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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

Objective To assess the agreement of posted menus with foods served to 3- to 5-year-old children attending federal Child and Adult Care Food Program (CACFP)-enrolled facilities, and the degree to which the facilities met the new meal patterns and best practices. Design On-site observations and menu coding. Participants/Setting Nine early care and education centers. Main Outcome Measures Agreement of posted menus with foods served, and comparison of foods served and consumed with the new CACFP meal guidelines and best practices. Analysis Data were compiled for each meal (breakfast, lunch, and snacks). Frequencies and percentages of agreement with the posted menu (coded matches, substitutions, additions, and omissions) were calculated for each food component in the CACFP menu guidelines. Menu total match was created by summing the menu match plus acceptable substitutions. Menus were compared with the new CACFP meal guidelines and best practices. Results The match between the posted menus and foods actually served to children at breakfast, lunch, and snack was high when the acceptable menu substitutions were considered (approximately 94% to 100% total match). Comparing the menus with the new meal guidelines and best practices, the 1 guideline that was fully implemented was serving only unflavored, low-fat, or 1% milk; fruit and vegetable guidelines were partially met; fruit juice was not served often, nor were legumes; the guideline for 1 whole grain–rich serving/d was not met; and regular beef and full-fat cheese products were commonly served. Conclusions and Implications Early care and education centers enrolled in CACFP provided meals that met the current CACFP guidelines. Some menu improvements are needed for the centers to meet the new guidelines and best practices. [ABSTRACT FROM AUTHOR]

Objective To investigate changes in student food selection and consumption in response to the new National School Lunch Program meal patterns during fall 2011. Design Eight elementary and four intermediate schools in one Houston area school district were matched on free/reduced-price meal eligibility and randomized into control or intervention conditions. Intervention Both intervention and control school cafeterias served the same menu. The intervention school cafeterias posted the new meal pattern daily; students could select one fruit and two vegetable servings per reimbursable meal. Control school students could only select the previous meal pattern: a total of two fruit and vegetable servings per meal. Main outcome measures Students were observed during lunch: student sex and foods selected/consumed were recorded. Diet analysis software was used to calculate energy/food groups selected/consumed. Statistical analyses performed Cochran-Mantel-Haenszel χ 2 tests examined differences in the percent of students selecting each meal component by condition, controlling for sex, grade, and school free/reduced-price meal eligibility. Analysis of covariance assessed differences in amount of energy/food groups selected and consumed, and differences in percent of food groups consumed. Results Observations were conducted for 1,149 elementary and 427 intermediate students. Compared with students in the control schools, significantly more intervention elementary and intermediate school students selected total ( P <0.001, P <0.05) and starchy vegetables ( P <0.001, P <0.01); more intervention intermediate school students selected fruit ( P <0.001), legumes ( P <0.05), and protein foods ( P <0.01). There were significantly greater amounts of these foods selected and consumed, but no differences in the proportion of the foods consumed by condition. Fewer calories were consumed by elementary and intermediate school intervention students. Conclusions More intervention students selected fruit and vegetables at lunch and consumed them compared with control condition students. Future studies with larger and more diverse student populations are warranted. [ABSTRACT FROM AUTHOR]

Abstract: We assessed the impact of a pilot middle school a la carte intervention on food and beverage purchases, kilocalories, fat, carbohydrate, and protein sold per student, and nutrient density of the foods sold. A la carte sales were obtained from six middle schools in three states for 1 baseline week and daily during the 6-week intervention. Intervention goals included reducing sizes of sweetened beverages and chips, and increasing the availability of water and reduced-fat/baked chips. Nutrients sold per day were computed and weekly nutrient means per student and per number of items sold were calculated and compared between baseline and week 6. Five schools achieved all goals at 6 weeks. Four schools showed increases in the percentage of kilocalories from protein and decreases in the amount of sweetened beverages sold; five showed substantial increases in water sales. Changes in regular chips varied by school. There were significant changes in energy density of foods sold. School foodservice changes in middle school snack bar/a la carte lines can be implemented and can lead to a reduction in the caloric density of foods purchased. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

Provides information on a study which compared the diet and physical activity factors involved in adiposity of children. Methodology; Analysis on the results; Discussion of the findings of the study.

A review of the article "From Squires Quest! II: A Serious Video Game Intervention'': Methodological Issues" is presented.

Objective Squire's Quest! II: Saving the Kingdom of Fivealot , an online video game, promotes fruit and vegetable (FV) consumption. An evaluation study varied the type of implementation intentions used during the goal-setting process (none, action, coping, or both action and coping plans). Participants who created action plans reported higher FV consumption 6 months after baseline. This study assessed changes by specific meal in that study. Methods A total of 400 fourth- and fifth-grade children completed 3 24-hour recalls at baseline and 6 months later. These were averaged to obtain FV intake. Analyses used repeated-measures ANCOVA. Results There was a significant group by time effect for vegetables at 6 months ( P = .01); Action ( P = .01) and coping ( P = .04) group participants reported higher vegetable intake at dinner. There were significant increases in fruit intake at breakfast ( P = .009), lunch ( P = .01), and snack ( P < .001). Conclusions and Implications Setting meal-specific goals and action or coping plans may enable children to overcome barriers and consume FV. [ABSTRACT FROM AUTHOR]

Background Children generally do not consume adequate amounts of fruits and vegetables (F/V). Eating more F/V can improve energy density and overall diet quality. Objective Our aim was to investigate whether improvements in F/V consumption were associated with improvements in energy density, total calories, and dietary components related to F/V. Design We performed secondary analyses of dietary data from a successful four-group randomized controlled trial promoting F/V. Data were collected at baseline, immediately after gameplay, and 3 months post intervention. Participants/setting Preadolescent child−parent dyads (n=400) were recruited. Eligibility criteria were 4th- or 5th-grade child (approximately 9 to 11 years old) with Internet access and a parent willing to participate in the intervention. Complete dietary data were collected on 387 of the 400 child participants. The videogame was available online on a secure, password-protected website. Main outcome measures Dietary intake was assessed with three unannounced dietary recalls collected at each data-collection period via telephone by trained staff using Nutrition Data System for Research software. Energy density and F/V, nutrient, and food consumption were calculated. Statistical analysis performed A 4×3 (group by time) repeated measures analysis of covariance with mixed-effect linear models was used. Covariates included child’s sex, race/ethnicity, and total energy intake as well as parent’s age and household education. Energy was excluded as a covariate in the energy density and energy models. Results Significant changes occurred in energy density. A significant interaction (group by time) was observed (F 6, 515 =2.40; P <0.05) in energy density from food only, while a significant time effect was observed for energy density from all foods and beverages (F 2, 388 =13.75; P <0.0001). Desirable changes were also observed in F/V-related dietary components. Conclusions Increasing F/V consumption improved energy density and diet quality considerably in preadolescent children. [ABSTRACT FROM AUTHOR]

: BackgroundFruit, juice, and vegetable (FJV) consumption among children is low. Innovative programs are needed to enable children to increase FJV intake. Psychoeducational multimedia permits the delivery of interventions as designed and capitalizes on known behavior change principles.: DesignElementary school was the unit of recruitment, assignment, and analysis. Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch, and randomly assigned to treatment or control groups. Data were collected just before and just after the program.: Setting/participantsAll fourth-grade students in participating elementary schools were invited to participate. Data were collected on 1578 students.: Main outcomeServings of fruit, 100% juice, and vegetables consumed.: InterventionSquire’s Quest! is a ten-session, psychoeducational, multimedia game delivered over 5 weeks, with each session lasting about 25 minutes. Based on social cognitive theory, educational activities attempted to increase preferences for FJV through multiple exposures and associating fun with their consumption, increase asking behaviors for FJV at home and while eating out, and increase skills in FJV preparation through making virtual recipes.: MeasuresFour days of dietary intake were assessed before and after the intervention. Assessment was made by the Food Intake Recording Software System (FIRSSt), which conducts a multiple pass, 24-hour dietary intake interview directly with the children.: ResultsChildren participating in Squire’s Quest! increased their FJV consumption by 1.0 servings more than the children not receiving the program.: ConclusionsPsychoeducational multimedia games have the potential to substantially change dietary behavior. More research is warranted. [Copyright &y& Elsevier]

Abstract: Self-administered instruments offer a low-cost diet assessment method for use in adult and pediatric populations. This study tested whether 8- to 13-year-old children could complete an early version of the Automated Self Administered 24-hour diet recall (ASA24) and how this compared to an interviewer-administered 24-hour diet recall. One-hundred twenty 8- to 13-year-old children were recruited in Houston from June through August 2009 and randomly assigned to complete either the ASA24 or an interviewer-administered 24-hour diet recall, followed by the other recall mode covering the same time interval. Multivariate analysis of variance, testing for differences by age, sex, and ethnic/racial group, were applied to percentages of food matches, intrusions, and omissions between reports on the ASA24 and the interviewer-administered 24-hour diet recall. For the ASA24, qualitative findings were reported regarding ease of use. Overall matches between interviewer-administered and ASA24 self-administered 24-hour diet recall was 47.8%. Matches were significantly lower among younger (8- to 9-year-old) compared with older (10- to 13-year-old) children. Omissions on ASA24 (18.9% overall) were most common among 8-year-olds and intermediate among 9-year-olds. Eight- and 9-year-olds had substantial difficulties and often required aid in completing ASA24. Findings from this study suggest that a simpler version of an Internet-based diet recall program would be easier for children to use. [Copyright &y& Elsevier]

Objectives To assess the validity of the Food Intake Recording Software System (FIRSSt) against observation of school lunch and a 24-hour dietary recall (24hDR); and to test the effects of sequencing, observation and a hair sample as a bogus pipeline on accuracy of dietary report.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.Subjects/setting 138 fourth-grade students in 2 elementary schools.Main outcome measures Accuracy of reported food consumption was measured in terms of matches, intrusions, and omissions among the FIRSSt, 24hDR, and as observed at school lunch. Students also completed self-report of performance with FIRSSt.Statistical analysis performed t tests, Pearson correlations, analysis of variance, factor analysis.Results When compared with school lunch observation for one meal, FIRSSt attained 46% match, 24% intrusion, and 30% omission rates, while a dietitian-conducted 24hDR obtained 59% match, 17% intrusion, and 24% omission rates. FIRSSt attained 60% match, 15% intrusion, and 24% omission rates against 24hDR for all meals in the previous day. There was no evidence of sequence of assessment affecting accuracy indicators, but there was a weak effect of school lunch observation on percent intrusions. Obtaining a hair sample reduced the omission rate for FIRSSt vs 24hDR and increased the match rate for 24hDR vs observation, thereby enhancing this as a bogus pipeline procedure. Children generally enjoyed completing FIRSSt. Hispanic children were more likely to report problems using FIRSSt.Applications/conclusions FIRSSt is somewhat less accurate than a dietitian-conducted 24hDR. However, this lower-cost procedure provides a promising method for assessing diet among children. Observation of consumption at school lunch may be reactive and artificially increase agreement. Obtaining a hair sample as a bogus pipeline may be a valuable technique for enhancing the accuracy of dietary assessment among children. J Am Diet Assoc. 2002; 102:380–385. [Copyright &y& Elsevier]

Objective To evaluate the Kids Café Program (KCP) nutrition education and assess its impact on children's diet quality and body mass index (BMI) percentile. Design An experimental design consisting of pretest-posttest comparison groups using mixed methods to evaluate a 6-session nutrition education intervention. Setting Four Boys and Girls Club sites Participants A total of 120 9- to 12-year-old children in the KCP (60 intervention and 60 comparison); 89% completed posttest evaluations. Intervention Trained KCP site staff taught the nutrition education curriculum at intervention sites. Main Outcome Measures Healthy Eating Index–2010 using 24-hour dietary recall data (primary) and BMI percentile (secondary) Analysis Repeated-measures mixed-effects modeling Results Mean age of children was 10.2 years; mean BMI percentile was about 79; 95% were from food-insecure households. The total Healthy Eating Index–2010 score for both groups at baseline and posttest ranged from 50 to 60. At posttest, compared with baseline scores, children from both groups scored significantly lower for total vegetables, and greens and beans; the intervention group children had significantly higher sodium scores. Process evaluation indicated that 60-minute lecture-based sessions were too long after children were in school all day. Conclusion This pilot study suggests that the KCP nutrition education curriculum needs improvement. Further research based on behavioral constructs is needed to refine the curriculum to encourage healthier food choices among children and using the MyPlate and the 2015-2020 Dietary Guidelines for Americans. [ABSTRACT FROM AUTHOR]