Comparisons of school and home-packed lunches for fruit and vegetable dietary behaviours among school-aged youths.

OBJECTIVE: School-based interventions and policies encourage youths to include and consume fruits and vegetables at lunchtime via school lunches, but limited research has examined how these behaviours compare when youths have home-packed lunches. The objective of the present study was to compare fruit and vegetable contents and consumption among students having school or home-packed lunches over the school week. DESIGN: Participants were observed over five consecutive days at school lunchtime. Trained analysts estimated students' lunchtime fruit and vegetable contents and consumption using digital imaging. Mixed models examined associations between fruit and vegetable dietary behaviours and lunch source (school v. home-packed), controlling for student gender, grade and school. SETTING: Three elementary schools in northern California, USA.ParticipantsFourth-, fifth- and sixth-grade students (nchildren 315; nobservations 1421). RESULTS: Students were significantly less likely to have and to consume fruits and vegetables (all P<0·05) when having home-packed lunches, compared with when having school lunches. Among those who did have or did consume these foods, having a home-packed lunch was associated with consuming significantly less fruit (P<0·05) but no differences for other dietary outcomes. CONCLUSIONS: The study adds to a growing body of literature indicating shortfalls in fruit and vegetable contents and consumption associated with having a home-packed lunch, relative to having a school lunch. Findings suggest that school-based interventions, particularly when targeting home-packed lunches, should focus on whether or not these foods are included and consumed, with less emphasis on quantities.

Parental and family predictors of fruits and vegetables in elementary school children's home-packed lunches across a school week.

Home-packed lunches have been found to be of lower nutritional quality than school-bought lunches, yet little is known about family-based factors associated with lunch packing. The current exploratory study examines parental and family predictors of fruits and vegetables packed in lunches, hypothesizing parents' nutrition knowledge and authoritative parenting as well as children's involvement in lunch decisions would relate to packing more fruits and vegetables, while financial difficulties would relate to packing fewer. Ninety parent-child dyads from 4th-6th grade participated for 5 consecutive school days. Lunch contents were recorded using a digital imaging procedure to capture the number of days a fruit or vegetable was packed, and servings of fruits and vegetables in lunches each day. Parents completed family and parenting questionnaires and daily reports of child involvement in lunch decisions. Count-based regression models and longitudinal analyses within a multilevel modeling framework were used to examine predictors of lunch contents. Higher nutrition knowledge was associated with packing more fruit across the week and more vegetables on Monday. Authoritative parenting was associated with packing fewer vegetables on Monday, but more servings across the week. Financial stress was related to higher rates of never packing vegetables and when vegetables were packed including fewer servings, while child involvement in lunch decisions was associated with packing more fruits across the week, packing vegetables on more days and more servings of vegetables on Monday. Findings suggest parental and family factors impact the foods in packed lunches, with implications for children's dietary intake at school. Outreach programs can help parents pack more fruits and vegetables by providing nutrition education and suggestions for affordable, healthy lunch options as well as encouraging child involvement in the lunch packing process.

My Child at mealtime parent self-assessment of food related behaviors: Validation with mealtime behaviors.

My Child at Mealtime (MCMT) is a visually enhanced, self-assessment tool designed to measure parent food related behaviors of low-income caregivers of preschool-aged children. The current study examined the factor structure of MCMT and the correspondence between MCMT parent- and child-centered food related behaviors with observed behaviors during a mealtime with their preschool aged child. Caregivers (N = 175) completed MCMT, and a subsample (n = 60) had a mealtime videotaped in their home. Exploratory and confirmatory factor analysis supported a two-factor structure resulting in parent-centered and child-centered MCMT subscales. There was a significant association between parent-centered MCMT scores and observed parent-centered behaviors at mealtime. Behavioral correspondence of MCMT child-centered behaviors was generally weaker. Overall, the findings suggest that caregivers' MCMT responses provide a valid measure of parent food related behaviors.

Feasibility and reliability of digital imaging for estimating food selection and consumption from students' packed lunches.

Although increasing attention is placed on the quality of foods in children's packed lunches, few studies have examined the capacity of observational methods to reliably determine both what is selected and consumed from these lunches. The objective of this project was to assess the feasibility and inter-rater reliability of digital imaging for determining selection and consumption from students' packed lunches, by adapting approaches previously applied to school lunches. Study 1 assessed feasibility and reliability of data collection among a sample of packed lunches (n = 155), while Study 2 further examined reliability in a larger sample of packed (n = 386) as well as school (n = 583) lunches. Based on the results from Study 1, it was feasible to collect and code most items in packed lunch images; missing data were most commonly attributed to packaging that limited visibility of contents. Across both studies, there was satisfactory reliability for determining food types selected, quantities selected, and quantities consumed in the eight food categories examined (weighted kappa coefficients 0.68-0.97 for packed lunches, 0.74-0.97 for school lunches), with lowest reliability for estimating condiments and meats/meat alternatives in packed lunches. In extending methods predominately applied to school lunches, these findings demonstrate the capacity of digital imaging for the objective estimation of selection and consumption from both school and packed lunches.

My child at mealtime: A visually enhanced self-assessment of feeding styles for low-income parents of preschoolers.

The importance of caregiver feeding styles on children's dietary outcomes is well documented. However, the instruments used to assess feeding style are limited by high literacy demands, making selfassessment with low-income audiences challenging. The purpose of the current study is to report on the development of My Child at Mealtime (MCMT), a self-assessment tool with reduced literacy demands, designed to measure feeding styles with parents of preschool-aged children. Cognitive interviews were conducted with 44 Head Start parents of 2-5 year old children to develop question wording and identify appropriate visuals. The resulting tool was administered to 119 ethnically diverse, low-income parents of 2-5 year old children. Factor analysis resulted in a two-factor structure that reflects responsiveness and demandingness in a manner consistent with existing assessment tools. Results indicate the final visually enhanced MCMT self-assessment tool provides a measure of parenting style consistent with existing measures, while reducing the literacy demand.

Cross-Cultural Adaptation and Initial Validation of Mi Niño: A Tool to Measure Food-Related Parenting Practices of Spanish-Speaking Parents with Young Children.

Background: Accurate measurement of food-related parenting practices is necessary to inform related interventions and program evaluation. Valid tools reflect cultural attributes that affect household food environments and feeding practices. Simple, unidirectional language adaptation approaches are insufficient to capture these attributes in assessment tools. My Child at Mealtime (MCMT) is a 27-item, validated, visually enhanced self-assessment tool to measure food-related parenting practices of low-income English-speaking parents of preschoolers. Objectives: The aim of this study was to describe the cross-cultural adaptation of MCMT into its Spanish version Mi Niño a la Hora the Comer (Mi Niño) and to establish its face validity, factor structure, and internal consistency. Methods: MCMT was adapted into its Spanish version after an iterative process that triangulated cognitive interviews with verification of conceptual equivalence by content experts to establish face validity and semantic equivalence. The resulting tool underwent confirmatory factor analysis to determine whether internal consistency was equivalent across the 2 versions. Results: Four rounds of cognitive interviews (n = 5, n = 6, n = 2, and n = 4, respectively) with Spanish-speaking women caregivers of children aged 3-5 y recruited from Head Start were conducted. Ten items were modified throughout the adaptation process. Modifications included improved clarity (6 items), comprehension (7 items), appropriateness (4 items), suitability (4 items), and usefulness (2 items) of text and/or accompanying visuals. Confirmatory factor analysis with a sample of Spanish-speaking caregivers (n = 243) resulted in 2 reliable factors representing "child-centered" (α = 0.82) and "parent-centered" (α = 0.87) food-related parenting practices. Conclusions: Face validity, semantic equivalence, and internal consistency of Mi Niño were established. This tool can be used in community settings to inform program content and measure changes in food-related parenting practices of Spanish-speaking parents and assist in setting food-related parenting goals. The next steps include exploring the correspondence of Mi Nino with mealtime behaviors observed through video recording.

Obesity Risk Assessment for Spanish-Speaking Immigrant Families with Young Children in the United States: Reliability and Validity with Nutrient Values.

The purpose is to examine validity and reliability for an obesity risk assessment tool developed in Spanish for immigrant families with children, 3-5 years old using an 8-week cross-sectional design with data collected over 1 year at Head Start and Special Supplemental Nutrition Program for Women, Infants and Children [WIC]. Parent/child dyads (206) provided a child obesity risk assessment, three child modified 24 h dietary recalls, three child 36+ h activity logs and one parent food behavior checklist. Main outcome measures were convergent validity with nutrients, cup equivalents, and diet quality and three assessments of reliability that included item difficulty index, item discrimination index, and coefficient of variation. Validity was demonstrated for assessment tool, named Niños Sanos. Scales were significantly related to variables in direction hypothesized [p ≤ 0.05]: Healthy Eating Index, fruit/vegetable cup equivalents, folate, dairy cup equivalents, vitamins D, ß-carotene, fiber, saturated fat, sugar, time at screen/ sleep/physical activity and parent behaviors. Three measures of reliability were acceptable. The addition of nutrient values as an analytical validation approach adds strength and consistency to previously reported Niños Sanos validation results using children's blood biomarkers and body mass index. This tool can be used by health professionals as an assessment of obesity risk in several capacities: (1) screener for counseling in a clinic, (2) large survey, (3) guide for participant goal setting and tailoring interventions, and (4) evaluation.

Supervision and training in child care: Does reflective supervision foster caregiver insightfulness?

The goal of this study was to explore the effects of reflective and traditional supervision and training on caregiver insightfulness. Caregiver insightfulness, or caregiver ability to understand "motives underlying the child's behavior in a complete, open, and accepting way" (D. Oppenheim, D. Goldsmith, & N. Koren-Karie, 2004, p. 352) was assessed at two time points with 21 new caregivers at two university-based childcare sites. Trends suggest that caregiver insightfulness was relatively stable while increased levels of components of caregiver insightfulness over a period of approximately 2.5 months were positively associated with reflective supervision and training. These findings suggest that encouraging caregivers to reflect on their interactions with the children in their care fosters caregivers' ability to see from the child's perspective in an open and accepting way.

Parent Food-Related Behaviors and Family-Based Dietary and Activity Environments: Associations with BMI z-Scores in Low-Income Preschoolers.

Background: In early childhood, the family dietary and activity environment and parent food-related practices have been found to be important predictors of children's weight. However, few studies account for both of these factors, or the interaction between the 2, when assessing BMI in early childhood. This study aims to examine the association between the family-based dietary and activity environment (including intake, physical activity, and structure) and children's BMI z-scores in the context of parent food-related behaviors in low-income families during the preschool years. Methods: Parents (n = 111) completed questionnaires assessing the family-based dietary and activity environment, including diet, physical activity, screentime and sleep, and their use of parent food-related behaviors including parent-centered (i.e., controlling) and child-centered (i.e., autonomy supportive) practices. Children's BMI z-scores were calculated from researcher-measured height and weight. Results: Parent-centered food-related behaviors were directly related to children's BMI z-scores and moderated the association between the family-based dietary and activity environment and children's BMI z-scores. Family-based behaviors were associated with lower BMI only when parents used fewer parent-centered behaviors. Conclusions: Findings indicate that programs working with low-income families to prevent child obesity should stress both the creation of a healthy home environment and the use of positive parent food-related behaviors with preschool aged children.

Consequences of socioeconomic disadvantage across three generations: parenting behavior and child externalizing problems.

This study considers the intergenerational consequences of experiencing socioeconomic disadvantage within the family of origin. Specifically, the influence of socioeconomic disadvantage experienced during adolescence on the timing of parenthood and the association between early parenthood and risk for harsh parenting and emerging child problem behavior was evaluated. Participants included 154 3-generation families, followed prospectively over a 12-year period. Results indicated that exposure to poverty during adolescence, not parents' (first generation, or G1) education, predicted an earlier age of parenthood in G2. Younger G2 parents were observed to be harsher during interactions with their own 2-year-old child (G3), and harsh parenting predicted increases in G3 children's externalizing problems from age 2 to age 3. Finally, G3 children's externalizing behavior measured at age 3 predicted increases in harsh parenting from ages 3 to 4, suggesting that G3 children's behavior may exacerbate the longitudinal effects of socioeconomic disadvantage.

A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes.

OBJECTIVE: To evaluate the effectiveness of the Shaping Healthy Choices Program (SHCP). DESIGN: A clustered, randomized, controlled intervention lasting 1 school year. SETTING: Schools in northern and central California. PARTICIPANTS: Fourth-graders (aged 9-10 years) at 2 control schools (n = 179) and 2 intervention schools (n = 230). INTERVENTION: Garden-enhanced education, family, and community partnerships; increased regionally procured produce in the lunchroom; and school-site wellness committees. MAIN OUTCOME MEASURES: Changes in body mass index (BMI) percentiles/Z-scores; nutrition knowledge, science process skills, and vegetable identification and preferences; and reported fruit and vegetable intake. ANALYSIS: Student t test, chi-square, ANOVA of change, and multilevel regression mixed model to evaluate change in outcomes with school as a random effect to account for cluster design effects. Statistical significance was set at P < .05. RESULTS: There was a greater improvement in BMI percentile (-6.08; P < 0.01), BMI Z-score (-0.28; P < .001), and waist-to-height ratio (-0.02; P < .001) in the intervention compared with the control schools. CONCLUSIONS AND IMPLICATIONS: The SHCP resulted in improvements in nutrition knowledge, vegetable identification, and a significant decrease in BMI percentiles. This supports the concept that the SHCP can be used to improve the health of upper elementary school students.

Grandmother involvement as a protective factor for early childhood social adjustment.

Despite high rates of grandmother involvement with young grandchildren, very little research has examined the associations between nonresidential grandmother involvement and grandchild social adjustment. The present study involved 127 families enrolled in the Family Transitions Project to consider the degree to which mother-reported maternal grandmother involvement buffered 3- and 4-year-old grandchildren from economic, parenting, and child temperamental risks for reduced social competence and elevated externalizing behaviors. Findings indicate that higher levels of mother-reported grandmother involvement reduced the negative association between observed grandchild negative emotional reactivity and social competence. Furthermore, higher levels of mother-reported grandmother involvement protected grandchildren from the positive association between observed mother harsh parenting and grandchild externalizing behaviors. These findings underscore the relevance of moving beyond the nuclear family to understand factors linked to social adjustment during early childhood.

Intergenerational Relationship Quality, Gender and Grandparent Involvement.

This prospective, intergenerational study (N = 181) considered how parent (G1, generation 1)-child (G2, generation 2) relationship quality during adolescence and adulthood is associated with G1's level of involvement with their 3-4 year-old grandchildren (G3, generation 3). Path model analyses indicated different patterns of results for the involvement of grandmothers and grandfathers with the children of their G2 sons and daughters. Current parent-reported G1-G2 relationship quality was positively associated with G2 report of G1 involvement with G3, especially for G2 daughters. The relations among confounding variables, including geographic distance, socioeconomic status, and grandparent marital status and grandparent involvement with grandchildren were considered. Results highlight the roles of intergenerational relationship quality and gender configuration of the G1-G2 dyad in shaping grandparent involvement with grandchildren.

Differential stability of temperament and personality from toddlerhood to middle childhood.

This prospective, longitudinal investigation examined differential consistency of three core dimensions of individuality from toddlerhood through middle childhood. Data came from 273 families who participated with their child at least once during three developmental periods: toddlerhood (2 years), early childhood (3 to 5 years), and middle childhood (6 to 10 years). Both mothers and fathers reported on attributes of their child using subscales from the Toddler Behavior Assessment Questionnaire, the Child Behavior Questionnaire, and the Iowa Personality Questionnaire. Reports were used as indicators of the latent "Big Three" dimensions of positive emotionality, negative emotionality, and constraint at each of the three developmental periods. Results pointed to consistency in these broad dimensions of temperament and personality from toddlerhood to middle childhood.

Intergenerational continuity in parenting behavior: mediating pathways and child effects.

This prospective, longitudinal investigation examined mechanisms proposed to explain continuities in parenting behavior across 2 generations (G1, G2). Data came from 187 G2 adults, their mothers (G1), and their children (G3). Prospective information regarding G2 was collected both during adolescence and early adulthood. G1 data were collected during G2's adolescence, and G3 data were generated during the preschool years. Assessments included both observational and self-report measures. The results indicated a direct relationship between G1 and G2 harsh parenting, and between G1 and G2 positive parenting. As predicted, specific mediators accounted for intergenerational continuity in particular types of parenting behavior. G2 externalizing behavior mediated the relationship between G1 and G2 harsh parenting, whereas G2 academic attainment mediated the relationship between G1 and G2 positive parenting. In addition, the hypothesized mediating pathways remained statistically significant after taking into account possible G2 effects on G1 parenting and G3 effects on G2 parenting.

Reformulating infant and toddler social competence with peers.

Efforts to identify children at risk for social and academic difficulties at an early age have begun to apply conceptualizations of social competence with peers from childhood to infancy and toddlerhood. These attempts have had limited success, in part because social behaviors studied in later childhood such as negative or aggressive acts may not capture relevant dimensions of social competence with peers during the infant and toddler years. The present study conducted an exploratory factor analysis to begin developing a conceptualization of social competence with peers that is appropriate for use with infants and toddlers, and that captures individual differences capable of predicting later social functioning. Results indicate three dimensions of infant and toddler social competence with peers: peer sociability, active peer refusal, and passive peer avoidance. Negative and aggressive behaviors loaded on each of the three factors rather than emerging as a unique dimension of social competence. Each factor demonstrated both convergent and predictive validity, indicating that early identification of social skills remains a reasonable goal for practitioners and researchers alike. Finally, antecedents within children, families, and out-of-home child care environments helped to explain individual variability in each of these three factors of social competence with peers.