Validation of a Brief Questionnaire Against Direct Observation to Assess Adolescents' School Lunchtime Beverage Consumption.
ABSTRACT: OBJECTIVE:Beverage consumption is an important determinant of youth health outcomes. Beverage interventions often occur in schools, yet no brief validated questionnaires exist to assess whether these efforts improve in-school beverage consumption. This study validated a brief questionnaire to assess beverage consumption during school lunch. METHODS:Researchers observed middle school students' (n = 25) beverage consumption during school lunchtime using a standardized tool. After lunch, students completed questionnaires regarding their lunchtime beverage consumption. Kappa statistics compared self-reported with observed beverage consumption across 15 beverage categories. RESULTS:Eight beverages showed at least fair agreement (kappa [?] > 0.20) for both type and amount consumed, with most showing substantial agreement (? > 0.60). One beverage had high raw agreement but ? < 0.20. Six beverages had too few ratings to compute ?'s. CONCLUSIONS AND IMPLICATIONS:This brief questionnaire was useful for assessing school lunchtime consumption of many beverages and provides a low-cost tool for evaluating school-based beverage interventions.
Project description:School lunch programs provide an opportunity to improve students' diets. We sought to determine the impact of a multifaceted intervention (cafeteria redesigns, increased points-of-sale and teacher education) on secondary students' perceptions of school-lunch quality and convenience and fruit and vegetable intake. Surveys (n = 12,827) from middle and high school students in 12 intervention and 11 control schools were analyzed. We investigated change in school-lunch perceptions and lunchtime and daily fruit and vegetable consumption from 2016 to 2018. Among 8th graders, perceptions that school lunch tastes good and that school lunch was enough to make students feel full increased 0.2 points (on a 5-point scale; p < 0.01) in intervention schools relative to control schools. Among 10th graders, lunchtime fruit and vegetable consumption increased 6% in intervention relative to control schools (p < 0.05 and p < 0.01 respectively). Daily fruit intake increased 0.1 cups/day in intervention relative to control schools among 9th graders (p < 0.01). This study provides important evidence on the limited effect of design approaches in the absence of meal changes. We observed only modest changes in school lunch perceptions and fruit and vegetable consumption that were not consistent across grades, suggesting that additional efforts are needed to improve school-lunch uptake.
Project description:(1) Background: Data about early life beverage intake patterns is sparse. We describe beverage patterns among infants and young children from the Feeding Infants and Toddlers Study (FITS) 2016. (2) Methods: FITS 2016 is a cross-sectional survey of U.S. parents/caregivers of children 0?47.9 months (n = 3235). Food and beverage intakes were collected by 24-h dietary recalls to describe beverage consumption patterns including: a) prevalence of consumption, per capita and per consumer intake, b) contribution to intake of calories and key nutrients, and c) prevalence according to eating occasions. (3) Results: Breast milk and infant formula were commonly consumed among <12-month-olds. Among 12?23.9-month-olds, the most commonly consumed beverage was whole milk (67% consuming), followed by 100% juice (50% consuming). Plain drinking water was consumed by 70% of 12?23.9-month-olds and 78% of 24?47.9-month-olds. Among 12?47.9-month-olds, milks provided more energy and key nutrients than all other beverages. Across eating occasions, sugar-sweetened beverage (SSB) consumption, especially in the form of fruit-flavored drinks, was higher among 24?47.9 compared to 12?23.9-month-olds. Only 23?32% of ≥12-month-olds consumed milk or water at lunch or dinner. (4) Conclusions: Opportunities exist to improve beverage patterns. Future interventions may benefit from focusing on timely introduction of age-appropriate beverages and reducing consumption of SSBs.
Project description:INTRODUCTION:Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages, but warnings' effects on actual purchase behavior remain uncertain. This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases. STUDY DESIGN:Participants completed one study visit to a life-sized replica of a convenience store in North Carolina. Participants chose six items (two beverages, two foods, and two household products). One item was randomly selected for them to purchase and take home. Participants also completed a questionnaire. Researchers collected data in 2018 and conducted analyses in 2019. SETTING/PARTICIPANTS:Participants were a demographically diverse convenience sample of 400 adult sugar-sweetened beverage consumers (usual consumption ?12 ounces/week). INTERVENTION:Research staff randomly assigned participants to a health warning arm (sugar-sweetened beverages in the store displayed a front-of-package health warning) or a control arm (sugar-sweetened beverages displayed a control label). MAIN OUTCOME MEASURES:The primary trial outcome was sugar-sweetened beverage calories purchased. Secondary outcomes included reactions to trial labels (e.g., negative emotions) and sugar-sweetened beverage perceptions and attitudes (e.g., healthfulness). RESULTS:All 400 participants completed the trial and were included in analyses. Health warning arm participants were less likely to be Hispanic and to have overweight/obesity than control arm participants. In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity, health warnings led to lower sugar-sweetened beverage purchases (adjusted difference, -31.4 calories; 95% CI= -57.9, -5.0). Unadjusted analyses yielded similar results (difference, -32.9 calories; 95% CI= -58.9, -7.0). Compared with the control label, sugar-sweetened beverage health warnings also led to higher intentions to limit sugar-sweetened beverage consumption and elicited more attention, negative emotions, thinking about the harms of sugar-sweetened beverage consumption, and anticipated social interactions. Trial arms did not differ on perceptions of sugar-sweetened beverages' added sugar content, healthfulness, appeal/coolness, or disease risk. CONCLUSIONS:Brief exposure to health warnings reduced sugar-sweetened beverage purchases in this naturalistic RCT. Sugar-sweetened beverage health warning policies could discourage sugar-sweetened beverage consumption. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT03511937.
Project description:We assess the repeatability and relative validity of a Spanish beverage intake questionnaire for assessing water intake from beverages. The present analysis was performed within the framework of the PREDIMED-PLUS trial. The study participants were adults (aged 55-75) with a BMI ?27 and <40 kg/m², and at least three components of Metabolic Syndrome (MetS). A trained dietitian completed the questionnaire. Participants provided 24-h urine samples, and the volume and urine osmolality were recorded. The repeatability of the baseline measurement at 6 and 1 year was examined by paired Student's t-test comparisons. A total of 160 participants were included in the analysis. The Bland-Altman analysis showed relatively good agreement between total daily fluid intake assessed using the fluid-specific questionnaire, and urine osmolality and 24-h volume with parameter estimates of -0.65 and 0.22, respectively (R² = 0.20; p < 0.001). In the repeatability test, no significant differences were found between neither type of beverage nor total daily fluid intake at 6 months and 1-year assessment, compared to baseline. The proposed fluid-specific assessment questionnaire designed to assess the consumption of water and other beverages in Spanish adult individuals was found to be relatively valid with good repeatability.
Project description:The contribution of beverages to overall diet is of increasing interest to researchers and policymakers, particularly in terms of consumption of drinks high in added sugars; however, few tools to assess beverage intake have been developed and evaluated. This study aimed to evaluate the relative validity of a new online Beverage Frequency Questionnaire (BFQ) among young adults in Canada.A cross-sectional relative validation study was conducted among young adults aged 16-30 years (n?=?50). Participants completed a 17-item BFQ, a 7-day food record (7dFR), and a single-item measure of sugary drink intake. Pearson correlations and paired t-tests were used to evaluate correlation and agreement between the measures for 17 individual beverage categories, total drink consumption, total alcoholic beverage consumption, and two definitions of drinks with excess sugars. Cognitive interviews were conducted to examine participant interpretation and comprehensiveness of the BFQ.Estimates of beverage intake based on the BFQ and the 7dFR were highly correlated, specifically for the total number and volume of beverages consumed, total alcoholic beverage consumption, sugary drink intake, and each of the 17 beverage categories with 3 exceptions: coffee or tea with sugar or cream, specialty coffees, and hard alcohol with caloric mix. Paired t-tests between the BFQ and the 7dFR indicated that the average reported volume was significantly different only for sweetened fruit drinks. The single-item measure of sugary beverage intake was not significantly correlated with the 7dFR. Cognitive interviewing demonstrated high comprehension levels, and confirmed the appropriateness of the BFQ beverage categories and sizes.Overall, the results suggest that the BFQ performed well relative to a 7dFR and had high usability among this study population, indicating its promise for collecting population-level data on beverage intake, including sugar-sweetened beverages, which are known indicators of diet and health.
Project description:BACKGROUND:Research on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited. OBJECTIVE:This study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children's dietary intakes. DESIGN:The Healthy Communities Study was a cross-sectional observational study conducted between 2013 and 2015. PARTICIPANTS AND SETTING:US children aged 4 to 15 years (n=5,106) were included. MAIN OUTCOME MEASURES:Dietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit and vegetables, fiber, whole grains, dairy, calcium, total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value. STATISTICAL ANALYSIS:Multivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs not every day) and dietary intake, adjusting for child- and community-level covariates. RESULTS:Children who ate school breakfast every day compared with children who ate 0 to 4 days/wk, reported consuming more fruits and vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day, compared with those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6). No significant associations were observed between school meal consumption and energy-dense nutrient-poor foods or added sugars. CONCLUSIONS:Eating school breakfast and school lunch every day by US schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.
Project description:The objective of this study was to evaluate an educational module for Latino parents about the health effects of sweet beverages. Latino parents were randomized to receive the beverage module or a control module. Child beverage consumption was assessed at baseline, 2 weeks, 2 months, and 3 months via a beverage recall survey. At 2-week follow-up, children of intervention participants had a mean reduction in 7-day total sugar-sweetened beverage and 100% fruit juice consumption of 16 ounces while controls had a mean increase of 4 ounces ( P = .01). At 2-month and 3-month follow-up, there was a reduction in mean total sugar-sweetened beverage and 100% fruit juice consumption among both intervention and control children. An educational module on beverages for Latino parents reduced child consumption of sweet beverages at 2-week follow-up. However, study participation appears to have also reduced controls' beverage consumption suggesting that frequent intensive surveys of beverage intake may be an intervention unto itself.
Project description:Long-term US trends in alcoholic beverage calorie intakes remain unexamined, particularly with respect to changes in population subgroup-specific patterns over time.This study examined shifts in the consumption of alcoholic beverages, in total and by beverage type, on any given day among US adults in relation to sociodemographic characteristics.This study was a repeated cross-sectional analysis of data from the 1989-1991 and 1994-1996 Continuing Survey of Food Intakes by Individuals and the 2003-2006 and 2009-2012 National Health and Nutrition Examination Surveys.Adults aged ?19 years (N=39,298) were targeted. A subset of alcoholic beverage consumers (n=7,081) were studied.Survey weighted mean per capita per day intakes (among all participants, both consumers of alcoholic beverages and nonconsumers) and contributions of beer, wine, and liquor/mixed drinks to total alcoholic beverage energy were determined. Multivariable regression models were used to examine trends in the proportion of alcoholic beverage consumers and the per consumer intakes (among consumers of alcoholic beverages only).Per capita intakes from alcoholic beverages increased from 49 kcal/capita/day in 1989-1991 to 109 kcal/capita/day in 2003-2006 (P<0.001). The proportion consuming alcoholic beverages on any given day increased significantly from 1989-1991 to 2009-2012 (P for overall increasing trend <0.0001) for most sociodemographic subgroups. Per consumer, alcoholic beverage calories increased between 1989-1991 and 1994-1996 (P<0.05) for many subpopulations. Adults with less than high school education were less likely to consume alcohol, yet had higher per consumer calorie intakes compared with adults with a college degree. Women and adults aged ?60 years experienced a shift away from liquor/mixed drinks toward wine between 2003-2006 and 2009-2012. Beer contributed roughly 70% to total alcoholic beverage intake for less educated consumers across time.These results indicate there has been an increase in the proportion of US adults who drink on any given day and an increase in calories consumed from alcoholic beverages when drinking occurs.
Project description:AbstractObjectivesNon-nutritive sweeteners (NNS) are zero- or low-calorie alternatives to caloric sugars and substituting caloric sweeteners with NNS is expected to reduce energy intake. The aim of this study was to examine appetite and food intake following the consumption of a beverage preload containing a natural zero calorie sweetener or caloric sweeteners (sugars).MethodsThis was a randomised controlled double-blind crossover study. Healthy participants (= 20, 9 males, mean body mass index 21.8 kg/m) completed five separate visits, corresponding to five study beverages: 330 mL of water (control-no calories and no taste) and either 330 mL of water containing 40 g glucose or sucrose (sweet taste and calories), maltodextrin (calories and no sweet taste), or 240 ppm all natural sweetener, stevia (Truvia RA-95-sweet taste and no calories). Subjective appetite ratings and blood glucose was measured at baseline and then study beverages were administered, with appetite ratings and blood glucose again measured at 15, 30 and 60 minutes. At 30 minutes participants were offered an lunch and food intake was measured.ResultsStevia and glucose preloads were rated to have equal sweetness levels, while water and maltodextrin the lowest levels of sweetness. Only glucose, sucrose and maltodextrin elevated blood glucose. Both calories and sweet taste affected appetite as there was a significant effect on suppressed subjective appetite ratings following the stevia and caloric preloads compared to water at 15 and 30 minutes postprandially. Compared to water preload, food intake was significantly lower after the consumption of each of the sweet or caloric preloads. Analysis of cumulative energy intake (preload and lunch) showed that total energy intake was lower after the stevia preload compared to the water preload with no differences between the water and caloric preloads (Figure 1).ConclusionsThis study, found a beneficial effect of a stevia beverage consumed prior to a meal on appetite and subsequent energy intake compared to water. This study was registered in clinicaltrial.gov as NCT03711084.Funding SourcesThis research was supported by a BBSRC Case Studentship.Supporting Tables, Images and/or Graphs
Project description:<h4>Background</h4>School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear.<h4>Objective</h4>To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children.<h4>Methods</h4>We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias.<h4>Results</h4>From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified.<h4>Conclusions</h4>Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.