Nila J. Rosen

Child Experience of Food Insecurity Is Associated with Child Diet and Physical Activity

BACKGROUND Food insecurity is associated with deficits in child development and health, but little is known about how childrens specific food-insecurity experiences play out through nutritional and non-nutritional pathways that may compromise well-being. OBJECTIVE This study used child self-reports of food insecurity to examine the types of food-insecurity experiences that were most prevalent and the relations between child food insecurity (CFI), child diet, and child physical activity (PA). METHODS A total of 3605 fourth- and fifth-grade children whose schools participated in the Network for a Healthy California-Childrens PowerPlay! campaign completed 24-h diary-assisted recalls and surveys including items from the Child Food Security Assessment and questions about PA. Data were analyzed by using regression and logistic regression models. RESULTS CFI was present in 60% of the children and included experiences of cognitive, emotional, and physical awareness of food insecurity. Greater levels of CFI were associated with higher consumption of energy, fat, sugar, and fiber and a diet lower in vegetables. For instance, a child at the highest level of CFI, on average, consumed ∼494 kJ/d (118 kcal), 8 g/d of sugar, and 4 g/d of fat more than a food-secure child. Higher CFI was associated with a marginally significant difference (P = 0.06) in minutes of PA (17 min/d less for children at the highest level of CFI vs. those who were food secure) and with significantly greater perceived barriers to PA. CONCLUSIONS CFI is a troublingly frequent, multidomain experience that influences childrens well-being through both nutritional (dietary) and non-nutritional (e.g., PA) pathways. CFI may lead to poor-quality diet and less PA and their developmental consequences. Practitioners should consider CFI when assessing child health and well-being and can do so by asking children directly about their CFI experiences.

Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students

BACKGROUND Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans. OBJECTIVE The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source). DESIGN An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year. PARTICIPANTS/SETTING Fourth- and fifth-grade students (N=3,944) completed a diary-assisted 24-hour food recall. MAIN OUTCOME MEASURES The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home. STATISTICAL ANALYSIS Analysis of variance, χ2 test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed. RESULTS School lunch eaters had a higher mean±standard deviation overall diet quality score (HEI-2010=49.0±11.3) compared with students who ate a lunch obtained from home (46.1±12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch). CONCLUSIONS Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on childrens diet quality.

Evaluation of Online and In-Person Nutrition Education Related to Salt Knowledge and Behaviors among Special Supplemental Nutrition Program for Women, Infants, and Children Participants

BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) differs from other federal nutrition programs in that nutrition education is a required component. WIC programs traditionally provide in-person education, but recently some WIC sites have started offering online education. Education focused on reducing salt intake is an important topic for WIC participants because a high-sodium diet has been associated with high blood pressure, and low-income populations are at increased risk. OBJECTIVE Our aim was to examine the impacts of traditional in-person and online nutrition education on changes in knowledge, self-efficacy, and behaviors related to reducing salt intake in low-income women enrolled in WIC. DESIGN Although a comparison of groups was not the primary focus, a randomized trial examining the impact of online and in-person nutrition education on participant knowledge, self-efficacy, and behaviors related to salt intake was conducted. PARTICIPANTS/SETTING Five hundred fourteen WIC participants from three Los Angeles, CA, WIC clinics received either in-person (n=257) or online (n=257) education. Questionnaires assessing salt-related knowledge, self-efficacy, and behaviors were administered at baseline and 2 to 4 months and 9 months later from November 2014 through October 2015. RESULTS Positive changes in knowledge and self-efficacy were retained 2 to 4 months and 9 months later for both groups (P<0.05). Both groups reported significant changes in behaviors related to using less salt in cooking (P<0.0001) and eating fewer foods with salt added at the table or during cooking (P<0.001) at 2 to 4 months and 9 months. CONCLUSIONS Both online and in-person education resulted in improvements during a 9-month period in knowledge, self-efficacy, and reported behaviors associated with reducing salt intake in a low-income population. Offering an online education option for WIC participants could broaden the reach of nutrition education and lead to long-term positive dietary changes.

Impact of California Children’s Power Play! Campaign on Fruit and Vegetable Intake and Physical Activity among Fourth- and Fifth-Grade Students:

Purpose. Examine the impact of the Children’s Power Play! Campaign on fruit and vegetable (FV) intake and physical activity (PA). Design. Study design was a cluster randomized, controlled trial. Setting. Forty-four low-resource public schools in San Diego County, California, were included in the study. Subjects. Study subjects comprised a total of 3463 fourth/fifth-graders (1571 intervention, 1892 control), with an 86.9% completion rate. Intervention. Throughout 10 weeks, activities were conducted during/after school, including weekly FV/PA lessons and PA breaks; biweekly classroom promotions/taste tests; posters displayed in/around schools; and weekly nutrition materials for parents. Measures. Self-reported FV intake (cups/d) and PA (min/d) were collected at baseline and follow-up using a diary-assisted, 24-hour dietary recall and Self-Administered Physical Activity Checklist. Analysis. Multivariate regression models adjusted for demographics and cluster design effects were used, with change as the dependent variable. Results. Intervention children, compared with controls, showed gains in daily FV intake (.26 cups, p < .001) and PA time at recess/lunch (5.1 minutes, p = .003), but not total daily PA minutes. Conclusion. Power Play! can help schools and community organizations improve low-income children’s FV intake and PA during recess/lunch.

Passive Commuting and Dietary Intake in Fourth and Fifth Grade Students

BACKGROUND Promoting active commuting by walking or biking to and from school could increase physical activity and reduce obesity among youth. However, exposure to the retail food environment while commuting may lead to greater dietary intake among active commuters. PURPOSE To examine the relationship between commute patterns and dietary intake and quality in elementary students. METHODS Fourth and fifth grade students (N=3,316) in 44 California schools reported commute modes to and from school and dietary intake for the same 24-hour period in 2012. Differences between active and passive commuters in total energy intake (kcal), energy from purchased foods, and energy from sweets and snack-type foods were compared, stratified by after-school program (ASP) participation (analysis conducted in 2013). RESULTS Twenty-three percent of youth actively commuted to school; 27% actively commuted from school. Passive commuters, 87% of whom traveled by car, consumed 78 more kcal from purchased foods (p<0.01) than active commuters in the 24-hour period, though total energy intake did not differ by commute mode overall or by ASP participation. Among the 72% of students who did not attend an ASP, passive commuters consumed 56 more kcal from purchased foods (p<0.01) and 25 more kcal from sweets and snack-type foods (p=0.02) than active commuters. CONCLUSIONS Passive commuters consumed more sweets and snack-type foods and more purchased foods than active commuters. These results, which suggest that parents are providing unhealthy foods for their children during the school commute, reinforce the need for multilevel strategies to promote energy balance in youth.