Revisiting nutrition backlash: Psychometric properties and discriminant validity of the nutrition backlash scale.

OBJECTIVES: Nutrition backlash is a disposition defined by negative feelings about dietary recommendations. Past research has measured nutrition backlash using the nutrition backlash scale (NBS) and found that it is negatively related to the consumption of fruits and vegetables. The aim of this study was to examine several aspects of the NBS, including factor structure, discriminant validity, and relationship to demographic characteristics and health behaviors. METHODS: Adults were recruited to participate in two studies. Study 1 (N = 480) included measures of nutritional backlash, information overload, worry, fatalism, and nutrition-related behaviors. Study 2 (N = 399) was a follow-up that examined the factor structure of the NBS in a separate sample. RESULTS: In study 1, a six-item version of the NBS was found to be a good fit for the data and discriminant from overload, worry, and fatalism. NBS was higher for those with less education, non-white participants, and men. Individuals with higher backlash were less likely to look at nutritional labels and to use sunscreen. Study 2 confirmed the factor structure from study 1. CONCLUSIONS: A six-item version of the NBS was found to be reliable, discriminant from related measures, higher in underserved groups (less-educated, non-white, and male participants), and related to nutrition label use.

Recruitment, Engagement, and Retention of Fathers in Nutrition Education and Obesity Research.

This article provides a perspective about recruiting, engaging, and retaining fathers in research and programming related to nutrition education and childhood obesity prevention. Recent research emphasizes the importance of fathers in childhood obesity prevention, and although father-friendly approaches can emulate other underserved populations, some researchers have acknowledged that differences may exist. Family sciences- related and nutritional sciences-related literature is summarized to provide guidance for nutrition and obesity scholars. Best practices may vary by the type of study and father characteristics; and the venues, content, structure, timing, and approach of research and interventions may need to be tailored for fathers.

Feeding Infants and Toddlers: A Qualitative Study to Determine Parental Education Needs.

Background: Limited evidence-based guidance is available to parents regarding optimal child feeding practices to prevent early childhood obesity from birth to 24 months of age (B-24). The objective of this qualitative study was to determine current child feeding practices, barriers to implementation, and educational needs of parents of varying socioeconomic backgrounds as it relates to responsive feeding to prevent early obesity in children of ages B-24. Methods: One-on-one interviews were conducted with parents (n = 66) of children ages B-24 from both low-and non-low-income households. Interviews were audiorecorded, transcribed verbatim, and analyzed with NVivo using classical qualitative analysis. Results: Participants were primarily female (91%), married (53%), low-income (59%), and were not first-time parents (72%). The results revealed overarching themes, including parents' reported need for information on preparing child meals, optimal dietary intake, affordable healthy foods, promoting child self-feeding, and food and nutrition knowledge. Low-income parents more frequently requested guidance about identifying affordable healthy options and overfeeding while non-low-income parents requested information about food allergens, transitioning to solids, and creating structured mealtimes. Conclusions: Additional and focused outreach to parents of children ages B-24 regarding optimal feeding practices is needed especially on topics related to complementary feeding during the transition to solid food.

The impact of environmental, parental and child factors on health-related behaviors among low-income children.

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S. SAMPLE: This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (ß: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (ß: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (ß: -0.19, 95% CI: -0.29; -0.10). More parental covert control (ß: 0.44, 95% CI: 0.35; 0.54), more parental overt control (ß: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (ß: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Innovative Techniques for Evaluating Behavioral Nutrition Interventions.

Assessing outcomes and the impact from behavioral nutrition interventions has remained challenging because of the lack of methods available beyond traditional nutrition assessment tools and techniques. With the current high global obesity and related chronic disease rates, novel methods to evaluate the impact of behavioral nutrition-based interventions are much needed. The objective of this narrative review is to describe and review the current status of knowledge as it relates to 4 different innovative methods or tools to assess behavioral nutrition interventions. Methods reviewed include 1) the assessment of stress and stress responsiveness to enhance the evaluation of nutrition interventions, 2) eye-tracking technology in nutritional interventions, 3) smartphone biosensors to assess nutrition and health-related outcomes, and 4) skin carotenoid measurements to assess fruit and vegetable intake. Specifically, the novel use of functional magnetic resonance imaging, by characterizing the brain's responsiveness to an intervention, can help researchers develop programs with greater efficacy. Similarly, if eye-tracking technology can enable researchers to get a better sense as to how participants view materials, the materials may be better tailored to create an optimal impact. The latter 2 techniques reviewed, smartphone biosensors and methods to detect skin carotenoids, can provide the research community with portable, effective, nonbiased ways to assess dietary intake and quality and more in the field. The information gained from using these types of methodologies can improve the efficacy and assessment of behavior-based nutrition interventions.

The Utility of the Memorable Messages Framework as an Intermediary Evaluation Tool for Fruit and Vegetable Consumption in a Nutrition Education Program.

Additional strategies to evaluate the impact of community nutrition education programs on low-income individuals are needed. The objective of this qualitative study was to examine the use of the Memorable Messages Framework as an intermediary nutrition education program evaluation tool to determine what fruit and vegetable messages were reported as memorable and the characteristics of those memorable messages. A convenience sample of low-income, primarily African American adults (N = 58) who previously completed a series of community nutrition education lessons within an urban area of Indiana participated in a focus group (N = 8 focus groups). A lead moderator using a semistructured script conducted the focus groups to determine what information about fruits and vegetables was most memorable from the participants' nutrition lessons and why this information was memorable. All focus group audiotapes were transcribed verbatim and ATLAS.ti software was used to code and identify themes within the data. Participants cited quantity, variety, and the positive nutritional impact of eating fruits and vegetables as most memorable. Information given in the form of recipes was also cited as most memorable. For example, participants referred to the recipe demonstrations as not only fun but also key components of the program that helped with message retention and memorability. Key characteristics of memorable messages included personal relevance and message vividness. These findings indicated that the Memorable Messages Framework may serve as an intermediary program evaluation tool to identify what information and messages are most influential to participants in community nutrition education programs.

Evaluation of Nutrition and Physical Activity Policies and Practices in Child Care Centers within Rural Communities.

BACKGROUND: Although some researchers have examined nutrition and physical activity policies within urban child care centers, little is known about the potentially unique needs of rural communities. METHODS: Child care centers serving preschool children located within low-income rural communities (n = 29) from seven states (Indiana, Kansas, Michigan, North Dakota, Ohio, South Dakota, and Wisconsin) were assessed to determine current nutrition and physical activity (PA) practices and policies. As part of a large-scale childhood obesity prevention project, the Community Healthy Living Index's previously validated Early Childhood Program Assessment Tool was used to collect data. Descriptive statistical analysis was conducted to identify high-priority areas. Healthy People 2020 and the Academy of Nutrition and Dietetics' recommendations for nutrition and PA policies in child care centers were used as benchmarks. RESULTS: Reports of not fully implementing (<80% of the time) recommended nutrition-related policies or practices within rural early child care centers were identified. Centers not consistently serving a variety of fruits (48%), vegetables (45%), whole grains (41%), limiting saturated fat intake (31%), implementing healthy celebration guidelines (41%), involving children in mealtime (62%), and referring families to nutrition assistance programs (24%) were identified. More than one third of centers also had limited structured PA opportunities. Although eligible, only 48% of the centers participated in the Child and Adult Care Food Program. CONCLUSIONS: Overall, centers lacked parental outreach, staff training, and funding/resources to support nutrition and PA. These results provide insight into where child care centers within low-income, rural communities may need assistance to help prevent childhood obesity.

Impact of a Short-Term Nutrition Education Child Care Pilot Intervention on Preschool Children's Intention To Choose Healthy Snacks and Actual Snack Choices.

BACKGROUND: Novel interventions within child care settings are needed for childhood obesity prevention. The aim of this study was to determine the impact of a short-term nutrition education pilot intervention on preschool-age children's snack food choices. METHODS: Children ages 3-5 years (n = 49) from one child care setting participated in a short-term nutrition education intervention (nine 30-minute interactive lessons) taught over a 2-week period. Pre-post assessments included snack knowledge and snack preference questionnaires and an observed snack selection trial to allow children to choose between a healthy and unhealthy snack choice similar to the current food environment. Children's height and weight were measured and BMI z-scores calculated. Parental reports of demographics and child's food preferences were also collected at baseline. RESULTS: Children significantly improved their preference of healthier snacks (p = 0.03) and the ability to distinguish them (p = 0.03) from other snacks. However, they did not significantly improve (p > 0.05) their snack choice between a healthy and unhealthy choice immediately after the short-term nutrition education program. Children who were younger (p = 0.003) or who had higher nutrition knowledge scores (p = 0.002) were more likely to select the healthy snack after the intervention. CONCLUSIONS: This study provides evidence that a short-term nutrition education program improves preschool children's knowledge about healthy snacks, but does not translate to immediate healthier snack selections for all children. Future research should investigate the optimal duration of a nutrition education program in a child care setting and other external influences (parents, policy) most influential on snack choice and eventual obesity risk.

Investigating the Relationship of Body Mass Index, Diet Quality, and Physical Activity Level between Fathers and Their Preschool-Aged Children.

BACKGROUND: Diet quality and physical activity are two important factors in determining a child's risk for obesity. In early childhood, parents may serve as role models for these behaviors. However, few studies have examined associations of a father's body mass index (BMI), dietary intake, and physical activity with his preschool-aged child. OBJECTIVE: The purpose of this study was to examine relationships between fathers' and children's body weight, diet quality, and physical activity. DESIGN: This cross-sectional study included one-on-one interviews with fathers (n=150) of preschool-aged children conducted by a trained interviewer (a registered dietitian nutritionist). PARTICIPANTS: To be eligible, biological fathers (n=150) of preschool-aged children (aged 3 to 5 years) were required to regularly eat at least one meal per week with their child and be able to read or speak English. They could be of any race, ethnicity, income, or education level. MAIN OUTCOME MEASURES: During the interview, diet quality was assessed using a single 24-hour recall and the Healthy Eating Index-2010. Physical activity was assessed using the Pre-Physical Activity Questionnaire. Height and weight for each father and child were also measured. BMI and BMI z scores were calculated for fathers and children, respectively. STATISTICAL ANALYSES PERFORMED: Linear regression was used to test relationships between fathers' and children's body weight, diet quality, and physical activity while controlling for income level, race, and ethnicity. RESULTS: Overall, the findings revealed that there were significant, positive relationships between father-child weight status (ß=.03; P=0.05), overall diet quality (ß=.39; P<0.0001), and weekday (ß=.27; P=0.002) and weekend (ß=.62; P=0.001) vigorous physical activity. CONCLUSIONS: These results suggest that there are relationships between fathers' and children's BMI z score, dietary intake, and physical activity level. Future research should consider the inclusion of fathers in obesity prevention programs for young children.

Identifying practical solutions to meet America's fiber needs: proceedings from the Food & Fiber Summit.

Fiber continues to be singled out as a nutrient of public health concern. Adequate intakes of fiber are associated with reduced risk for cardiovascular disease, cancer, diabetes, certain gastrointestinal disorders and obesity. Despite ongoing efforts to promote adequate fiber through increased vegetable, fruit and whole-grain intakes, average fiber consumption has remained flat at approximately half of the recommended daily amounts. Research indicates that consumers report increasingly attempting to add fiber-containing foods, but there is confusion around fiber in whole grains. The persistent and alarmingly low intakes of fiber prompted the "Food & Fiber Summit," which assembled nutrition researchers, educators and communicators to explore fiber's role in public health, current fiber consumption trends and consumer awareness data with the objective of generating opportunities and solutions to help close the fiber gap. The summit outcomes highlight the need to address consumer confusion and improve the understanding of sources of fiber, to recognize the benefits of various types of fibers and to influence future dietary guidance to provide prominence and clarity around meeting daily fiber recommendations through a variety of foods and fiber types. Potential opportunities to increase fiber intake were identified, with emphasis on meal occasions and food categories that offer practical solutions for closing the fiber gap.

Parenting styles, feeding styles, and their influence on child obesogenic behaviors and body weight. A review.

With recommendations to include parents as targets for childhood obesity interventions, there is a need to review the relationship of general parenting influences on childhood obesity. Therefore, the aim of this review is to examine the existing literature regarding the influence of parenting style and/or feeding styles on childhood obesogenic behaviors and body weight. Research articles related to parenting style (n=40) and parental feeding style (n=11) were identified and reviewed. An authoritative style appears to be the most protective parenting and feeding style while the indulgent feeding style is consistently associated with negative health outcomes. Overall, results for parenting style studies are inconsistent due to differences in conceptualization and measurement, while the results for feeding styles are much more cohesive. The literature is lacking in the ability to describe the interplay between parenting and feeding styles and child obesity risk. Recommendations for future research and interventions are discussed in regards to feeding style and influences on childhood obesity.

Comparison of a web-based vs in-person nutrition education program for low-income adults.

As access to computers and the Internet by the low-income population is increasing and the "digital divide" is slowly diminishing, other methods of delivering nutrition information to this audience are evolving. This randomized, block equivalence trial sought to determine whether web-based nutrition education could result in equivalent nutrition-related behavior outcomes when compared with traditional in-person nutrition education in low-income adults. A convenience sample of low-income adults (n=123) was randomized to receive in-person education (n=66) or web-based education (n=57) in a community setting within 14 counties of Indiana from April through December 2010. The web-based group received three nutrition education lessons (eg, fruits and vegetables, Nutrition Facts label reading, and whole grains) designed to replicate lessons received by the in-person group. Lessons were developed using Kolb's Learning Styles and Experiential Learning Model. Self-reported nutrition-related behaviors were assessed using a previously validated survey for low-income adults. Most nutrition-related behavior outcomes (eg, fruit, vegetable, whole-grain intake, Nutrition Facts label use, breakfast, and meal-planning frequency) improved significantly (P<0.05) from pre to post within both groups, meaning that each intervention was effective. When these nutrition-related behavior improvements were compared between groups, the changes were statistically equivalent (P>0.05), except for one question about use of the Nutrition Facts label. Therefore, web-based nutrition education can lead to favorable and equivalent nutrition-related changes when compared with in-person delivery. Most (83%) web-based participants also reported willingness to use the website again. Future application of web-based interventions for low-income populations could broaden delivery reach, increase frequency and length of contacts, and possibly decrease costs.

Filling America's fiber intake gap: summary of a roundtable to probe realistic solutions with a focus on grain-based foods.

Current fiber intakes are alarmingly low, with long-term implications for public health related to risk of coronary heart disease, stroke, hypertension, certain gastrointestinal disorders, obesity, and the continuum of metabolic dysfunctions including prediabetes and type 2 diabetes. Eating patterns high in certain fibers are known to lower LDL cholesterol and blood pressure, lower blood glucose, and decrease insulin resistance in people with prediabetes and type 2 diabetes; help with both weight loss and maintenance; and improve bowel regularity and gastrointestinal health. With >90% of adults and children who fall short of meeting their daily fiber recommendations, the 2010 Dietary Guidelines for Americans once again classified fiber as a nutrient of concern. Despite efforts over the past decade to promote adequate fiber through fruit, vegetable, and whole-grain intakes, fiber consumption has remained flat at approximately half the daily recommended amount. The public health implications of inadequate fiber intake prompted the roundtable session "Filling America's Fiber Gap: Probing Realistic Solutions," which assembled nutrition researchers, educators, and communicators to identify challenges, opportunities, and realistic solutions to help fill the current fiber gap. The roundtable discussions highlighted the need for both consumer and professional education to improve acceptance for and inclusion of grain-based foods with added fiber as one strategy for increasing fiber intakes within daily energy goals.

Assessment of low-income adults' access to technology: implications for nutrition education.

OBJECTIVE: The main objective of this study was to investigate access and use of technologies such as the Internet among Indiana's low-income population. The secondary objective was to determine whether access and use of computers significantly differed by age, race, and/or education level. METHODS: Data were collected from low-income adult Supplemental Nutrition Assistance Program Education participants for a 2-year period using a cross-sectional questionnaire about access and use of technology. RESULTS: Approximately 50% of the total respondents (n = 1,620) indicated that they had a working computer in their home, and of those, the majority (78%) had a high-speed Internet connection. Chi-square analysis revealed that younger adults who were white and had more education were more likely to have a computer (P < .001) and Internet. CONCLUSIONS AND IMPLICATIONS: The results of this study provide evidence that using Internet-based nutrition education in a low-income population is a viable and possibly cost-effective option.