%, (4) program satisfaction was high (≥80% of families), (5) therapeutic alliance was high (average score of ≥60/84), (6) families expressed positive attitudes toward the relational agent (average item score of ≥5 on ≥4 items), (7) ≥80% of data were collected at post 1 and post 2, and (8) few technical issues (≤10%) occurred during intervention delivery. All feasibility criteria were met. Qualitative data confirmed that adolescents and parents had positive reactions to both the content and approach. ConclusionsThe Diabetes Family Teamwork Online intervention proved to be a feasible and acceptable method for enhancing communication around diabetes management tasks in families with an adolescent who has type 1 diabetes. International Registered Report Identifier (IRRID)RR2-10.2196/resprot.5817

Background: This study evaluates the relationship of goal setting to low-fat vegetable (LV) and fruit/100% juice (FJ) consumption and physical activity (PA) change. Methods: A total of 473 10- to 14-year-old Boy Scouts from Houston took part in a 9-week intervention. A two-group (LV and FJ or PA) intervention design was used with each group serving as the control for the other. Internet-based activities included goal setting at home. Food frequencies measured dietary intake. Results: Goals attained were not related to LV intake or PA. Immediate posttest FJ consumption increased about 0.7 servings as home FJ availability increased, but social desirability of response appeared to confound reports of FJ intake at posttest 6 months assessment. Conclusions: Goals attained were not related to LV intake or PA but was related to FJ intake, but only when home FJ availability was high and the relationship was confounded by social desirability of response. Further research is needed with higher quality measures of dietary intake to clarify these relationships. (Contains 3 tables and 2 figures.)

Background: Computerized point-of-sale (POS) machine software that allows parents to place restrictions on their child's school meal accounts is available. Parents could restrict specific foods (e.g., chips), identify specific days the child can purchase extra foods, or set monetary limits. This descriptive study examines the use of parental restrictions on student cafeteria POS accounts in a convenience sample of 2 school districts. Methods: POS alerts, with student gender, grade, ethnicity, and students' free or reduced-price meal eligibility, were obtained from 2 school food service departments for the 2007-2008 school year. The alerts were coded into 5 categories: financial, medical, restrictions, snacks OK, and extras OK. The distribution of alerts by district, students, and demographics was then tabulated. Results: District A (4839 students) had more students with alerts (n = 789, 16%) than District B (8510 students; n = 217, 2.6%), and 94 District A students had a second alert. District A parents had to provide written permission for their child to purchase snacks (n = 654, 13.5%) and extra meal items (n = 113, 2.3%). Most alerts were for full-pay students in both districts (74% and 66%) and varied by demographics of the students. Conclusions: Few parents actually used this system to limit student purchases of foods outside the school meal. Future studies should investigate the influence of these restrictions on student food choices. (Contains 2 tables.)

Purpose/Objectives: The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. Methods: Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburgh, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n = 21 schools) or control (n = 21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. Results: At baseline, 15 intervention and 15 control schools had beverage and/or snack vending machines, compared with 11 intervention and 11 control schools at the end of the study. At the end of study, all of the intervention schools with beverage vending machines, but only one out of the nine control schools, met the beverage goal. The snack goal was met by all of the intervention schools and only one of the four control schools with snack vending machines. Applications to Child Nutrition Professionals: The HEALTHY study's vending machine beverage and snack goals were successfully achieved in intervention schools, reducing access to less healthy food items outside the school meals program. Although the effect of these changes on student diet, energy balance and growth is unknown, these results suggest that healthier options for snacks can successfully be offered in school vending machines. (Contains 3 tables.)

Purpose: This study assessed student perceptions of school meals under the new federal meal patterns for the National School Lunch Program (NSLP). Student feedback is instrumental in developing strategies to increase and maintain NSLP participation, satisfaction, and ultimately provide students with a healthy meal. Methods: Anonymous questionnaires were completed by 1,867 6th to 8th grade students in the Houston, Texas area during Spring 2013. Analysis of variance was used to assess whether student perceptions about school meals, fruit/vegetables/whole grain consumption, and staff attentiveness varied by grade level, gender, school free/reduced price (FRP) meal eligibility, or frequency of eating school lunch. The top five reasons why participants choose to eat school lunch were also assessed. Results: Sixth graders (p < 0.001) reported greater satisfaction with the NSLP meal than other grades, while students from schools with higher FRP eligibility reported less satisfaction (p < 0.001) than other schools. Sixth graders (p < 0.001), as well as boys (p = 0.015), were more likely to report selecting and consuming fruits, vegetables, and whole grains. Students from schools with higher FRP eligibility (p < 0.001) and students who reported eating school lunch more frequently (p < 0.001) were more satisfied with staff attentiveness. The most popular reason for eating school lunch was "I am hungry". The least popular reasons for participating in the NSLP were "I get a balanced meal", and "It prepares me for after school activities".

Objectives. We assessed the statewide impact of the 2004 Texas Public School Nutrition Policy on foods and beverages served or sold in schools. Methods. We collected lunch food production records from 47 schools in 11 Texas school districts for the school years before (2003-2004) and after (2004-2005) policy implementation. Cafeteria servings of fruit, vegetables (regular and fried), and milk served each day were calculated. Twenty-three schools from 5 districts provided records of a la carte sales of candy, chips, desserts, drinks, ice cream, and water. We examined aggregated school-level differences in total items served or sold per day per student between study years. Results. School demographics were similar to state data. Regardless of district and school size, cafeterias served significantly fewer high-fat vegetable items per student postpolicy (P Conclusions. School food policy changes have improved foods served or sold to students. It is not known whether improved lunch choices influence consumption for the whole day. (doi:10.2105/AJPH.2007.129387)

Our objective for this study was to examine the feasibility of instituting environmental changes during a 6-week pilot in school foodservice programs, with long-term goals of improving dietary quality and preventing obesity and type 2 diabetes in youth. Participants included students and staff from six middle schools in three states. Formative assessment with students and school staff was conducted in the spring of 2003 to inform the development of school foodservice policy changes. Thirteen potential policy goals were delineated. These formed the basis for the environmental change pilot intervention implemented during the winter/spring of 2004. Questionnaires were used to assess the extent to which the 13 foodservice goals were achieved. Success was defined as achieving 75% of goals not met at baseline. Daily data were collected on goal achievement using the schools' daily food production and sales records. Qualitative data were also collected after the pilot study to obtain feedback from students and staff. Formative research with staff and students identified potential environmental changes. Most schools made substantial changes in the National School Lunch Program meal and snack bar/a la carte offerings. Vending goals were least likely to be achieved. Only one school did not meet the 75% goal achievement objective. Based on the objective data as well as qualitative feedback from student focus groups and interviews with students and school staff, healthful school foodservice changes in the cafeteria and snack bar can be implemented and were acceptable to the staff and students. Implementing longer-term and more ambitious changes and assessing cost issues and the potential enduring impact of these changes on student dietary change and disease risk reduction merits investigation.

Objective: To understand diet, physical activity, and inactivity influences among preadolescent African American girls at risk of becoming obese. Design: Interviews and group qualitative discussions (ie, mixed qualitative research method) were conducted separately with 8- to 10-year-old African American girls and their parents. Setting: Greater Houston, Texas. Participants: Eight- to 10-year-old African American girls above the 50th percentile body mass index with a home computer (n = 82) and a parent (n = 74). Variables Measured: Influences on dietary practices and physical activity/inactivity among preadolescent African American girls. Analysis: Discussions were audiotaped, manually recorded, transcribed, and coded. The primary coder analyzed the transcribed notes. The secondary coder reviewed and critiqued the initial coding. Results: Parents and girls were concerned about overweight and viewed physical activity as a weight control practice. Mothers facilitated daughters' physical activity, while fathers and siblings were coparticipants. Girls had access to physical activity equipment and facilities. Snack food items and carbonated beverages were often limited by the parents, and water consumption was encouraged. Discrepancies were apparent between girls' and parents' responses. Conclusions and Implications: Parental convenience and girls' food preferences influenced dietary intake. Obesity prevention programs should capitalize on parental motivation for their child's health and provide practical strategies to facilitate healthful eating and physical activity. KEY WORDS: focus groups, children, physical activity, diet, African American, girls, water, family

ABSTRACT Design Six-group design systematically varying sequence of self-report (FIRSSt vs 24hDR), observation of school lunch, and hair sample as a bogus pipeline manipulation, with random assignment of participants. Objectives [...]

Objective To compare diet and physical activity between a group of children aged 4 to 7 years who had increased their sum of 7 skinfolds by 1.5 standard deviations or more since the previous year and those who had not. Subjects/design A longitudinal design was used wherein children had their body composition assessed at 4 annual intervals. Fifteen study subjects were identified from a larger study on the development of cardiovascular risk factors in children. Three matched control subjects were identified for all but 4 study subjects. Children were included if they were 3 or 4 years old at the time of the first of 4 annual clinics to collect data. Children were volunteers from a mid-sized city. Measures Seven skinfold sites were assessed, each 3 times. An average was taken of the mean at each site. Diet and physical activity were assessed using observational methods for up to 4 days for each of 3 years between the 4 annual clinics (held in the summers of 1986, 1987, 1988, and 1989). Results Children consumed significantly (P = .02) more fat grams and suggestively higher percentages of energy from fat (P = .06), total energy (P = .08), and percentage energy from protein (P = .10). No differences were detected for percent energy from carbohydrate, physical activity, or height. Conclusions Programs to prevent childhood obesity might have success by targeting dietary fat consumption among children as young as 4 years old, but further research is needed., Obesity is a growing public health concern among children in the United States (1). Childhood obesity may be influenced by distinct growth periods during early childhood. The first period occurs […]

Abstract Objective To improve an existing measure of fruit and vegetable intake self efficacy by including items that varied on levels of difficulty, and testing a corresponding measure of water intake self efficacy. Design Cross sectional assessment. Items were modified to have easy, moderate and difficult levels of self efficacy. Classical test theory and item response modeling were applied. Setting One middle school at each of seven participating sites (Houston TX, Irvine CA, Philadelphia PA, Pittsburg PA, Portland OR, rural NC, and San Antonio TX). Subjects 714 6th grade students. Results Adding items to reflect level (low, medium, high) of self efficacy for fruit and vegetable intake achieved scale reliability and validity comparable to existing scales, but the distribution of items across the latent variable did not improve. Selecting items from among clusters of items at similar levels of difficulty along the latent variable resulted in an abbreviated scale with psychometric characteristics comparable to the full scale, except for reliability. Conclusions The abbreviated scale can reduce participant burden. Additional research is necessary to generate items that better distribute across the latent variable. Additional items may need to tap confidence in overcoming more diverse barriers to dietary intake.

Abstract Background The physical environments in which adolescents reside and their access to food stores may influence their consumption of fruit and vegetables. This association could either be direct or mediated via psychosocial variables or home availability of fruit and vegetables. A greater understanding of these associations would aide the design of new interventions. The purpose of this study was to examine associations between distance to food stores and restaurants and fruit and vegetable consumption and the possible mediating role of psychosocial variables and home availability. Methods Fruit and vegetable consumption of 204 Boy Scouts was assessed by a food frequency questionnaire in 2003. Participant addresses were geo-coded and distance to different types of food stores and restaurants calculated. Fruit and vegetable preferences, home availability and self-efficacy were measured. Regression models were run with backward deletion of non-significant environmental and psychosocial variables. Mediation tests were performed. Results Residing further away from a small food store (SFS) (convenience store and drug store) was associated with increased fruit and juice and low fat vegetable consumption. Residing closer to a fast food restaurant was associated with increased high fat vegetable and fruit and juice consumption. Vegetable preferences partially mediated (26%) the relationship between low fat vegetable consumption and distance to the nearest SFS. Conclusion Distance to SFS and fast food restaurants were associated with fruit and vegetable consumption among male adolescents. Vegetable preferences partially mediated the distance to low fat vegetable relationship. More research is needed to elucidate how environmental variables impact children's dietary intake.

Abstract Background Including children in food preparation activities has long been recommended as a method to encourage children's consumption, but has not been evaluated. Goal setting is also a common component of behavior change programs. This study assessed the impact of attaining goals to prepare fruit-juice or vegetable recipes on student fruit and vegetable consumption as part of a 10-week fruit and vegetable intervention for fourth grade students. Methods At six of the 10 sessions, students (n = 671) selected a fruit-juice or vegetable recipe to prepare at home before the next session. Students returned parent-signed notes reporting their child's goal attainment. Baseline and post consumption were assessed with up to four days of dietary recalls. Analyses included regression models predicting post consumption from the number of fruit-juice or vegetable recipe preparation goals attained, controlling for baseline consumption. Results In general, girls and Hispanic students achieved the most recipe preparation goals. For students with highest baseline fruit-juice consumption, post fruit-juice consumption was higher by about 1.0 serving for those achieving 2 or 3 fruit-juice recipe preparation goals. Post vegetable consumption was highest for students reporting the highest baseline vegetable consumption and who achieved two or three vegetable recipe preparation goals. In general, recipe goal setting was a useful procedure primarily for those with high baseline consumption. Conclusion This is one of the first reports demonstrating that home recipe preparation was correlated with dietary change among children.