Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: mediation analysis from the Healthy Habits cluster randomised controlled trial

BACKGROUND: The home food environment can influence the development of dietary behaviours in children, and interventions that modify characteristics of the home food environment have been shown to increase children’s fruit and vegetable consumption. However to date, interventions to increase children’s fruit and vegetable consumption have generally produced only modest effects. Mediation analysis can help in the design of more efficient and effective interventions by identifying the mechanisms through which interventions have an effect. This study aimed to identify characteristics of the home food environment that mediated immediate and sustained increases in children’s fruit and vegetable consumption following the 4-week Healthy Habits telephone-based parent intervention. METHOD: Analysis was conducted using 2-month (immediate) and 12-month (sustained) follow-up data from a cluster randomised control trial of a home food environment intervention to increase the fruit and vegetable consumption of preschool children. Using recursive path analysis, a series of mediation models were created to investigate the direct and indirect effects of immediate and sustained changes to characteristics of the home food environment (fruit and vegetable availability, accessibility, parent intake, parent providing behaviour, role-modelling, mealtime eating practices, child feeding strategies, and pressure to eat), on the change in children’s fruit and vegetable consumption. RESULTS: Of the 394 participants in the randomised trial, 357 and 329 completed the 2- and 12-month follow-up respectively. The final mediation model suggests that the effect of the intervention on the children’s fruit and vegetable consumption was mediated by parent fruit and vegetable intake and parent provision of these foods at both 2- and 12-month follow-up. CONCLUSION: Analysis of data from the Healthy Habits trial suggests that two environmental variables (parental intake and parent providing) mediate the immediate and sustained effect of the intervention, and it is recommended these variables be targeted in subsequent home food environment interventions to bring about immediate and sustained changes in child fruit and vegetable intake. TRIAL REGISTRATION: ACTRN12609000820202

Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: A cross-sectional study

Early childhood is critical to the development of lifelong food habits. Given the high proportion of children with inadequate fruit and vegetable consumption, identification of modifiable factors associated with higher consumption may be useful in developing interventions to address this public health issue. This study aimed to identify the characteristics of the home food environment that are associated with higher fruit and vegetable consumption in a sample of Australian preschool children. A cross-sectional telephone survey was conducted with 396 parents of 3 to 5 year-old children attending 30 preschools within the Hunter region, New South Wales, Australia. Children's fruit and vegetable consumption was measured using a valid and reliable subscale from the Children's Dietary Questionnaire. Associations were investigated between children's fruit and vegetable intake and characteristics of the home food environment including parental role-modeling, parental providing behaviour, fruit and vegetable availability, fruit and vegetable accessibility, pressure to eat, family eating policies and family mealtime practices. Characteristics of the home food environment that showed evidence of an association with children's fruit and vegetable consumption in simple regression models were entered into a backwards stepwise multiple regression analysis. The multiple regression analysis used generalised linear mixed models, controlled for parental education, household income and child gender, and was adjusted for the correlation between children's fruit and vegetable consumption within a preschool. The multiple regression analysis found positive associations between children's fruit and vegetable consumption and parental fruit and vegetable intake (p = 0.005), fruit and vegetable availability (p = 0.006) and accessibility (p = 0.012), the number of occasions each day that parents provided their child with fruit and vegetables (p < 0.001), and allowing children to eat only at set meal times all or most of the time (p = 0.006). Combined, these characteristics of the home food environment accounted for 48% of the variation in the child's fruit and vegetable score. This study identified a range of modifiable characteristics within the home food environment that are associated with fruit and vegetable consumption among preschool children. Such characteristics could be considered potential targets for interventions to promote intake among children of this age

A cluster randomised controlled trial of a telephone-based intervention targeting the home food environment of preschoolers (The Healthy Habits Trial): the effect on parent fruit and vegetable consumption

AbstractBackground: The home food environment is an important setting for the development of dietary patterns in childhood. Interventions that support parents to modify the home food environment for their children, however, may also improve parent diet. The purpose of this study was to assess the impact of a telephone-based intervention targeting the home food environment of preschool children on the fruit and vegetable consumption of parents.Methods: In 2010, 394 parents of 3 &ndash; 5 year &ndash; old children from 30 preschools in the Hunter region of Australia were recruited to this cluster randomised controlled trial and were randomly assigned to an intervention or control group. Intervention group parents received four weekly 30-minute telephone calls and written resources. The scripted calls focused on; fruit and vegetable availability and accessibility, parental role-modelling, and supportive home food routines. Two items from the Australian National Nutrition Survey were used to assess the average number of serves of fruit and vegetables consumed each day by parents at baseline, and 2-, 6-, 12-, and 18-months later, using generalised estimating equations (adjusted for baseline values and clustering by preschool) and an intention-to-treat-approach.Results: At each follow-up, vegetable consumption among intervention parents significantly exceeded that of controls. At 2-months the difference was 0.71 serves (95% CI: 0.58-0.85, p &lt; 0.0001), and at 18-months the difference was 0.36 serves (95% CI: 0.10-0.61, p = 0.0067). Fruit consumption among intervention parents was found to significantly exceed consumption of control parents at the 2-,12- and 18-month follow-up, with the difference at 2-months being 0.26 serves (95% CI: 0.12-0.40, p = 0.0003), and 0.26 serves maintained at 18-months, (95% CI: 0.10-0.43, p = 0.0015).Conclusions: A four-contact telephone-based intervention that focuses on changing characteristics of preschoolers&rsquo; home food environment can increase parents&rsquo; fruit and vegetable consumption.(ANZCTR12609000820202)<br /

The price of healthy and unhealthy foods in Australian primary school canteens

Objective: To describe the price of Australian school canteen foods according to their nutritional value.Methods: Primary school canteen menus were collected as part of a policy compliance randomised trial. For each menu item, dietitians classified its nutritional value; &lsquo;green&rsquo; (&lsquo;good sources of nutrients&rsquo;), &lsquo;amber&rsquo; (&lsquo;some nutritional value&rsquo;), &lsquo;red&rsquo; (&lsquo;lack adequate nutritional value&rsquo;) and assigned a food category (e.g. &lsquo;Drinks&rsquo;, &lsquo;Snacks&rsquo;). Pricing information was extracted. Within each food category, ANOVAs assessed differences between the mean price of &lsquo;green&rsquo;, &lsquo;amber&rsquo; and &lsquo;red&rsquo; items, and post-hoc tests were conducted.Results: Seventy of the 124 invited schools participated. There were significant differences in the mean price of &lsquo;green&rsquo;, &lsquo;amber&rsquo; and &lsquo;red foods&rsquo; across categories, with &lsquo;green&rsquo; items more expensive than &lsquo;amber&rsquo; items in main-meal categories (&lsquo;Sandwiches&rsquo; +0.43, ‘Hot Foods’ +0.71), and the reverse true for non-meal categories (&lsquo;Drinks&rsquo; &minus;0.13, ‘Snacks’ −0.18, &lsquo;Frozen Snacks&rsquo; &minus;$0.25^).Conclusion: Current pricing may not encourage the purchasing of healthy main-meal items by and for students. Further investigation of pricing strategies that enhance the public health benefit of existing school canteen policies and practices are warranted.Implications for Public Health: Providing support to canteen managers regarding healthy canteen policies may have a positive impact on public health nutrition

Cluster randomised controlled trial of a consumer behaviour intervention to improve healthy food purchases from online canteens: study protocol

Introduction School canteens represent an opportune setting in which to deliver public health nutrition strategies given their wide reach, and frequent use by children. Online school canteen ordering systems, where students order and pay for their lunch online, provide an avenue to improve healthy canteen purchases through the application of consumer behaviour strategies that impact on purchasing decisions. The aim of this study is to assess the efficacy of a consumer behaviour intervention implemented in an online school canteen ordering system in reducing the kilojoule, saturated fat, sugar and sodium content of primary student lunch orders.Methods and analysis The study will employ a cluster randomised controlled trial design. Approximately 1040 students (aged 5&ndash;12 years) from 10 primary schools in New South Wales, Australia, currently using an online canteen ordering system will be invited to participate. Schools will be randomised in a 1:1 ratio to receive either the intervention (enhanced system) or control (standard online ordering only). The intervention will include evidence-based strategies shown to influence healthy food purchasing (strategies targeting availability, menu labelling, placement and prompting). The primary outcomes of the trial will be the mean content per student online lunch order of (1) energy (kJ), (2) saturated fat (g), (3) sugar (g) and (4) sodium (mg). The impact of the intervention will be determined by between-group assessment of the nutritional content of lunch purchases over a 2-month period postintervention initiation

Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial

BackgroundInternationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children&rsquo;s canteen purchases and on schools&rsquo; canteen revenue was also assessed.MethodsAustralian primary schools with a canteen were randomised to receive a 12&ndash;14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as &lsquo;red&rsquo; or &lsquo;banned&rsquo;) from regular sale and encouraged schools to &lsquo;fill the menu&rsquo; with healthy items (classified as &lsquo;green&rsquo;). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015).ResultsSeventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without &lsquo;red&rsquo; or &lsquo;banned&rsquo; items (RR&thinsp;=&thinsp;21.11; 95% CI 3.30 to 147.28; p&thinsp;&le;&thinsp;0.01) and to have at least 50% of menu items classified as &lsquo;green&rsquo; (RR&thinsp;=&thinsp;3.06; 95% CI 1.64 to 5.68; p&thinsp;&le;&thinsp;0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference&thinsp;=&thinsp;&minus;1.51 g; 95% CI &minus;2.84 to &minus;0.18; p&thinsp;=&thinsp;0.028) compared to controls, but not in energy (difference&thinsp;=&thinsp;&minus;132.32 kJ; 95% CI &minus;280.99 to 16.34; p&thinsp;=&thinsp;0.080) or sodium (difference&thinsp;=&thinsp;&minus;46.81 mg; 95% CI &minus;96.97 to 3.35; p&thinsp;=&thinsp;0.067). Canteen revenue did not differ significantly between groups.ConclusionPoor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools.<br /

Creative learning environments in education-A systematic literature review

This paper reports on a systematic review of 210 pieces of educational research, policy and professional literature relating to creative environments for learning in schools, commissioned by Learning and Teaching Scotland (LTS). Despite the volume of academic literature in this field, the team of six reviewers found comparatively few empirical studies published in the period 2005–2011 providing findings addressing the review objectives. There was, however a reasonable weight of research evidence to support the importance of the following factors in supporting creative skills development in children and young people: flexible use of space and time; availability of appropriate materials; working outside the classroom/school; ‘playful’ or ‘games-bases’ approaches with a degree of learner autonomy; respectful relationships between teachers and learners; opportunities for peer collaboration; partnerships with outside agencies; awareness of learners’ needs; and non-prescriptive planning. The review also found evidence for impact of creative environments on pupil attainment and the development of teacher professionalism. LTS intend to use the review as a basis for recommendations to Scottish schools in promoting creativity within Curriculum for Excellence. However, the findings of the review and methodological gaps in the reviewed studies have implications for policy, practice and research internationally

A cluster randomised trial of a telephone-based intervention for parents to increase fruit and vegetable consumption in their 3- to 5-year-old children: study protocol

Background: Inadequate fruit and vegetable consumption in childhood increases the risk of developing chronic disease. Despite this, a substantial proportion of children in developed nations, including Australia, do not consume sufficient quantities of fruits and vegetables. Parents are influential in the development of dietary habits of young children but often lack the necessary knowledge and skills to promote healthy eating in their children. The aim of this study is to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption of their 3- to 5-year-old children. Methods/Design: The study, conducted in the Hunter region of New South Wales, Australia, employs a cluster randomised controlled trial design. Two hundred parents from 15 randomly selected preschools will be randomised to receive the intervention, which consists of print resources and four weekly 30-minute telephone support calls delivered by trained telephone interviewers. The calls will assist parents to increase the availability and accessibility of fruit and vegetables in the home, create supportive family eating routines and role-model fruit and vegetable consumption. A further two hundred parents will be randomly allocated to the control group and will receive printed nutrition information only. The primary outcome of the trial will be the change in the child's consumption of fruit and vegetables as measured by the fruit and vegetable subscale of the Children's Dietary Questionnaire. Pre-intervention and post-intervention parent surveys will be administered over the telephone. Baseline surveys will occur one to two weeks prior to intervention delivery, with follow-up data collection calls occurring two, six, 12 and 18 months following baseline data collection. Discussion: If effective, this telephone-based intervention may represent a promising public health strategy to increase fruit and vegetable consumption in childhood and reduce the risk of subsequent chronic disease. Trial registration: Australian Clinical Trials Registry ACTRN12609000820202