Confirmatory factor analysis of a questionnaire measuring control in parental feeding practices in mothers of Head Start children.

Parental control in child feeding has focused primarily on directive types of control, such as pressure to eat and food restriction. This study aimed to develop an instrument to assess other types of directive control and two additional aspects of parental child feeding, non-directive and food environmental control. Mothers of Head Start children (n=330) completed a 29-item instrument designed to assess these three feeding constructs and reported their children's food intakes. Researchers measured heights and weights of both mothers and children. Confirmatory factor analysis revealed that the model with three constructs did not provide an acceptable fit to the data, but an alternative model with seven sub-constructs did (Chi-square=330, df=228 p<.05, CFI=.942, RMSEA=.037). The latter model included 24 items loading onto one of the following seven factors: high control, high contingency, child-centered feeding, encouraging nutrient-dense foods, discouraging energy-dense foods, mealtime behaviors, and timing of meals. By allowing researchers to quantitatively measure feeding practices in parents with limited resources, this instrument may contribute to an improved understanding of how parental child feeding behaviors can influence children's food intakes and weight status.

Associations among parental feeding styles and children's food intake in families with limited incomes.

BACKGROUND: Although general parenting styles and restrictive parental feeding practices have been associated with children's weight status, few studies have examined the association between feeding styles and proximal outcomes such as children's food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young children's evening food intake in a multiethnic sample of families in Head Start. METHODS: Participants were 715 Head Start children and their parents from Texas and Alabama representing three ethnic groups: African-American (43%), Hispanic (29%), and White (28%). The Caregivers Feeding Styles Questionnaire (Hughes) was used to characterize authoritative, authoritarian (referent), indulgent or uninvolved feeding styles. Food intake in several food groups was calculated from 3 days of dietary recalls for the child for evening food intakes from 3 PM until bedtime. RESULTS: Compared to children of authoritarian parents, intakes of fruits, juice and vegetables were lowest among children of indulgent or uninvolved parents (1.77 +/- 0.09 vs 1.45 +/- 0.09 and 1.42 +/- 0.11 cups) as were intakes of dairy foods (0.84 +/- 0.05 vs 0.67 +/- 0.05 and 0.63+0.06 cups), respectively. CONCLUSION: Findings suggest that permissive parent feeding styles like indulgent or uninvolved relate negatively to children's intake of nutrient-rich foods fruit, 100% fruit juice, vegetables and dairy foods from 3 PM until bedtime.

Diet quality varies by race/ethnicity of Head Start mothers.

BACKGROUND: Despite the key role that women from limited income families play as family food providers and their high risk for diet-related chronic diseases, there is a paucity of data about their diet quality and how it might vary by race/ethnicity. OBJECTIVE: To compare nutrient and food intakes of multiethnic mothers with children in Head Start from Texas and Alabama. DESIGN: Cross-sectional, secondary data analysis. METHODS: The sample was 603 mothers, 33% Hispanic American from Texas; 19% African American from Texas; 24% African American from Alabama; and 24% white from Alabama who were interviewed from fall 2004 to spring 2005. Diet quality was evaluated by averaging 24-hour dietary recalls from 3 nonconsecutive days and calculating the percent meeting the Estimated Average Requirement, the Dietary Guidelines for fat and added sugar, and the mean adequacy ratio for eight nutrients. For multiple comparisons, the least square means statement was used for general linear model procedures, adjusted for age, body mass index, and energy intake. RESULTS: The average mean adequacy ratio scores for diet quality were low overall, but 44% of Hispanic Americans had mean adequacy ratio scores <85, whereas 96% to 97% of other groups did. Most mothers exceeded 35% of energy from fat, with Hispanic Americans having the lowest percentage. Overall, 15% of mothers exceeded 25% of energy from added sugars, with Hispanic Americans having 5% with excess intakes. Energy intakes were highest for Hispanic Americans (2,017 kcal) and lowest for African Americans (1,340 kcal). The Hispanic Americans surveyed averaged 4.6 c fruit and vegetables per day compared to 3.2, 2.3, and 2.9 c/day among African Americans from Texas, African Americans from Alabama, and whites from Alabama, respectively. CONCLUSIONS: Despite limited food resources, Hispanic-American mothers consumed adequate amounts of fruit and vegetables. There was considerable variation in diet quality among race/ethnic groups on a low income budget.

Previous experience with older adults positively affects nutrition students' attitudes toward this age group.

OBJECTIVES: To explore: (1) dietetic and nutritional science students' attitudes toward working with older adults and the factors affecting those attitudes; (2) the differences in attitudes between students who preferred to work with older adults and those who did not; (3) factors affecting self-efficacy to work with them; and (4) factors influencing current preference to work with older adults. DESIGN: Triangulated qualitative research methods (focus groups and in-depth interviews). SETTING: Department of Food Science and Human Nutrition at a land grant university in the north central United States. PARTICIPANTS: Upper-level dietetics and nutritional sciences students (N=27), half of whom preferred to work with older adults and half who did not. MAIN OUTCOMES: Attitudes and preference for working with older adults and influencing factors. ANALYSIS: Transcripts from audiotapes and field notes were analyzed using open and axial coding methods. RESULTS: Students who preferred working with older adults had more positive attitudes toward working with older adults compared to those who did not. Previous experience with older adults was strongly associated with comfort level, self-efficacy to work with them, attitudes toward this age group, and preference for working with them. IMPLICATIONS FOR RESEARCH AND PRACTICE: Direct and positive interaction with older adults is likely a key intervention to improving students' attitudes toward working with this age group.

What Social, Program, and Behavioral Factors Influence the Healthy Eating Index for EFNEP and SNAP-Ed Adult Participants?

The main objectives of this article were to determine the demographic factors, the program related factors and the behavioral factors that influence Michigan Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education outcomes. Secondarily, we sought to understand the trends and changes in Healthy Eating Index (HEI) scores across the differing baseline score groups. The data were collected by nutrition instructors in a pretest, posttest design to capture change in healthy eating habits through changes in HEI scores. The participants were all low-income program participants during the years of 2011 and 2012, living in Michigan. Findings show that eating habits improved most in households with weekly per-person income within $100 to $500, and with Caucasian females living in cities or suburbs. Improvements were also greater with those who took part in the Expanded Food and Nutrition Education Program, where the participants exhibited higher baseline frequency of planning meals before grocery shopping, comparing prices, and budgeting enough money for food and food related purchases. Overall, the average change in HEI scores increased by 2.3 points, however, the variability between the participants' changes was high, suggesting that more targeted program lessons might increase program efficacy, especially for those participants with high baseline HEI scores.

College Students' Health Behavior Clusters: Differences by Sex.

OBJECTIVE: The study purpose was to identify clusters of weight-related behaviors by sex in a college student populations. METHODS: We conducted secondary data analysis from online surveys and physical assessments collected in Project Young Adults Eating and Active for Health (YEAH) with a convenience sample of students on 13 college campuses in the United States. We performed 2-step cluster analysis by sex to identify subgroups with homogeneous characteristics and behaviors. We used 8 derivation variables: healthy eating; eating restraints; external cues; stress; fruit/vegetable intake; calories from fat; calories from sugar-sweetened beverages; and physical activity. Contribution of derivation variables to clusters was analyzed with a MANOVA test. RESULTS: Data from 1594 students were included. Cluster analysis revealed 2-clusters labeled "Healthful Behavior" and "At-risk" for males and females with an additional "Laid Back" cluster for males. "At-risk" clusters had the highest BMI, waist circumference, elevated health risk, and stress and least healthy dietary intake and physical activity. The "Laid Back" cluster had normal weights and the lowest restrained eating, external cues sensitivity, and stress. CONCLUSION: Identified differences in characteristics and attitudes towards weight-related behaviors between males and females can be used to tailor weight management programs.

Predictors of nutritional adequacy in mother-toddler dyads from rural families with limited incomes.

OBJECTIVE: To predict the mean adequacy ratio (MAR) scores of mothers and toddlers from intakes of fruits, vegetables, and dairy group foods and being seated during mealtimes. DESIGN/SUBJECTS: This was a regression analysis of cross-sectional data of the diet quality and being seated during mealtimes of 100 rural mother-toddler dyads from limited-income families using two 24-hour dietary recalls. Children were 11 to 25 months of age and at or below 100% of the poverty index. MEASURES OF OUTCOME: Dietary quality for mothers and toddlers was assessed using a MAR score for eight different nutrients (vitamin A, vitamin C, vitamin D, folate, calcium, zinc, iron, and magnesium), and a score of 85 or above was considered nutritionally adequate. The main food groups of interest were servings from the fruits, vegetables, and dairy group foods. Mealtime sitting behavior was the percentage of times the toddler remained seated while eating. RESULTS: Servings of fruits, vegetables, and dairy foods predicted 0.62 of the variance in the mother's MAR score, whereas vegetable and dairy intakes along with being seated while eating indicated nutritional adequacy for toddlers. Mothers with low MAR scores were most likely to have toddlers with poor diets, although few toddlers had poor diet quality. CONCLUSIONS: Adequate intakes of dairy, vegetables, and whole fruits along with being seated while eating could be quick assessment tools to screen toddlers for nutritional risk. Mothers with poor diet quality were likely to have toddlers with poor diets; low intakes of fruits, vegetables, and dairy foods were markers for poor diet quality in mothers.

Screening for infants' and toddlers' dietary quality through maternal diet.

PURPOSE: To investigate the relationship of mothers' dietary quality to that of their infants and toddlers in limited-income families at risk for poor health. STUDY DESIGN AND METHODS: Secondary data analysis was conducted of dietary quality from 24-hour dietary recalls collected from 113 mother-infant/toddler pairs in limited-income families with a child at age 6 months and again at age 14 months. Dietary quality of mothers was evaluated on the basis of eating breakfast and having at least one serving of the five food groups from the Food Guide Pyramid. Diet quality of infants was determined by comparison to the Women, Infants, and Children feeding guidelines for their ages; the diet quality of the mother was then compared to that of her infant and, later, toddler. RESULTS: Most mothers and their infants had poor diet quality at the first interview. By 14 months most mothers still had poor diet quality, but diet quality for the children improved such that only about one-half remained poor. Poor diet quality of mothers was useful to detect poor diet quality for her infant or toddler showing high concordance at both interviews. CLINICAL IMPLICATIONS: A consistent marker for infants at risk for poor diet quality is having a mother who skipped breakfast and omitted fruits, vegetables, or dairy products. This could be a quick indicator to identify those at greatest risk for not following recommended guidelines in feeding their infants and toddlers.

Concordance of self-report and measured height and weight of college students.

OBJECTIVE: This study examined associations between college students' self-report and measured height and weight. METHODS: Participants (N = 1,686) were 77% white, 62% female, aged 18-24 years (mean ± SD, 19.1 ± 1.1 years), and enrolled at 8 US universities. Body mass index (BMI) was calculated for self-report (via online survey); trained researchers measured height and weight and categorized them as normal (18.5 to < 25), overweight (25 to < 30), obese (30 to < 35), and morbidly obese (≥ 35). RESULTS: Concordance of self-report vs objectively measured BMI groups using chi-square revealed that 93% were accurate, 4% were underestimated, and 2.7% were overestimated. Pearson correlations and adjusted linear regression revealed significant associations between self-report and measured BMI (r = .97; P < .001) and BMI adjusted for age, gender, and race/ethnicity (R² = .94). Concordance was also high between BMI categories (kappa = 0.77; P < .001). CONCLUSIONS AND IMPLICATIONS: Findings provide support for the utility of self-report height and weight for survey research in college students.

An interactive parents' guide for feeding preschool-aged children: pilot studies for improvement.

There are few motivational materials to help families with limited resources develop optimal, practical feeding strategies for young children to reduce dietary risk for poor diet and weight status. Formative evaluation strategies consisting of both qualitative and quantitative data helped to refine the parent feeding guide Eat Healthy, Your Children are Watching, A Parent's Guide to Raising a Healthy Eater. An interdisciplinary planning team developed a five-topic, multimedia, interactive guide addressing the strategies most associated with improved diet quality and weight status of children aged 3 to 5 years. Research staff conducted iterative phases of field testing, reformatting, in-depth interviews, and materials testing with Head Start or Supplemental Nutrition Assistance Program-Education caregivers (N=38) of children aged 3 to 5 years during 2011 and 2012. Convergence of feedback from caregivers' interviews and each booklet's attention, relevance, confidence, and satisfaction subscale scores were used to determine and affirm areas for improvement. Lower than desired attention, relevance, confidence, and satisfaction scores (optimal score=5) in 2011 and too much text resulted in revisions and reformatting that improved scores from 3.8 to 4.9 in 2012. The revision of materials to reflect less text, additional white space, checklists of mealtime behaviors, and learning activities for preschool-aged children resulted in dramatically improved materials and greater acceptance by parents, as shown by both quantitative and qualitative evaluations. Formative evaluation procedures involving the use of data-based decision making allowed for the development of intervention materials that met the unique needs of the population served.

The effects of Young Adults Eating and Active for Health (YEAH): a theory-based Web-delivered intervention.

OBJECTIVE: To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process. DESIGN: A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail. SETTING: Thirteen college campuses. PARTICIPANTS: A total of 1,639 college students. INTERVENTION: Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content. MAIN OUTCOME MEASURE: All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline. ANALYSIS: Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes. RESULTS: There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control. CONCLUSIONS AND IMPLICATIONS: Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Development of Young Adults Eating and Active for Health (YEAH) internet-based intervention via a community-based participatory research model.

OBJECTIVE: To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model. DESIGN: Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery. RESULTS: Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed. CONCLUSIONS AND IMPLICATIONS: Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

Maternal parenting behaviors during childhood relate to weight status and fruit and vegetable intake of college students.

OBJECTIVE: Examine how maternal parenting behaviors in childhood, both general and feeding specific, relate to weight status and fruit and vegetable consumption in college students. DESIGN: Retrospective surveys on maternal behaviors and assessments on the college-aged child's current anthropometric measures and dietary intakes. PARTICIPANTS: College students (n = 424; 66% women). MAIN OUTCOME MEASURES: Students' weight, height, waist circumference, fruit and vegetable intakes, students' reports on mothers' general and feeding-specific parenting behaviors during childhood. ANALYSIS: Correlation and regression analyses tested how maternal behaviors in childhood related to students' body mass index, waist circumference, and fruit and vegetable intake. RESULTS: Mothers' psychological control during childhood was associated with higher body mass index and waist circumference in students, and behavioral control was associated with lower waist circumference. Parent-centered feeding behaviors related to lower fruit and vegetable intakes of students, whereas child-centered feeding behaviors related to higher fruit and vegetable intakes. CONCLUSIONS AND IMPLICATIONS: Findings suggest that parental use of behavioral control and child-centered feeding practices and minimal use of psychological control and parent-centered feeding practices during childhood may promote a child's healthful weight status and fruit and vegetable consumption in young adulthood, specifically during college.

Feeding behaviors of low-income mothers: directive control relates to a lower BMI in children, and a nondirective control relates to a healthier diet in preschoolers.

BACKGROUND: A topic of interest in the etiology of child obesity is whether and how parental feeding behaviors are associated with the food intake and weight status of children. OBJECTIVE: The objective was to explore whether and how directive (overt) and nondirective (covert and food environmental structure) types of parental feeding control were associated with children's food intake and weight status. DESIGN: This was a cross-sectional exploratory study using structural equation modeling to determine directional associations between maternal feeding practices and children's food intake and weight status. Researchers collected data from 330 dyads of children aged 3-5 y and mothers participating in a federal preschool program for low-income families (Head Start) in Michigan. The mothers' feeding practices (directive and nondirective control), the children's food intakes, and the height and weight of both the mothers and children were measured. Structural equation models tested the relations between maternal feeding practices, the children's food intake, and weight status. RESULTS: The structural equation model confirmed that children's weight status was inversely associated with mothers' directive control, and mothers' nondirective control was associated with children's intakes of more nutrient-dense foods and less energy-dense foods. No association was found between the mothers' directive control and the children's food intakes. CONCLUSIONS: Mothers' use of nondirective feeding practices was associated with children's intakes of more nutrient-dense foods. However, use of more directive feeding control was associated with lower weight status in preschoolers of low-income mothers. These findings need to be examined in longitudinal studies. This trial was registered at clinicaltrials.gov as NCT01525186.

Impact of an online healthful eating and physical activity program for college students.

PURPOSE: To identify impact of an online nutrition and physical activity program for college students. DESIGN: Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up). SETTING: Online intervention delivered to college students; a centralized Web site was used for recruitment, data collection, data management, and intervention delivery. SUBJECTS: College students (18-24 years old, n = 1689), from eight universities (Michigan State University, South Dakota State University, Syracuse University, The Pennsylvania State University, Tuskegee University, University of Rhode Island, University of Maine, and University of Wisconsin). INTERVENTION: A 10-lesson curriculum focusing on healthful eating and physical activity, stressing nondieting principles such as size acceptance and eating competence (software developer: Rainstorm, Inc, Orono, Maine). MEASURES: Measurements included anthropometrics, cardiorespiratory fitness, fruit/vegetable (FV) intake, eating competence, physical activity, and psychosocial stress. ANALYSIS: Repeated measures analysis of variance for outcome variables. RESULTS: Most subjects were white, undergraduate females (63%), with 25% either overweight or obese. Treatment group completion rate for the curriculum was 84%. Over 15 months, the treatment group had significantly higher FV intake (+.5 cups/d) and physical activity participation (+270 metabolic equivalent minutes per week) than controls. For both groups, anthropometric values and stress increased, and fitness levels decreased. Gender differences were present for most variables. First-year males and females gained more weight than participants in other school years. CONCLUSION: A 10-week online nutrition and physical activity intervention to encourage competence in making healthful food and eating decisions had a positive, lasting effect on FV intake and maintained baseline levels of physical activity in a population that otherwise experiences significant declines in these healthful behaviors.

Identifying clusters of college students at elevated health risk based on eating and exercise behaviors and psychosocial determinants of body weight.

Weight gain and an increase in overweight and obesity in college students raise serious health concerns. Weight management interventions for college-age men and women might be more effective if they were tailored to subgroups of students with similar behavioral and psychosocial characteristics associated with body weight status. The purpose of this study was to use cluster analysis to identify homogenous subgroups of college-aged men and women enrolled in a weight gain prevention study (Project WebHealth) using baseline data collected in 2008. Project WebHealth was a 15-month nutrition and physical activity intervention designed to decrease the rate of unwanted weight gain in 1,689 college students at eight geographically diverse universities in the United States. Outcome measures included anthropometrics, fruit and vegetable intake, physical activity, cardiorespiratory fitness, and psychosocial variables associated with weight status in college students. Cluster analysis was performed separately by sex using a two-step clustering procedure using weight-related eating and exercise behaviors and psychosocial variables. Cluster groupings were validated against students' measured weight status and waist circumference as indicators of health risk. The study design was cross-sectional. Results showed that three similar clusters were identified for each sex. Validity of the cluster solution was supported by significant group differences in body mass index and waist circumference with the High Risk cluster at elevated health risk compared to the others. For men, variability in eating competence and cognitive restraint scores contributed most to the difference between clusters, whereas for women, emotional eating and uncontrolled eating scores did. These findings could be used to improve effectiveness of messages and interventions by tailoring them to subgroups of college students with similar behavioral and psychosocial characteristics associated with elevated health risk.

Predictors of calcium intake at dinner meals of ethnically diverse mother-child dyads from families with limited incomes.

Diets adequate in calcium and other key nutrients early in life are critical for optimal growth. This study's objective was to determine associations between beverage and dairy food intakes of mothers and their young children and food/beverage contributions to calcium at dinner meals from ethnically diverse families with limited incomes. This was a secondary analysis of dietary data on mother-child dyads from a cross-sectional study. The sample was 465 children (4.4+/-0.6 years) and their mothers, 41% African American, 34% Hispanic, and 21% white. Dietary and anthropometric data were collected in 52 Head Start centers in Alabama and Texas during 1 year starting fall 2004. Associations between mother-child intakes were examined by race/ethnicity using correlations. Calcium intake from dinners was predicted (stepwise regression) from four beverage categories-milk, sweetened beverages, 100% fruit juices, and non-energy-containing beverages plus water-and from cheese and dairy desserts. Overall, the mother's dinnertime intake of milk did not predict that of her child. Mother-child intakes of cheese, dairy desserts, and sweetened beverages correlated more strongly than did milk. All the beverages and dairy groups demonstrated moderate correlations for dyads with those for cheese (r=0.56), dairy desserts (r=0.39), fruit juice (r=0.36), and sweetened beverages (r=0.31) higher than that for milk overall (r=0.29, P<0.01). Milk and cheese predicted the most variance in calcium intake for both mothers and children overall (R(2)=0.82), and for all race-ethnic groups, except African-American children, where the contribution from cheese predominated. Food and nutrition professionals should encourage replacing sweet beverages at dinner with low-fat milk or calcium-fortified beverages to improve the nutrient density of meals.

Nutrition students improve attitudes after a guided experiential assignment with older adults.

OBJECTIVE: Develop, implement, and evaluate an intervention (a guided experiential assignment) to improve nutrition students' attitudes toward working with older adults. DESIGN: A quasi-experimental design with an additional qualitative component (mixed methods). SETTING: A North Central land-grant university. PARTICIPANTS: 100 college students from an upper-level community nutrition course. INTERVENTION: Students were randomly assigned to conduct a guided experiential assignment (dietary behavior change project) working with either an older adult (intervention, n = 52) or a younger adult (comparison, n = 48). Each student conducted 3 client interviews and completed a project report by responding to reflective questions about changes in beliefs, values, and self-efficacy in working with older adults. MAIN OUTCOME: The primary outcome was attitudes toward older adults as changed in reference to students' beliefs, values, and self-efficacy in working with other adults. Additional outcomes were knowledge of aging and interest in working with older adults. ANALYSIS: General linear model multivariate/univariate analysis and content analysis were conducted on the quantitative and qualitative data, respectively. RESULTS: The intervention group had significantly increased scores on attitudes toward older adults relative to the comparison group. This finding appeared as a result of changes in beliefs about older adults and the increased value and self-efficacy in working with this group by most students in the intervention group. CONCLUSION AND IMPLICATIONS: Completion of a guided experiential assignment with older adults in the community was an effective method to improve students' attitudes. Used in the curriculum for nutrition students, this technique might help to improve both attitudes toward and self-efficacy in working with older adults.

Nutrient quality of fast food kids meals.

BACKGROUND: Exposure of children to kids meals at fast food restaurants is high; however, the nutrient quality of such meals has not been systematically assessed. OBJECTIVE: We assessed the nutrient quality of fast food meals marketed to young children, ie, "kids meals." DESIGN: The nutrient quality of kids meals was assessed primarily by using criteria from the National School Lunch Program (NSLP). Analysis compared the nutrient values of meals offered by major fast food companies with restaurants in Houston, TX, with complete publicly available data. Data described every combination of meals offered in the target market. For each meal combination, the following were analyzed: total energy, percentage of energy from fat, total fat, saturated fat, sodium, total carbohydrates, dietary fiber, added sugars, protein, vitamin A, vitamin C, calcium, iron, energy density (food only), and the number of NSLP nutrient criteria met. RESULTS: Three percent of kids meals met all NSLP criteria. Those that met all criteria offered a side of fruit plus milk. Most were deli-sandwich-based meals. Meals that met the criteria had about one-third the fat, one-sixth the added sugars, twice the iron, and 3 times the amount of vitamin A and calcium as did kids meals that did not meet the criteria (P