Food parenting at-home vs. in restaurants among African American parents of 3-to-8-year-old children.

Feeding style refers to the approach that parents use to feed their child and the emotional climate during eating. Indulgent styles, characterized by low structure and high responsiveness, have been linked to childhood weight gain. Few studies have examined feeding styles within out-of-home contexts (e.g., restaurants), which are common eating environments for many families. This study sought to examine feeding styles at-home and in restaurants among African American parents. 52 African American parents with a 3-to-8-year-old child (M = 35.6 years, 86% mothers, 57% annual household income <$50,000, 57% Associate's degree or higher) who regularly dined at restaurants completed an online survey in winter 2022-2023. Parents reported on demographics, anthropometrics, and their feeding styles at home and in restaurants via The Caregiver's Feeding Style Questionnaire. Findings indicated that the indulgent style was the most common overall. Indulgent styles were more prevalent in restaurants (χ2 = 7.4, p = 0.007) than home, and authoritarian styles more prevalent at home (χ2 = 4.5, p = 0.03). Child weight status differed by feeding style in both contexts (p ≤ 0.04); indulgent styles in restaurants were linked to higher BMI z-scores, while authoritarian styles at home were linked to lower BMI z-scores. Higher parent BMI was linked to increased likelihood of having an indulgent style at home (OR = 1.13, p = 0.03), while lower parent BMI was linked to increased likelihood of the uninvolved style at home (OR = 0.76, p = 0.049). Overall, indulgent styles were common and more prevalent in restaurants, where they were linked to higher child weight status. Findings may inform future health promotion efforts in out-of-home eating contexts.

Effect of the INSIGHT Responsive Parenting Intervention on Parenting and Child Behavior at Ages 3 and 6 Years.

OBJECTIVES: To examine effects of the INSIGHT study responsive parenting (RP) intervention on reported and observed general parenting and child behavior during early and middle childhood. STUDY DESIGN: Primiparous mother-newborn dyads (n = 279) were randomized to RP intervention or a safety control, with intervention content delivered at research nurse home visits at infant ages 3-4, 16, 28, and 40 weeks and research center visits at 1 and 2 years. At age 3 (n = 220) and 6 years (n = 171) parenting and child behavior were observed during dyadic interactions and coded using the Iowa Family Interaction Rating Scales. Mothers also reported on child behavior (age 3) and aspects of general parenting (age 6) via the Child Behavior Checklist and The Comprehensive General Parenting Questionnaire, respectively. RESULTS: RP group children had fewer mother-reported externalizing (F = 8.69, P = .004) and problem behaviors at age 3 (F = 4.53, P = .03), and higher observed prosocial (F = 4.73, P = .03) and lower antisocial (ie, externalizing; F = 4.79, P = .03) behavior at age 6 vs controls. There were no study group differences in observed maternal sensitivity at age 3 or 6 years. At age 6, RP group mothers reported higher use of structure defined by establishing consistent rules and routines (F = 5.45, P = .02) and organization of their child's environment (F = 7.12, P = .008) compared with controls. CONCLUSIONS: The INSIGHT RP intervention increased parental organization of the child's environment to facilitate competence, and had beneficial impacts on child behavior at 3 and 6 years. No impacts were found on maternal sensitivity in childhood. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01167270.

Feasibility and implementation of a grocery shopping intervention for adults diagnosed with or at-risk for type 2 diabetes.

OBJECTIVE: To examine the feasibility and implementation of an optimal defaults intervention designed to align grocery purchases with a diet recommended for people with or at-risk for type 2 diabetes. DESIGN: This was a 5-week pilot randomised trial with three groups: in-person grocery shopping, shopping online and shopping online with 'default' carts. Participants were asked to shop normally in Week One, according to group assignment in Weeks Two-Four (intervention period), and as preferred in Week Five. All groups received diabetes-friendly recipes via email each intervention week. SETTING: Participants grocery shopped in person or online. Grocery receipt forms, enrolment information and exit surveys were collected remotely and used to assess feasibility and implementation. PARTICIPANTS: Sixty-five adults with or at-risk for type 2 diabetes. RESULTS: Sixty-two participants completed the exit survey and fifty-five submitted receipts all 5 weeks. Forty utilised recipes, 95 % of whom indicated recipes were somewhat or very useful. Orange chicken, quesadillas and pork with potato and apples were the most liked recipes. Most Defaults group participants accepted at least some default cart items. Recipes with the highest default acceptance were whole grain pasta and chicken, quesadillas with black beans and chicken with olives. Participants' primary concerns about the intervention were costs associated with online shopping, inability to select preferred foods and some recipes including ingredients household members would not eat. CONCLUSIONS: The study had high retention, data were successfully collected remotely and the intervention was acceptable to most participants. Tailoring recipes to household preferences may be beneficial in future studies.

Effects of a randomized controlled hiking intervention on daily activities, sleep, and stress among adults during the COVID-19 pandemic.

BACKGROUND: Physical activity promotes health, and physical activity done outdoors in nature may be particularly beneficial. We conducted two randomized studies to examine the implementation of a winter hiking intervention and whether this intervention affected activity choices and aspects of well-being during the COVID-19 pandemic. METHODS: Convenience samples of adults (n = 53; n = 51) were recruited into two different randomized studies in 2021 and 2022 respectively. Participants completed online surveys at baseline and 6 and 11-12 weeks later. Participants were randomized to a study group (intervention or control) shortly after the baseline assessments. In both studies, the intervention group received free access to a regional winter hiking challenge. In the second study, we also provided winter traction cleats to this group to facilitate engagement in the hiking challenge. Descriptive statistics were used to summarize intervention implementation, including participants' engagement in challenge hikes. Repeated measures ANOVA models were used to test intervention effects on key outcome variables, including hiking frequency via the Pleasant Activities List, stress via the Perceived Stress Scale, and sleep duration via the Pittsburgh Sleep Quality Index. RESULTS: In the first study, the intervention group's engagement in challenge hikes was low (38.5%); reported barriers included access to winter hiking equipment. In the second study, when winter traction cleats were provided, engagement in the intervention was higher, and the intervention increased hiking frequency and improved sleep. There were no significant intervention effects on stress, but the direction of effects was in the expected direction. CONCLUSIONS: Results highlight some potential positive impacts of this intervention designed to facilitate access to winter hiking. Future research could examine whether effects are stronger in a larger sample, in which additional barriers to engagement are addressed. TRIAL REGISTRATION: This study was registered at clinicaltrials.gov on 28/12/2020 prior to participant enrollment (NCT04685681), https://clinicaltrials.gov/ct2/show/NCT04685681 .

Differences in food parenting at home versus restaurants among parents of 3-to-8-year-old children.

Indulgent parent feeding styles have been linked to less healthful eating behaviors and higher BMI among children. Restaurants are becoming a frequent eating environment for children. Frequent intake of food from restaurants has been associated with increased weight status, making restaurants a target for childhood obesity prevention efforts. Currently, little research has considered parent feeding styles in restaurants and how they might differ from the home setting. Given the increased frequency of children's restaurant consumption, examining parent feeding styles in restaurants may contribute to future research in this area. Therefore, the objective of this study was to examine parent feeding styles at home and in restaurants. Parents whose 3-to-8-year-old children dined out regularly completed a one-time, online survey in February/March 2022. The Caregiver's Feeding Style Questionnaire assessed parent feeding styles at home and in restaurants. Differences in feeding styles were examined across settings. Indulgent feeding styles were most common overall. Parents (n = 117; 92% mothers; 85% white; 61% reported household income > $75,000/year) reported higher demandingness at home (M = 2.6 ± 0.5) compared to restaurants (M = 2.4 ± 0.5; t(116) = 6.7, P < 0.001). Parents were more likely to use indulgent feeding styles (X2 = 11.6, P < 0.001) and less likely to use authoritarian feeding styles (X2 = 4.6, P < 0.05) in restaurants compared to the home, suggesting parent feeding styles are less structured in restaurants. Results may have implications for future healthy eating interventions in away-from-home contexts.

Changes in food behavior during the first lockdown of COVID-19 pandemic: A multi-country study about changes in eating habits, motivations, and food-related behaviors.

The COVID-19 pandemic resulted in severe, unprecedented changes affecting the world population. Restrictions in mobility, social distancing measures, and the persistent social alarm, during the first period of pandemic, resulted in dramatic lifestyle changes and affected physical and psychological wellbeing on a global scale. An international research team was constituted to develop a study involving different countries about eating motivations, dietary habits and behaviors related with food intake, acquisition, and preparation. This study presents results of an online survey, carried out during the first lockdown, in 2020, assessing food-related behavior and how people perceived them to change, comparatively to the period preceding the COVID-19 outbreak. A total of 3332 responses, collected from 16 countries, were considered for analysis [72.8% in Europe, 12.8% in Africa, 2.2% in North America (USA) and 12.2% in South America]. Results suggest that the main motivations perceived to drive food intake were familiarity and liking. Two clusters were identified, based on food intake frequency, which were classified as "healthier" and "unhealthier". The former was constituted by individuals with higher scholarity level, to whom intake was more motivated by health, natural concerns, and weight control, and less by liking, pleasure or affect regulation. The second cluster was constituted by individuals with a higher proportion of male and intake more influenced by affect-related motivations. During this period, a generalized lower concern with the convenience attributes of foods was noted (namely, choice of processed products and fast-food meals), alongside an increase in time and efforts dedicated to home cooking. Understanding the main changes and their underlying motivations in a time of unprecedented crisis is of major importance, as it provides the scientific support that allows one to anticipate the implications for the future of the global food and nutrition system and, consequently, to take the appropriate action.

Helping parents provide vegetable snacks: Investigating price and taste as barriers.

Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.

Examining taste testing and point-of-purchase prompting as strategies to promote healthier food selection from food trucks.

OBJECTIVE: To examine the feasibility of taste testing and point-of-purchase prompting to promote healthier food choices at a food truck event. DESIGN: A pre-/post-study was conducted where food trucks provided samples of healthy food items to patrons and implemented point-of-purchase prompting (promotional signage; verbal cues). Implementation fidelity, acceptability and initial effectiveness were assessed via observation, patron surveys and sales data. A linear mixed model with a random effect for subject (food truck) and fixed effect for time point (baseline, intervention and post-intervention) was used to assess changes in relative sales of promoted healthy items as a percentage of food items sold. SETTING: Weekly food truck event in Buffalo, New York. PARTICIPANTS: Seven food trucks; 179 patrons. RESULTS: Implementation fidelity data illustrated that all food trucks complied with manualised procedures. Approximately one-third of surveyed patrons accepted a healthy sample, with the majority rating the sample positively. There was no main effect of time when examining changes in relative sales of promoted healthy items across all periods (P = 0·32); however, effect sizes representing changes between individual time points are consistent with an increase from baseline to intervention (d = 0·51), which was maintained through post-intervention (d = 0·03). The change from baseline to post-intervention corresponded to a medium effect size (d = 0·55). CONCLUSIONS: Findings generally support the feasibility of implementing taste testing and point-of-purchase prompting to increase the selection of healthy food items from food trucks; implications for future research in this novel setting are discussed.

Using fundraising incentives and point-of-purchase nutrition promotion to improve food choices among school families in restaurants: a pilot and feasibility study.

OBJECTIVE: To assess the feasibility and efficacy of in-restaurant interventions aiming to promote healthy choices via fundraising incentives benefiting school wellness programmes and point-of-purchase nutrition promotion. DESIGN: Twelve schools were randomly assigned to one of the two intervention periods: Fundraising Incentive (FI) donated funds for visiting the study restaurant and Fundraising-Healthy Eating Incentive (F-HEI) included FI with additional funds given when selecting a healthier item. Both conditions included point-of-purchase nutrition promotions. Families were recruited to attend their designated intervention and complete a survey. Feasibility was assessed based on recruitment and participation, implementation fidelity and intervention acceptability. Efficacy was assessed by comparing participant receipts between intervention periods and by comparing overall restaurant sales during intervention v. two no-intervention time frames. SETTING: Fast-casual restaurant in Southern California. PARTICIPANTS: Parents with children attending participating schools. RESULTS: Eighty-one families visited the restaurant during the intervention, with sixty-six completing surveys. All study activities were implemented successfully, but school family participation in the intervention was low (0·95 %). Among participants completing surveys, all indicated satisfaction with the programme. The percentage of healthier items ordered was significantly greater during both FI (χ2 = 5·97, P = 0·01) and F-HEI (χ2 = 8·84, P = 0·003) v. Comparison 2. Results were similar but did not reach statistical significance when comparing the interventions to Comparison 1. CONCLUSIONS: Results support potential efficacy of this programme, but more research is needed to inform feasibility. Fidelity and acceptability data supported feasibility, but participation rates were low in this initial study. Methods evaluating this intervention with a greater proportion of parents should be considered.

Development of a measure of the relative reinforcing value of food versus parent-child interaction for young children.

The relative reinforcing value (RRV) of food captures individual differences in the motivation to eat and is associated with weight status among infants, children, and adults. Currently, there is no concurrent measure of the RRV of food versus a non-food alternative for 4-to-5-year-old children. The present study aimed to develop and validate a measure of the RRV of food versus time spent interacting with a parent in the context of reading among 4-to-5-year-old children. The first phase of the study involved an online survey. Parents of 4-to-5 year olds (n = 102) reported their children's consumption frequency and liking for thirty-six snack foods. A priori criteria were used to identify snacks that were well-liked and served at least sometimes for use in the subsequent laboratory study. Then, a validation study was conducted in the laboratory to examine the construct validity of the finalized RRV task. Thirty-one parent-child dyads completed a laboratory visit, in which children's RRV of food versus time spent reading with a parent was measured concurrently on a progressive ratio reward schedule. Linear regression was used to assess validity of the task. Children's RRV of food positively and significantly predicted BMI z-scores among children with complete data (B = 0.41, p < 0.05, n = 28). Maximum schedules reached for food also positively and significantly predicted BMI z-scores (B = 0.30, p < 0.05). The relationship between maximum schedules reached for parent-child reading and BMI z-scores was in the expected direction, but this relationship was non-significant. Results support the validity and feasibility of the RRV paradigm used in the present study. Future research could continue to examine the measurement properties of this paradigm, as well as the potential for positive parent-child interactions to serve as a novel alternative to food.

Incentivizing Healthy Snacks During Out-of-School Time Through Grocery Store Partnerships.

CONTEXT: Volunteer-led out-of-school-time (OST) programs, such as 4-H, scouting, and youth sports, reach a large population of children and are positioned to offer opportunities for healthy eating. However, cost is a barrier to providing healthy snacks such as fruits and vegetables (FVs) during OST. OBJECTIVE: Offering discounts through grocery store partnerships has shown promise in addressing this barrier in structured, staff-led after-school programs. We tested this model in volunteer-led OST programs and evaluated it using mixed methods. DESIGN/SETTING: The Snack It Up (SIU) intervention was designed to promote FV snacks to volunteer-led OST programs through weekly $5 grocery store discounts. Participation was limited to 1 leader per program. PARTICIPANTS: Thirty-five of 36 recruited OST program leaders completed the study; 16 were enrolled in SIU and 19 in a comparison group. MAIN OUTCOME MEASURES: We assessed the following: (1) discount redemption among SIU leaders; (2) snacks served by SIU and comparison group leaders via photographs from 3 to 4 OST program sessions during SIU implementation; and (3) SIU leader perspectives using key informant interviews before and after implementation. RESULTS: SIU leaders saved an average of $48.75 on FV snacks throughout the intervention ($2.90 per week, more than one-fifth of typical self-reported spending on snacks). SIU leaders also served a greater frequency (100% of sessions vs 75%, P < .001) and variety of FVs (an average of 3.5 types per session vs 1.3, P < .001) and fewer salty/sweet snacks (0.0 vs 1.3 types per session, P < .001) than those in the comparison group and expressed positive impressions of SIU. CONCLUSIONS: Partnerships between OST programs and grocery stores are a promising avenue for promoting healthier snacks during OST.

Availability of Healthier Children's Menu Items in the Top Selling Quick Service Restaurant Chains (2004-2015).

OBJECTIVES: To describe time trends in the availability of healthier children's menu items in the top selling quick service restaurant (QSR) chains. METHODS: We used Technomic Inc.'s MenuMonitor to construct a data set of side and beverage items available on children's menus from 2004 to 2015 at 20 QSR chains in the United States. We evaluated the significance of time trends in the average availability of healthier fruit and nonfried vegetable sides and nonsugary beverages offered as options and by default in children's meal bundles. RESULTS: Healthier sides and beverages offered as options increased by 57.5 and 25.0 percentage points, respectively, from 2004 to 2015 but leveled off starting in 2013. Healthier items bundled by default also increased during this time frame, with most adoption occurring after 2010. However, these items remain relatively uncommon, with less than 20% of meal bundles including healthier items by default. All tests evaluating time trends in the availability of healthier items in meal bundles were significant at P < .001. CONCLUSIONS: The QSRs evaluated made improvements in the quality of sides and beverages offered on children's menus from 2004 to 2015. Additional efforts are needed to increase the percentage of healthier options offered by default.

Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis.

Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012-2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale.

Repeatability of the infant food reinforcement paradigm: Implications of individual and developmental differences.

The relative reinforcing value of food versus engagement in other behaviors may be related to the development of obesity, and interventions to reduce FRR may prevent the development of obesity. Our laboratory recently developed a paradigm to measure the reinforcing value of food versus an alternative behavior (i.e., playing with bubbles) in infants using a computerized laboratory task, during which infants press a button to earn reinforcers following a progressive ratio schedule of reinforcement. The primary purpose of this study was to examine the short-term (within 2 weeks) repeatability of this measure, specifically the outcome of infant food reinforcing ratio (FRR), or how hard infants will work for food relative to the alternative. The secondary aim was to examine whether infant age and temperament dimensions related to novelty responsiveness (high intensity pleasure and approach) moderated the repeatability of FRR. Thirty-seven infants aged 9-18 months completed this study. Repeated measures analysis of variance (ANOVA) showed no differences between time 1 and time 2 in responding for food (F = 0.463, p = 0.501), bubbles (F = 1.793, p = 0.189), or overall FRR (F = 0.797, p = 0.378). Regression models showed the association between BUB Pmax at time 1 and time 2 were moderated by infant age (p = 0.04), with greater repeatability in older infants. Linear regression models also demonstrated that the infant temperamental dimension of high intensity pleasure significantly predicted BUB Pmax at time 1 (ß = 2.89, p = 0.01), but not at time 2. Overall, our findings support the repeatability of this measure for food portion of the reinforcement task, but demonstrated that the measure of non-food portion of the task required modification, in particular among children younger than 13 months old.

Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial.

Importance: Rapid growth and elevated weight status in early childhood increase risk for later obesity, but interventions that improve growth trajectories are lacking. Objective: To examine effects of a responsive parenting intervention designed to promote developmentally appropriate, prompt, and contingent responses to a child's needs on weight outcomes at 3 years. Design, Setting, and Participants: A single-center randomized clinical trial comparing a responsive parenting intervention designed to prevent childhood obesity vs a home safety intervention (control) among 279 primiparous mother-child dyads (responsive parenting group, 140; control group, 139) who enrolled and completed the first home visit from January 2012 through March 2014 with follow-up to age 3 years (completed by April 2017). Interventions: Research nurses conducted 4 home visits during infancy and annual research center visits. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. Main Outcomes and Measures: The primary outcome was body mass index (BMI) z score at 3 years (z score of 0 represents the population mean; 1 and -1 represent 1 SD above and below the mean, respectively). BMI percentile at 3 years was designated previously as the primary outcome. Secondary outcomes included the prevalence of overweight (BMI ≥85th percentile and <95th percentile) and obesity (BMI ≥95th percentile) at 3 years. Results: Among 291 mother-child dyads randomized, 279 received the first home visit and were included in the primary analysis. 232 mother-child dyads (83.2%) completed the 3-year trial. Mean age of the mothers was 28.7 years; 86% were white and 86% were privately insured. At age 3 years, children in the responsive parenting group had a lower mean BMI z score (-0.13 in the responsive parenting group vs 0.15 in the control group; absolute difference, -0.28 [95% CI, -0.53 to -0.01]; P = .04). Mean BMI percentiles did not differ significantly (47th in the responsive parenting group vs 54th in the control group; reduction in mean BMI percentiles of 6.9 percentile points [95% CI, -14.5 to 0.6]; P = .07). Of 116 children in the responsive parenting group, 13 (11.2%) were overweight vs 23 (19.8%) of 116 children in the control group (absolute difference, -8.6% [95% CI, -17.9% to 0.0%]; odds ratio [OR], 0.51 [95% CI, 0.25 to 1.06]; P = .07); 3 children (2.6%) in the responsive parenting group were obese vs 9 children (7.8%) in the control group (absolute difference, -5.2% [95% CI, -10.8% to 0.0%]; OR, 0.32 [95% CI, 0.08 to 1.20]; P = .09). Conclusions and Relevance: Among primiparous mother-child dyads, a responsive parenting intervention initiated in early infancy compared with a control intervention resulted in a modest reduction in BMI z scores at age 3 years, but no significant difference in BMI percentile. Further research is needed to determine the long-term effect of the intervention and assess its efficacy in other settings. Trial Registration: ClinicalTrials.gov Identifier: NCT01167270.

Low parental awareness about energy (calorie) recommendations for children's restaurant meals: findings from a national survey in the USA.

OBJECTIVE: To assess parental awareness of per-meal energy (calorie) recommendations for children's restaurant meals and to explore whether calorie awareness was associated with parental sociodemographic characteristics and frequency of eating restaurant food. DESIGN: Cross-sectional online survey administered in July 2014. Parents estimated calories (i.e. kilocalories; 1 kcal=4·184 kJ) recommended for a child's lunch/dinner restaurant meal (range: 0-2000 kcal). Responses were categorized as 'underestimate' (600 kcal). Confidence in response was measured on a 4-point scale from 'very unsure' to 'very sure'. Logistic regressions estimated the odds of an 'accurate' response and confident response ('somewhat' or 'very sure') by parental sociodemographic characteristics and frequency of eating from restaurants. Sampling weights based on demographics were incorporated in all analyses. SETTING: USA. SUBJECTS: Parents (n 1207) of 5-12-year-old children. RESULTS: On average, parents estimated 631 (se 19·4) kcal as the appropriate amount for a 5-12-year-old child's meal. Thirty-five per cent answered in the accurate range, while 33·3 and 31·8 % underestimated and overestimated, respectively. Frequent dining at restaurants, lower income and urban geography were associated with lower odds of answering accurately. Parents' confidence in their estimates was low across the sample (26·0 % confident) and only 10·1 % were both accurate and confident. CONCLUSIONS: Parent education about calorie recommendations for children could improve understanding and use of menu labelling information in restaurants. Targeted strategies are recommended to ensure that such efforts address, rather than exacerbate, health disparities.

Child and parent perspectives on healthier side dishes and beverages in restaurant kids' meals: results from a national survey in the United States.

BACKGROUND: Children frequently consume foods from restaurants; considering the quick-service sector alone, 1/3 of children eat food from these restaurants on a given day, and among these consumers, 1/3 of their daily calories come from fast food. Restaurant foods and beverages are second only to grocery store foods and beverages in their contribution to total energy intake of U.S. 4- to 11-year-olds. Shifting their restaurant consumption in healthier directions could have a positive impact on child health. In 2014 this study examined self-reported child receptivity and parent awareness of child receptivity to ordering a fruit or vegetable side dish instead of French fries; and milk, water, or flavored water instead of soda/pop with a kids' meal when eating out. Child receptivity to side dishes was compared between 2010 and 2014. METHODS: An online survey was administered by Nielsen via their Harris Poll Online to a national panel of 711 parents and their 8- to 12-year-old child, as part of a larger study. Frequencies, logistic regressions, t-tests, chi-square tests, and percent agreement were used to evaluate child likelihood of ordering certain side dishes; receptivity to healthier side dish and beverage alternatives; changes in receptivity to healthier sides across years; and parent awareness. RESULTS: A majority of children said they were likely to order a meal with a vegetable (60%), fruit (78%), or French fry (93%) side dish. They were receptive to receiving a fruit or vegetable (FV) side dish instead of French fries (68%); or milk, water, or flavored water instead of soda (81%) with their restaurant kids' meal. Liking/taste was the most common reason for children's feelings. Child receptivity to a FV side dish instead of French fries was high in both years and significantly higher in 2014 (t = -2.12, p = 0.034). The majority of parent and child reports of child receptivity were concordant (85%). CONCLUSIONS: These national survey results indicate that children are receptive to FV side dishes and healthier beverage options with their restaurant meals. Their receptivity has remained high in the recent past, and parents are aware of child receptivity. An opportunity exists for restaurants to leverage child receptivity to healthier sides and beverages by providing and promoting healthy options.

A pilot and feasibility study to assess children's consumption in quick-service restaurants using plate waste methodology.

BACKGROUND: Children regularly consume foods from quick-service restaurants (QSR), but little is known about the foods that children order, the calories and nutrients consumed, the accuracy of stated calorie information, or the ability to assess food orders and consumption in QSRs. This study evaluated the feasibility of plate waste collection in QSRs and examined children's orders and consumption of meals from the standard and children's menus. Additional aims were to examine if the meals ordered met healthier standards for children's menu items and determine the accuracy of the QSR-stated energy content of foods. METHODS: Fifteen QSRs, two malls, and 116 eligible parents were approached to participate in the study in 2015. Among the families recruited, children's meal orders and consumption were analyzed using plate waste methodology, and a subsample of foods was analyzed using bomb calorimetry in 2015. RESULTS: Two individual QSRs and one mall food court with two QSRs agreed to participate, and n = 50 participants (parents with children between the ages of 5-10 years) were recruited. Children consumed on average 519 calories, 5.7 g saturated fat, 957 mg sodium, 3.7 g fiber, and 22.7 g sugar. Children ordered and consumed significantly fewer calories and less sodium and sugar with meals ordered exclusively from the children's menu compared with the standard menu. Overall there were no significant differences between the measured and stated energy contents of the QSR foods. CONCLUSIONS: Conducting plate waste research in QSRs is feasible and there is concordance with stated calorie information. Consuming foods exclusively from the children's menu may help limit overconsumption in QSRs.

Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: a cross-sectional analysis.

BACKGROUND: Tens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states. METHODS: An online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5-12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively). RESULTS: About half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three. CONCLUSIONS: Most programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted.

Promoting healthier children's meals at quick-service and full-service restaurants: Results from a pilot and feasibility study.

High-calorie restaurant foods contribute to childhood overweight. Increased consumer demand for healthier kids' meals may motivate the restaurant industry to provide additional healthy options. This study pilot-tested a combination of four strategies (toy incentive, placemats, server prompts, signage) designed to increase demand for healthier kids' meals, which were defined as those eligible for the National Restaurant Association's Kids LiveWell program. Relative sales of healthier kids' meals were examined before (n = 3473 total kids' meal orders) and during Month 1 (n = 3546 total kids' meal orders) and Month 2 of implementation (n = 3645 total kids' meal orders) of an 8-week intervention in two locations each of a quick-service (QSR) and full-service (FSR) restaurant chain. Convenience samples of children (n = 27) and their parents (n = 28) were surveyed regarding parent and child perceptions of intervention components. Findings regarding the effectiveness and feasibility of the intervention were mixed. At the FSRs, the relative percentage of monthly sales from healthier kids' meals increased from 5.0% of kids' meal orders at baseline to 8.3% during Month 1, ending at 6.4% during Month 2. At the QSRs, the relative percentage of monthly sales from healthier kids' entrees decreased from 27.5% at baseline to 25.2% during Month 1, ending at 25.9% during Month 2. Implementation quality tracking showed that consistent implementation of intervention components was a challenge; parent- and child-reported awareness of intervention components supported this finding. Future directions are discussed, aiming to build upon these findings and maximize the feasibility, effectiveness, and sustainability of efforts to promote healthier eating in restaurants.