Increasing vegetable consumption in early childhood: parents as facilitators

This thesis aimed to investigate the potential to increase young children s vegetable consumption by using caregivers as facilitators. This was achieved in two parts. Part I set out to investigate whether parent led interventions using three known successful methods of offering can be effective for increasing children s acceptance of a disliked vegetable. Three studies were conducted for Part I. The first tested the efficacy of these interventions, the second investigated the role of individual factors in intervention success, and the third examined the longitudinal efficacy of such interventions over two, six and 12 months. The findings suggested that parent led home-based interventions may be successful for increasing children s acceptance of disliked vegetables in the short-term, and that such interventions may be more successful for children who are more sociable and less fussy eaters. While these interventions may not be successful for sustained long-term changes, there was a lack of statistical power for these analyses and further studies with larger samples are required. Part II of the thesis sought to investigate the wider variety of methods which caregivers use to offer vegetables to their children, as well as the possible barriers to offering. These studies worked towards informing the design of future interventions as well as providing information for caregivers on achieving a healthful diet in their children. This was achieved via two studies which used qualitative and quantitative methods. One study used focus groups to gather a comprehensive report of caregivers methods of offering, as well as caregivers perceived influences on how and whether they offer their child vegetables. Methods of offering vegetables formed three main categories: active/behavioural methods, passive methods, and food manipulations. The influences on offering which caregivers perceived formed four categories: information, cost, caregiver factors, and child factors. These methods and influences were then assessed in a large scale cross-sectional study. This study examined which methods caregivers perceive as successful for encouraging consumption of vegetables, as well as assessing predictors of offering vegetables and children s vegetable consumption. Caregiver factors predicted reoffering of rejected vegetables while a combination of caregiver and child factors predicted children s consumption of vegetables. A number of discrepancies were found between methods caregivers perceived as successful and those which were associated with greater consumption of vegetables. As food fussiness was identified as a significant factor in children s consumption of vegetables, a final study investigated whether children categorised as fussy or not fussy with vegetables differed on a number of caregiver and child factors. Differences were found between these groups on both caregiver and child factors. Using a mixed methodology, the research in this thesis investigates possibilities for increasing vegetable consumption in early childhood and highlights the central role or caregivers in this process. Together, these findings suggest utility of whole family interventions aimed at increasing vegetable consumption, as well as providing caregivers with information on how best to offer vegetables to children of this age

Investigating the role of parent and child characteristics in healthy eating intervention outcomes

While numerous studies have investigated the efficacy of interventions at increasing children's vegetable consumption, little research has examined the effect of individual characteristics on intervention outcomes. In previous research, interventions consisting of modelling and rewards have been shown to increase children's vegetable intake, but differences were identified in terms of how much children respond to such interventions. With this in mind, the current study investigated the role of parental feeding practices, child temperament, and child eating behaviours as predictors of intervention success. Parents (N = 90) of children aged 2-4 years were recruited from toddler groups across Leicestershire, UK. Parents completed measures of feeding practices, child eating behaviours and child temperament, before participating in one of four conditions of a home-based, parent led 14 day intervention aimed at increasing their child's consumption of a disliked vegetable. Correlations and logistic regressions were performed to investigate the role of these factors in predicting intervention success. Parental feeding practices were not significantly associated with intervention success. However, child sociability and food fussiness significantly predicted intervention success, producing a regression model which could predict intervention success in 61% of cases. These findings suggest that future interventions could benefit from being tailored according to child temperament. Furthermore, interventions for children high in food fussiness may be better targeted at reducing fussiness in addition to increasing vegetable consumption

If at first you don't succeed:Assessing influences associated with mothers' reoffering of vegetables to preschool age children

Repeatedly offering vegetables has been shown to be one of the most effective methods for increasing acceptance and subsequent intake in young children. In order to increase successful offerings of vegetables and resultant consumption amongst young children, it is necessary to consider the influences on maternal reoffering of vegetables. This study aimed to investigate the relationships between mothers' tendency to reoffer vegetables and a range of demographic factors and psychological variables. A cross-sectional design was used, where mothers completed questionnaires assessing how often they reoffer rejected vegetables, concerns for economic factors, and a range of possible child and maternal influences. Mothers of preschool children were recruited from toddler groups across Leicestershire, UK, as well as online. Spearman's correlations were run to look for associations between demographic and psychological factors with maternal reoffering of vegetables. Significantly associated factors were then entered into a stepwise regression to predict maternal reoffering of vegetables. Mothers were significantly less likely to reoffer rejected vegetables if they were concerned about time, money, and waste, were influenced by their child's mood, or were concerned about their child having tantrums. Moreover, mothers who consumed more vegetables themselves reoffered vegetables more frequently. Regression analyses revealed that mothers' concern about food waste and tantrums, as well as maternal vegetable consumption, all significantly predicted mothers' reoffering of vegetables. With these findings in mind, mothers should be educated and supported with how to tackle and minimise children's tantrums during feeding, as well as being made aware of effective methods for avoiding food waste. Moreover, given that mothers' own vegetable consumption is associated with lower reoffering of vegetables to their child, interventions which seek to increase familial vegetable consumption should be pursued

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families’ use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: ‘Child factors’, ‘Eating beliefs’, ‘Effectiveness beliefs’, ‘Past experience’, ‘Current family behaviours’, ‘Harms’, ‘Knowledge’, ‘Need for change’, ‘Parent effort’, ‘Parent values’ and ‘Practical issues’. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a “protective mindset” that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake

Unpacking the relationships between positive feeding practices and children's eating behaviours:The moderating role of child temperament

Evidence suggests that children's eating behaviours are influenced by the feeding practices which parents employ. Furthermore, parents may alter the feeding practices they use according to their child's temperament. However, there is a paucity of literature on how children's temperament moderates the relationship between parents' use of feeding practices and children's eating behaviours. One hundred and eleven mothers of 2 to 4-year-old children completed questionnaire measures of their feeding practices along with their child's eating behaviours and temperament. Two-tailed Spearman's correlations revealed that mothers' use of a range of positive (health promoting) feeding practices was associated with greater enjoyment of food and lower food fussiness among children. Moderation analyses found that relationships between mothers involving their children in food choice and preparation and children's eating behaviours were moderated by children's temperament. Involvement in food choice and preparation was no longer associated with higher enjoyment of food and lower fussiness for children who were either highly emotional or low in sociability. These findings suggest that while many previously identified positive feeding practices may be associated with more healthy eating for all children, some may be less helpful or less achievable with children who have particular temperamental traits. Future research should seek to develop interventions to promote healthy eating which are tailored towards children's individual characteristics

Adaptations to Holiday Club Food Provision to Alleviate Food Insecurity During the Covid-19 Pandemic

Holiday clubs play a pivotal role in providing food and vital enrichment opportunities to alleviate food insecurity among children during the school holidays (holiday hunger). The need for these opportunities increased substantially for families throughout 2020, as food insecurity quadrupled in the UK during the Covid-19 pandemic. In this qualitative study, holiday club staff from England and Wales reflected on the adaptations they implemented in order to maintain food supplies and food-related enrichment activities for families during the first UK national Covid-19 lockdown and subsequently throughout the summer of 2020. Staff also reflected on the opportunities and challenges related to implementing these adaptations during this period. Twenty-five holiday club staff engaged in video-based interviews during August and September 2020. The findings revealed a range of innovative changes to holiday club food provision, and the challenges and opportunities faced varied across holiday clubs. Challenges during the pandemic in some clubs included staff shortages (typically due to furloughing and/or increased working demands) and difficulties sourcing adequate funding. However, staff identified that the opportunities for holiday clubs included enhanced partnership working during the pandemic, increased engagement with digital technology to communicate with families and deliver their online cooking sessions, and their ability to continue providing food and much needed creative opportunities for children unable to attend school and/or the holiday club. The ability of clubs to adapt their models of working when faced with adversity was essential in protecting their organisational resilience and delivering their vital services. The findings emphasise the important role that holiday clubs play in their communities and highlight their willingness to adapt and expand their role in response to the pandemic to continue to tackle food insecurity and provide vital food and food-related enrichment opportunities to families. The findings also identify lessons that can be applied to practise in the future

Exposure to, and searching for, information about suicide and self-harm on the Internet:Prevalence and predictors in a population based cohort of young adults

AbstractBackgroundThere is concern over the potential impact of the Internet on self-harm and suicidal behaviour, particularly in young people. However, little is known about the prevalence and patterns of suicide/self-harm related Internet use in the general population.MethodsCross sectional study of 3946 of the 8525 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were sent a self-report questionnaire including questions on suicide/self-harm related Internet use and self-harm history at age 21 years.ResultsSuicide/self-harm related Internet use was reported by 22.5% (886/3946) of participants; 11.9% (470/3946) had come across sites/chatrooms discussing self-harm or suicide, 8.2% (323/3946) had searched for information about self-harm, 7.5% (296/3946) had searched for information about suicide and 9.1% (357/3946) had used the Internet to discuss self-harm or suicidal feelings. Suicide/self-harm related Internet use was particularly prevalent amongst those who had harmed with suicidal intent (70%, 174/248), and was strongly associated with the presence of suicidal thoughts, suicidal plans, and history of self-harm. Sites offering help, advice, or support were accessed by a larger proportion of the sample (8.2%, 323/3946) than sites offering information on how to hurt or kill yourself (3.1%, 123/3946). Most individuals (81%) who had accessed these potentially harmful sites had also accessed help sites.Limitations(i) There were differences between questionnaire responders and non-responders which could lead to selection bias and (ii) the data were cross-sectional, and we cannot conclude that associations are causal.ConclusionsSuicide/self-harm related Internet use is common amongst young adults, particularly amongst those with suicidal thoughts and behaviour. Both harmful and helpful sites were accessed, highlighting that the Internet presents potential risks but also offers opportunities for suicide prevention

'Why don't you try it again?' A comparison of parent led, home based interventions aimed at increasing children's consumption of a disliked vegetable

Previous research suggests that the use of modelling and non-food rewards may be effective at increasing tasting, and consequential liking and acceptance, of a previously disliked food. Although successful school-based interventions have been developed, there is a lack of research into home-based interventions using these methods. This study aimed to develop and investigate the efficacy of a parent led home-based intervention for increasing children's acceptance of a disliked vegetable. A total of 115 children aged 2-4 years were allocated to one of four intervention groups or to a no-treatment control. The four intervention conditions were: repeated exposure; modelling and repeated exposure; rewards and repeated exposure; or modelling, rewards and repeated exposure. Children in all of the intervention conditions were exposed by a parent to daily offerings of a disliked vegetable for 14 days. Liking and consumption of the vegetable were measured pre and post-intervention. Significant increases in post-intervention consumption were seen in the modelling, rewards and repeated exposure condition and the rewards and repeated exposure condition, compared to the control group. Significant post-intervention differences in liking were also found between the experimental groups. Liking was highest (>60%) in the modelling, rewards and repeated exposure group and the rewards and repeated exposure group, intermediate (>26%) in the modelling and repeated exposure and repeated exposure groups, and lowest in the control group (10%). Parent led interventions based around modelling and offering incentives may present cost efficient ways to increase children's vegetable consumption

Opportunities and Challenges Arising from Holiday Clubs Tackling Children’s Hunger in the UK: Pilot Club Leader Perspectives

With the school holidays being recognised as a high-risk time for children to experience food insecurity, there is a growing prevalence of school holiday initiatives that include free food. However, information is lacking into what constitutes effective practice in their delivery, and how this can be evaluated. This paper provides insight from individuals who implemented a pilot of a national project which provided free food for children at UK community summer holiday sports clubs in 2016. Focus groups were conducted with all 15 leaders of the holiday clubs that participated in the pilot to understand: (1) what opportunities are provided by community holiday sports clubs which include free food; (2) what challenges arose as a result of offering free food within a broader community holiday club sports offer. Results indicate that offering free food at such clubs creates multiple opportunities for attending children, including: experiencing social interactions around food; enhancing food experiences and food confidence; and promoting positive behaviour. However, free food provision is associated with challenges including resource constraints and tensions around project aims. Future work should determine whether holiday clubs can positively impact children’s wellbeing and healthy eating