Christopher J. Finney

Nonsignificant Relationship between Participation in School-Provided Meals and Body Mass Index during the Fourth-Grade School Year

Data from four cross-sectional studies involving fourth-grade children were analyzed to investigate the relationship between participation in school-provided meals and body mass index (BMI), and the effect observed energy intake has on that relationship. Participation and BMI data were available on 1,535 children (51% black; 51% girls) for 4 school years (fall 1999 to spring 2003; one study per school year) at 13 schools total. Direct meal observations were available for a subset of 342 children (54% black; 50% girls) for one to three breakfasts and one to three lunches per child for a total of 1,264 school meals (50% breakfast). Participation in breakfast, lunch, and combined (both meals on the same day) was determined from nametag records compiled for meal observations for each study. Weight and height were measured. A marginal regression model was fit with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, combined participation, sex, age, race, and study. For the subset of children, observed energy intake at breakfast, lunch, and combined was included in additional analyses. Participation in breakfast, lunch, and combined was not significantly associated with BMI regardless of whether analyses included observed energy intake (P values >0.181). The relationship between observed energy intake at breakfast and lunch, separately and combined, with BMI was positive (P values <0.01). In conclusion, these results do not support a relationship between school-meal participation and BMI but do support a relationship between observed energy intake at school meals and BMI during fourth grade.

Effectiveness of Prompts on Fourth-Grade Children's Dietary Recall Accuracy Depends on Retention Interval and Varies by Gender

BACKGROUND Dietary recall accuracy is related to retention interval (RI) (i.e., time between to-be-reported meals and the interview), and possibly to prompts. To the best of our knowledge, no study has evaluated their combined effect. OBJECTIVE The combined influence of RI and prompts on childrens recall accuracy was investigated in this study. Two RIs [short (prior-24-h recall obtained in afternoon) and long (previous-day recall obtained in morning)] were crossed with 4 prompts [forward (distant-to-recent), meal-name (breakfast, lunch, etc.), open (no instructions), and reverse (recent-to-distant)], creating 8 conditions. METHODS Fourth-grade children (n = 480; 50% girls) were randomly selected from consenting children at 10 schools in 4 districts in a southern state during 3 school years (2011-2012, 2012-2013, and 2013-2014). Each child was observed eating school-provided breakfast and lunch, and interviewed one time under 1 of the 8 conditions. Condition assignment was constrained so that each had 60 children (30 girls). Accuracy measures were food-item omission and intrusion rates, and energy correspondence rate and inflation ratio. For each measure, linear models determined effects of RI, prompt, gender, and interactions (2-way, 3-way); race/ethnicity, school year, and district were control variables. RESULTS RI (P values < 0.015) and prompt (P values < 0.005) were significant for all 4 accuracy measures. RI × prompt (P values < 0.001) was significant for 3 accuracy measures (not intrusion rate). Prompt × gender (P = 0.005) was significant for omission rate. RI × prompt × gender was significant for intrusion rate and inflation ratio (P values < 0.001). For the short vs. long RI across prompts and genders, accuracy was better by 33-50% for each accuracy measure. CONCLUSIONS To obtain the most accurate recalls possible from children, studies should be designed to use a short rather than long RI. Prompts affect childrens recall accuracy, although the effectiveness of different prompts depends on RI and varies by gender: at a short RI, the choice of prompts has little systematic effect on accuracy, whereas at a long RI, reverse prompts may elicit the most accurate recalls.

Cognitive ability, social desirability, body mass index and socioeconomic status as correlates of fourth-grade children’s dietary-reporting accuracy

Background/Objectives:To investigate the relationship of reporting accuracy in 24-h dietary recalls to child-respondent characteristics—cognitive ability, social desirability, body mass index (BMI) percentile and socioeconomic status (SES).Subjects/Methods:Fourth-grade children (mean age 10.1 years) were observed eating two school meals and interviewed about dietary intake for 24 h that included those meals. (Eight multiple-pass interview protocols operationalized the conditions of an experiment that crossed two retention intervals—short and long—with four prompts (ways of eliciting reports in the first pass)). Academic achievement-test scores indexed cognitive ability; social desirability was assessed by questionnaire; height and weight were measured to calculate BMI; nutrition-assistance program eligibility information was obtained to index SES. Reported intake was compared to observed intake to calculate measures of reporting accuracy for school meals at the food-item (omission rate; intrusion rate) and energy (correspondence rate; inflation ratio) levels. Complete data were available for 425 of 480 validation-study participants.Results:Controlling for manipulated variables and other measured respondent characteristics, for one or more of the outcome variables, reporting accuracy increased with cognitive ability (omission rate, intrusion rate, correspondence rate, P<0.001), decreased with social desirability (correspondence rate, P<0.0004), decreased with BMI percentile (correspondence rate, P=0.001) and was better by higher- than by lower-SES children (intrusion rate, P=0.001). Some of these effects were moderated by interactions with retention interval and sex.Conclusions:Children’s dietary-reporting accuracy is systematically related to such respondent characteristics as cognitive ability, social desirability, BMI percentile and SES.

Retention Interval and Prompts: Creation and Cross-Sectional Pilot-Testing of Eight Interview Protocols to Obtain 24-Hour Dietary Recalls from Fourth-Grade Children.

BACKGROUND Any 24-hour dietary recall (24hDR) has a retention interval and prompts. No research has investigated their combined effect. OBJECTIVE Eight 24hDR protocols, constructed by crossing two retention intervals (prior-24-hour recall obtained in afternoon and previous-day recall obtained in morning) with four prompts (forward [distant-to-recent], reverse [recent-to-distant], meal-name [eg, breakfast, lunch, etc], and open [no instructions]), were pilot-tested. DESIGN Via a cross-sectional design, children were interviewed once, using one of eight 24hDR protocols. PARTICIPANTS/SETTING Forty-eight fourth-grade children (79% black; 50% girls; six per protocol) were randomly selected from two schools during spring 2011. Protocol assignment was random. Analyses excluded one interview due to protocol deviation. STATISTICAL ANALYSES PERFORMED Multivariate analysis of variance (MANOVA) with four nonaccuracy-related response variables was conducted, with independent variables retention interval, prompt, and their interaction. The significance level was 0.10 due to the studys exploratory nature. RESULTS The response variable set differed across retention intervals (P=0.0003) and prompts (P=0.045) but not their interaction (P=0.11). Follow-up analysis of variance for each of four variables showed differences by retention interval for three and prompt for two: Interview length (minutes) differed by retention interval (prior-24-hour-afternoon=21.8, previous-day-morning=16.1; P<0.0008) and prompt (open=20.3, reverse=20.0, forward=19.1, and meal-name=16.3; P=0.079). Number of school meals reported eaten during the target period did not depend on retention interval or prompt, but was greater using meal-name prompts (1.7) than the other three prompts (1.3; P=0.055; contrast t test). Number of 10 possible meal components reported eaten at school meals differed by retention interval (prior-24-hour-afternoon=4.1, previous-day-morning=2.9; P=0.048). Weighted number of items (condiment=0.33, combination entrée=2.0, and else=1.0) reported eaten at school meals differed by retention interval (prior-24-hour-afternoon=5.8, previous-day-morning=4.1; P=0.079) and prompt (forward=6.2, meal-name=5.3, reverse=4.9, and open=3.3; P=0.093). CONCLUSIONS Childrens nonaccuracy-related responses to eight 24hDR protocols varied as hypothesized. The selected protocols will be useful in a planned validation study to investigate differences by protocol in childrens recall accuracy.

Secondary analyses of data from 4 studies with fourth-grade children show that sex, race, amounts eaten of standardized portions, and energy content given in trades explain the positive relationship between body mass index and energy intake at school-provided meals.

Results from a 2012 article showed a positive relationship between childrens body mass index (BMI) and energy intake at school-provided meals. To help explain that positive relationship, secondary analyses investigated (1) whether the relationship differed by sex and race and (2) the relationship between BMI and 6 aspects of school-provided meals--amounts eaten of standardized portions, energy content given in trades, energy intake received in trades, energy intake from flavored milk, energy intake from a la carte ice cream, and breakfast type. Data were from 4 studies conducted 1 per school year (1999-2000 to 2002-2003). Fourth-grade children (n = 328; 50% female; 54% black) from 13 schools total were observed eating school-provided breakfast and lunch on 1 to 3 days per child for 1178 total meals (50% breakfast). Children were weighed and measured. Marginal regression models were fit using BMI as the dependent variable. For purpose 1, independent variables were energy intake at school-provided meals, sex, race, age, and study; additional models included interaction terms involving energy intake and sex/race. For purpose 2, independent variables were the 6 aspects of school-provided meals, sex, race, age, and study. The relationship between BMI and energy intake at school-provided meals differed by sex (P < .0001; stronger for females) and race (P = .0063; stronger for black children). BMI was positively related to amounts eaten of standardized portions (P < .0001) and negatively related to energy content given in trades (P = .0052). Explaining the positive relationship between BMI and energy intake at school-provided meals may contribute to school-based obesity prevention efforts.

Test-Retest Reliability of the National Health and Nutrition Examination Survey's 5-Item Food Insecurity Questionnaire Completed by Fourth-Grade Children

OBJECTIVE To examine test-retest reliability and internal consistency of a 5-item food insecurity questionnaire used in the National Health and Nutrition Examination Survey (NHANES). METHODS Researchers administered NHANESs questionnaire in the classroom to 92 fourth-grade children (74 African American; 48 girls) in 2 sessions 27-30 days apart in spring, 2011. Each classroom administration lasted 5-10 minutes. RESULTS Test-retest reliability was 0.66 (Kendall tau), which is modest. Internal consistency (Cronbach alpha) was .67 and .70 for respective administrations. Food insecurity scores were related to gender (adjusted P = .05) and academic achievement (adjusted P = .004) but not to socioeconomic status or body mass index percentile (binomial regression). On average, boys reported higher food insecurity than girls. Children with lower academic achievement scores reported higher food insecurity than children with higher academic achievement scores. CONCLUSIONS AND IMPLICATIONS NHANESs 5-item questionnaire may be group administered to assess food insecurity efficiently as reported by individual fourth-grade children.

The National Health and Nutrition Examination Survey’s Food Insecurity Questionnaire Completed by Children: Effects of Assessment Mode (Classroom Versus Interview)

ABSTRACT The National Health and Nutrition Examination Survey’s food insecurity questionnaire was administered to 155 children (77 African American, 65 white, 13 “other” [7 Hispanic; 6 mixed races]) in grade 4 twice, 28–32 days apart. Test-retest reliabilities were modest and somewhat similar for assessment mode (classroom, interview) and subgroup variables (gender, race, socioeconomic status, academic achievement, body mass index percentile, social desirability). As academic achievement increased, white and other children reported less food insecurity, and African American children reported slightly less. As social desirability increased, white and African American children reported slightly more food insecurity, and other children reported substantially more. Although the questionnaire may be acceptable for use with diverse groups of children in grade 4, validation is needed.