Are Caregivers' Feeding Competence and Autonomy Associated with Healthier Restaurant Food Purchases for Their Child at Fast Food or Counter Service Restaurants? A Cross-Sectional Study in a Diverse Sample of U.S. Caregivers.

This study examined the cross-sectional relationship between caregivers' perceived competence and autonomy (as defined by the Self-Determination Theory) and their fast food or counter service restaurant food purchases (side dishes, beverage, and dessert) for their child. A U.S. national convenience sample of caregivers with at least one 3-12-year-old child completed an online survey with questions adapted from the Intrinsic Motivation Inventory that measured perceived competence and autonomy for feeding fruits and vegetables and limiting sugar-sweetened beverages (SSBs) and desserts. The survey included four questions asking about their fast food or counter service restaurant food purchases (side dish, beverage, and dessert). We applied logistic and multinomial logistic regression models to examine the associations between competence or autonomy and restaurant orders. Competence and autonomy were associated with ordering fruits and vegetables as side dishes (OR [95% CI], 1.14 [1.06, 1.24] and 1.09 [1.03, 1.14], respectively). However, higher competence was also associated with ordering desserts at restaurants and higher autonomy was associated with lower odds of ordering water. These findings will inform interventions and programs that aim to support caregivers' psychological needs, like competence and autonomy, to promote supportive environments and healthier restaurant purchases for their children.

Diet and Physical Activity by Prediabetes Status Among U.S. Adolescents: National Health and Nutrition Examination Survey, 2007-2018.

Background: Prediabetes among adolescents is on the rise, yet it is unclear if modifiable risk factors vary by prediabetes status. Methods: This study examined associations between diet (primary objective) and physical activity (secondary objective) by prediabetes status among U.S. adolescents (12-19 years) who participated in the National Health and Nutrition Examination Survey from 2007-2018. Differences in Healthy Eating Index (HEI)-2015-2020 scores (total and 13 component scores), nutrients of public health concern, and physical activity were examined by prediabetes status (no prediabetes vs. prediabetes). Results: Adolescents (n = 2,487) with prediabetes had significantly lower whole grains component scores and intakes of vitamin D, phosphorus, and potassium (all p < .05), than adolescents without prediabetes. Physical activity levels were not optimal for either group, there were no differences by prediabetes status (n = 2,188). Conclusion: Diabetes prevention interventions for adolescents are needed and should promote a healthy diet target and encourage physical activity.

Examining the feasibility of a youth advocacy program promoting healthy snacking in New York City: a mixed-methods process evaluation.

Adolescents from urban communities are at risk for unhealthy snacking behaviors. Youth advocacy interventions are shown to improve certain adolescent health behaviors, such as substance use. However, it remains unclear if youth advocacy is a feasible method to promote healthy snacking. As such, the aim of this study was to examine the feasibility of a youth advocacy program promoting healthy snacking among adolescents in New York City by conducting a mixed-methods process evaluation. Adolescents (12-18 years) at a Boys and Girls Club in New York City were recruited to participate in a 12-session adaptation of the Youth Engagement and Action for Health! program to advocate for the promotion of healthy snacks in corner stores. A mixed-methods process evaluation was conducted to assess recruitment, reach (attendance), dose delivered (amount of intervention delivered), fidelity (degree to which intervention was implemented according to curriculum) and dose received (participant engagement/satisfaction). Satisfaction was also evaluated through focus groups. Descriptive statistics were calculated for quantitative data, and focus groups were analyzed using thematic analysis. Participant retention (94.74%), attendance (93.52%), dose delivered (98.94%), fidelity (98.5%), engagement (4.97/5) and program satisfaction (4/5) were high. Focus groups (n = 6; 28 participants) revealed that participants learned about nutrition, enjoyed being advocates and improved snacking behaviors.

Cultural influences on infant and toddler feeding among low-income Latinx mothers.

Latinx infants and toddlers experience higher obesity rates than their black or white counterparts, increasing chronic disease risk later in life. Infant and toddler feeding (ITF) interventions are shown to improve dietary behaviours, but few studies target Latinx populations. Culturally tailoring such interventions is imperative, but cultural influences on Latinx ITF practices remain unclear. The purpose of this study was to characterize how culture influences ITF practices among Latinx mothers of low income. A brief survey and semistructured interview informed by the theory of planned behaviour (TPB) were conducted on Zoom with New York City-based Latinx mothers of children 4 to 24 months old. A directed content analysis approach was used to identify themes using TPB theoretical codes and inductive codes. Transcripts were coded independently by two researchers using NVivo 12. Survey data were analyzed using descriptive statistics in Excel. Participants (n = 19) were of Dominican, Mexican and Central and South American origin, had low acculturation scores and mean child age was 16.7 months (range: 5-24 months old). The central theme identified was that participants balanced cultural information with evidence-based health information to determine which ITF practices were most beneficial to infant/toddler health. This resulted in the adoption of evidence-based ITF recommendations, adoption of cultural practices that aligned with evidence-based recommendations and dismissal or postponement of cultural ITF practices that contradicted evidence-based recommendations. The present results can be applied to culturally relevant ITF education as follows: emphasizing the benefits of desirable ITF practices on children's health and promoting healthy cultural ITF practices.

Factors That Influence Snacking Behaviors of Adolescents From Urban Communities: A Qualitative Study.

OBJECTIVE: To qualitatively explore factors that influence snacking behaviors of adolescents from urban communities. DESIGN: One-time, semistructured phone interviews based on Social Cognitive Theory. SETTING: Boys and Girls Club in New York City. PARTICIPANTS: A total of 30 adolescents (aged 12-18 years; mean age 15.2 years, mostly female [57%], and Black or African American [83%]) were purposively recruited. This sample is representative of adolescent members at this Boys and Girls Club in New York City. PHENOMENON OF INTEREST: Adolescents were asked about personal, environmental, and behavioral factors influencing snacking. ANALYSIS: Interviews were audio-recorded, transcribed, and transcripts were analyzed using the thematic analysis approach in NVivo (version 12). RESULTS: In terms of personal factors, adolescents' snacking was influenced by preference (eg, taste and brand), health benefits, and health concerns. Regarding the social environment, adolescents remarked that snacking with peers promoted unhealthy snacking, while snacking, with family promoted healthier snacking. The family culture was also a salient factor. In addition, adolescents discussed how proximity to corner stores in their physical environment fostered unhealthy snacking. Finally, behavioral factors that influenced frequent snacking were high self-efficacy and food autonomy. CONCLUSIONS AND IMPLICATIONS: Snacking among adolescents from urban communities is influenced by preference, health, family/peer influence, neighborhood availability/access, and high autonomy. These factors can be targeted in interventions to improve snacking among this demographic.

Collecting, Using, and Reporting Race and Ethnicity Information: Implications for Research in Nutrition Education, Practice, and Policy to Promote Health Equity.

This report will describe approaches for collecting, analyzing, and reporting race and ethnicity information in nutrition education and behavior research, practice, and policy to advance health equity. Race and ethnicity information is used to describe study participants and compare nutrition and health-related outcomes. Depending on the study design, race and ethnicity categories are often defined by the research question or other standardized approaches. Participant self-reported data are more acceptable than researcher adjudicated identification data, which can add bias and/or error. Valid methods to collect, use, and report race and ethnicity information are foundational to publication quality, findings of value, contribution to the knowledge base, and health equity.

What is a "Snack"? Perspectives from Adolescents in Urban Communities.

Snacking contributes significantly to U.S. adolescents' dietary intake and is a particularly significant eating occasion for urban adolescents, who have high amounts of food autonomy and access to corner stores. Consequently, research has focused on understanding and improving snacking among urban adolescents. However, the word "snack" possesses several definitions in the literature, leading to inconsistences in research efforts. As such, the aim of this study was to explore the definition of a snack among urban adolescents by conducting phone interviews with 30 adolescents from a Boys & Girls Club in New York City. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Overall, adolescents defined a snack as a small, unhealthy food item that can be quickly eaten to reduce hunger between meals. Future directions include using the definition of a snack that emerged from this study to improve subsequent adolescent snacking interventions.

Association Between Birthplace and Time in the United States With Diet Quality in US Adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018.

BACKGROUND: During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of US immigrant adults, but research is limited among adolescents. OBJECTIVES: We investigated the associations between birthplace and length of time living in the United States, 2 proxy measures of acculturation, and diet quality among adolescents (12-19 years old). METHODS: Data were from the NHANES (2007-2018), which included two 24-hour dietary recalls (n = 6113) to estimate Healthy Eating Index 2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 to <10 years (n = 201), and ≥10 years (n = 290) of US residency. RESULTS: Foreign-born adolescents with <5 years (53.3 ± 1.2), 5 to <10 years (51.4 ± 1.5), and ≥10 years of US residency (49.9 ± 0.8) had higher HEI-2015 total scores than US-born adolescents (47.0 ± 0.3; P < 0.0001) and higher component scores for total vegetables, seafood and plant proteins, and added sugars (P values ≤ 0.0001). Foreign-born adolescents with more years of US residency had higher component scores for total fruits, whole fruits, and saturated fats than those with fewer years of US residency. A sensitivity analysis revealed this pattern held for Mexican-American and other Hispanic adolescents. CONCLUSIONS: Being born outside the United States and living in the United States for less time (among foreign-born adolescents) are associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.

Healthy Eating Index Scores, Body Mass Index and Abdominal Obesity Among Asian Americans: NHANES 2011-2018.

Objective: Obesity rates are increasing among Asian Americans so, the objective of this study was to examine associations between Healthy Eating Index scores (a measure of adherence to the Dietary Guidelines for Americans (DGAs)) and body mass index (BMI) and waist circumference (measure of abdominal obesity) among Asian American adults. Methods: Included in these analyses were Asian Americans ≥20 years from the National Health and Nutrition Examination Survey (2011-18) who had: (1) two 24 h diet recalls to calculate HEI and HEI subcomponent scores, (2) height and weight data to calculate BMI overweight ≥25 kg/m2 and obese ≥ 30kg/m (2), and (3) waist circumference data (high risk ≥ 80 cm for women and ≥ 90 cm for men; n = 1024 women and n = 904 men). Multinomial logistic regression models were run with BMI as the outcome and logistic regression models were run with waist circumference as the outcome, controlling for age, income, marital status, education, and physical activity. Results: Among women, a diet with greater adherence to the DGAs for total fruit, fatty acids and total protein was associated with lower likelihood of developing obesity, but a diet with greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a higher likelihood of obesity. Among men, greater adherence to the DGAs for fatty acids was associated with a lower likelihood of obesity but greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a greater likelihood of obesity. Conclusions: Future research is needed to examine associations between consumption of specific foods and beverages and how they are associated with BMI and waist circumference among Asian American adults. Furthermore, there is a need culturally relevant obesity prevention interventions for Asian American adults, especially interventions that take into consideration cultural food norms of specific Asian American subgroups.

Fiber-rich foods delivered to Low-Income Households: A feasibility study of children with prediabetes and spillover effect on their caregivers.

INTRODUCTION: The incidence of pediatric prediabetes and type 2 diabetes mellitus (T2DM) is increasing, with those from low socioeconomic status (SES) households at increased risk. Dietary fiber (e.g., whole grains) is shown to improve glucose control and there is need for innovative strategies that address barriers to consumption (e.g., limited availability). METHODS: Food Overcoming our Diabetes Risk (FoodRx) was a pre-post study (N = 47) that provided 16 weeks of home-delivered whole grains, vegetables, and beans/legumes to households of low-income children in [blinded for submission] who had obesity and prediabetes. Child liking and intake (24-hour diet recalls) was evaluated. Anthropometrics and T2DM-related laboratory measurements (e.g. glycated hemoglobin) were measured for children, and for caregivers to evaluate potential spillover effect. RESULTS: Post-intervention, children increased liking of whole grains, vegetables, and beans/legumes (P < 0.05 for all). Child whole grain intake increased from 1.7 to 2.5 oz-equivalent servings/day (P < 0.001), and the percent of total grain intake that were whole increased from 30% to 44% (P < 0.001). Children's body mass index, blood pressure, and serum triglyceride levels increased (+14.6 mg/dl, P = 0.04). Caregivers fasting glucose (-7.5 mg/dl; P = 0.03), fasting insulin (-2.5 µIU/ml, P = 0.0009) and homeostatic model assessment for insulin resistance (HOMA-IR) decreased (-0.8, P = 0.01). CONCLUSIONS: Home deliveries of fiber rich foods improved liking and intake among children at risk for T2DM. There was spillover effect on caregivers, who demonstrated improvement in T2DM-related laboratory measurements instead of the children.

U.S. Adolescents' Diet Consumption Patterns Differ between Grocery and Convenience Stores: National Health and Nutrition Examination Survey 2011-2018.

Among U.S. adolescents, foods/beverages that are store-bought (i.e., from grocery and convenience stores) are significant contributors of energy intake. However, it remains unclear (1) what foods/beverages are consumed by U.S. adolescents from grocery and convenience stores and (2) if there are differences in foods/beverages consumed by store type. Therefore, we analyzed 29,216 eating occasions from adolescents (12-19 years; n = 4065) in the National Health and Nutrition Examination Survey 2011-2018 to report food/beverage groups and nutrients consumed from grocery and convenience stores. Differences in food/beverage groups and nutrient densities by store type were calculated using multiple logistic and linear regressions. Adolescents were more likely to consume "Beverages" and "Snacks and Sweets" and less likely to consume "Grains", "Protein", "Milk and Dairy", "Condiments and Sauces", and "Fruits" from convenience compared to grocery stores (all p < 0.0025). Foods/beverages from convenience stores were higher in carbohydrates, total sugar, and added sugar and lower in protein, fat, saturated fat, sodium, and fiber than those from grocery stores (all p < 0.0025). In conclusion, while foods/beverages from convenience stores are more energy-dense and nutrient-poor, there is a critical need to increase the availability, accessibility, and affordability of healthier foods/beverages in both store types to encourage healthier dietary behaviors among U.S. adolescents.

Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005-2018.

Snacking contributes a significant portion of adolescents' daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12-19 years) from the National Health and Nutrition Examination Survey 2005-2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories "Milk and Dairy" (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and "Fruits" (aOR: 0.62, 95% CI: 0.50-0.78; p = 0.001) as snacks and higher odds of consuming "Beverages" (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3-3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

Stakeholders' Views on Mobile Applications to Deliver Infant and Toddler Feeding Education to Latina Mothers of Low Socioeconomic Status.

Infant- and toddler-feeding (ITF) practices are critical to long-term health and chronic disease prevention. Using mobile applications (apps) to promote desirable ITF practices shows promise for overcoming challenges of in-person education. However, the viability of ITF apps for Latina mothers of low-socioeconomic status (SES) remains unclear. The objective of this study was to characterize stakeholders' views on Latina mothers' capability, motivation, and barriers to using ITF apps. New York City-based health professionals who frequently engage with Latina mothers of low SES completed in-depth interviews. Directed content analysis was used to identify themes through theoretical and inductive codes. Participants included dietitians, nutrition educators, and physicians (n = 17). The following themes were identified: (1) Most Latina mothers of low-SES are tech-savvy (i.e., high capability and experience using smartphones and apps); (2) Apps are an appealing way to deliver ITF education; (3) There are challenges to using apps that must be carefully considered for ITF education development. Overall, ITF apps are a viable option as skills and use appear high among Latina mothers. Key considerations for app development include targeted app promotion; detailed instructions for obtaining and using app; more visuals, less text for low literacy and multiple dialects; making key features available offline.

Sociodemographic characteristics are associated with prevalence of high-risk waist circumference and high-risk waist-to-height ratio in U.S. adolescents.

BACKGROUND: Adiposity status in adolescence is associated with various health outcomes in adulthood. Waist circumference [WC] and waist-to-height ratio [WHtR] are measures of abdominal obesity and have shown to be valid predictors of future chronic diseases. However, the relationship between sociodemographic characteristics and WC, as well as WHtR in U.S. adolescents remain unclear. Thus, the study aims to examine associations between sociodemographic characteristics and abdominal obesity among a nationally representative sample of U.S. adolescents. METHODS: The sample included 4712 adolescents (12-19 years) in the 2007-2016 National Health and Nutrition Examination Survey. Associations between sociodemographic characteristics and abdominal obesity (WC and WHtR) were examined using multiple logistic regression models, adjusted for age, physical activity level, and sedentary activity. RESULTS: Around 18% of adolescents had high-risk WC (≥90th percentile) and 34% had high-risk WHtR (≥0.5). Females had higher odds of high-risk WHtR compared to males (OR = 1.46, 95%CI = 1.23-1.72). Mexican American adolescents had higher odds of high-risk WHtR compared to non-Hispanic White (OR = 1.66, 95%CI = 1.24-2.20), non-Hispanic Black (OR = 1.73, 95%CI = 1.26-2.36), and other race/multi-racial adolescents (OR = 1.84, 95%CI = 1.21-2.80). When their parent were college graduates, adolescents had lower odds for high-risk WC compared to when the parent had some college education (OR = 0.68, 95%CI = 0.49-0.93) or a high school degree or less (OR = 0.70, 95%CI = 0.51-0.97). Similar associations were seen between parental education level and high-risk WHtR, as well as between household income and high-risk WHtR. CONCLUSIONS: Measures of abdominal obesity should be considered to assess burden of adiposity, especially among female adolescents, adolescents from racial/ethnic minority and low socioeconomic status backgrounds. Additionally, future health interventions should consider including changes in WC and WHtR to measure the impact of these interventions.

Facilitators and barriers to preparing and offering whole grains to children diagnosed with prediabetes: qualitative interviews with low-income caregivers.

BACKGROUND: The prevalence of U.S. youth with prediabetes and type 2 diabetes (T2D) is increasing, with those from racial/ethnic minority and low socioeconomic status (SES) backgrounds at greater risk. Dietary fiber (e.g., whole grains and vegetables) is shown to be inversely associated with T2D risk, yet dietary recommendations are not being met. Caregivers play an important role in home food availability, but low SES neighborhoods are shown to have limited access to fiber-rich foods such as whole grains. The overall aim of this qualitative study was to assess caregiver perceptions about facilitators and barriers to preparing and offering whole grains that they received as part of the 16-week Food Overcoming Our Diabetes Risk (FoodRx) pilot study. METHODS: A convenience sample of 60 youth (8-17 years) with obesity and prediabetes were recruited from an urban pediatric weight management clinic to participate in the FoodRx pilot study. Caregivers accompanied youth to a baseline clinic visit and completed a survey that asked about individual and household characteristics. Exit interviews were conducted at the follow-up clinic visit with caregivers of all youth who completed the study (n = 48) in order to assess facilitators and barriers experienced when preparing and offering whole grains. Interview transcripts were coded using the constant comparative method and grounded theory approaches. RESULTS: Caregivers (n = 48) had a mean age of 43 years and were primarily female (n = 46) and Hispanic (71%). Main facilitators to preparing and offering whole grains in the home were caregivers' improved knowledge of whole grain health benefits and the development of strategies to encourage their children to consume whole grains (i.e., pairing whole grains with another liked food). A main barrier for caregivers was the lack of resources available to identify and prepare the novel whole grains that they received. CONCLUSION: Findings suggest that caregivers are receptive to incorporating more whole grains into home-prepared meals, but they may need additional nutrition and cooking education to improve their self-efficacy.

Youth Willingness to Purchase Whole Grain Snack Packs from New York City Corner Stores Participating in a Healthy Retail Program.

Corners stores in low-income communities are a promising setting to intervene in youth whole grain intake. One strategy that may encourage whole grain intake is if corner stores were to pair and sell whole grain snacks in combination with either a liked fruit or vegetable and an optional condiment (i.e., a whole grain snack pack). This study examined youth in terms of their (1) liking of fruits, vegetables, and whole grain snacks; (2) perceptions about which fruits and vegetables pair best with whole grain snacks; and (3) willingness to pay for a whole grain snack pack. One-time intercept surveys were conducted with 10-18-year-olds (n = 402) who visited a New York City (NYC) corner store (n = 34) participating in the City Harvest Healthy Retail Program. On average, youth were willing to spend $2.38 (SD $4.32) on a whole grain snack pack. Higher overall liking scores for vegetables and whole grain snacks were associated with willingness to spend 24.4% (95% confidence interval (CI): 11.5-38.7%) and 21.6% (95%CI: 5.2-40.6%) more on whole grain snack packs, respectively. In conclusion, youth are receptive to purchasing whole grain snack packs from NYC corner stores participating in a healthy retail program.

The Role of Adolescents From a Low Socioeconomic Background in Household Food Preparation: A Qualitative Study.

The purpose of this study was to understand adolescents' from low-income households perceptions of their involvement in home food preparation, reasons underlying the extent to which they were involved, and positive and negative consequences associated with their involvement. Semistructured interviews were conducted with a convenience sample of 19 adolescents (13-18 years). Audio-recorded interviews were transcribed verbatim. Themes were identified using grounded theory and the constant comparative method. Eight adolescents described cooking as a primary responsibility due to adult work and family schedules, age, gender, and/or cultural expectations. They were typically preparing food for themselves and their family without assistance, and making decisions about what was prepared. They identified positive and negative consequences including enjoyment and satisfaction, as well as stress and less time for other activities. Eleven adolescents mostly assisted the primary food preparer, with little input in deciding what was prepared. They identified benefits such as enjoyment and family interaction. Foods prepared by many adolescents tended to be quick and easy to prepare foods. Future studies should investigate the relationship between adultified cooking responsibilities, diet quality, and health. Also, cooking education for adolescents needs to address how to prepare a healthy family meal on a budget.

Children Residing in Low-Income Households Like a Variety of Vegetables.

Child vegetable intake falls far below the minimum recommended levels. Knowing which vegetables children may like help those responsible for providing vegetables to children to improve intake. The objective of this study was to measure vegetable liking for a wide variety of vegetables by a racially and ethnically diverse population of 9⁻12-year old children from low-income families. Children rated their liking of 35 vegetables using a 10-point hedonic scale. We tabulated the number of children that found each vegetable acceptable (ratings of 'okay' or above) and the number that found each vegetable unacceptable (ratings below 'okay'). More than 50% of children who had tried a vegetable considered it acceptable. A large majority of the vegetables had mean ratings in the acceptable range. Corn was the most liked vegetable, closely followed by potatoes, lettuce, and carrots. Artichoke had the lowest mean liking, followed by onion and beets. We found children liked a wide variety of vegetables which offers counter evidence to the commonly held perception that children do not like vegetables.

Recent Uptrend in Whole-Grain Intake Is Absent for Low-Income Adolescents, National Health and Nutrition Examination Survey, 2005-2012.

INTRODUCTION: Whole-grain consumption reduces risk of chronic disease, yet adolescents consume suboptimal amounts. It is unclear whether trends in consumption of whole grains have been positive among adolescents, and research assessing disparities by socioeconomic status is limited. The objective of our study was to evaluate recent trends in whole-grain consumption by US adolescents. METHODS: We examined data on 3,265 adolescents aged 13 to18 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2012. Intake of whole and refined grains was analyzed by using generalized linear models, and odds of no whole-grain intake were examined with logistic regression, adjusting for socioeconomic and demographic factors. We evaluated trends and examined heterogeneity of trends with respect to annual household income. RESULTS: Daily whole-grain consumption among adolescents increased overall by about a quarter-ounce-equivalent per day (oz-eq/d) (P trend <.001). We found a significant relationship between whole-grain intake and income. Daily whole grains (recommended as ≥3 oz-eq/d), increased (0.6 to 1.0 oz-eq/d) among high-income adolescents (P trend < .001) but remained at 0.5 oz-eq/d for low-income adolescents. The ratio of whole grains to total grains (recommended to be at least 50%) rose from 7.6% to 14.2% for high-income adolescents (P trend < .001), with no significant trend for the low-income group. Consumption of refined grains did not change. Odds of having no whole grains trended downward, but only for the high-income adolescents (P trend = .01). CONCLUSION: These data show significant (albeit modest) trends toward increased intake of whole grains among high-income adolescents nationwide that are absent among low-income peers. Future interventions and policies should address barriers to whole-grain consumption among this vulnerable group.

Examining the feasibility of implementing behavioural economics strategies that encourage home dinner vegetable intake among low-income children.

OBJECTIVE: To examine the feasibility of implementing nine behavioural economics-informed strategies, or 'nudges', that aimed to encourage home dinner vegetable intake among low-income children. DESIGN: Caregivers were assigned six of nine strategies and implemented one new strategy per week (i.e. 6 weeks) during three dinner meals. Caregivers recorded child dinner vegetable intake on the nights of strategy implementation and rated the level of difficulty for assigned strategies. Baseline data on home vegetable availability and child vegetable liking were collected to assess overall strategy feasibility. SETTING: Participants' homes in a large Midwestern metropolitan area, USA. SUBJECTS: Low-income caregiver/child (aged 9-12 years) dyads (n 39). RESULTS: Pairwise comparisons showed that child dinner vegetable intake for the strategy 'Serve at least two vegetables with dinner meals' was greater than intake for each of two other strategies: 'Pair vegetables with other foods the child likes' and 'Eat dinner together with an adult(s) modelling vegetable consumption'. Overall, caregivers' mean rating of difficulty for implementing strategies was 2·6 (1='not difficult', 10='very difficult'). Households had a mean of ten different types of vegetables available. Children reported a rating ≥5 for seventeen types of vegetable on a labelled hedonic scale (1='hate it', 5-6='it's okay', 10='like it a lot'). CONCLUSIONS: Behavioural economics-informed strategies are feasible to implement during dinner meals, with some strategies differing by how much they influence vegetable intake among low-income children in the home.