Suzanne Domel Baxter

Accuracy of Fourth-Graders' Dietary Recalls of School Breakfast and School Lunch Validated with Observations: In-Person versus Telephone Interviews

OBJECTIVE To investigate the accuracy of childrens dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews. DESIGN Each child was observed eating school breakfast and school lunch and was interviewed that evening about that days intake. SETTING Ten elementary schools. PARTICIPANTS A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36). MAIN OUTCOMES MEASURED Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined. ANALYSIS Analysis of variance; chi-square. RESULTS Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch. CONCLUSIONS AND IMPLICATIONS The accuracy of childrens recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed.

Prevalence of Cardiovascular Risk Factors in Schoolchildren in a Rural Georgia Community

Background:In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community. Methods:Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years). Results:Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected. Conclusions:Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.

Reverse versus forward order reporting and the accuracy of fourth-graders’ recalls of school breakfast and school lunch

BACKGROUND Do children recall school breakfast and school lunch intake during 24-h recalls more accurately when prompted to report meals and snacks in reverse versus forward order? METHODS One hundred twenty-one fourth-graders stratified by race (Black, White) and gender were each observed and interviewed twice (once per order) regarding the previous days intake. Omission and intrusion rates determined accuracy for reporting items. Total inaccuracy determined accuracy for reporting items and amounts. RESULTS Results failed to indicate significant effects of interviewer, weekday, sequence (first or second recall), or race on omission rates, intrusion rates, or total inaccuracy. A significant order by gender interaction was found for omission rates, which were lower (i.e., better) for males for reverse (53%) versus forward recalls (62%), but not females (61 versus 53%) (P < 0.008). Intrusion rates were acceptable for males for 54% of reverse recalls and 40% of forward recalls (P = 0.095). Means were 57 and 32%, and 6.4 servings for omission rate, intrusion rate, and total inaccuracy for reverse recalls, and 56 and 39%, and 6.9 servings for forward recalls. CONCLUSIONS Prompting children to report in reverse versus forward order improved omission and intrusion rates for males more so than females. Regardless of reverse or forward order, children reported <50% of items observed; furthermore, >30% of items reported were not observed. Research is needed to enhance accuracy of childrens dietary recalls.

Children's Social Desirability and Dietary Reports

We investigated telephone administration of the Childrens Social Desirability (CSD) scale and our adaptation for children of the Social Desirability for Food scale (C-SDF). Each of 100 4th-graders completed 2 telephone interviews 28 days apart. CSD scores had adequate internal consistency and test-retest reliability, and a 14-item subset was identified that sufficiently measures the same construct. Our C-SDF scale performed less well in terms of internal consistency and test-retest reliability; factor analysis revealed 2 factors, 1 of which was moderately related to the CSD. The 14-item subset of the CSD scale may help researchers understand error in childrens dietary reports.

Fourth-Grade Children's Dietary Recall Accuracy Is Influenced by Retention Interval (Target Period and Interview Time)

BACKGROUND For a 24-hour dietary recall, two possible target periods are the prior 24 hours (24 hours immediately preceding the interview time) and previous day (midnight to midnight of the day before the interview), and three possible interview times are morning, afternoon, and evening. Target period and interview time determine the retention interval (elapsed time between to-be-reported meals and the interview), which, along with intervening meals, can influence reporting accuracy. OBJECTIVE The effects of target period and interview time on childrens accuracy for reporting school meals during 24-hour dietary recalls were investigated. DESIGN AND SUBJECTS/SETTING: During the 2004-2005, 2005-2006, and 2006-2007 school years in Columbia, SC, each of 374 randomly selected fourth-grade children (96% African American) was observed eating two consecutive school meals (breakfast and lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions defined by crossing two target periods with three interview times. Each condition had 62 or 64 children (half boys). MAIN OUTCOME MEASURES Accuracy for reporting school meals was quantified by calculating rates for omissions (food items observed eaten but unreported) and intrusions (food items reported eaten but unobserved); a measure of total inaccuracy combined errors for reporting food items and amounts. STATISTICAL ANALYSES PERFORMED For each accuracy measure, analysis of variance was conducted with target period, interview time, their interaction, sex, interviewer, and school year in the model. RESULTS There was a target-period effect and a target-period by interview-time interaction on omission rates, intrusion rates, and total inaccuracy (six P values <0.004). For prior-24-hour recalls compared to previous-day recalls, and for prior-24-hour recalls in the afternoon and evening compared to previous-day recalls in the afternoon and evening, omission rates were better by one third, intrusion rates were better by one half, and total inaccuracy was better by one third. CONCLUSIONS To enhance childrens dietary recall accuracy, target periods and interview times that minimize the retention interval should be chosen.

Prompting Methods affect the Accuracy of Children's School Lunch Recalls

OBJECTIVES To evaluate the feasibility of implementing 3 specific prompting methods among students in the first and fourth grades (mean age = 7.2 and 10.1 years, respectively), to validate recall accuracy of first- and fourth-grade students against observation, to develop a single measure of inaccuracy that cumulated errors in reporting food items and amounts without allowing underreporting and overreporting to cancel each other, and to establish information regarding the measure of inaccuracy for use in future studies. DESIGN Children were interviewed the morning after they were observed eating lunch provided by the school. Interviews included free recall, nonsuggestive prompted recall, and specific prompted recall (either preference, food category, or visual). SUBJECTS/SETTING Ninety-six children (48 students per grade) were studied--32 per the specific prompting method--stratified by grade, sex, and ethnicity (African-American or white). Specific prompting method was randomly assigned to children within strata. STATISTICAL ANALYSIS Food items were categorized and weighted as: combination entree = 2, condiments = 1/3, and other = 1. To calculate inaccuracy of recall, absolute differences between amounts reported and observed eaten were calculated for each item and then multiplied by each items weight; these values were then summed across all items for each child. Inaccuracy of recall was determined before specific prompting and after specific prompting and for the difference (inaccuracy after specific prompting minus inaccuracy before specific prompting). RESULTS Before specific prompting, median inaccuracy was 2.7 servings for the 48 first-grade students and 1.7 servings for the 48 fourth-grade students. The median difference in inaccuracy from before to after specific prompting was 0 for both grades. Specific prompting increased recall accuracy for 9 first-graders and 12 fourth-graders, but decreased recall accuracy for 21 first-graders and 7 fourth-graders, and did not change recall accuracy for 18 first-graders and 29 fourth-graders. Among children whose recall accuracy increased after specific prompting, 5 first-graders and 8 fourth-graders received prompting for food category. APPLICATIONS/CONCLUSIONS Among first-grade students, specific prompting (either preference, food category, or visual) may hurt more than help recall accuracy. Among fourth-grade students, prompting for food category yields small gains in recall accuracy with minimal losses. Validation studies are needed with larger sample sizes to determine prompting methods that produce more accurate dietary recalls from children of various socioeconomic status groups, other racial/ethnic groups, and at other meals.

Cognitive processes in children's dietary recalls: insight from methodological studies.

Background/Objectives:This article summarizes 12 dietary-reporting methodological studies with children (six validation studies, one non-validation study, five secondary analyses studies of data from one or more of the six validation studies), identifies research gaps and provides recommendations for (a) improving childrens recall accuracy and (b) details to specify in publications of studies that utilize childrens dietary recalls.Subjects/Methods:Randomly selected children (aged 9–10 years) were observed eating school breakfast and school lunch, and interviewed to obtain dietary recalls.Results:Childrens recall accuracy improved slightly between the first and third recalls, but an individual childs accuracy was inconsistent from one interview to the next. Although accuracy was poor overall, it was better for boys with reverse-order (evening-to-morning) prompts and for girls with forward-order (morning-to-evening) prompts. Children recalled breakfast intake less accurately than lunch intake. Childrens accuracy did not depend on whether recalls were obtained in person or by telephone, but was better for recalls obtained with an open format than a meal format. Retention interval was crucial as childrens accuracy was better for prior-24-h recalls (about the 24 h immediately preceding the interview) than for previous-day recalls (about midnight to midnight of the day before the interview). Observations of school meals did not affect childrens recalls. Childrens recall accuracy was related to their age/sex body mass index percentile. Conventional report rates (which disregard accuracy for items and amounts) overestimated accuracy for energy and macronutrients, and masked complexities of recall error.Conclusions:Research concerning errors in childrens dietary recalls provides insight for improving childrens recall accuracy.

Trading of food during school lunch by first- and fourth-grade children

Abstract This retrospective analysis helped determine the extent of trading of food by first- and fourth-graders during school lunch from a study using observations to validate the accuracy of childrens lunch recalls. Trading was defined as giving away or receiving food from school lunch for an individual child. A sample stratified by gender and ethnicity (White, African American) of 48 first- and 48 fourth-graders was randomly selected from two public schools during one year. Each child was observed once while eating school lunch. Fishers Exact Test (two-tailed) indicated a significant difference between the probability of trading by grade ( p

Physical Activity, Metabolic Syndrome, and Overweight in Rural Youth

BACKGROUND Research suggests significant health differences between rural dwelling youth and their urban counterparts with relation to cardiovascular risk factors. This study was conducted to (1) determine relationships between physical activity and markers of metabolic syndrome, and (2) to explore factors relating to physical activity in a diverse sample of rural youth. METHODS Data were collected from 4th, 6th, 8th, and 11th grade public school students in the rural Southeastern United States in the spring of 2002. Physiological data included anthropometrics, fasting glucose, lipids, hemodynamics, and skinfold measurements. Psychosocial data included parental support for physical activity, accessibility of physical activity facilities, and safety concerns for physical activity. Behavioral data included self-reported physical activity and sedentary behaviors. RESULTS After adjusting for sex, race, and age, subjects with low level of physical activity were 3 times more likely to be positive for metabolic syndrome compared to those reporting a high level of physical activity. Subjects reporting a low level of physical activity were 2.4 times more likely to be overweight compared to subjects reporting a high level of physical activity. Students with high levels of physical activity were more likely to have parents who provided money for physical activity lessons and sports teams. CONCLUSIONS Rural youth with low levels of physical activity participation were at increased risks for metabolic syndrome and overweight. Effective physical activity promotions addressing supports for physical activity are urgently needed in rural America.

Interview format influences the accuracy of children's dietary recalls validated with observations

This report describes a comparison of the accuracy of childrens dietary recalls obtained using either open or meal format interviews. Fourth-graders were randomly selected, observed eating school meals (breakfast, lunch), and interviewed that evening regarding that days intake with children randomly assigned to open (n = 12) or meal (n = 11) format interviews. The weighted numbers of items observed eaten did not differ by format, but greater weighted numbers of items were reported eaten with meal format interviews than with open format interviews. Reporting performance was more accurate with open than with meal format interviews: Although the omission rates did not differ significantly between the formats, higher intrusion rates and total inaccuracy were found in meal format interviews than in open format interviews. Interview format influences childrens dietary reporting accuracy; in particular, providing meal cues elevates false reports. These analyses exemplify the importance of treating omissions and intrusions separately when examining reporting performance.