Community approval required for periconceptional adolescent adherence to weekly iron and/or folic acid supplementation: a qualitative study in rural Burkina Faso.

BACKGROUND: Iron deficiency remains a prevalent adolescent health problem in low income countries. Iron supplementation is recommended but improvement of iron status requires good adherence. OBJECTIVES: We explored factors affecting adolescent adherence to weekly iron and/or folic acid supplements in a setting of low secondary school attendance. METHODS: Taped in-depth interviews were conducted with participants in a randomised, controlled, periconceptional iron supplementation trial for young nulliparous women living in a rural, malaria endemic region of Burkina Faso. Participants with good, medium or poor adherence were selected. Interviews were transcribed and analysed thematically. RESULTS: Thirty-nine interviews were conducted. The community initially thought supplements were contraceptives. The potential benefits of giving iron supplementation to unmarried "girls" ahead of pregnancy were not recognised. Trial participation, which required parental consent, remained high but was not openly admitted because iron supplements were thought to be contraceptives. Unmarried non-school attenders, being mobile, were often sent to provide domestic labour in varied locations. This interrupted adherence - as did movement of school girls during vacations and at marriage. Field workers tracked participants and trial provision of free treatment encouraged adherence. Most interviewees did not identify health benefits from taking supplements. CONCLUSIONS: For success, communities must be convinced of the value of an adolescent intervention. During this safety trial, benefits not routinely available in iron supplementation programmes were important to this low income community, ensuring adolescent participation. Nevertheless, adolescents were obliged to fulfil cultural duties and roles that interfered with regular adherence to the iron supplementation regime. TRIAL REGISTRATION: Trial Registration at clinicaltrials.gov : NCT01210040.

Dietary sources of sugars in adolescents' diet: the HELENA study.

OBJECTIVE: To report dietary sugars consumption and their different types and food sources, in European adolescents. METHODS: Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5-17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders. RESULTS: Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was 'carbonated, soft and isotonic drinks,' followed by 'non-chocolate confectionary' and 'sugar, honey, jam and syrup.' Older boys and girls had significantly higher intakes of free sugars from 'cakes, pies and biscuits.' Free sugars intake was negatively associated with low socioeconomic status for 'non-chocolate confectionary' and 'sugar, honey and jam' groups; with low maternal educational level for carbonated and 'soft drinks,' 'sugar, honey and jam,' 'cakes and pies' and 'breakfast cereals' groups; and with high paternal educational level for 'carbonated and soft drinks' and 'chocolates' group. CONCLUSIONS: The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level.

Food patterns and nutritional assessment in Galician university students.

The access of the young people to the university marks a fundamental break in their lives that may also result in a substantial change in their dietary habits. The aim of this study was to characterize the food patterns, body composition and biochemical profiles of Galician university students from the University of Santiago de Compostela (Campus de Lugo). A total of 62 students participated in this survey. For each individual, anthropometric parameters, blood pressure, blood glucose and lipid profile were measured. Also, the participants filled questionnaires of dietary habits, Mediterranean and Atlantic diet adherence, risk of type II diabetes and physical activity, lifestyle and personal and family histories. A BMI within the normal range was shown by 72% of students. Eight volunteers (12.90%) presented high levels of total cholesterol (>200 mg/dL), and 54.55% of women had levels of HDL-cholesterol above 60 mg/dL. Five students had levels of glucose above 100 mg/dL, being four men and one woman. None of the participants presented high blood pressure, but 11.29% were in pre-hypertension status. The intake of carbohydrates was below the recommendations, while protein and lipids were above. There was an excessive consumption of bakery, alcohol beverages, sausages and ready-made food. The students showed medium adherence to Atlantic and Mediterranean diet and low risk of type II diabetes mellitus and a sedentary lifestyle. Since university students are a group especially prone to poor dietary habits, it seems necessary to promote changes towards healthier meals and rescue the Mediterranean-like dietary pattern.

Dietary patterns, cost and compliance with low-protein diet of phenylketonuria and other inherited metabolic diseases.

BACKGROUND/OBJECTIVES: Phenylketonuria (PKU) and several other inherited metabolic diseases (IMD) require a lifelong low-protein diet (LPD), otherwise they lead to many health complications. LPDs, however, carry a significant economic burden for patients and their families. The objective of this study was to explore the costs of low-protein foods (LPFs) necessary for LPD as well as dietary patterns and compliance towards an LPD. SUBJECTS/METHODS: A detailed questionnaire was created in cooperation with National Association of PKU and other IMD (NSPKU), and consequently sent to all NSPKU members treated with an LPD (n=303). A total of 184 respondents from the Czech Republic were included in the study (174 had PKU, 10 had other IMD). RESULTS: The average daily consumption of LPF was equal to 411.7 g (PKU) and 345.6 g (other IMD), which corresponds to energy value of 5558 kJ and 4438 kJ, respectively, per patient per day. Patients mostly consumed low-protein flour (≈30% of energy intake), pasta (≈18%), basic pastry (≈15%) and sweets (≈10%). The average monthly costs of LPDs were equal to [euro ]130 (PKU) and [euro ]129 (other IMD) per patient per month. The compliance with LPD was decreasing with increasing age (P<0.0001). CONCLUSIONS: This is the largest study examining costs and dietary patterns of LPDs in patients with PKU and the first study of this kind in other IMD patients requiring an LPD. The study clearly showed that an LPD carries a very high economic burden for families, which may lead to less LPD compliance and potential severe health consequences.

Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality.

PURPOSE: To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents. METHODS: In 2081 adolescents (12.5-17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country. RESULTS: The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23-64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17-44% of the total effect). CONCLUSION: Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.

The school environment and sugar-sweetened beverage consumption among Guatemalan adolescents.

OBJECTIVE: The current study sought to examine Guatemalan adolescents' consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students' SSB consumption. DESIGN: Within this observational pilot study, a questionnaire was used to assess students' consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample. SETTING: Guatemala City, Guatemala. SUBJECTS: Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools. RESULTS: Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property. CONCLUSIONS: Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies.

Perceptions and Knowledge of Caffeinated Energy Drinks: Results of Focus Groups With Canadian Youth.

OBJECTIVE: To examine use, knowledge, and perceptions of caffeinated energy drinks (CEDs) among youth. DESIGN: Qualitative research using focus group discussions (n = 4). SETTING: Two Canadian cities (Toronto and Montreal). PARTICIPANTS: Youth aged 12-18 years (n = 41). PHENOMENON OF INTEREST: Perceived definitions of CEDs, reasons for use, knowledge of health effects, use with alcohol, marketing perceptions, and use and understanding of cautionary statements on packaging. ANALYSIS: Data were analyzed using a modified grounded-theory approach. RESULTS: Youth identified CEDs as products that provide energy and contain caffeine and sugar. Compared with mainstream CED brands and energy shots, youth were less likely to perceive Gatorade, Coca-Cola, and a Starbucks beverage as energy drinks, despite some ambiguity. The majority of participants believed that CEDs, including mixed with alcohol, were not necessarily harmful in moderation and that marketing was targeted toward older youth and young adults. Awareness of cautionary statements on CEDs was low; cautionary statements were perceived as difficult to find and read owing to the design and small font. CONCLUSIONS AND IMPLICATIONS: Findings suggest a need to increase public education regarding the potential risks of CED consumption, including enhancements to the mandated cautionary statements, with greater attention to the impact of CED marketing on youth.

Factors associated with high consumption of soft drinks among Australian secondary-school students.

OBJECTIVE: To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility. DESIGN: Cross-sectional self-completion survey and height and weight measurements. SETTING: Australian secondary schools. SUBJECTS: Students aged 12-17 years participating in the 2012-13 National Secondary Students' Diet and Activity (NaSSDA) survey (n 7835). RESULTS: Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week ('high soft drink consumers'). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine. CONCLUSIONS: High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents' soft drink intake.

Culture and Diet Among Chinese American Children Aged 9-13 Years: A Qualitative Study.

OBJECTIVE: To examine Chinese American children's behaviors, food preferences, and cultural influences on their diet. DESIGN: Qualitative individual interviews using constructs from the proposed model of dietary acculturation. SETTING: Community centers and Chinese schools in Houston, TX. PARTICIPANTS: Twenty-five Chinese American children aged 9-13 years. PHENOMENON OF INTEREST: Diet, favorite restaurants, and parents' cooking and grocery shopping habits. ANALYSIS: Content analysis and thematic data analysis to identify code categories and themes. Coders also identified patterns based on demographic and acculturation factors. RESULTS: Overall, participants described their diets and associated behaviors as Asian and non-Asian. Key themes included preference for Asian and non-Asian foods; consumption of non-Asian foods for breakfast and lunch, but Asian foods for dinner; infrequent dining at restaurants; grocery shopping at Asian and non-Asian stores; and familial influences on diet. Acculturated children and children of higher socioeconomic status appeared to prefer and consume a more Westernized/non-Asian diet. CONCLUSIONS AND IMPLICATIONS: Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia.

OBJECTIVE: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. METHODS: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. RESULTS: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with a Western-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. CONCLUSION: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth.

Food insecurity and malnutrition in Chinese elementary school students.

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6-14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number = 4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6.1% in the entire studied population and 16.3% in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1.14 v. 0.96; P=0.043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3.08; 95% CI 1.47, 6.46; P=0.003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community.

Eating- and weight-related parenting of adolescents in the context of food insecurity.

BACKGROUND: Food insecurity is hypothesized to influence mothers' use of parenting strategies to regulate children's eating. Little is known about the parenting practices directed toward adolescents in food-insecure households. OBJECTIVE: Our aim was to examine the differences in use of eating- and weight-related parenting practices among mothers of adolescents by household food-security status. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: A sociodemographically diverse sample of mothers and adolescents from the Minneapolis/St Paul, MN, metropolitan area who participated in the Eating and Activity Among Teens 2010 and Project Families and Eating and Activity Among Teens studies in 2009 to 2010 (dyad n=2,087). Seventy percent of mothers identified as nonwhite. MAIN OUTCOME MEASURES: We examined mother-reported use of parenting practices, including pressuring children to eat, restricting high-calorie foods, and encouraging dieting. STATISTICAL ANALYSES PERFORMED: Logistic regression models were used to determine the predicted probabilities of parenting practices among food-secure, low food-secure, and very-low food-secure households. Sociodemographic characteristics, mothers' body mass index, and adolescents' body mass index-for-age percentile were examined as confounders. RESULTS: In unadjusted models, food-insecure mothers were more likely than food-secure mothers to frequently encourage their children to diet, comment on their child's weight, be concerned about their child's weight, use restrictive feeding practices, and use pressured feeding practices. After adjustment for sociodemographic characteristics and mothers' and children's body mass index, compared to food-secure mothers, mothers with low food security were more likely to frequently comment on their sons' weight (41.5% vs 32.9%, prevalence difference=8.6; 95% CI 0.9 to 16.3) and mothers with very low food security were more likely to be concerned about their sons' weight (48.8% vs 35.1%; prevalence difference=13.7; 95% CI 3.5 to 23.9). Mothers with very low food security were more likely to frequently use restrictive feeding practices with their daughters compared to food-secure mothers (33.0% vs 20.5%; prevalence difference=12.4; 95% CI 4.2 to 20.7). CONCLUSIONS: Interventions to improve food-insecure adolescents' eating behaviors may benefit from supporting mothers' use of health-promoting parenting practices.

Racial and ethnic differences in the home food environment explain disparities in dietary practices of middle school children in Texas.

OBJECTIVE: To examine racial and ethnic differences among middle school children in the home food environment (HFE) and the extent to which associations of healthy and unhealthy eating with the HFE differ by race and ethnicity. DESIGN: Cross-sectional secondary analyses of baseline data from Coordinated Approach to Child Health Middle School, a school-based intervention targeting obesity and obesogenic behaviors among middle school children in Austin, TX. PARTICIPANTS: A total of 2,502 children (mean age, 13.9 years; 58% Hispanic, 28% white, and 14% black). VARIABLES MEASURED: Availability and accessibility of healthy foods, and parental support of healthy eating, and family meals. Consumption of both healthy and unhealthy foods was examined. ANALYSIS: Differences across racial and ethnic groups in aspects of HFE were estimated using linear regression. Models also examined racial and ethnic differences in consumption of healthy and unhealthy foods. If adjusting for HFE, such differences were accounted for. RESULTS: White children had significantly better HFEs than Hispanic and black children with greater availability and accessibility of healthy foods (P < .001). Adjusting for a healthy HFE reduced disparities in consumption of healthy foods but not in consumption of unhealthy foods. CONCLUSIONS AND IMPLICATIONS: Improved HFE may increase healthy eating among ethnic minorities but is unlikely to reduce unhealthy eating.

Ecological momentary assessment of urban adolescents' technology use and cravings for unhealthy snacks and drinks: differences by ethnicity and sex.

BACKGROUND: Adolescents' technology use is generally associated with food cravings, but it is not clear whether specific types of technology elicit particular types of cravings or whether personal characteristics play a role in these associations. OBJECTIVE: We examined whether momentary associations between four technology types (ie, television, video games, computer messaging, and phone messaging) and cravings for unhealthy snack foods and sweetened drinks were moderated by youths' sex, ethnicity, body mass index, and age. METHODS: Urban adolescents (N=158) aged 14 to 17 years provided momentary information about their technology use and food cravings during the course of 1 week and completed survey reports of their personal characteristics. We used multilevel modeling to determine momentary associations and interactions. RESULTS: Non-Hispanic adolescents showed stronger associations between television exposure and cravings for sweet snacks, salty snacks, and sweetened drinks. Being Hispanic was associated with stronger associations between phone messaging and cravings for sweet snacks, salty snacks, and sweetened drinks. Males showed stronger associations between video game use and salty snack cravings. CONCLUSIONS: As the public health field continues to monitor the effects of technology use on adolescents' eating and overall health, it will be important to determine the extent to which these groups are differentially affected by different forms of technology.

Literature research of the Nutrition Improvement Programme for Rural Compulsory Education Students in China.

OBJECTIVE: To describe the Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES) in China and to share the experiences of developing and implementing nationwide school meal programmes with other countries. DESIGN: The article is based on a literature review of technical documents and reports of NIPRCES and relevant national legislation, technical reports and studies on school nutrition, minutes of meetings and national conferences, and official documents of the National Office of Student Nutrition and the Chinese Center for Disease Control and Prevention. SETTING: People's Republic of China. SUBJECTS: Published papers, national policies, legislation and unpublished official documents. RESULTS: A total of 23 million rural compulsory education students were covered by NIPRCES. In the development and implementation process of NIPRCES, fifteen ministries and national committees were involved and an efficient collaborative mechanism was established. All NIPRCES-covered schools were required to serve meals on a daily basis. By the end of June 2012, the proportions of students choosing 'school feeding', 'food package' and 'family feeding' modes were respectively 64.0 %, 32.0 % and 4.0 %. The central government subsidized school meals annually by more than $US 2.5 billion and invested $US 4.8 billion on school kitchens to support this programme. CONCLUSIONS: The NIPRCES is a significant movement of governmental nutritional intervention in China. Food safety, financial security, decentralization and other potential concerns should be considered and lessons can be learned from other countries. Further relevant research and a nationwide monitoring and evaluation programme are needed.

Consumption of added sugars among US children and adults by food purchase location and food source.

BACKGROUND: The proposed changes to the Nutrition Facts Label by the US Food and Drug Administration will include information on added sugars for the first time. OBJECTIVE: The objective was to evaluate the sources of added sugars in the diets of a representative sample of US children and adults by food purchase location and food source (eg, food group). DESIGN: This cross-sectional study among 31,035 children, adolescents, and adults aged ≥6 y from the 2003-2004, 2005-2006, 2007-2008, and 2009-2010 NHANES used data from a 24-h dietary recall to evaluate consumption of added sugars. Food locations of origin were identified as stores (supermarket or grocery store), quick-service restaurants/pizza (QSRs), full-service restaurants (FSRs), schools, and others (eg, vending machines or gifts). Added sugars consumption by food purchase location was evaluated by age, family income-to-poverty ratio, and race-ethnicity. Food group sources of added sugars were identified by using the National Cancer Institute food categories. RESULTS: Added sugars accounted for ∼14.1% of total dietary energy. Between 65% and 76% of added sugars came from stores, 6% and 12% from QSRs, and 4% and 6% from FSRs, depending on age. Older adults (aged ≥51 y) obtained a significantly greater proportion of added sugars from stores than did younger adults. Lower-income adults obtained a significantly greater proportion of added sugars from stores than did higher-income adults. Intake of added sugars did not vary by family income among children/adolescents. Soda and energy and sports drinks were the largest food group sources of added sugars (34.4%), followed by grain desserts (12.7%), fruit drinks (8.0%), candy (6.7%), and dairy desserts (5.6%). CONCLUSIONS: Most added sugars came from foods obtained from stores. The proposed changes to the Nutrition Facts Label should capture the bulk of added sugars in the US food supply, which suggests that the recommended changes have the potential to reduce added sugars consumption.

Race/ethnicity and income in relation to the home food environment in US youth aged 6 to 19 years.

BACKGROUND: The home food environment is complex and has the potential to influence dietary habit development in young people. Several factors may influence the home food environment, including income and race/ethnicity. OBJECTIVE: To examine the relationship of income and race/ethnicity with three home food environment factors (ie, food availability frequency, family meal patterns [frequency of family and home cooked meals], and family food expenditures). DESIGN: A cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: A total of 5,096 youth aged 6 to 19 years from a nationally representative sample of US individuals participating in NHANES 2007-10. STATISTICAL ANALYSES PERFORMED: Prevalence of food availability frequency was assessed for the entire sample, race/ethnicity, poverty income ratio (PIR), and race/ethnicity stratified by PIR. Mean values of family meal patterns and food expenditures were calculated based on race/ethnicity, PIR, and race/ethnicity stratified by PIR using analysis of variance and least squares means. Tests of main effects were used to assess differences in food availability prevalence and mean values of family meal patterns and food expenditures. RESULTS: Non-Hispanic whites had the highest prevalence of salty snacks (51.1%±1.5%) and fat-free/low-fat milk (39.2%±1.7%) always available. High-income homes had the highest prevalence of fruits (75.4%±2.4%) and fat-free/low-fat milk (38.4%±2.1%) always available. Differences were found for prevalence of food availability when race/ethnicity was stratified by PIR. Non-Hispanic blacks had the lowest prevalence of fat-free/low-fat milk always available across PIR groups. Differences in mean levels of family meal patterns and food expenditures were found for race/ethnicity, PIR, and race/ethnicity stratified by PIR. CONCLUSIONS: Race/ethnicity and PIR appear to influence food availability, family meal patterns, and family food expenditures in homes of youth. Knowledge of factors that influence the home food environment could assist in developing effective strategies to improve food environments for young people.

Characteristics of fast-food/takeaway-food and restaurant/café-food consumers among New Zealand adults.

OBJECTIVE: To investigate: (i) the percentage of the New Zealand (NZ) population reporting fast food/takeaway food and restaurant/café food per day; (ii) examine demographic factors associated with their use; (iii) quantify their contribution to energy intake; and (iv) describe the specific types of foods reported from both sources. DESIGN: Twenty-four hour diet recalls from the cross-sectional 2008/09 NZ Adult Nutrition Survey were used to identify fast-food and restaurant-food consumers. SETTING: NZ households. SUBJECTS: Adults aged 15 years and older (n 4721). RESULTS: Overall 28 % reported consuming at least one fast food and 14 % a restaurant food within the 24 h diet recall. Fast-food consumption was not associated with level of education or an area-based measure of socio-economic status, but a higher education was positively associated with restaurant-food consumption. Individual factors such as ethnicity, household size, age, sex and marital status were found to be important influences on the use of fast food and restaurant food. Fast-food consumption was more prevalent among participants living in urban areas, young adults (19-30 years) and Maori compared with NZ European and Others. The most frequently reported fast foods were bread-based dishes, potatoes (including fries) and non-alcoholic beverages. CONCLUSIONS: Given the high reported consumption of fast food by young adults, health promotion initiatives both to improve the nutritional quality of fast-food menus and to encourage healthier food choices would likely make a large impact on the overall diet quality of this group.

"I eat to be happy, to be strong, and to live." perceptions of rural and urban adolescents in Cameroon, Africa.

OBJECTIVE: To investigate factors influencing rural and urban adolescents' food perceptions during a time of nutritional transition in Cameroon, Africa. DESIGN: Qualitative in-depth interviews. SETTINGS: Yaoundé urban and Bandja rural areas. PARTICIPANTS: Fifteen adolescents 12 to 15 years old purposely selected from schools in urban and rural areas. ANALYSIS: Interviews were audiotaped, transcribed, and analyzed using Grounded Theory method. FINDINGS: Factors influencing adolescents' food perceptions from the rural area were "to live" "health" and "poverty." Among adolescents from the urban poor area, "health," "beauty," and "not enough money" were factors. Among adolescents from the urban rich area, "pleasure" and "beauty" were factors. Rural girls liked "to be fat," whereas girls from the urban poor wanted "to be a little bit fat," and girls from the urban rich wanted "to be normal." CONCLUSIONS AND IMPLICATIONS: Food behavior is changing from a diet composed of traditional food in rural areas to a more westernized diet in urban areas. The relationship between socioeconomic factors and nutrition needs to be examined with a sufficiently large number of adolescents to investigate these factors in a quantitative survey. Healthful local food should be available at home and from vendors. Nutrition education about food and diet-related diseases is needed in school.