Adolescent Independent Eating Occasions, Dietary Intake, and Parenting Practices During the COVID-19 Pandemic: A Qualitative Study of Parents and Adolescents From Households With Low Income.

OBJECTIVE: Examine how experiencing the coronavirus disease 2019 (COVID-19) pandemic influenced adolescent independent eating occasions (iEOs) and iEO-related parenting practices from the perspective of parents and adolescents METHODS: Cross-sectional remote interviews were conducted for this basic qualitative research study. Participants were a purposive sample of multiracial/ethnic adolescents aged 11-14 years and their parents from households with low income (n = 12 dyads) representing 9 US states. The main outcome measures were iEOs and iEO-related parenting practices. Data were analyzed using directed content analysis. RESULTS: About half of the parents indicated that their adolescents had more iEOs during the COVID-19 pandemic and that there were changes in the types of foods consumed during iEOs. In contrast, most adolescents indicated their iEOs had not changed remarkably in frequency or foods consumed since the onset of the pandemic. Most parents reported no change in how they taught their adolescents about healthy food, the rules for foods/beverages permitted during iEOs, or how they monitored what their adolescents ate during iEOs; adolescent reports were in general agreement. Most parents indicated that family members were home together more often during the pandemic, which increased cooking frequency. CONCLUSIONS AND IMPLICATIONS: The effect of the COVID-19 pandemic on adolescents' iEOs varied, and the parenting practices used to influence iEOs remained stable during the pandemic. Families experienced having more time together and cooking at home more often.

Youth and Peer Mentor Led Interventions to Improve Biometric-, Nutrition, Physical Activity, and Psychosocial-Related Outcomes in Children and Adolescents: A Systematic Review.

The utilization of youth (older) and peer (same age) mentor-led interventions to improve nutrition and physical activity has been an emerging trend in recent years. This systematic review is intended to synthesize the effectiveness of these intervention programs on participants and mentors based on biometric, nutrition, physical activity, and psychosocial outcomes of youth and peer mentor-led interventions among children and adolescents. Online databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar, were searched, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A three-step screening process was used to meet the proposed eligibility criteria, and the risk-of-bias tool for randomized trials (RoB 2) was used to assess bias for the included studies. Nineteen unique intervention programs and twenty-five total studies were deemed eligible when considering the criteria required for review. Multiple studies demonstrated positive evidence of the biometric and physical activity outcomes that were considered significant. The findings regarding the nutritional outcomes across the included studies were mixed, as some studies reported significant changes in eating habits while others did not find a significant change. Overall, the utilization of youth and peer mentor-led models in nutrition- and physical-activity-related interventions may be successful in overweight and obesity prevention efforts for those children and adolescents receiving the intervention and the youths and peers leading the interventions. More research is needed to explore the impact on the youths and peers leading the interventions and disseminating more detailed implementation strategies, e.g., training mentors would allow for advancements in the field and the replicability of approaches. Terminology: In the current youth- and peer-led nutrition and physical activity intervention literature, a varying age differential exists between the targeted sample and the peers, and varying terminology with regards to how to name or refer to the youth. In some instances, the youth mentors were individuals of the same grade as the target sample who either volunteered to serve in the peer role or were selected by their fellow students or school staff. In other cases, the youth mentors were slightly older individuals, either in high school or college, who were selected based upon their experience, leadership skills, passion for the project, or demonstration of healthy lifestyle behaviors.

Parenting Practices Are Associated With Adolescent Food Choices During Independent Eating Occasions.

BACKGROUND: Frequency of independent eating occasions (iEOs) has been linked to intake of unhealthy foods and overweight or obesity among adolescents. Parenting practices involving modeling healthy food intake and making healthy foods available have been associated with healthy food intake among adolescents; however, little is known about these associations during iEOs. OBJECTIVE: To determine whether parenting practices involving structure (monitoring, availability, modeling, and expectations), lack of structure (indulgence), and autonomy support reported by adolescents or parents were associated with adolescent iEO intake of junk foods, sugar-sweetened beverages (SSBs), sugary foods, and fruit and vegetables. DESIGN: Cross-sectional study measuring parenting practices and adolescent iEO food choices via an online survey and adapted food frequency questionnaire. PARTICIPANTS/SETTING: Parent/adolescent dyads (n = 622) completed surveys (November-December 2021) using a national Qualtrics panel database. Adolescents were 11 to 14 years of age and had iEOs at least weekly. MAIN OUTCOME MEASURES: Primary measures included parent- and adolescent-reported frequency of food parenting practices and adolescent-reported iEO intake of junk foods, sugary foods, SSBs, and fruits and vegetables. STATISTICAL ANALYSES PERFORMED: Multivariable linear regression models were used to examine associations between parenting practices and iEO intake of foods/beverages, adjusting for adolescent's age, sex, race and ethnicity, iEO frequency, parent's education and marital status, and household food security status. Bonferroni multiple comparison corrections were conducted. RESULTS: More than half of parents were female (66%) and 35 to 64 years of age (58%). Adolescents/parents identified as White/Caucasian (44%/42%), Black/African American (28%/27%), Asian (21%/23%), and Hispanic ethnicity (42%/42%). Positive associations were observed among adolescent-reported and parent-reported autonomy support, monitoring, indulgence and expectations parenting practices, and adolescent-reported daily iEO intake frequencies of junk foods, sugary foods, and fruits and vegetables (P < 0.001). CONCLUSIONS: Structural and autonomy support parenting practices were positively associated with both healthy and unhealthy iEO food intake by adolescents. Interventions to improve adolescent iEO intake could promote positive practices associated with healthy food consumption.

Caregiver Nutritional Health Outcomes of the Simple Suppers Study: Results from a 10 Week, Two-Group Quasi-Experimental Family Meals Intervention.

Individuals from racial minority backgrounds, especially those in low income situations, are at increased risk for obesity. Family meals positively impact child nutritional health; however, there is limited evidence examining the impact on caregivers, particularly racial minority and income-restricted individuals. The objective of this intervention study was to determine the effect of Simple Suppers, a 10 week family meals program, on caregiver diet and nutrition outcomes. Intervention versus waitlist control participants were compared from baseline (T0) to post-intervention (T1). In addition, intervention participants were assessed at a 10 week follow-up time point (T2). This study was a two-group quasi-experimental intervention trial. Lessons (10 total) were delivered on a weekly basis for 90 min. Data were collected from intervention and waitlist control participants at T0 and T1, and intervention participants at T2. After baseline (T0) data collection, families enrolled in the immediate upcoming session of Simple Suppers (intervention group) or waited for 10 weeks (waitlist control group) to begin the program. Participants were caregivers of children ages 4-10 years. This study was conducted in a faith-based community center for underserved families in Columbus, Ohio. Primary outcomes were: diet quality assessed by Healthy Eating Index (HEI) total and component scores, and total energy intake (kcal/day); body mass index (BMI) (kg/m2), waist circumference (cm), systolic and diastolic blood pressure (BP) (mmHG); and self-efficacy for having healthy meals and menu planning (both scalar). The impact of the intervention (T0:T1) was assessed using generalized mixed-effects linear regression models. Maintenance of change in study outcomes among intervention participants (T1:T2) was examined with paired t-tests. 109 caregivers enrolled in this study. The retention rate at T1 was 90% (i.e., 98 participants). 56 of 68 intervention participants completed T2, resulting in a retention rate of 82%. Almost all (99%) were female, 61% were Black, and 50% were between 31 and 40 years old. In total, 40% had low income and 37% had low or very low food security. At T1, intervention vs. waitlist controls had a lower daily energy intake (p = 0.04), but an HEI-2010 component score for fatty acids (adequacy) that was lower indicating a lower dietary intake of fatty acids (p = 0.02), and a component score for empty calories (moderation) that was significantly lower indicating a higher intake of empty calorie foods (p = 0.03). At T1, intervention vs. waitlist controls also had a lower BMI (p < 0.001) and systolic BP (p = 0.04), and higher self-efficacy (p = 0.03). There were no group differences in other outcomes. At T2, intervention participants maintained the changes in daily energy intake, BMI, systolic BP, and self-efficacy that improved during the intervention period. There was no change (improvement) in the component score for fatty acids; however, the component score for empty calories significantly improved (p = 0.02). Engagement in the Simple Suppers program led to improvements in caregivers' daily caloric intake, weight status, systolic blood pressure, and self-efficacy for family meals. Future research should further explore the dietary and nutritional health benefits of family meals among caregivers at the highest risk for obesity.

Caregiver Perceptions of Environmental Facilitators and Barriers to Healthy Eating and Active Living during the Summer: Results from the Project SWEAT Sub-Study.

OBJECTIVE: The aim of this study was to examine caregiver perceptions of summertime neighborhood-level environmental barriers and facilitators to healthy eating and active living in their elementary-age racial minority children. METHODS: Caregivers with students in the prekindergarten-fifth grade were recruited from two schools located in low-income urban neighborhoods of Columbus, OH, with a predominantly Black population. Participants engaged in the research portion of the Healthy Eating Active Living: Mapping Attribute using Participatory Photographic Surveys (HEALth MAPPSTM) protocol, which included (1) orientation; (2) photographing and geotagging facilitators and barriers to HEALth on daily routes; (3) in-depth interview (IDI) discussing images and routes taken; (4) focus groups (FG). IDIs and FGs were transcribed verbatim. Analyses were guided by grounded theory and interpretive phenomenology and were coded by researchers (n = 3), who used comparative analysis to develop a codebook and determine major themes. RESULTS: A total of 10 caregivers enrolled and 9 completed the IDIs. Five caregivers participated in focus groups. A majority (77.8%, n = 7) of caregivers identified as Black, female (88.9%, n = 8), and low income (55.6%, n = 5). IDI and FG themes included (1) walkway infrastructure crucial for healthy eating and active living; (2) scarce accessibility to healthy, affordable foods; (3) multiple abandoned properties; (4) unsafe activity near common neighborhood routes. CONCLUSIONS: Caregivers perceived multiple neighborhood-level barriers to healthy eating and activity during the summer months when school is closed. Findings from this study provide initial insights into environmental determinants of unhealthy summer weight gain in a sample of predominantly racial minority school-age children from low-income households.

The Diet Quality of a Sample of Predominantly Racial Minority Children From Low-Income Households Is Lower During the Summer vs School Year: Results From the Project Summer Weight and Environmental Assessment Trial Substudy.

BACKGROUND: Little is known about the diet quality of racial minority children during the summertime when school is out of session and there is risk of accelerated weight gain. Project Summer Weight and Environmental Assessment Trial was an observational, prospective study exploring child weight status and health trends during the summer. OBJECTIVE: The objective of this substudy of Project Summer Weight and Environmental Assessment Trial was to examine the diet quality of elementary-aged racial minority children during the summertime vs school year. DESIGN: This observational, prospective substudy was conducted from June to September 2017. PARTICIPANTS/SETTING: Students in prekindergarten through fifth grade were recruited from 2 schools located in low-income urban neighborhoods of Columbus, OH, with a predominantly Black population. Sixty-two children (39 families) enrolled. MAIN OUTCOME MEASURES: Twenty-four-hour dietary recalls (2 weekdays, 1 weekend day) were collected at 3 time points: (1) beginning of summer (T0); (2) midsummer (T1); and (3) beginning of subsequent school year (T2). Healthy Eating Index (HEI)-2015 total and component scores were calculated to assess diet quality. Daily calories (kilocalories) and servings of types of foods within food groups were also assessed. STATISTICAL ANALYSES: Repeated measures analysis of variance and Tukey's post hoc analyses were performed. RESULTS: Retention was 76% (n = 47). Mean age was 7.0 ± 0.3 years, 79% (n = 37) were African American, and 58% of participants (n = 26) reported annual household incomes ≤$20,000. HEI-2015 total score was significantly lower during the summertime vs school year (P = .02). HEI-2015 component score for whole fruits (P = .04) was also lower in the summer vs school year, along with total vegetables (P < .001), greens and beans (P < .001) specifically, and legumes (P < .001). The HEI-2015 component score for added sugars (P = .04) was significantly lower in the summer vs the school year as well, indicating a higher intake of added sugars during the summer. On the other hand, whole grains were higher during the summer vs school year (P < .01), specifically snack chips (P = .03) and popcorn (P < .01). Total daily calories did not differ between the summertime vs school year. CONCLUSIONS: In a small sample of predominantly racial minority school-aged children from low-income households, child diet quality is better during the school year vs summer. Future research is needed to determine if and to what extent summer vs school year diet quality may be associated with differences in weight status.

Knowledge, Attitudes, and Practices Regarding Dietary Sodium in College Students.

OBJECTIVE: Test a dietary sodium survey in a US adult population of college students using a survey previously validated in a non-US adult population. METHODS: Cross-sectional study of a convenience sample of college students from a Midwest (n = 168) and Pacific Island (n = 152) university. Main outcome measures were knowledge, attitudes, and practices regarding dietary sodium (38 items). Sum scores and percentages for constructs were calculated. A score <75% was considered unfavorable; t test or ANOVA were used to examine group differences. RESULTS: Midwest students were primarily non-Hispanic White individuals (81%) and 65% female. Pacific Island students were predominantly Asian (51%) and 66% female. Mean ± SD construct scores (percentage) for knowledge, attitudes, and practices were 58.69 ± 10.62, 63.96 ± 16.18, 66.00 ± 12.34 (Midwest) and 57.54 ± 10.93, 64.84 ± 14.96, 64.94 ± 13.18 (Pacific Island), respectively; there were no significant differences between schools or race. CONCLUSIONS AND IMPLICATIONS: College students scored low in knowledge, attitudes, and practices regarding sodium. Results from this formative study may inform assessment strategies in future dietary sodium interventions.

Predicting the hotspots of age-adjusted mortality rates of lower respiratory infection across the continental United States: Integration of GIS, spatial statistics and machine learning algorithms.

OBJECTIVE: Although lower respiratory infections (LRI) are among the leading causes of mortality in the US, their association with underlying factors and geographic variation have not been adequately examined. METHODS: In this study, explanatory variables (n = 46) including climatic, topographic, socio-economic, and demographic factors were compiled at the county level across the continentalUS.Machine learning algorithms - logistic regression (LR), random forest (RF), gradient boosting decision trees (GBDT), k-nearest neighbors (KNN), and support vector machine (SVM) - were employed to predict the presence/absence of hotspots (P < 0.05) for elevated age-adjusted LRI mortality rates in a geographic information system framework. RESULTS: Overall, there was a historical shift in hotspots away from the western US into the southeastern parts of the country and they were highly localized in a few counties. The two decision tree methods (RF and GBDT) outperformed the other algorithms (accuracies: 0.92; F1-scores: 0.85 and 0.84; area under the precision-recall curve: 0.84 and 0.83, respectively). Moreover, the results of the RF and GBDT indicated that higher spring minimum temperature, increased winter precipitation, and higher annual median household income were among the most substantial factors in predicting the hotspots. CONCLUSIONS: This study helps raise awareness of public health decision-makers to develop and target LRI prevention programs.

Youth Mentor Dietary Outcomes and Waist Circumference Improvement: Camp NERF Study Findings.

Background. The health impact of youth mentors serving in the delivery of child nutrition and physical activity (PA) interventions on youth mentors themselves has been understudied. Objective. The primary objective of the current study was to examine the impact of engaging youth mentors in the delivery of a summertime childhood obesity prevention intervention on youth mentors' behavioral health. Method. Data were collected at baseline and postintervention. A survey of validated nutrition, mental health, PA, and psychosocial questionnaires was administered. Diet was assessed via 24-hour recall. Height, weight, and waist circumference (WC) were measured. In-depth interviews were conducted with youth mentors. Results. Eleven youth mentors enrolled: 60% were female, mean age was 16.1 ± 0.38 years, and 100% were Black. Mean kilocalories (p = .05), sugar-sweetened beverage intake (p = .08), and waist circumference (p = .04) decreased. In-depth interviews were conducted with 11 youth mentors, and three themes emerged: perceived improvement in nutrition, PA, and mental health-related behaviors; formation of a positive role modeling relationship with the child campers; and strengthening of higher education goals and future career aspirations. Conclusions. Youth mentor staffing may be an important intervention strategy for changing health behaviors among youth mentors. Results from this study can be used to inform utilization of youth mentors in the delivery of this and similar health behavior interventions in the future.

Child diet and health outcomes of the simple suppers program: a 10-week, 2-group quasi-experimental family meals trial.

BACKGROUND: Racial minority children, particularly from low-income households, are at risk for obesity. Family meals have a protective effect on child nutritional health. However, the current evidence is limited in racial and socioeconomic diversity. The objective of this study was to evaluate the impact of a family meals intervention, Simple Suppers, on improvements in diet and health outcomes from baseline (T0) to post-intervention (T1) in intervention compared to waitlist control participants, and determine retention of change in outcomes among intervention participants at 10-week follow-up (T2). METHODS: Simple Suppers was a 10-week family meals intervention implemented as a 2-group quasi-experimental trial. Ten 90-min lessons were delivered weekly. Data were collected at T0 and T1, and from intervention participants at T2. Participants were racially diverse 4-10 year-old children from low-income households. Setting was a faith-based community center. Main outcomes were daily servings of fruit, vegetables, and sugar-sweetened beverages and diet quality; z-scores for body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP); weight status categories; food preparation skills; and family meals (frequency of dinner, breakfast, TV viewing during meals, meals in dining area). Generalized linear mixed models (GLMMs) and mixed-effects ordinal regression models were used to assess intervention impact (T0:T1). Paired t-tests examined retention of change among intervention participants (T1:T2). RESULTS: One hundred forty children enrolled and 126 completed T1 (90% retention); 71 of 87 intervention participants completed T2(79% retention). Mean (SD) age was 6.9(1.9) yr, 62% female, 60% Black, and 42% low-income. Intervention vs waitlist controls had higher food preparation skills (p < 0.001) and lower TV viewing during meals (p = 0.04) at T1.There were no group differences in dietary intake or quality or z-scores for BMI, waist circumference, or BP, however intervention versus waitlist controls experienced a greater change toward healthy weight (p = 0.04) At T2, intervention participants demonstrated a retention of improved food preparation skills. CONCLUSIONS: Simple Suppers led to improvements in children's weight status, food preparation skills, and TV viewing during meals, but not diet or z-scores for BMI, waist circumference, or BP. Future research should examine the preventive effects of healthy family mealtime routines in children at greatest risk for obesity. TRIAL REGISTRATION: NCT02923050; Simple Suppers Scale-up (S3); Retrospectively registered on Oct 2016; First participant enrolled on Jan 2015.

Food Parenting Practices That Influence Early Adolescents' Food Choices During Independent Eating Occasions.

OBJECTIVE: To identify practices that parents use to influence early adolescents' food choices during independent eating occasions (iEOs) from parent and child perspectives. DESIGN: In-depth interviews. PARTICIPANTS: Low-income parents (n = 49) and early adolescent children (aged 10-13 years; n = 44) from 10 US states and the District of Columbia. PHENOMENON OF INTEREST: Parent and child perspectives on parenting practices that influence food choices during iEOs. ANALYSIS: Audio-recorded interviews transcribed verbatim, NVivo coding, and directed content analysis. RESULTS: Parents reported setting rules and expectations and managing availability or accessibility as the most common practices used to influence iEOs. Other practices included teaching, pressuring to eat, monitoring, and modeling. Children reported that their parents had rules about what they could or could not eat during iEOs and that they used specific strategies (eg, call or text) to monitor their iEOs. CONCLUSIONS AND IMPLICATIONS: Additional studies are needed to confirm findings from this exploratory study. Future cross-sectional and longitudinal studies could determine whether and to what extent food parenting practices identified in the current study are associated with healthy dietary intake during iEOs, as well as potential racial and ethnic differences.

Participation in structured programming may prevent unhealthy weight gain during the summer in school-aged children from low-income neighbourhoods: feasibility, fidelity and preliminary efficacy findings from the Camp NERF study.

OBJECTIVE: Evaluate the feasibility, fidelity and preliminary efficacy of Camp NERF to prevent unhealthy weight gain and promote healthy behaviours in children during the summer. DESIGN: Camp NERF was an 8-week, multicomponent, theory-based programme coupled with the US Department of Agriculture's Summer Food Service Program. Twelve eligible elementary-school sites were randomized to one of three treatment groups: (i) Active Control (non-nutrition, -physical activity (PA), -mental health); (ii) Standard Care (nutrition and PA); or (iii) Enhanced Care (nutrition and PA, plus cognitive behavioural techniques) programming. Efficacy was determined by assessing mean change by group in child outcomes using hierarchical linear regression models. SETTING: Low-income, urban neighbourhoods in Columbus, OH, USA.ParticipantsEconomically disadvantaged, racial minority children of elementary school age (kindergarten-5th grade). RESULTS: Eighty-seven child-caregiver dyads consented; eighty-one completed pre- and post-intervention assessments resulting in a 93·10 % retention rate. Delivery of the intended lesson occurred 79-90 % of the time. Of the children, 56·98 % (n 49) were female; 89·53 % (n 77) were Black. Overall mean change in BMI Z-score from baseline to post-intervention was -0·03 (se 0·05); change in BMI Z-score did not differ significantly between treatment group. Change in nutrition, PA, mental health or psychosocial outcomes did not differ between groups. CONCLUSIONS: Results from the current study demonstrate feasibility and fidelity, yet no intervention effect of Camp NERF. Instead, findings suggest that participation in structured programming of any type (health behaviour-related or not) may prevent unhealthy summer weight gain. Additional studies are needed to confirm findings. Results have implications for child nutrition policy addressing the issue of summer health.

Feasibility and acceptability of technology-based caregiver engagement strategies delivered in a summertime childhood obesity prevention intervention: results from an internal pilot of the Camp NERF (Nutrition, Education, Recreation, and Fitness) study.

BACKGROUND: The most efficacious childhood obesity prevention interventions have involved caregivers directly or indirectly. Due to the high reliance on technology, research examining technological intervention approaches is warranted, particularly during the summer when parents may be more difficult to engage and the risk for excess weight gain among children is high. METHODS: The feasibility and acceptability of a multi-component childhood obesity prevention intervention incorporating a caregiver component utilizing technology-based approaches-texting and social media-was explored. This was an internal pilot of the Camp Nutrition Education Recreation and Fitness (NERF) study, a group RCT for school-age children coupled to the USDA Summer Food Service Program. Feasibility and acceptability of the technology caregiver engagement component were assessed via process outcomes (participation rates) and in-depth interviews. RESULTS: Participants (n = 37) were 91.9% female, 91.8% Black, 58.7% low-income, and 75.0% overweight/obese. Participation rates in texting and social media were 62.2% and < 3%, respectively. Themes emerged from the in-depth interviews were texting provides connection; desire more involvement with program; fear social media privacy intrusion. CONCLUSIONS: Results will be used to inform changes to technology-based caregiver engagement strategies to be tested in future interventions. TRIAL REGISTRATION: Clinical Trials, NCT02908230/09-19-2016. Registered 20 September 2016.

Project SWEAT (Summer Weight and Environmental Assessment Trial): study protocol of an observational study using a multistate, prospective design that examines the weight gain trajectory among a racially and ethnically diverse convenience sample of economically disadvantaged school-age children.

INTRODUCTION: Racial/ethnic minority school-age children are at risk for unhealthy weight gain during the summer, and there is a dearth of information regarding the underlying behavioural and environmental factors. The study objective is to provide an in-depth examination of dietary and physical activity behaviours and food, physical activity, and social environments of African American and Hispanic school-age children during the summer. METHODS AND ANALYSIS: An observational study will be conducted using a multistate (Ohio and Indiana, USA) prospective design examining the weight gain trajectory among a racially/ethnically diverse convenience sample of economically disadvantaged school-age children. In addition, a subset of these children will be evaluated to learn their daily health behaviours and food, physical activity, and social environments during the summer. Comparisons will be made between children who routinely attend programming and those who do not, both in the larger sample and subset. Determinants of programme participation and factors that may enhance the beneficial effects of programme participation will also be identified. Data collection at the Indiana site is planned for summer 2018. ETHICS AND DISSEMINATION: This study is approved by The Ohio State University Behavioral and Social Sciences Institutional Review Board. Results from this study will be disseminated in publications for practitioners, scientists and stakeholders. TRIAL REGISTRATION NUMBER: NCT03010644; Pre-results.

Psychosocial Determinants of Food Acquisition and Preparation in Low-Income, Urban African American Households.

BACKGROUND: Psychosocial factors are important determinants of health behaviors and diet-related outcomes, yet relatively little work has explored their relation to food-purchasing and preparation behaviors in low-income populations. AIM: To evaluate the psychosocial factors associated with food-related behaviors. METHODS: Cross-sectional data collected from 465 low-income African American adult caregivers in the baseline evaluation of the B'more Healthy Communities for Kids obesity prevention trial. Questionnaires were used to assess household sociodemographic characteristics, food sources frequently used, and food preparation and food acquisition behaviors. Multiple linear regression models explored the associations between caregiver psychosocial variables and food-related behaviors, controlling for caregivers' age, sex, household income, household size, and food assistance participation. RESULTS: Caregivers purchased prepared food at carry-outs on average 3.8 times (standard deviation [ SD] = 4.6) within 30 days. Less healthy foods were acquired 2 times more frequently than healthier foods ( p < .001). Higher food-related behavioral intention and self-efficacy scores were positively associated with healthier food acquisition (ß = 0.7; 95% confidence interval [CI] [0.09, 1.4]; ß = 0.04; 95% CI [0.02, 0.06]) and negatively associated with frequency of purchasing at prepared food sources (ß = -0.4; 95% CI [-0.6, -0.2]; ß = -0.5; 95% CI [-0.7, -0.3]), respectively. Higher nutrition knowledge was associated with lower frequency of purchasing food at prepared food venues (ß = -0.7; 95% CI: [-1.2, -0.2]). DISCUSSION: Our findings indicate a positive association between psychosocial determinants and healthier food acquisition and food preparation behaviors. CONCLUSION: Interventions that affect psychosocial factors (i.e., food-related behavioral intentions and self-efficacy) may have the potential to increase healthier food preparation and food-purchasing practices among low-income African American families.

Breakfast Consumption Frequency and Its Relationships to Overall Diet Quality, Using Healthy Eating Index 2010, and Body Mass Index among Adolescents in a Low-Income Urban Setting.

The aim of this study was to describe the relationship of breakfast frequency to diet quality and BMI among low-income, predominantly African American adolescents aged 9-15 (n = 239). Mean frequency of breakfast consumption was 5.0 ± 0.15 times per week. A significant, positive relationship was seen between HEI scores and frequency of breakfast consumption (p = .01). Dairy (p = .02) and whole grains (p < .01) HEI component scores were significantly related to breakfast frequency. No relationship was seen between breakfast frequency and BMI. Research with more rigorous designs should be conducted to assess the potential effects of breakfast consumption on diet quality in this population.

Securing a Stop to the Summer Setback: Policy Considerations in the Future Expansion of the Summer Electronic Benefit Transfer for Children.

The Summer Electronic Benefits Transfer for Children (SEBTC) has been proposed as a solution to address the problem of child food security during the summer. Initial SEBTC findings from a demonstration project show promise and the federal government has approved substantial funding for its continuation. This report reviews empirical assessments of SEBTC and Electronic Benefits Transfer research, and presents policy considerations in the program's future expansion.

Inconsistency between Self-Reported Energy Intake and Body Mass Index among Urban, African-American Children.

BACKGROUND: To prevent obesity, it is important to assess dietary habits through self-reported energy intake (EI) in children. We investigated how EI is associated with body mass index and which elements of dietary habits and status are associated with EI among African-American (AA) children. METHODS: We assessed and included data from 218 10-14-year-old AA children in Baltimore, MD, USA. EI was calculated using a food frequency questionnaire. The basal metabolic rate (BMR) was used as the predicted minimal rate of energy expenditure of children. A fully adjusted multiple logistic regression was used to determine the prevalence of obesity (≥ 95th BMI-for-age percentile) among the quartiles of EI/BMR ratio using the third quartile for the reference. The differences in the age-adjusted mean EI/BMR among the categories of dietary habits, social support, and socio economic status were analyzed using a general linear model. RESULTS: Children with the lowest EI/BMR had significantly higher adjusted odds ratio (aOR) of obesity as compared to those in the third quartile of EI/BMR (boys aOR 4.3; 95% confidence interval 1.08, 20 and girls aOR 4.1; 1.02, 21). In girls, the adjusted mean EI/BMR in the group that prepared food less than the means (3.8 times/week) was significantly lower than the group that prepared food over the means (P = 0.03). Further, the group that reported eating breakfast under 4 times/week indicated an adjusted mean EI/BMR lower than the group that ate breakfast over 5 times/week in both sexes. CONCLUSIONS: When EI was under-reported with reference to BMR, we may observe high prevalence of obesity. Further, food preparation by children and frequent consumption of breakfast may instill food cognition with usual dietary habits. Therefore, holistic assessments including dietary habits are required to examine self-reported food intake especially among overweight/obese children.

Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months.

BACKGROUND: The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess. METHODS: Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected. DISCUSSION: This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk. TRIAL REGISTRATION: NCT02908230/09-19-2016.

A Historical Review of Changes in Nutrition Standards of USDA Child Meal Programs Relative to Research Findings on the Nutritional Adequacy of Program Meals and the Diet and Nutritional Health of Participants: Implications for Future Research and the Summer Food Service Program.

BACKGROUND: The USDA child meal programs (CMPs) (National School Lunch Program (NSLP), School Breakfast Program (SBP), and Summer Food Service Program (SFSP) were established in 1946 (NSLP) and 1975 (SBP and SFSP) to improve the diet and nutritional health of US children. There is concern that participation in these programs may in fact be a contributor to the current childhood obesity epidemic. OBJECTIVE: The purpose of this study was to determine if the CMPs are meeting their intended goal by reviewing the historical changes to nutrition standards of the CMPs in correspondence with the literature that examines the nutritional adequacy of meals served as part of these programs, as well as the dietary intakes and nutritional status of participants. METHODS: Public Law and the Federal Register were reviewed and websites and online databases were systematically searched. RESULTS: NSLP and SBP first underwent updates to the nutrition standards in 1994 and subsequently 2010, whereas SFSP last underwent modifications in 2000. The majority of data, all collected prior to 2010, demonstrate that meals served as part of the NSLP and SBP are not meeting nutrition standards. In addition, the dietary intakes of NSLP and SBP participants are high in calories, fat, saturated fat, and sodium, and low in fiber. Studies examining the weight status and other nutrition-related health outcomes of NSLP and SBP participants have produced mixed results. In contrast, no studies published in the peer-reviewed literature have been conducted examining the nutritional adequacy of SFSP meals or the dietary intakes or nutritional health of SFSP participants. There are public reports available on the nutritionally adequacy of SFSP meals, however, they are severely outdated (1988 and 2003). Due to this dearth of information, a case study on a sample SFSP menu from summer 2015 was conducted; results showed that the meals are high in carbohydrate and protein content and insufficient in vegetable servings. CONCLUSIONS: There is critical need for policy change that would enable updates to the SFSP nutrition standards to match those of the NSLP and SBP. In addition, strategies are needed to facilitate development of CMP menus that meet current nutrition standards. Finally, rigorously designed studies are needed to understand the direct impact of CMP participation on child diet and health, particularly the SFSP for which there is limited published data.