Examining plausibility of self-report energy intake data: considerations for method selection.

Self-reported dietary intake data contain valuable information and have long been used in the development of nutrition programs and policy. Some degree of measurement error is always present in such data. Biological plausibility, assessed by determining whether self-reported energy intake (rEI) reflects physiological status and physical activity level, must be examined and accounted for before drawing conclusions about intake. Methods that may be used to account for plausibility of rEI include crude methods such as excluding participants reporting EIs at the extremes of a range of intake and individualized methods such as statistical adjustment and applying cutoffs that account for the errors associated with within-participant variation in EI and total energy expenditure (TEE). These approaches allow researchers to determine how accounting for under- and overreporting affects study results and to appropriately address misreporting in drawing conclusions with data collected and in interpreting reported research. In selecting a procedure to assess and account for plausibility of intake, there are a number of key considerations, such as resources available, the dietary-report instrument, as well as the advantages and disadvantages of each method. While additional studies are warranted to recommend one procedure as superior to another, researchers should apply one of the available methods to address the issue of implausible rEI. If no method is applied, then at minimum, mean TEE or rEI/TEE should be reported to allow readers to ascertain the degree of misreporting at a gross level and better interpret the data and results provided

Preferred Tone of Nutrition Text Messages for Young Adults: Focus Group Testing

BACKGROUND: Young adults are a particularly hard to reach group using conventional health promotion practices as they do not see nutrition messages as personally relevant to them. Text messaging (short message service, SMS) offers an innovative approach to reaching young adults to support and promote dietary behavior change. OBJECTIVE: The aim of this study was to develop and test tonal preferences for nutrition text messages among young adults using focus groups. METHODS: A total of 39 young adults aged 18-30 years residing in Perth, Western Australia participated in four focus groups. Participants briefly discussed their perception of healthy eating and their responses to messages about increasing fruit and vegetables, and reducing "junk food" and alcohol intake. They ranked their preference for 15 nutrition messages across 3 dietary behaviors (fruit and vegetables, junk food, and alcohol) with 5 different message tones (authoritative, empathetic, generation Y, solutions, and substitutions) and identified the messages most likely to persuade young adults to change their diet. A 5-point ranking of the nutrition messages was from the most likely to least likely to persuade (1-5). The focus groups were conducted by a trained facilitator and observer and were recorded. Data driven content analysis was used to explore themes. Tonal preferences and potential motivators were collated and frequencies presented. RESULTS: Participants ranked offering substitutes (29%, 11/39) and using empathy (22%, 9/39) as the most persuasive message techniques in improving diets of young adults, with low responses for Generation Y (17%, 7/39), solutions (17%, 7/39), and authoritative (15%, 6/39) tones. Females were more likely to consider substitution messages persuasive (35%, 7/20) compared with males (22%, 4/19). A greater proportion of males compared with females considered authoritative messages persuasive: (22%, 4/19) compared with (7%, 1/20). There is a strong preference for a substitution tone for fruit and vegetable messages (52%, 20/39), and no overall message tone preference for junk food and alcohol messages. Substitutions were viewed as helpful and practical. Empathy was liked as it acknowledged previous efforts. Responses to authoritative tone were mixed with some feeling guilt while others found them informative. Acceptability of the solutions depended on the behavioral change and acceptability of the solution proposed. Generation Y tone had some support for junk food and alcohol messages, and if favored, was considered casual, humorous, catchy, and motivational. CONCLUSIONS: Substitutions and tone of empathy were favored as the most likely execution styles to motivate nutrition behavior change across all participants. There is no "one size fits all" with different tones preferred by individuals for different dietary behaviors. Although text messaging provides instant message delivery direct to the individual, these results demonstrate the complexity of developing motivational nutrition message for young adults. These findings reveal the importance of considering the tone and content and pretesting messages for health promotion text message interventions

Feasibility and use of the mobile food record for capturing eating occasions among children ages 3–10 years in Guam

Children’s readiness to use technology supports the idea of children using mobile applications for dietary assessment. Our goal was to determine if children 3–10 years could successfully use the mobile food record (mFR) to capture a usable image pair or pairs. Children in Sample 1 were tasked to use the mFR to capture an image pair of one eating occasion while attending summer camp. For Sample 2, children were tasked to record all eating occasions for two consecutive days at two time periods that were two to four weeks apart. Trained analysts evaluated images. In Sample 1, 90% (57/63) captured one usable image pair. All children (63/63) returned the mFR undamaged. Sixty-two children reported: The mFR was easy to use (89%); willingness to use the mFR again (87%); and the fiducial marker easy to manage (94%). Children in Sample 2 used the mFR at least one day at Time 1 (59/63, 94%); Time 2 (49/63, 78%); and at both times (47/63, 75%). This latter group captured 6.21 ± 4.65 and 5.65 ± 3.26 mean (±SD) image pairs for Time 1 and Time 2, respectively Results support the potential for children to independently record dietary intakes using the mFR

Characterizing early adolescent food waste using the mobile food record.

This study aimed to assess the amount of plate waste and how plate waste was disposed by early adolescent girls using a mobile food record (mFR). Participants were girls nine to thirteen years residing in O’ahu, Hawai’i (n = 93). Foods selected and leftover were estimated using a three day mFR. Each leftover food was then classified as thrown into the trash, fed to a pet, eaten later, or other (e.g., composted). Repeated measures analyses of variance (ANOVA) were conducted and Tukey’s post-hoc test were used to adjust for multiple comparisons between times (breakfast, lunch, dinner, and snack) on leftover food and leftover food thrown into the trash. The percentage of food leftover and thrown into the trash was highest at lunch. The percentage of protein, grain, vegetables, fruit, and dairy leftover at lunch were unexpectedly low compared to previous studies. The median for percentage of food thrown into the trash at lunch was <5% for all food groups, and was consistently low across the day (<10%). Average energy intake was 436 kcal (±216) at lunch, and 80% of caregivers reported total household income as ≥$70,000. Studies in real-time using technology over full days may better quantify plate waste among adolescents

Testing the predictive validity of the healthy eating index-2015 in the multiethnic cohort: Is the score associated with a reduced risk of all-cause and cause-specific mortality?

The Healthy Eating Index-2015 (HEI-2015) was created to assess conformance of dietary intake with the Dietary Guidelines for Americans (DGA) 2015–2020. We assessed the association between the HEI-2015 and mortality from all-cause, cardiovascular disease (CVD), and cancer in the Multiethnic Cohort (MEC). White, African American, Native Hawaiian, Japanese American, and Latino adults (n > 215,000) from Hawaii and California completed a quantitative food-frequency questionnaire at study enrollment. HEI-2015 scores were divided into quintiles for men and women. Radar graphs were used to demonstrate how dietary components contributed to HEI-2015 scores. Mortality was documented over 17–22 years of follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox proportional hazards models. High HEI-2015 scores were inversely associated with risk of mortality from all-cause, CVD, and cancer for men and women (p-trend <0.0001 for all models). For men, the HRs (CIs) for all-cause, CVD, and cancer comparing the highest to the lowest quintile were 0.79 (0.76, 0.82), 0.76 (0.71, 0.82), and 0.80 (0.75, 0.87), respectively. For women, the HRs were 0.79 (0.76, 0.82), 0.75 (0.70, 0.81), and 0.84 (0.78, 0.91), respectively. These results, in a multiethnic population, demonstrate that following a diet aligned with the DGAs 2015–2020 recommendations is associated with lower risk of mortality from all-cause, CVD, and cancer

Technology-assisted dietary assessment

Dietary intake provides valuable insights for mounting intervention programs for prevention of disease. With growing concern for adolescent obesity, the need to accurately measure diet becomes imperative. Assessment among adolescents is problematic as this group has irregular eating patterns and have less enthusiasm for recording food intake. Preliminary studies among adolescents suggest that innovative use of technology may improve the accuracy of diet information from young people. In this paper, we propose a novel food record method using a mobile device that will provide an accurate account of daily food and nutrient intake among adolescents. Our approach includes the use of image analysis tools for identification and quantification of food consumption. Images obtained before and after food is consumed can be used to estimate the diet of an individual. In this paper we describe our initial results and indicate the potential of the proposed system

How willing are adolescents to record their dietary intake? The mobile food record

Background: Accurately assessing the diets of children and adolescents can be problematic. Use of technologies, such as mobile apps designed to capture food and beverages consumed at eating occasions with images taken using device-embedded cameras, may address many of the barriers to gathering accurate dietary intake data from adolescents. Objective: The objectives of this study were to assess the willingness of adolescents to take images of food and beverages at their eating occasions using a novel mobile food record (mFR) and to evaluate the usability of the user confirmation component of the mFR app, referred to as the “review process.” Methods: Mixed methods combining quantitative and qualitative protocols were used in this study. Adolescents (11-15-year olds) attending a summer camp were recruited to participate in the study. First, the participants were asked to take images of foods and beverages consumed as meals and snacks for 2 consecutive days using the mFR app running on an iPhone and the number of images taken was noted. This was followed by focus group sessions to evaluate usability, which was analyzed by content and themes. After using the mFR, a think-aloud method was used to evaluate the usability of the mFR method for reviewing system-identified foods (ie, the review process). A usability questionnaire was administered at the end of all activities.Results: The mFR was accepted by the majority of the 24 boys and 17 girls (n=41) but varied according to gender and eating occasion. Girls were significantly more likely than boys to capture images of their eating occasions (Fisher exact test, P=.03). Participants were more likely to take images of their breakfasts (90%, 36/40) and lunches (90%, 72/80) and least likely to capture afternoon and evening snacks, 54% (43/80) and 40% (32/80), respectively. The major themes from the focus groups with regard to using the mFR were games, rewards, and the need to know more about why they were using the app. Results of the usability questionnaire indicated that including a game component would be important to increase willingness to use the mFR, and a high majority of the participants indicated a willingness to use the mFR for 7 days or more. The image review process was found to be easy to use except for some confusion with overlapping markers on the screen. Conclusions: The adolescents’ experiences with and feedback about the mFR highlighted the importance of increased training, reminders, entertainment (eg, games), and training with practice in using the device to capture complete dietary intake as part of their active lifestyles

Constructing female entrepreneurship policy in the UK : is the US a relevant benchmark?

Successive UK governments have introduced a range of policy initiatives designed to encourage more women to start new firms. Underpinning these policies has been an explicit ambition for the UK to achieve similar participation rates as those in the US where it is widely reported that women own nearly half the stock of businesses. The data underlying these objectives are critically evaluated and it is argued that the definitions and measures of female enterprise used in the UK and the US restrict meaningful comparisons between the two. It is suggested that the expansion of female entrepreneurship in the US is historically and culturally specific to that country. UK policy goals should reflect the national socioeconomic context, while drawing upon good practice examples from a range of other countries. The paper concludes by discussing the economic and social viability of encouraging more women in the UK to enter self-employment without fully recognising the intensely competitive sectors in which they are often located

Behavioral intervention in adolescents improves bone mass, yet lactose maldigestion is a barrier

Calcium intake during adolescence is important for attainment of peak bone mass. Lactose maldigestion is an autosomal recessive trait, leading to lower calcium intake. The Adequate Calcium Today study aimed to determine if a school-based targeted behavioral intervention over one year could improve calcium intake and bone mass in early adolescent girls. The school-randomized intervention was conducted at middle schools in six states over one school year. A total of 473 girls aged 10–13 years were recruited for outcome assessments. Bone mineral content (BMC) was determined by dual energy X-ray absorptiometry. Dietary calcium intake was assessed with a semi-quantitative food frequency questionnaire. Baseline calcium intake and BMC were not significantly different between groups. After the intervention period, there were no differences in changes in calcium intake and BMC at any site between groups. An unanticipated outcome was a greater increase in spinal BMC among lactose digesters than lactose maldigesters in the intervention schools only (12 months) (6.9 ± 0.3 g vs. 6.0 ± 0.4 g, p = 0.03) and considering the entire study period (18 months) (9.9 ± 0.4 vs. 8.7 ± 0.5 g, p < 0.01). Overall, no significant differences between the intervention and control schools were observed. However, lactose digesters who received the intervention program increased bone mass to a greater extent than lactose maldigesters