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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.)

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., (Copyright © 2016 Society for Nutrition Education and Behavior. All rights reserved.)

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 χ² 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., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

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.

Background: Fruit, 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., Design: Elementary 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/participants: All fourth-grade students in participating elementary schools were invited to participate. Data were collected on 1578 students. MAIN OUTCOME Servings of fruit, 100% juice, and vegetables consumed., Intervention: Squire'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., Measures: Four 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., Results: Children participating in Squire's Quest! increased their FJV consumption by 1.0 servings more than the children not receiving the program., Conclusions: Psychoeducational multimedia games have the potential to substantially change dietary behavior. More research is warranted.

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. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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 FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

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

Background. Boy Scouts are an important channel to complement school-based programs to enable boys to eat more fruit, 100% juice, and vegetables (FJV) for chronic disease prevention. The “5 a Day Achievement Badge” program was presented on a pilot study basis to African-American Boy Scout troops in Houston.Methods. Troops were the unit of recruitment and random assignment to treatment and control groups. The badge program was presented in Fall 1997 by trained dietitians and included activities to increase availability and accessibility of fruit and vegetables at scouts'' homes, increase preferences for vegetables, and train in the preparation of FaSST (fast, simple, safe, and tasty) recipes. Weekly comic books demonstrated and reinforced what scouts were expected to do at home. A weekly newsletter with recipes was sent to parents. The program was revised and presented to the control group in Winter 1998. Two 24-h recalls were the primary assessment tools. Telephone interviews were conducted with parents.Results. The intervention resulted in a 0.8 FJV serving difference (post values of treatment versus control groups with pre value covaried).Conclusions. The changes obtained suggest that the intervention was effective in promoting dietary change. [Copyright &y& Elsevier]