Katy Tapper

Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children

Objective: To measure childrens consumption of, and liking for, fruit and vegetables and how these are altered by a peer modelling and rewards-based intervention.Design: In this initial evaluation of the programme, childrens consumption of fruit and vegetables were compared within and across baseline and intervention phases.Setting: Three primary schools in England and Wales.Subjects: In total, 402 children, aged from 4 to 11 y.Interventions: Over 16 days, children watched six video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves.Main outcome measures: Fruit and vegetable consumption was measured (i) in school at lunchtime and snacktime using a five-point observation scale, with inter-rated reliability and weighed validation tests; and (ii) at home using parental recall. A questionnaire measured childrens liking for fruit and vegetables before and after the intervention.Results: Consumption during the intervention was significantly higher than during baseline at lunchtime and at snacktime (P<0.001 in all instances). Consumption outside school was significantly higher during the intervention on weekdays (P<0.05) but not weekend days. Following the intervention, childrens liking for fruit and vegetables also showed a significant increase (P<0.001).Conclusions: The peer modelling and rewards-based intervention was shown to be effective in bringing about substantial increases in childrens consumption of, and expressed liking for, fruit and vegetables.Sponsorship: Horticultural Development Council, Fresh Produce Consortium, ASDA, Co-operative Group, Safeway, Sainsbury, Somerfield, Tesco and Birds Eye Walls.

Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention

Objective: To evaluate a peer-modelling and rewards-based intervention designed to increase childrens fruit and vegetable consumption.Design: Over a 5-month period, children in an experimental and a control school were presented with fruit and vegetables at lunchtime. Children aged 5–7 y also received fruit at snacktime (mid-morning). The intervention was implemented in the experimental school and levels of fruit and vegetable consumption were measured at baseline, intervention and at 4-month follow-up.Setting: Two inner-city London primary schools.Subjects: In total, 749 children aged 5–11 y.Intervention: Over 16 days children watched video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. After 16 days there were no videos and the rewards became more intermittent.Main outcome measures: Consumption was measured (i) at lunchtime using a five-point observation scale; (ii) at snacktime using a weighed measure; (iii) at home using parental recall.Results: Compared to the control school, lunchtime consumption in the experimental school was substantially higher at intervention and follow-up than baseline (P<0.001), while snacktime consumption was higher at intervention than baseline (P<0.001). The lunchtime data showed particularly large increases among those who initially ate very little. There were also significant increases in fruit and vegetable consumption at home (P<0.05).Conclusions: The intervention was effective in bringing about substantial increases in childrens consumption of fruit and vegetables.Sponsorship: Horticultural Development Council, Fresh Produce Consortium, ASDA, Co-operative Group, Safeway, Sainsbury, Somerfield, Tesco and Birds Eye Walls.

Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention.

Background/Objectives:Previous research in the United Kingdom, where there is a school canteen system, has shown that the Food Dudes intervention substantially increases childrens fruit and vegetable consumption. The current study evaluated its effectiveness in Ireland where school meals are not provided and children bring food to school in lunchboxes.Subjects/Methods:Participants were 4- to 11-year-old children attending two primary schools; the schools were randomly assigned to experimental or control conditions (n=228 and 207, respectively). During the 16-day intervention in the experimental school, children watched video adventures featuring the heroic Food Dudes, and received small rewards for eating fruit and vegetables provided. In both schools, parental provision and childrens consumption of fruit and vegetables in the lunchboxes were assessed at baseline and 12-month follow-up (Lunchbox measures). Fruit and vegetables were provided in both schools over an 8-day baseline phase and the 16-day intervention, and childrens consumption was measured (school-provided food measures).Results:Relative to baseline, consumption of the school-provided foods increased during the intervention in the experimental school (P<0.001), whereas in the control school it showed a significant decline. At 12-month follow-up, parents in the experimental school provided and their children consumed significantly more lunchbox fruit, vegetables and juice relative to baseline and to the control school (P<0.001 in all instances).Conclusions:The Food Dudes intervention was effective in changing parental provision and childrens consumption of lunchbox fruit and vegetables in Ireland.

The impact of school fruit tuck shops and school food policies on children's fruit consumption: A cluster randomised trial of schools in deprived areas.

Aims: To estimate the impact of school fruit tuck shops on children’s consumption of fruit and sweet and savoury snacks. Design: Cluster randomised effectiveness trial with school as the unit of randomisation. Setting: 43 primary schools in deprived areas in south Wales and south-west England with a range of school food policies. Intervention: Schools operated fruit tuck shops throughout one academic year. Control schools did not do so. Measures: Repeated cross-sections of children aged 9–11 years completed a computerised 24-hour recall questionnaire at baseline (n = 1902) and at 1-year follow-up (n = 1924), when a brief questionnaire was also completed (n = 1976). Results: Approximately 70 000 fruits were sold in the 23 intervention schools over the year, equivalent to 0.06 fruits per student per day. Children in intervention schools were more likely to report eating fruit as a snack at school ‘often’ (OR 1.49, 95% CI 1.15 to 1.95). There were no significant differences in children’s intake of fruit or other snacks. There was a significant interaction (p<0.02) between the intervention group and school food policy: where students were only allowed to bring fruit to school, fruit consumption was 0.37 portions per day (0.11 to 0.64) higher in intervention schools, compared to 0.14 portions (−0.30 to 0.58) where no food was allowed and −0.13 portions (−0.33 to 0.07) where there were no restrictions. Conclusions: In isolation, fruit tuck shops were not effective in changing children’s snacking behaviour in schools. However, the results suggest that fruit tuck shops had a greater impact when reinforced by school policies restricting the types of foods students were allowed to bring to school.

Cognitive Biases to Healthy and Unhealthy Food Words Predict Change in BMI

The current study explored the predictive value of cognitive biases to food cues (assessed by emotional Stroop and dot probe tasks) on weight change over a 1‐year period. This was a longitudinal study with undergraduate students (N = 102) living in shared student accommodation. After controlling for the effects of variables associated with weight (e.g., physical activity, stress, restrained eating, external eating, and emotional eating), no effects of cognitive bias were found with the dot probe. However, for the emotional Stroop, cognitive bias to unhealthy foods predicted an increase in BMI whereas cognitive bias to healthy foods was associated with a decrease in BMI. Results parallel findings in substance abuse research; cognitive biases appear to predict behavior change. Accordingly, future research should consider strategies for attentional retraining, encouraging individuals to reorient attention away from unhealthy eating cues.

Feeding strategies used by mothers of 3–5-year-old children

Appropriate use of parental feeding strategies could help establish healthy childhood eating practices. Research suggests that repeated taste exposure and modelling may be effective, pressuring and restricting may be counterproductive, and rewards may be effective or counterproductive depending on their use. However, little is known about the extent to which parents employ these strategies and within what contexts. The present study explored this using qualitative interviews with twelve mothers of children aged 3-5 years. Common strategies involved modelling, attempts to influence the childs attitudes and norms, and use of moderate pressure. The results are discussed in relation to the literature.

Validation of a self-completion measure of breakfast foods, snacks and fruits and vegetables consumed by 9- to 11-year-old schoolchildren

Objective:To evaluate the validity and reliability of a dietary recall questionnaire, designed for group-level comparisons of foods eaten at breakfast and intake of fruits, vegetables, sweet items and crisps.Design:Validity was assessed relative to 24-h dietary recall interviews, and reliability by comparing the baseline data with 4-month follow-up data.Subjects and setting:Fifty-eight schools took part in the validity assessments, with 374 children completing both measures. Reliability was assessed using 29 schools, with 1233 children at baseline and 1033 at follow-up. Children were aged 9–11 years and schools were located in socio-economically deprived areas of Wales.Results:Results indicated moderate to substantial agreements for most foods eaten at breakfast on the day of reporting and fair to moderate agreements for breakfast foods the previous day. For items throughout the rest of the previous day, agreement was fair to substantial during school hours, but slight after school. Correlations were moderate in terms of ‘healthy’ items and ‘unhealthy’ items consumed at breakfast on the day of reporting, but weaker for the previous breakfast. Correlations between measures in terms of fruits, vegetables, sweet items and crisps throughout the rest of the previous day were fair to moderate. The measure demonstrated fair to substantial group-level reliability.Conclusions:The questionnaire, while subject to a number of limitations, gives an adequately valid and reliable overview of selected aspects of childrens diet. It is likely to be of value at group-level in randomized controlled trials of school-based interventions.Sponsorship:The research was funded by the Public Health Improvement Division of the Welsh Assembly Government.

Restraint, disinhibition and food-related processing bias

This study examined associations between restraint, disinhibition and food-related processing bias (FPB, assessed by the emotional Stroop task) in males and females in the UK, Greece and Iran. Results showed high restraint was associated with higher FPB. However, high restrained current dieters showed lower FPB that high restrained non-dieters. There was no significant difference in FPB for those showing high versus low disinhibition. Results are discussed in relation to theories of incentive salience and current concerns.

Estimating everyday portion size using a 'method of constant stimuli': In a student sample portion size is predicted by gender, dietary behaviour, and hunger, but not BMI

This paper (i) explores the proposition that body weight is associated with large portion sizes and (ii) introduces a new technique for measuring everyday portion size. In our paradigm, the participant is shown a picture of a food portion and is asked to indicate whether it is larger or smaller than their usual portion. After responding to a range of different portions an estimate of everyday portion size is calculated using probit analysis. Importantly, this estimate is likely to be robust because it is based on many responses. First-year undergraduate students (N=151) completed our procedure for 12 commonly consumed foods. As expected, portion sizes were predicted by gender and by a measure of dieting and dietary restraint. Furthermore, consistent with reports of hungry supermarket shoppers, portion-size estimates tended to be higher in hungry individuals. However, we found no evidence for a relationship between BMI and portion size in any of the test foods. We consider reasons why this finding should be anticipated. In particular, we suggest that the difference in total energy expenditure of individuals with a higher and lower BMI is too small to be detected as a concomitant difference in portion size (at least in our sample).

Free healthy breakfasts in primary schools: a cluster randomised controlled trial of a policy intervention in Wales, UK

OBJECTIVE The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK. DESIGN A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour. SETTING Primary schools in nine local education authority areas. SUBJECTS A total of 4350 students (aged 9-11 years) at baseline and 4472 at follow-up in 111 schools. RESULTS Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found. CONCLUSIONS The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in childrens nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers.