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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., (Copyright © 2017 Society for Nutrition Education and Behavior. All rights reserved.)

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 (F6, 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 (F2, 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., Competing Interests: / Conflicts of Interest The authors have no conflicts of interest to declare., (Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Child fruit and vegetable intake is below recommended levels, increasing risk for chronic disease. Interventions to influence fruit and vegetable intake among youth have had mixed effects. Innovative, theory-driven interventions are needed. Goal setting, enhanced by implementation intentions (i.e., plans tightly connected to a behavioral goal), may offer a solution. Action plans state "how" a goal will be achieved, while coping plans identify a potential barrier and corresponding solution. The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode, theoretically-grounded serious videogame promoting fruit and vegetables. This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children., Methods: A four-group randomized design with three data collection periods (baseline, immediate post-intervention, 3 months post-intervention) was employed. Groups varied on whether children created an implementation intention (none, action, coping, both) as part of goal setting. Participants were 4th and 5th grade children (~9-11 years old) and one parent. An a priori power analysis indicated this would provide >80% power to detect a small effect (Cohen's d = 0.17). Children played a 10-episode online videogame; parents received 10 electronic newsletters and access to a parent-only website. The primary outcome was child fruit and vegetable intake, assessed via three, dietitian-assisted telephone recalls at each data collection period. The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure. Secondary analyses examined intervention effects on fruit and vegetables separately., Results: Four hundred parent/child dyads were recruited. A significant group-by-time interaction for fruit and vegetable intake (p < 0.001) was found in only the Action group, which had significant increases in fruit and vegetable intake at post 1 (p < 0.0001) and post 2 (p < 0.0001). No other significant interactions were observed; however, there were significant time effects for fruit (p < 0.0001)., Conclusions: Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children. Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children., Trial Registration: ClinicalTrials.gov NCT01004094 .

This study identified fruit, 100% juice and vegetables (FJV) consumption changes by meal among fourth grade students participating in Squire's Quest!, a 10-session individually focused psychoeducational multimedia game with many meal/environment specific behavioral change techniques incorporated into the programming. Participants in 26 elementary schools were randomly assigned to treatment or control groups. Four days of dietary intake were assessed before and after the intervention to determine FJV servings consumed by meal. Overall, students receiving the intervention consumed 1.0 serving FJV more per day compared with control condition students. Using mixed model analysis of covariance, significant increases were found for servings of fruit and 100% fruit juice at snacks, and regular vegetables at lunch for intervention school children compared with children in control condition schools. These meals and snacks were targeted by the intervention activities and appear to represent eating occasions for which the children might have had more control. Interventions need to incorporate new procedures to more directly target intake at breakfast and dinner.

Objective: This paper identifies the anthropometric, parental, and psychosocial characteristics and meal practices (e.g., breakfast skipping and number of meals and snacks consumed) associated with consumption of total energy, percent energy from fat, fruit, 100% fruit juice, vegetables, sweetened beverages, and water among 8- to 10-year-old African-American girls., Research Methods and Procedures: This study included 114 8- to 10-year-old African-American girls and a parent or primary caregiver. Girls and a parent or primary caregiver completed several dietary questionnaires. Two 24-hour dietary recalls were conducted with each girl. Height and weight were measured. Separate hierarchical regression analyses were conducted for each dependent dietary variable; potential field center differences were examined., Results: The number of meals and snacks consumed was correlated with energy intake. Lower BMI was related to higher vegetable consumption, and the number of snacks consumed was positively related to sweetened beverage consumption. Greater low-fat food preparation practices reported by parents were related to lower consumption of fat as a percentage of total energy., Discussion: Dietary behavior differed across geographic areas. Low-fat food preparation practices in the home seemed to be an important influence on the percentage of energy consumed from fat. Greater vegetable consumption was associated with lower BMI. Interventions to prevent excessive weight gain in African-American girls should encourage low-fat food preparation in the home and greater consumption of vegetables.

Background: Quality control methods are key components of dietary assessment, but have rarely been evaluated., Methods: One hundred forty-four 8-10-year-old African-American girls at three field centers completed two 24-h dietary recalls at baseline before a pilot weight gain prevention intervention (one recall collected in-person and one by telephone). The dietary recall data were initially reviewed by the dietary interviewer (Phase 1), then by a local lead nutritionist at the field center (Phase 2), and then by the Nutrition Coordinating Center (NCC) (Phase 3); any differences identified by NCC were reconciled (Phase 4). Bland-Altman and generalizability theory methods were used to assess agreement of consumption for selected food variables and nutrients between phases., Results: Only small differences occurred. Quality control procedures primarily reduced the variances of nutrients rather than caused the means to shift. Most of the variability among phases was due to individual level variability in dietary intake., Conclusions: Decisions to review dietary recall data beyond local review should be based on the level of precision and accuracy required for the study outcomes and the availability of financial resources.

Objective: This paper presents the reliability and validity of several diet-related psychosocial questionnaires., Methods: At baseline and 12 weeks follow-up, parents/caregivers of one hundred fifty 8- to 10-year-old African-American completed questionnaires on food preparation habits for their daughter, perceived home barriers to healthy eating, and fruit, juice, vegetable (FJV), low-fat and high-fat food availability. Girls completed a sweetened beverage preferences questionnaire and two 24-h dietary recalls to assess intake. Principal components analyses were conducted for two newly designed measures. Internal consistency was calculated and construct validity was assessed between the psychosocial scales and obesity-related dietary variables., Results: Low-fat and high-fat food preparation for daughters, and perceived home barriers to eating low-fat food and FJV subscales were derived from the new questionnaires. Internal consistency reliabilities were moderate (0.58) to substantial (0.80) across all new and existing scales. Test-retest reliabilities were moderate (0.44) to substantial (0.79). Girls' intake of fat as a percentage of energy was positively related to parental high-fat food preparation for daughters (P < 0.01) and negatively related to parental low-fat food preparation practices for daughters (P < 0.05)., Conclusions: Measures of family influences on FJV, fat, and sweetened beverage consumption were internally consistent with moderate to substantial stability. Scales for low-fat and high-fat food preparation practices for daughters achieved construct validity with fat consumption in the hypothesized direction. Family food preparation habits appear to be important targets for future interventions.

Background: This paper presents the rationale, reliability, and validity of a behavior-based food coding system for measuring fruit (F), juice (J), vegetable (V), sweetened beverage, and water consumption in children., Methods: Coding algorithms for FJV, sweetened beverages, and water were developed for use with the Nutrition Data System for Research (NDS-R). Two hundred and ten 8- to 10-year-old African American girls at four field centers completed two 24-h dietary recalls at baseline and at 12 weeks follow-up after a weight gain prevention intervention. Differences in mean baseline consumption of selected food variables and other selected nutrients across the four field centers were analyzed. Intraclass correlation coefficients (ICCs) for reliability across 2 days of food recalls and 12-week test-retest reliability correlations were calculated. For the purposes of this paper, nutrient intake estimates were considered construct validators of food intake, and validity was assessed by correlating the coded food variable servings with nutrient intake., Results: ICCs varied from zero (0.001 for beta carotene equivalents) to moderate (0.44 for sucrose), indicating substantial instability in consumption or reporting. Twelve-week test-retest correlations were slight to moderate (0.09 for lycopene to 0.49 for folate). FJV consumption was negatively related to percent energy from fat (r = -0.28; P = 0.001) and positively related to other nutrients. Sweetened beverage consumption was positively related to energy, sucrose, fructose, and vitamin C consumption., Conclusions: This behavior-based food coding system demonstrated construct validity among 8- to 10-year-old African American girls and can measure the desired food groups.

The impact of goal attainment in a dietary change program to increase fruit, 100% juice, and vegetable consumption was assessed among fourth-grade students. At each session, the students were given goals related to increasing fruit, juice, and vegetable consumption. Baseline consumption and postconsumption were assessed with up to 4 days of computerized dietary recalls. Analyses included regression models predicting postconsumption from the numbers of fruit-juice goals, vegetable goals, or total number of general goals attained, respectively. For students with low baseline fruit-juice preferences, attaining more fruit-juice goals resulted in increased post-fruit-juice consumption. Among those with low baseline vegetable consumption, attaining one vegetable goal was related to higher post-vegetable consumption. For boys and those with high baseline fruit, juice, and vegetable consumption, attaining three general goals was related to increased fruit, juice, and vegetable intake. The results show that goal attainment was somewhat effective in promoting dietary change among children.