School-Age Children Can Recall Some Foods and Beverages Consumed the Prior Day Using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) without Assistance.

BACKGROUND: Technological innovations allow for collection of 24-h recalls (24HRs) in a broader range of studies than previously possible. The web-based Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) has been shown to be feasible and to perform well in capturing true intake among adults. However, data to inform use with children are limited. OBJECTIVE: This observational feeding study was conducted to evaluate children's ability to accurately report a lunchtime meal using ASA24 without assistance. METHODS: The study was conducted among children (n = 100) aged 10-13 y within a school setting. Students were served an individual cheese pizza, baby carrots, ranch dip, yogurt, a cookie, and 1 choice of water, juice, or milk. Plate waste was collected and weighed. The next day, participants completed ASA24 and a sociodemographic questionnaire. Descriptive statistics were generated to determine match rates by food item and age, and linear regression analyses were conducted to examine associations between sociodemographic characteristics and accuracy of reported energy and nutrient intake. Associations between true and reported energy and nutrient intakes and portion sizes were assessed with use of t tests. RESULTS: Just under half (49%) of children fully completed ASA24 (median time, 41 min). Children reported an exact, close, or far match for 58% of all foods and beverages consumed, ranging from 29% for dip to 76% for pizza, but also reported some items not consumed as part of the study meal. Older children completed the recall in a shorter time than younger children (mean 31 among 13 y compared with 52 min among 10 y). Intakes of energy (39%), protein (33%), and sodium (78%) were significantly overestimated, whereas portion sizes for cookies (53%) and juice (69%) were underestimated. CONCLUSIONS: Children can report some foods and drinks consumed using ASA24, but our findings suggest challenges with independent completion, necessitating research to examine strategies, such as training and resources, to support data quality.

Grocery Shopping, Dinner Preparation, and Dietary Habits among Adolescents and Young Adults in Canada.

PURPOSE: The current study aimed to characterize grocery shopping and dinner preparation behaviours among young people in Canada and to examine associations with eating habits. METHODS: A cross-sectional online survey was conducted with 2008 participants aged 16-24 from across Canada. The survey measured self-reported grocery shopping and dinner preparation behaviours, frequency of eating breakfast and eating meals prepared away from home, frequency of vegetable and fruit intake, and socio-demographic characteristics. Chi-square tests examined differences in proportions; logistic and linear regressions examined dietary habits, including covariates for grocery shopping and dinner preparation and socio-demographics. RESULTS: Overall, 37.3% had helped with grocery shopping in the past week, and 84.3% had participated in dinner preparation at least 1 day in the past week. Engaging in shopping at least once weekly was associated with increased vegetable and fruit consumption only, whereas more frequent engagement in dinner preparation was associated with increased vegetable and fruit consumption, more frequent breakfast consumption, and fewer meals consumed that were prepared away from home (P < 0.001 for all). CONCLUSIONS: Increased participation in grocery shopping and dinner preparation were associated with healthier dietary habits. Interventions that increase these behaviours may contribute to improving dietary behaviours among adolescents and young adults.

Evaluation of the online Beverage Frequency Questionnaire (BFQ).

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Added sugar in the packaged foods and beverages available at a major Canadian retailer in 2015: a descriptive analysis.

BACKGROUND: Excess consumption of added sugars has been associated with a variety of health problems, but there is little information available characterizing added sugar in the Canadian food supply. This study examined the presence and types of added sugars in the packaged food and beverage products available at a major Canadian grocery retailer. METHODS: We searched the ingredients lists of over 40 000 packaged food products available for sale in March 2015 for a variety of added sugar terms. Proportions of food products containing added sugar were identified overall and within food product categories. Differences in total sugar content were identified between food products with and without added sugar. RESULTS: Overall, 66% of the packaged food products analyzed contained at least 1 added sugar. The added sugar term "sugar" (and its variations) appeared the most frequently, followed by "dextrose." Added sugar presence and total sugar content varied within many product categories but were consistently higher in expected categories such as "beverages." Mean total sugar content was significantly higher in products with added sugar than in those without, both overall (p < 0.001) and within most product subcategories (p < 0.02). INTERPRETATION: About two-thirds of the packaged foods and beverages available at a major Canadian grocery retailer contain added sugar, similar to recent patterns estimated for the US food supply. The results provide an estimation of the baseline characterization of added sugar in the Canadian food supply, which can be used to assess outcomes of future changes to sugar labelling policies in Canada.

'How many calories did I just eat?' An experimental study examining the effect of changes to serving size information on nutrition labels.

OBJECTIVE: To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults. DESIGN: Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format. SETTING: Canada. SUBJECTS: Canadian youth and young adults (n 2008; aged 16-24 years). RESULTS: In experiment 1, participants randomized to view the nutrition label with per container or dual column were more likely to correctly identify energy content than those using per serving information (P<0·01). For experiment 2, the serving size display format had no association with correct energy estimation. The majority of participants (61·9 %) preferred the serving size format that included servings per package. CONCLUSIONS: Labelling foods with nutrition information using a serving size reference amount for the entire container increased understanding of energy content. Consumers prefer nutrition labels that include more prominently featured serving size information. Additional modifications that further improve consumers' accuracy should be examined. These results have direct implications for nutrition labelling policy.

The efficacy of sugar labeling formats: Implications for labeling policy.

OBJECTIVE: To examine knowledge of sugar recommendations and test the efficacy of formats for labeling total and added sugar on pre-packaged foods. METHODS: Online surveys were conducted among 2008 Canadians aged 16-24. Participants were asked to identify recommended limits for total and added sugar consumption. In Experiment 1, participants were randomized to one of six labeling conditions with varying information for total sugar for a high- or low-sugar product and were asked to identify the relative amount of total sugar in the product. In Experiment 2, participants were randomized to one of three labels with different added sugar formats and were asked if the product contained added sugar and the relative amount of added sugar. RESULTS: Few young people correctly identified recommendations for total sugar (5%) or added sugar (7%). In Experiment 1, those who were shown percent daily value information were more likely to correctly identify the relative amount of total sugar (P < 0.05). In Experiment 2, those shown added sugar information were more likely to correctly identify that the product contained added sugar and the relative amount of added sugar in the product (P < 0.05). CONCLUSIONS: Improved labeling may improve consumer understanding of the amount of sugars in food products.

Are environmental influences on physical activity distinct for urban, suburban, and rural schools? A multilevel study among secondary school students in Ontario, Canada.

BACKGROUND: This study examined differences in students' time spent in physical activity (PA) across secondary schools in rural, suburban, and urban environments and identified the environment-level factors associated with these between school differences in students' PA. METHODS: Multilevel linear regression analyses were used to examine the environment- and student-level characteristics associated with time spent in PA among grades 9 to 12 students attending 76 secondary schools in Ontario, Canada, as part of the SHAPES-Ontario study. This approach was first conducted with the full data set testing for interactions between environment-level factors and school location. Then, school-location specific regression models were run separately. RESULTS: Statistically significant between-school variation was identified among students attending urban (σ(2) µ0 = 8959.63 [372.46]), suburban (σ(2) µ0 = 8918.75 [186.20]), and rural (σ(2) µ0 = 9403.17 [203.69]) schools, where school-level differences accounted for 4.0%, 2.0%, and 2.1% of the variability in students' time spent in PA, respectively. Students attending an urban or suburban school that provided another room for PA or was located within close proximity to a shopping mall or fast food outlet spent more time in PA. CONCLUSION: Students' time spent in PA varies by school location and some features of the school environment have a different impact on students' time spent in PA by school location. Developing a better understanding of the environment-level characteristics associated with students' time spent in PA by school location may help public health and planning experts to tailor school programs and policies to the needs of students in different locations.

A multilevel examination of gender differences in the association between features of the school environment and physical activity among a sample of grades 9 to 12 students in Ontario, Canada.

BACKGROUND: Creating school environments that support student physical activity (PA) is a key recommendation of policy-makers to increase youth PA. Given males are more active than females at all ages, it has been suggested that investigating gender differences in the features of the environment that associate with PA may help to inform gender-focused PA interventions and reduce the gender disparity in PA. The purpose of this cross-sectional study was to explore gender differences in the association between factors of the school environment and students' time spent in PA. METHODS: Among a sample of 10781 female and 10973 male students in grades 9 to 12 from 76 secondary schools in Ontario, Canada, student- and school-level survey PA data were collected and supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools. RESULTS: Findings from the present study revealed significant differences in the time male and female students spent in PA as well as in some of the school- and student-level factors associated with PA. Results of the gender-specific multilevel analyses indicate schools should consider providing an alternate room for PA, especially for providing flexibility activities directed at female students. Schools should also consider offering daily physical education programming to male students in senior grades and providing PA promotion initiatives targeting obese male students. CONCLUSIONS: Although most variation in male and female students' time spent in PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers. More research investigating gender differentials in environment factors associated with youth PA are warranted.

The Happy Meal® Effect: the impact of toy premiums on healthy eating among children in Ontario, Canada.

OBJECTIVES: "Toy premiums", offered with McDonald's Happy Meals®, are a prominent form of food marketing directed at children. Two California jurisdictions recently implemented policies that only permit offering fast-food toy premiums with meals that meet certain nutritional criteria. The primary objective of the current study was to examine elements of this policy in a Canadian context and determine if children select healthier food products if toy premiums are only offered with healthier food options. The study also examined if the impact of restricting toy premiums to healthier foods varied by gender and age. METHODS: A between-groups experimental study was conducted with 337 children aged 6-12 years attending day camps in Ontario, Canada. Children were offered one of four McDonald's Happy Meals® as part of the camp lunch program: two "healthier" meals that met the nutritional criteria and two meals that did not. In the control condition, all four meals were offered with a toy premium. In the intervention condition, the toy was only offered with the two "healthier" meals. RESULTS: Children were significantly more likely to select the healthier meals when toys were only offered with meals that met nutritional criteria (OR=3.19, 95% CI: 1.89-5.40). The effect of pairing toys with healthier meals had a stronger effect on boys than girls (OR=1.90, 95% CI: 1.14-3.17). CONCLUSION: Policies that restrict toy premiums to food that meet nutritional criteria may promote healthier eating at fast-food restaurants.

The Battle River Project: school division implementation of the health-promoting schools approach: assessment for learning: using student health and school capacity measures to inform action and direct policy in a local school district.

The Battle River Project (BRP) is a school division-level intervention in rural Alberta, Canada, built upon the health-promoting schools approach to health promotion. Using self-reported school and student-level data from administrators and students, the central aim of the BRP is to examine: 'How can the school environment and health behaviours (healthy eating, physical activity and mental wellness) of children and youth be improved when a health-promoting schools model, the Ever Active Schools program, is implemented with school division support?' Evidence used to inform school level changes included students' demographic, behavioral, and psychosocial variables linked to school environment data, comprised of school demographics and administrator-assessed quality of policies, facilities, and programs related to physical activity. Each participating school and the division were provided with a tailored report of their schools' results to reflect, plan and implement for positive health behavior change. The main lesson learned was that sharing school-specific evidence can operate as a catalyst for embedding health promoting policy and practices within the school and division culture.

A multilevel examination of school and student characteristics associated with physical education class enrollment among high school students.

BACKGROUND: Schools can be an efficient venue for promoting physical activity (PA) among adolescents. Physical education (PE) requires investigation because it is a variable associated with adolescent PA levels and its existence in schools represents a significant opportunity for strategies to combat declining PA levels among this population. This article examines the between-school variability in student rates of PE enrollment among a large sample of high schools in Ontario, Canada, and identifies the school- and student-level characteristics associated with PE enrollment. METHODS: This cross-sectional study utilized self-reported school- and student-level data from administrators and students at 73 high schools. Students' enrollment in PE, demographic, behavioral, and psychosocial variables was linked to school environment data comprising of school demographics and administrator assessed quality of policies, facilities, and programs related to PA. Analysis involved multilevel modeling. RESULTS: The mean rate of PE enrollment among the 73 high schools was 62.4%, with rates by school ranging from 28.9% to 81.1%. When student demographics, behavioral, and psychosocial factors were controlled for, there was still a school effect for student PE enrollment. The school effect was explained by the provision of daily PE and school median household income. CONCLUSIONS: This is the first study to examine the extent to which PE enrollment varies between schools and to identify school factors associated with school variability in rates of PE enrollment. Although most variation in PE enrollment lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy makers.

A multilevel examination of school and student characteristics associated with moderate and high levels of physical activity among elementary school students (Ontario, Canada).

OBJECTIVES: Schools represent an important environment for physical activity (PA) promotion among youth. Schools can promote PA through policies and programs but our understanding of how these school characteristics associate with student PA levels is largely unknown. Developing this understanding is critical for implementing new prevention interventions. The aim of this study was to identify the school- and student-related characteristics associated with moderate and high levels of PA in a sample of Ontario elementary schools. METHODS: Using multi-level logistic regression analyses, we explored the school- and student-level characteristics associated with being moderately and highly active using data collected from administrators and from students in grades 5 to 8 at 30 elementary schools in Ontario. Students' PA levels, sex, grade, and the number of physical education classes per week were linked to school environment data--specifically, a school's chosen implementation model for daily physical activity and whether it offers intramural and interschool PA programming. RESULTS: Findings indicate that there was significant between-school variation for being moderately and highly active. Students were less likely to be moderately or highly active if they attended a school offering interschool PA programming. An important student characteristic positively associated with student PA levels included participating in at least two physical education classes per week. CONCLUSION: The residual differences in PA by school suggest that school-level characteristics facilitate higher levels of student PA beyond individual-level factors. Although most variation in student PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers.