An educational video game for nutrition of young people: Theory and design.

BACKGROUND: Playing Escape from DIAB (DIAB) and Nanoswarm (NANO), epic video game adventures, increased fruit and vegetable consumption among a multi-ethnic sample of 10-12 year old children during pilot testing. Key elements of both games were educational mini-games embedded in the overall game that promoted knowledge acquisition regarding diet, physical activity and energy balance. 95-100% of participants demonstrated mastery of these mini-games suggesting knowledge acquisition. AIM: This article describes the process of designing and developing the educational mini-games. A secondary purpose was to explore the experience of children while playing the games. METHOD: The educational games were based on Social Cognitive and Mastery Learning Theories. A multidisciplinary team of behavioral nutrition, PA, and video game experts designed, developed, and tested the mini-games. RESULTS: Alpha testing revealed children generally liked the mini-games and found them to be reasonably challenging. Process evaluation data from pilot testing revealed almost all participants completed nearly all educational mini-games in a reasonable amount of time suggesting feasibility of this approach. CONCLUSIONS: Future research should continue to explore the use of video games in educating children to achieve healthy behavior changes.

Physical activity problem-solving inventory for adolescents: development and initial validation.

Youth encounter physical activity barriers, often called problems. The purpose of problem solving is to generate solutions to overcome the barriers. Enhancing problem-solving ability may enable youth to be more physically active. Therefore, a method for reliably assessing physical activity problem-solving ability is needed. The purpose of this research was to report the development and initial validation of the physical activity problem-solving inventory for adolescents (PAPSIA). Qualitative and quantitative procedures were used. The social problem-solving inventory for adolescents guided the development of the PAPSIA scale. Youth (14- to 17-year-olds) were recruited using standard procedures, such as distributing flyers in the community and to organizations likely to be attended by adolescents. Cognitive interviews were conducted in person. Adolescents completed pen and paper versions of the questionnaire and/or scales assessing social desirability, self-reported physical activity, and physical activity self-efficacy. An expert panel review, cognitive interviews, and a pilot study (n = 129) established content validity. Construct, concurrent, and predictive validity were also established (n = 520 youth). PAPSIA is a promising measure for assessing youth physical activity problem-solving ability. Future research will assess its validity with objectively measured physical activity.

Development and feasibility of an objective measure of patient-centered communication fidelity in a pediatric obesity intervention.

OBJECTIVE: To develop a measure of person-centered communication (PCC) and demonstrate feasibility for use in primary care child obesity interventions. METHODS: Helping Healthy Activity and Nutrition Directions was a primary care intervention for families of overweight or obese 5- to 8-year-old children. The PCC Coding System (PCCCS) was based on theory and a validated motivational interviewing instrument. The PCCCS provided global scores, and total, positive, and negative PCC utterance frequencies. Three trained coders tested reliability of the PCCCS on audio recordings of sessions with 30 families. Potential uses of the PCCCS were demonstrated. RESULTS: The PCCCS demonstrated good inter-rater reliability for utterance frequencies but not for global scores. CONCLUSIONS AND IMPLICATIONS: The PCCCS is a reliable and feasible measure of PCC utterances. More research is needed to improve inter-rater reliability of the PCC global scale. The PCCCS may be used in the future to test fidelity of PCC interventions.

Impact of a pilot walking school bus intervention on children's pedestrian safety behaviors: a pilot study.

Walking school buses (WSB) increased children's physical activity, but impact on pedestrian safety behaviors (PSB) is unknown. We tested the feasibility of a protocol evaluating changes to PSB during a WSB program. Outcomes were school-level street crossing PSB prior to (Time 1) and during weeks 4-5 (Time 2) of the WSB. The protocol collected 1252 observations at Time 1 and 2548 at Time 2. Mixed model analyses yielded: intervention schoolchildren had 5-fold higher odds (p<0.01) of crossing at the corner/crosswalk but 5-fold lower odds (p<0.01) of stopping at the curb. The protocol appears feasible for documenting changes to school-level PSB.

Physical activity in youth with well-controlled versus poorly controlled type 2 diabetes.

PURPOSE: Type 2 diabetes increases risk of chronic disease. The recommendations are for youth to attain at least 60 minutes of daily physical activity (PA). Fewer than 20% achieve this goal. This study examines differences between blood glucose control and PA in youth with type 2 diabetes. METHODS: A1c levels and PA were tested in youth 9 to 17 years old with newly diagnosed type 2 diabetes during clinic visits. Average daily minutes of moderate to vigorous physical activity (MVPA) was calculated. Differences in MVPA were investigated. RESULTS: Slightly more than half of youth had well-controlled diabetes. All engaged in less PA than recommended. Youth with well-controlled diabetes engaged in slightly less MVPA than those whose diabetes was not in control. There were no significant differences in minutes of MVPA by gender, race, or diabetes control. CONCLUSIONS: It is necessary to identify ways to increase PA among youth with type 2 diabetes.

The walking school bus and children's physical activity: a pilot cluster randomized controlled trial.

OBJECTIVE: To evaluate the impact of a "walking school bus" program on children's rates of active commuting to school and physical activity. METHODS: We conducted a pilot cluster randomized controlled trial among 4th-graders from 8 schools in Houston, Texas (N = 149). Random allocation to treatment or control conditions was at the school level. Study staff walked with children to and from school up to 5 days/week. Outcomes were measured the week before (time 1) and during weeks 4 and 5 of the intervention (time 2). The main outcome was the weekly rate of active commuting, and a secondary outcome was moderate-to-vigorous physical activity. Covariates included sociodemographics, distance from home to school, neighborhood safety, child BMI z score, parent self-efficacy/outcome expectations, and child self-efficacy for active commuting. A mixed-model repeated measures regression accounted for clustering by school, and stepwise procedures with backward elimination of nonsignificant covariates were used to identify significant predictors. RESULTS: Intervention children increased active commuting (mean ± SD) from 23.8% ± 9.2% (time 1) to 54% ± 9.2% (time 2), whereas control subjects decreased from 40.2% ± 8.9% (time 1) to 32.6% ± 8.9% (time 2) (P < .0001). Intervention children increased their minutes of daily moderate-to-vigorous physical activity from 46.6 ± 4.5 (time 1) to 48.8 ± 4.5 (time 2), whereas control children decreased from 46.1 ± 4.3 (time 1) to 41.3 ± 4.3 (time 2) (P = .029). CONCLUSIONS: The program improved children's active commuting to school and daily moderate-to-vigorous physical activity.

Active commuting to school and association with physical activity and adiposity among US youth.

BACKGROUND: Walking or bicycling to school (ie, active commuting) has shown promise for improving physical activity and preventing obesity in youth. Our objectives were to examine, among US youth, whether active commuting was inversely associated with adiposity and positively associated with moderate-to-vigorous physical activity (MVPA). We also examined whether MVPA mediated the relationships between active commuting and adiposity. METHODS: Using data of participants aged 12 to 19 years from the US National Health and Nutrition Examination Survey 2003 to 2004 (n=789 unweighted), we constructed multiple linear regression models that controlled for dietary energy intake and sociodemographics. The main exposure variable was active commuting. The outcomes were BMI z-score, waist circumference, skinfolds and objectively measured MVPA. The product-of-coefficients method was used to test for mediation. RESULTS: Active commuting was inversely associated with BMI z-score (ß=-0.07, P=.046) and skinfolds (ß=-0.06, P=.029), and positively associated with overall daily (ß=0.12, P=.024) and before- and after-school (ß=0.20, P<.001) MVPA. Greater before- and after-school MVPA explained part of the relationship between active commuting and waist circumference (Sobel z=-1.98, P=.048). CONCLUSIONS: Active commuting was associated with greater MVPA and lower measures of adiposity among US youth. Before- and after-school MVPA mediated the relationships between active commuting and waist circumference.

Effects of goal setting on dietary and physical activity changes in the Boy Scout badge projects.

BACKGROUND: This study evaluates the relationship of goal setting to low-fat vegetable (LV) and fruit/100% juice (FJ) consumption and physical activity (PA) change. METHODS: A total of 473 10- to 14-year-old Boy Scouts from Houston took part in a 9-week intervention. A two-group (LV and FJ or PA) intervention design was used with each group serving as the control for the other. Internet-based activities included goal setting at home. Food frequencies measured dietary intake. RESULTS: Goals attained were not related to LV intake or PA. Immediate posttest FJ consumption increased about 0.7 servings as home FJ availability increased, but social desirability of response appeared to confound reports of FJ intake at posttest 6 months assessment. CONCLUSIONS: Goals attained were not related to LV intake or PA but was related to FJ intake, but only when home FJ availability was high and the relationship was confounded by social desirability of response. Further research is needed with higher quality measures of dietary intake to clarify these relationships.

Components of the diet associated with child adiposity: a cross-sectional study.

OBJECTIVE: This study sought to determine which components of youths' diets were related to adiposity while controlling for potential often-neglected confounders such as moderate to vigorous physical activity (MVPA) and dietary reporting error. Secondary goals of this study were to determine the extent to which MVPA confounded the associations between diet and adiposity and whether associations between diet and adiposity would differ depending on reporting error. METHODS: An ethnically diverse urban sample of 342 children aged 9-10 years and 323 adolescents aged 17-18 years were recruited for this cross-sectional study. Body mass index (BMI) and waist circumference (WC) were measured in the school; dietary assessment included three 24-hour recalls via telephone in the evenings, and MVPA assessment included 5 days of accelerometry. Over (n = 68), under (n = 250), or plausible (n = 347) dietary intake reporters were identified with the Huang calculation method. Linear regression assessed the relationship between adiposity indicators (BMI z-score and WC) and components of the diet (energy intake, food groups, macronutrients) after controlling for reporting error, demographic variables, and MVPA. RESULTS: When dietary reporting error and potential confounders such as MVPA and demographic variables were controlled, energy intake (EI), vegetables, refined grains, total fat, total protein, and total carbohydrate were positively related to BMI z-score and WC and artificially sweetened beverages to WC. MVPA was a significant confounder. For BMI z-score, but not WC, relationships and strength of these relationships differed depending on dietary reporting error group (plausible, underreporter, overreporter). CONCLUSIONS: Among plausible reporters, as expected, EI, refined grains, and all macronutrients were positively related to adiposity; however, artificially sweetened beverages and vegetables, which are low-energy-dense foods, were also positively related to adiposity. Reporting error interfered with associations between diet and BMI z-score but not WC, suggesting WC is a more robust measure of adiposity in relation to diet.

Overeating styles and adiposity among multiethnic youth.

Reasons for inconsistent associations between overeating styles and adiposity among youth may include differences in effects by age, gender, or ethnicity; failure to control for social desirability of response; or adiposity measurement limitations. This study examined the relationship between overeating styles and multiple measures of adiposity, after controlling for social desirability and testing for moderation by ethnicity, age, and gender. Data from 304 9-10 year old children and 264 17-18 year old adolescents equally representing African American, Hispanic, and White ethnic groups were extracted from a larger cross-sectional study. Measures included the Dutch Eating Behavior Questionnaire (restrained, external, and emotional overeating subscales), the "Lie Scale" from the Revised Children's Manifest Anxiety Scale, and measured weight, height, waist circumference, and triceps skinfold. BMI z-score and a global adiposity index were calculated. Mixed model linear regression showed restraint was positively and external eating was negatively related to measures of adiposity. African American youth had a stronger inverse association between emotional eating and adiposity than White or Hispanic youth. Relationships were not influenced by social desirability nor moderated by age or gender. Overeating styles are related to adiposity in nearly all youth but the nature of these associations are moderated by ethnicity.

Health professionals' and dietetics practitioners' perceived effectiveness of fruit and vegetable parenting practices across six countries.

Fruit and vegetable intake may reduce the risk of some chronic diseases. However, many children consume less-than-recommended amounts of fruit and vegetables. Because health professionals and dietetics practitioners often work with parents to increase children's fruit and vegetable intake, assessing their opinions about the effectiveness of parenting practices is an important step in understanding how to promote fruit and vegetable intake among preschool-aged children. Using a cross-sectional design, collaborators from six countries distributed an Internet survey to health and nutrition organization members. A self-selected sample reported their perceptions of the effectiveness of 39 parenting practices intended to promote fruit and vegetable consumption in preschool-aged children from May 18, 2008, to September 16, 2008. A total of 889 participants (55% United States, 22.6% Mexico, 10.9% Australia, 4.4% Spain, 3.3% Chile, 2.2% United Kingdom, and 1.6% other countries) completed the survey. The fruit and vegetable intake-related parenting practices items were categorized into three dimensions (structure, responsiveness, and control) based on a parenting theory conceptual framework and dichotomized as effective/ineffective based on professional perceptions. The theoretically derived factor structures for effective and ineffective parenting practices were evaluated using separate confirmatory factor analyses and demonstrated acceptable fit. Fruit and vegetable intake-related parenting practices that provide external control were perceived as ineffective or counterproductive, whereas fruit and vegetable intake-related parenting practices that provided structure, nondirective control, and were responsive were perceived as effective in getting preschool-aged children to consume fruit and vegetables. Future research needs to develop and validate a parent-reported measure of these fruit and vegetable intake-related parenting practices and to empirically evaluate the effect of parental use of the parenting practices on child fruit and vegetable consumption.

Validity of instruments to assess students' travel and pedestrian safety.

BACKGROUND: Safe Routes to School (SRTS) programs are designed to make walking and bicycling to school safe and accessible for children. Despite their growing popularity, few validated measures exist for assessing important outcomes such as type of student transport or pedestrian safety behaviors. This research validated the SRTS school travel survey and a pedestrian safety behavior checklist. METHODS: Fourth grade students completed a brief written survey on how they got to school that day with set responses. Test-retest reliability was obtained 3-4 hours apart. Convergent validity of the SRTS travel survey was assessed by comparison to parents' report. For the measure of pedestrian safety behavior, 10 research assistants observed 29 students at a school intersection for completion of 8 selected pedestrian safety behaviors. Reliability was determined in two ways: correlations between the research assistants' ratings to that of the Principal Investigator (PI) and intraclass correlations (ICC) across research assistant ratings. RESULTS: The SRTS travel survey had high test-retest reliability (kappa = 0.97, n = 96, p < 0.001) and convergent validity (kappa = 0.87, n = 81, p < 0.001). The pedestrian safety behavior checklist had moderate reliability across research assistants' ratings (ICC = 0.48) and moderate correlation with the PI (r = 0.55, p = < 0.01). When two raters simultaneously used the instrument, the ICC increased to 0.65. Overall percent agreement (91%), sensitivity (85%) and specificity (83%) were acceptable. CONCLUSIONS: These validated instruments can be used to assess SRTS programs. The pedestrian safety behavior checklist may benefit from further formative work.

Connecting the dots of heart disease, poor mental health, and abuse to understand gender disparities and promote women's health: a prospective cohort analysis.

Heart disease, poor mental health, and abuse are epidemic among women worldwide. Our purpose was to identify a group of women with heart disease and explore the relationship between a history of abuse and existing symptoms of depression and post-traumatic stress disorder (PTSD) and analyze the relationships over time. A prospective cohort analysis design with mental health measures repeated at 3 and 6 months postintake was followed. Abused women (n = 25) reported significantly more symptoms of depression (p = .004) and PTSD (p = .003) compared with nonabused women (n = 14). To promote global mental health among women with heart disease, interventions must address a history of abuse.

Change in dietary energy density after implementation of the Texas Public School Nutrition Policy.

Consumption of energy-dense foods has been associated with rising obesity rates and the metabolic syndrome. Reducing dietary energy density is an important strategy to address obesity, but few studies have examined the effect of nutrition policies on children's energy density. The study's objective was to assess the impact of the Texas Public School Nutrition Policy on children's energy density by using a pre- and post-policy evaluation. Analysis of variance/covariance and nonparametric tests compared energy density after the Texas policy change to intakes at baseline. Two years of lunch food records were collected from middle school students in Southeast Texas at three public middle schools: baseline (2001-2002) and 1 year after implementation of the Texas Policy (2005-2006). Students recorded the amount and source of foods consumed. The Texas Public School Nutrition Policy was designed to promote a healthy school environment by restricting portion sizes of high-fat and high-sugar snacks and sweetened beverages, fat content of foods, and serving of high-fat vegetables like french fries. Energy density (kcal/g): energy density-1 was the energy of foods only (no beverages) divided by the gram weight and has been previously associated with obesity and insulin resistance; energy density-2 included all food and beverages to give a complete assessment of all sources of calories. Following implementation of the Texas policy, students' energy density-1 significantly decreased from 2.80+/-1.08 kcal/g to 2.17+/-0.78 kcal/g (P<0.0001). Similarly, energy density-2 significantly decreased from 1.38+/-0.76 kcal/g to 1.29+/-0.53 kcal/g (P<0.0001). In conclusion, the Texas Public School Nutrition Policy was associated with desirable reductions in energy density, which suggests improved nutrient intake as a result of student school lunch consumption.

Ethnic Minority Children's Active Commuting to School and Association with Physical Activity and Pedestrian Safety Behaviors.

BACKGROUND: Children's active commuting to school, i.e. walking or cycling to school, was associated with greater moderate-to-vigorous physical activity, although studies among ethnic minorities are sparse. OBJECTIVES: Among a low-income, ethnic minority sample of fourth grade students from eight public schools, we examined (1) correlates of active commuting to school and (2) the relationship between active commuting to school and moderate-to-vigorous physical activity. METHODS: We conducted a cross-sectional analysis of baseline measurements from a sample of participants (n=149) aged 9-12 years from a walk to school intervention study in Houston, Texas. The primary outcome was the weekly rate of active commuting to school. Daily moderate-to-vigorous physical activity, measured by accelerometers, was a secondary outcome. Child self-efficacy (alpha=0.75), parent self-efficacy (alpha=0.88), and parent outcome expectations (alpha=0.78) were independent variables. Participant characteristics (age, gender, race/ethnicity, distance from home to school, acculturation, and BMI percentile) were independent sociodemographic variables. We used mixed-model regression analyses to account for clustering by school and a stepwise procedure with backward elimination of non-significant interactions and covariates to identify significant moderators and predictors. School-level observations of student pedestrians were assessed and compared using chi-square tests of independence. RESULTS: Among our sample, which was 61.7% Latino, the overall rate of active commuting to school was 43%. In the mixed model for active commuting to school, parent self-efficacy (std. beta = 0.18, p=0.018) and age (std. beta = 0.18, p=0.018) were positively related. Latino students had lower rates of active commuting to school than non-Latinos ( 16.5%, p=0.040). Distance from home to school was inversely related to active commuting to school (std. beta = 0.29, p<0.001). In the mixed model for moderate-to-vigorous physical activity, active commuting to school was positively associated (std. beta = 0.31, p <0.001). Among the Latino subsample, child acculturation was negatively associated with active commuting to school (std. beta = -0.23, p=0.01). With regard to school-level pedestrian safety observations, 37% of students stopped at the curb and 2.6% looked left-right-left before crossing the street. CONCLUSION: Although still below national goals, the rate of active commuting was relatively high, while the rate of some pedestrian safety behaviors was low among this low-income, ethnic minority population. Programs and policies to encourage safe active commuting to school are warranted and should consider the influence of parents, acculturation, and ethnicity.

6-n-Propylthiouracil sensitivity and obesity status among ethnically diverse children.

OBJECTIVE: To examine the relationship of 6-n-propylthiouracil (PROP) sensitivity to BMI while statistically controlling for demographic characteristics in two age groups of children: 9-10 years and 17-18 years (n 1551). DESIGN: Cross-sectional design with a multi-ethnic (White, African-American, Hispanic, Other) sample of 813 children aged 9-10 years and 738 children aged 17-18 years. Children were recruited from local elementary and high schools with at least 30 % minority ethnic enrolment. Children's height, weight and waist circumference were measured along with their PROP taster status. PROP was measured using two paper discs, one impregnated with NaCl (1.0 mol/l) and the other with PROP solution (0.50 mmol/l). RESULTS: A significant PROP sensitivity by socio-economic status (SES) interaction term (P = 0.010) was detected wherein supertasters had the largest BMI percentile and Z-score, but only among the group with highest SES. CONCLUSIONS: The results suggest that other factors overwhelmed the influence of PROP sensitivity on adiposity in lower-SES groups. The percentage of variance accounted for by the interaction term was about 1 %. Thus, PROP supertasters had the largest BMI percentile and Z-score, but only among the highest-SES group.

Parenting practices are associated with fruit and vegetable consumption in pre-school children.

OBJECTIVE: Parents may influence children's fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children. DESIGN: An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004-5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children's consumption of F&V, after controlling for potential confounding factors. RESULTS: A three-cluster solution provided the best fit (R2 = 0.62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments' practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized beta = 0.09, P < 0.1; final model R2 = 0.17) after controlling for confounders, including parental feeding styles. CONCLUSIONS: Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children's F&V intake.

Boy Scout 5-a-Day Badge: outcome results of a troop and Internet intervention.

OBJECTIVES: The effects of a Boy Scout Five-A-Day Badge program on fruit juice (FJ) and low-fat vegetable (LV) consumption were evaluated using a two-condition (treatment, active-attention-placebo-control) group randomized trial, with three data collection periods (baseline, immediate post, 6-month post). METHODS: Forty-two Boy Scout troops (n=473, 10- to 14-year-old Scouts) in Houston, TX, were randomly assigned to condition. The 9-week program included approximately 30 min of weekly troop time, plus approximately 25 min of weekly Internet programming. The intervention was delivered in two waves (Spring and Fall). Data were collected in 2003-2004, and analyses were completed in 2008. Main outcomes were FJ and LV consumption (validated food frequency questionnaire). FV self-efficacy, preferences, and home availability were also measured. RESULTS: Significant increases in FJ consumption (p=.003), FJ home availability (p=.009), and LV self-efficacy (p=.004) were observed among the intervention group immediately following the intervention but were not maintained 6 months later. CONCLUSION: A Boy Scout troop-plus-Internet intervention promoting FJ and LV consumption resulted in short-term changes in FJ consumption among U.S. Boy Scouts. Future research should investigate ways to extend these results to LV and maintain the increases over time.

Development of new physical activity and sedentary behavior change self-efficacy questionnaires using item response modeling.

BACKGROUND: Theoretically, increased levels of physical activity self-efficacy (PASE) should lead to increased physical activity, but few studies have reported this effect among youth. This failure may be at least partially attributable to measurement limitations. In this study, Item Response Modeling (IRM) was used to develop new physical activity and sedentary behavior change self-efficacy scales. The validity of the new scales was compared with accelerometer assessments of physical activity and sedentary behavior. METHODS: New PASE and sedentary behavior change (TV viewing, computer video game use, and telephone use) self-efficacy items were developed. The scales were completed by 714, 6th grade students in seven US cities. A limited number of participants (83) also wore an accelerometer for five days and provided at least 3 full days of complete data. The new scales were analyzed using Classical Test Theory (CTT) and IRM; a reduced set of items was produced with IRM and correlated with accelerometer counts per minute and minutes of sedentary, light and moderate to vigorous activity per day after school. RESULTS: The PASE items discriminated between high and low levels of PASE. Full and reduced scales were weakly correlated (r = 0.18) with accelerometer counts per minute after school for boys, with comparable associations for girls. Weaker correlations were observed between PASE and minutes of moderate to vigorous activity (r = 0.09 - 0.11). The uni-dimensionality of the sedentary scales was established by both exploratory factor analysis and the fit of items to the underlying variable and reliability was assessed across the length of the underlying variable with some limitations. The reduced sedentary behavior scales had poor reliability. The full scales were moderately correlated with light intensity physical activity after school (r = 0.17 to 0.33) and sedentary behavior (r = -0.29 to -0.12) among the boys, but not for girls. CONCLUSION: New physical activity and sedentary behavior change self-efficacy scales have fewer items than classical test theory derived alternatives and have reasonable validity for boys, but more work is needed to develop comparable scales for girls. Fitting the items to a underlying variable could be useful in tailoring interventions to this scale.

Fruit and vegetables are similarly categorised by 8-13-year-old children.

OBJECTIVE: This exploratory study assessed how 8-13-year-old children categorised and labelled fruit and vegetables (FaV), and how these were influenced by child characteristics, to specify second-level categories in a hierarchical food search system for a computerised 24 h dietary recall (hdr). DESIGN: Two sets of food cards, sixty-seven for fruit (F) and sixty-four for vegetables (V), with pictures and names of FaV from ten professionally defined food categories were sorted, separately, by each child into piles of similar foods. Demographic data, BMI and 6-n-propylthiouracil (PROP) taster status were obtained. SETTING: Participants attended the Children's Nutrition Research Center in the summer of 2006. SUBJECTS: In all, 152 8-13-year-old children, predominantly English-speaking, of whom sixteen were predominantly Spanish-speaking. RESULTS: Children created an average of 8.5 (5.3) piles with 7.9 (11.4) cards per pile for the F, and an average of 10.1 (4.8) piles with 6.2 (7.9) cards per pile for the V. No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics, BMI or PROP sensitivity. Children provided clusters names that were mostly 'Taxonomic - Professional' labels, such as salads, berries, peppers, for both F (51.8 %) and V (52.1 %). CONCLUSIONS: These categories should be tested to assess their ability to facilitate search of FaV items in a computerised 24 hdr for children in this age group.