Gail Kaye

Improving Patrons' Meal Selections Through the Use of Point-of-Selection Nutrition Labels

OBJECTIVES We examined changes in meal selection by patrons of university food-service operations when nutrition labels were provided at the point of selection. METHODS We used a quasi-experimental, single-group, interrupted time-series design to examine daily sales before, during, and after provision of point-of-selection nutrition labels. Piecewise linear regression was employed to examine changes in the average energy content of entrées and a paired t test was used to detect differences in sales across the periods. RESULTS The average energy content of entrées purchased by patrons dropped immediately when nutrition labels were made available at point of selection and increased gradually when nutrition information was removed. There was no significant change in number of entrées sold or in revenues between the 2 periods. CONCLUSIONS Use of nutrition labels reduced the average energy content of entrées purchased without reducing overall sales. These results provide support for strengthening the nutrition labeling policy in food-service operations.

An Evaluation of the Validity and Reliability of a Food Behavior Checklist Modified for Children

OBJECTIVE The objective of this study was to report the construct validity and internal consistency reliability of the Food Behavior Checklist modified for children (FBC-MC), with low-income, Youth Expanded Food and Nutrition Education Program (EFNEP)-eligible children. METHODS Using a cross-sectional research design, construct validity was assessed using confirmatory factor analysis (weighted least squares method), and internal consistency reliability for 3 subscales was assessed using Cronbach alpha. RESULTS Ninety-seven children from low-income families completed the FBC-MC. Indicator tests suggest adequate model fit (comparative fit index = 0.962; root mean square error of approximation = 0.064) and item factor loadings were significant for all subscales (P < .05). The instrument appeared to have adequate reliability for 1 subscale (fruit and vegetable consumption, alpha = 0.67), but not for the other 2 (milk consumption, alpha = 0.43; healthful eating behaviors, alpha = 0.56). CONCLUSIONS AND IMPLICATIONS The FBC-MC may be a suitable instrument for evaluating dietary behaviors among Youth EFNEP-eligible children; however, more work is needed to establish internal reliability and criterion validity.

An Evaluation of Holiday Weight Gain Among Elementary-aged Children

Background Previous studies suggest adults gain extra weight during the holiday season, however, few studies have been done with children during this time. The purpose of this study was to evaluate gains in growth among elementary children, and compare differences by gender and weight status. Methods Children’s (n = 90) height and weight were measured before and after their holiday break. Height, weight and body mass index (BMI) and body mass index-percentiles (BMI-%) were evaluated and compared by groups using repeated measures ANCOVA’s. Results On average, children grew 0.82 cm (0.32 in), and gained 0.56 kg (1.2 lbs) and 0.28 BMI units, however the average BMI-% slightly decreased by 0.4%. Overweight and obese children gained significantly more weight, BMI units and BMI-% units compared with normal weight children. Conclusions This study supports that the holiday period may be an important time to target children, especially those who are already overweight and obese. Keywords Holiday weight gain; Childhood obesity

Diet qualities: healthy and unhealthy aspects of diet quality in preschool children

BACKGROUND Diet quality indexes combine the healthy and unhealthy aspects of diet within a single construct, but few studies have evaluated their association. Emerging evidence suggests that predictors differ for the more and less healthy components of childrens diets. OBJECTIVES Our objectives were to determine whether preschool-aged childrens frequency of eating healthy foods was inversely related to their intake of unhealthy foods and to determine whether this differed by household income, maternal education, or child race-ethnicity. DESIGN We analyzed data from a representative sample of 8900 US children (mean age: 52.5 mo) who were born in 2001 and participated in the Early Childhood Longitudinal Study-Birth Cohort. Primary caregivers reported the frequency with which children consumed fruit, vegetables, milk, juice, sugar-sweetened beverages (SSBs), fast food, sweets, and salty snacks in the past week. Response options ranged from none to ≥4 times/d. We created healthy (fruit, vegetables, milk) and unhealthy (SSBs, fast food, sweets, salty snacks) diet scores. Healthy diet behaviors were defined as ≥2 daily servings of fruit, vegetables, and milk. RESULTS The prevalence of consuming fruit, vegetables, and milk ≥2 times/d (i.e., having 3 healthy diet behaviors) was 18.5%, and a similar proportion (17.6%) of children had none of these healthy behaviors. Contrary to our hypotheses, children with more healthy diet behaviors did not have lower unhealthy diet scores. The intake of healthy foods was not inversely associated with unhealthy foods overall or within any subgroup. Overall, the Spearman rank correlation between healthy and unhealthy diet scores was positive (r = 0.09). From the lowest to the highest strata of household income, these correlations were 0.12, 0.14, 0.14, 0.05, and 0.00, respectively. CONCLUSIONS No evidence was found in US preschool-aged children of an inverse association between eating healthy and unhealthy foods. The implications of combining healthy and unhealthy aspects of diet quality within an overall index should be considered by researchers.

An Evaluation of Reach for a Work Site Implementation of the National Diabetes Prevention Program Focusing on Diet and Exercise

Purpose: Our objective is to evaluate the “reach” component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program. Design: A cross-sectional study design was used. Setting: The setting was a large health system in the Midwest. Participants: Prediabetic health plan enrollees and spouses (N = 2158). Measures: An online health survey, annual voluntary biometric screenings delivered by a trained health-care professional using standardized protocols via point-of-care testing, and records from the DPP office were the sources of data for this study. Analysis: Health behaviors and biometric screening results were simultaneously compared using multivariable logistic regression. Results: The study population was 63% female, 79% white, and 16% black, and the mean age was 50.2 years (SD = 10.2). The reach of this program was 10%. Prediabetics were more likely to express interest in the DPP, if they were female (adjusted odds ratio [AOR]: 2.4; 95% confidence interval [95% CI]: 1.55-3.72; P < .001), black (AOR = 2.23; 95% CI: 1.43-3.47; P < .001), older in age (AOR: 1.08; 95% CI: 0.99-1.17; P = .05), or had a high-risk waist circumference (AOR = 1.44; 95% CI: 0.98-2.13; P = .07), lower self-efficacy to make healthy changes (AOR = 0.48; 95% CI: 0.26-0.91; P = .03), and 5 or more doctor visits in the last year (AOR = 2.13; 95% CI: 0.99-4.57; P = .05), after controlling for other covariates. Conclusion: Current recruitment and implementation strategies are reaching only a small group of individuals who are not representative of the larger prediabetic population. These findings inform future engagement strategies, and we recommend that public health practitioners evaluate reach to ensure that health promotion programs are of high value.