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Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
Marisa Tsai; Sean B. Cash; Stephanie Anzman-Frasca; Jeanne P. Goldberg; Sarah K. Johnson; Jennifer Oslund; Sara C. Folta. Helping parents provide vegetable snacks: Investigating price and taste as barriers. Appetite 2021, 166, 105481 .
AMA StyleMarisa Tsai, Sean B. Cash, Stephanie Anzman-Frasca, Jeanne P. Goldberg, Sarah K. Johnson, Jennifer Oslund, Sara C. Folta. Helping parents provide vegetable snacks: Investigating price and taste as barriers. Appetite. 2021; 166 ():105481.
Chicago/Turabian StyleMarisa Tsai; Sean B. Cash; Stephanie Anzman-Frasca; Jeanne P. Goldberg; Sarah K. Johnson; Jennifer Oslund; Sara C. Folta. 2021. "Helping parents provide vegetable snacks: Investigating price and taste as barriers." Appetite 166, no. : 105481.
Restaurants are regular eating environments for many families. Children’s consumption of restaurant foods has been linked with poorer diet quality, prompting emerging research examining strategies to encourage healthier eating among children in restaurants. Although taste is a primary determinant of restaurant meal choices, there is a lack of research considering children’s perspectives on the taste of different healthier kids’ meal options. The current study sought to examine, via objective taste testing, children’s liking of and preference for healthier kids’ meal options at a quick-service restaurant (QSR) and to describe bundled kids’ meals with evidence of both taste acceptability and consistency with nutrition guidelines. Thirty-seven 4-to-8-year-old children completed taste tests of ten healthier main and side dish options. Liking and preference were assessed using standard methods after children tasted each food. Children also reported their ideal kids’ meal. Results show the majority of children liked and preferred three main (turkey sandwich, chicken strips, peanut butter/banana sandwich) and side dishes (yogurt, applesauce, broccoli), with rank order differing slightly by age group. Accepted foods were combined into 11 bundles meeting nutritional criteria. Results highlight healthier kids’ meals with evidence of appeal among children in a QSR. Findings can inform future research and may increase the success of healthy eating interventions in these settings.
Sara Tauriello; Lily McGovern; Brianna Bartholomew; Leonard Epstein; Lucia Leone; Juliana Goldsmith; Elizabeth Kubiniec; Stephanie Anzman-Frasca. Taste Ratings of Healthier Main and Side Dishes among 4-to-8-Year-Old Children in a Quick-Service Restaurant Chain. Nutrients 2021, 13, 673 .
AMA StyleSara Tauriello, Lily McGovern, Brianna Bartholomew, Leonard Epstein, Lucia Leone, Juliana Goldsmith, Elizabeth Kubiniec, Stephanie Anzman-Frasca. Taste Ratings of Healthier Main and Side Dishes among 4-to-8-Year-Old Children in a Quick-Service Restaurant Chain. Nutrients. 2021; 13 (2):673.
Chicago/Turabian StyleSara Tauriello; Lily McGovern; Brianna Bartholomew; Leonard Epstein; Lucia Leone; Juliana Goldsmith; Elizabeth Kubiniec; Stephanie Anzman-Frasca. 2021. "Taste Ratings of Healthier Main and Side Dishes among 4-to-8-Year-Old Children in a Quick-Service Restaurant Chain." Nutrients 13, no. 2: 673.
Evidence of short-term impacts of the coronavirus disease 2019 (COVID-19) pandemic on family life is emerging. Continued research can shed light on potential longer-term impacts. An online survey of U.S. parents with 4- to 8-year-old children (n = 1000) was administered in October 2020. The survey examined parent-reported impacts of COVID-19 on lifestyle (e.g., work, child-care, grocery shopping), as well as current family food acquisition and eating behaviors (e.g., cooking, restaurant use). Descriptive statistics were calculated, incorporating sampling weights based on sociodemographics. In terms of COVID-19 impacts, parents reported increases in working from home, decreased work hours, and increased child care and instruction, with most children attending school or receiving care at home. Parents reported increased home cooking and online grocery shopping; only 33% reported increased take-out or delivery from restaurants. About half of parents reported that their child dined at restaurants, 62% reported getting take-out, and 57% reported delivery from restaurants at least 2–3 times per month. About half viewed dining at restaurants as safe, while take-out and delivery were seen as safe by around three-quarters. Approximately two-thirds reported recent food insecurity. These nationally-representative results illustrate possible longer-lasting shifts in family life, with the potential to impact health and well-being. Sociodemographic differences and research and policy implications are discussed.
Mackenzie J. Ferrante; Juliana Goldsmith; Sara Tauriello; Leonard H. Epstein; Lucia A. Leone; Stephanie Anzman-Frasca. Food Acquisition and Daily Life for U.S. Families with 4-to 8-Year-Old Children during COVID-19: Findings from a Nationally Representative Survey. International Journal of Environmental Research and Public Health 2021, 18, 1734 .
AMA StyleMackenzie J. Ferrante, Juliana Goldsmith, Sara Tauriello, Leonard H. Epstein, Lucia A. Leone, Stephanie Anzman-Frasca. Food Acquisition and Daily Life for U.S. Families with 4-to 8-Year-Old Children during COVID-19: Findings from a Nationally Representative Survey. International Journal of Environmental Research and Public Health. 2021; 18 (4):1734.
Chicago/Turabian StyleMackenzie J. Ferrante; Juliana Goldsmith; Sara Tauriello; Leonard H. Epstein; Lucia A. Leone; Stephanie Anzman-Frasca. 2021. "Food Acquisition and Daily Life for U.S. Families with 4-to 8-Year-Old Children during COVID-19: Findings from a Nationally Representative Survey." International Journal of Environmental Research and Public Health 18, no. 4: 1734.
Objective: Delay of gratification, or the extent to which one can resist the temptation of an immediate reward and wait for a larger reward later, is a self-regulatory skill that predicts positive outcomes. The aim of this research was to conduct initial tests of the effects of a board game designed to increase children’s delay of gratification via two experimental studies. Methods: Preschool children were randomized to play the study game or a control game. In Study 1, there were 48 children in the analytic sample, with a mean age of 4.81 ± 0.55 years; Study 2 included 50 children (M = 4.02 ± 0.76 years). Delay of gratification was assessed during the study game, as well as before and after game play sessions using the Marshmallow Test. Results: In both studies, the intervention group’s likelihood of delaying gratification during the study game increased across game-play sessions (p < 0.05). In Study 1, the intervention group also increased wait times during the Marshmallow Test versus controls (p = 0.047). In Study 2, there was no effect on Marshmallow Test wait times. Conclusion: Results provide some initial evidence supporting potential efficacy of a board game designed to increase delay of gratification. Future research can clarify: (1) which components of game play (if any) are linked with broader changes in delay of gratification, (2) impacts of this intervention in more diverse samples, and (3) whether experimental manipulation of delay of gratification affects outcomes like achievement and weight, which have been linked to this skill in observational studies.
Stephanie Anzman-Frasca; Anita Singh; Derek Curry; Sara Tauriello; Leonard H. Epstein; Myles S. Faith; Kaley Reardon; Dave Pape. Evaluating a Board Game Designed to Promote Young Children’s Delay of Gratification. Frontiers in Psychology 2020, 11, 1 .
AMA StyleStephanie Anzman-Frasca, Anita Singh, Derek Curry, Sara Tauriello, Leonard H. Epstein, Myles S. Faith, Kaley Reardon, Dave Pape. Evaluating a Board Game Designed to Promote Young Children’s Delay of Gratification. Frontiers in Psychology. 2020; 11 ():1.
Chicago/Turabian StyleStephanie Anzman-Frasca; Anita Singh; Derek Curry; Sara Tauriello; Leonard H. Epstein; Myles S. Faith; Kaley Reardon; Dave Pape. 2020. "Evaluating a Board Game Designed to Promote Young Children’s Delay of Gratification." Frontiers in Psychology 11, no. : 1.
This study evaluated orders of adult menu items designated as healthier at the Silver Diner, a regional full-service restaurant chain serving over 4 million customers annually. This restaurant implemented a healthier children’s menu in April 2012. Orders of adult menu items were abstracted from before (September 2011–March 2012; PRE; n = 1,801,647) and after (September 2012–March 2013; POST; n = 1,793,582) the healthier children’s menu was introduced. Entrées, appetizers, and sides listed as healthier options on the menu were coded as healthier. PRE to POST changes in the percentage of orders of healthier items, soda, and dessert were evaluated using McNemar tests of paired proportions. Orders of healthier entrées, appetizers, and sides on the adult menu increased PRE to POST (8.9% to 10.4%, 25.5% to 27.5%, and 7.3% to 9.3%, respectively), and soda and dessert orders decreased (23.2% to 21.7% and 29.0% to 28.3%, respectively). All shifts were statistically significant (p < 0.0001). Our findings demonstrate improvements in orders of healthier adult menu options during the same time frame as a healthy children’s menu change. Future research can help elucidate mechanisms to inform future health promotion efforts in restaurants in ways that have the potential to impact both adults and children.
Megan P. Mueller; Eleanor T. Shonkoff; Sara C. Folta; Stephanie Anzman-Frasca; Christina D. Economos. Orders of Healthier Adult Menu Items in a Full-Service Restaurant Chain with a Healthier Children’s Menu. Nutrients 2020, 12, 3253 .
AMA StyleMegan P. Mueller, Eleanor T. Shonkoff, Sara C. Folta, Stephanie Anzman-Frasca, Christina D. Economos. Orders of Healthier Adult Menu Items in a Full-Service Restaurant Chain with a Healthier Children’s Menu. Nutrients. 2020; 12 (11):3253.
Chicago/Turabian StyleMegan P. Mueller; Eleanor T. Shonkoff; Sara C. Folta; Stephanie Anzman-Frasca; Christina D. Economos. 2020. "Orders of Healthier Adult Menu Items in a Full-Service Restaurant Chain with a Healthier Children’s Menu." Nutrients 12, no. 11: 3253.
Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's risk for developing undesirable eating behaviours and unhealthy weight outcomes. Fewer reviews adopt a strengths‐based perspective focusing on the ways that parents can actively support the development of healthy eating behaviours and weight trajectories. Emerging research on such positive parenting styles and practices offers solutions beyond the avoidance of coercive control, as well as opportunities to highlight parallels between research on food parenting and the broader, well‐established developmental literature on positive parenting. The focus of this review is to summarize what is known regarding benefits of positive parenting styles and practices for child eating and weight outcomes and discuss recommendations for future research. Current evidence supports starting with responsive feeding and parenting during infancy and incorporating structure and limit setting in early childhood, with monitoring and mealtime structure remaining important during middle childhood and adolescence. Areas for future research include: (1) further examination of the implications of identified food parenting practices and styles among diverse groups and caregivers; (2) increased consideration of child factors (eg, temperament) as moderators or mediators; and (3) further clarification of the relationship between general parenting and food parenting.
Katherine N. Balantekin; Stephanie Anzman‐Frasca; Lori A. Francis; Alison K. Ventura; Jennifer O. Fisher; Susan L. Johnson. Positive parenting approaches and their association with child eating and weight: A narrative review from infancy to adolescence. Pediatric Obesity 2020, 15, e12722 -e12722.
AMA StyleKatherine N. Balantekin, Stephanie Anzman‐Frasca, Lori A. Francis, Alison K. Ventura, Jennifer O. Fisher, Susan L. Johnson. Positive parenting approaches and their association with child eating and weight: A narrative review from infancy to adolescence. Pediatric Obesity. 2020; 15 (10):e12722-e12722.
Chicago/Turabian StyleKatherine N. Balantekin; Stephanie Anzman‐Frasca; Lori A. Francis; Alison K. Ventura; Jennifer O. Fisher; Susan L. Johnson. 2020. "Positive parenting approaches and their association with child eating and weight: A narrative review from infancy to adolescence." Pediatric Obesity 15, no. 10: e12722-e12722.
Objective: To examine the feasibility of taste testing and point-of-purchase prompting to promote healthier food choices at a food truck event. Design: A pre-/post-study was conducted where food trucks provided samples of healthy food items to patrons and implemented point-of-purchase prompting (promotional signage; verbal cues). Implementation fidelity, acceptability and initial effectiveness were assessed via observation, patron surveys and sales data. A linear mixed model with a random effect for subject (food truck) and fixed effect for time point (baseline, intervention and post-intervention) was used to assess changes in relative sales of promoted healthy items as a percentage of food items sold. Setting: Weekly food truck event in Buffalo, New York. Participants: Seven food trucks; 179 patrons. Results: Implementation fidelity data illustrated that all food trucks complied with manualised procedures. Approximately one-third of surveyed patrons accepted a healthy sample, with the majority rating the sample positively. There was no main effect of time when examining changes in relative sales of promoted healthy items across all periods (P = 0·32); however, effect sizes representing changes between individual time points are consistent with an increase from baseline to intervention (d = 0·51), which was maintained through post-intervention (d = 0·03). The change from baseline to post-intervention corresponded to a medium effect size (d = 0·55). Conclusions: Findings generally support the feasibility of implementing taste testing and point-of-purchase prompting to increase the selection of healthy food items from food trucks; implications for future research in this novel setting are discussed.
Jacob Bleasdale; Jessica S Kruger; April Gampp; Kelsey Kurtz; Stephanie Anzman-Frasca. Examining taste testing and point-of-purchase prompting as strategies to promote healthier food selection from food trucks. Public Health Nutrition 2020, 24, 738 -745.
AMA StyleJacob Bleasdale, Jessica S Kruger, April Gampp, Kelsey Kurtz, Stephanie Anzman-Frasca. Examining taste testing and point-of-purchase prompting as strategies to promote healthier food selection from food trucks. Public Health Nutrition. 2020; 24 (4):738-745.
Chicago/Turabian StyleJacob Bleasdale; Jessica S Kruger; April Gampp; Kelsey Kurtz; Stephanie Anzman-Frasca. 2020. "Examining taste testing and point-of-purchase prompting as strategies to promote healthier food selection from food trucks." Public Health Nutrition 24, no. 4: 738-745.
(1) Background: The recommendation for screen use among preschool-aged children is ≤ 1 h per day. We aimed to assess the relationship between parental and child screen use and home environment characteristics. (2) Methods: Thirty-six 3–to-4-year-old healthy children were recruited. Parents reported their own and their child’s weekday and weekend daytime screen use. The child’s home environment and parent-child interactions were assessed using the Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME). Analyses were run to identify relationships between parental and child screen use and the six subscales of the IT-HOME: Responsivity, Acceptance, Organization, Learning Materials, Involvement and Variety. (3) Results: Parents’ weekend screen use was correlated to parental responsivity and variety of people and events at home. These relationships remained significant after adjusting for maternal education and number of children at home (Responsivity β = 7.30 (95% CI: 1.75, 12.86), p = 0.012) and (Variety β = −2.45, (95% CI: −4.58, −0.31), p = 0.026). There was a trend level association between low child’s weekend screen use and high presence of learning materials. Other aspects of screen time were not associated with home environment characteristics. (4) Conclusions: Higher parental screen use predicted lower variety and greater parental responsivity, the latter of which was an unexpected finding. Administering the IT-HOME alongside a screen use questionnaire may offer the opportunity for a more comprehensive representation of home environments in today’s society. Future research can also clarify facets of parental screen use (e.g., co-viewing, timing) that are more vs. less likely to impact children.
Parveen Attai; Jacqueline Szabat; Stephanie Anzman-Frasca; Kai Ling Kong. Associations between Parental and Child Screen Time and Quality of the Home Environment: A Preliminary Investigation. International Journal of Environmental Research and Public Health 2020, 17, 6207 .
AMA StyleParveen Attai, Jacqueline Szabat, Stephanie Anzman-Frasca, Kai Ling Kong. Associations between Parental and Child Screen Time and Quality of the Home Environment: A Preliminary Investigation. International Journal of Environmental Research and Public Health. 2020; 17 (17):6207.
Chicago/Turabian StyleParveen Attai; Jacqueline Szabat; Stephanie Anzman-Frasca; Kai Ling Kong. 2020. "Associations between Parental and Child Screen Time and Quality of the Home Environment: A Preliminary Investigation." International Journal of Environmental Research and Public Health 17, no. 17: 6207.
Objective : Despite recommendations to consume iron-, calcium-, and vitamin C-rich foods for managing blood lead levels (BLLs), limited evidence exists on how specific foods affect children's BLLs. Using data from 12-36 month-olds (n=992) from the 2009-2014 National Health and Nutrition Examination Survey, we assessed how foods rich in these nutrients associate with BLLs, and with potential inadvertent exposures to cadmium and mercury. Methods : Food intake was assessed from one 24-hour dietary recall. Foods were categorized into 10 energy-adjusted groups, with intake categorized as none (reference) and tertiles. BLLs were natural log-transformed. Linear regressions tested associations between food groups and BLLs. Logistic regressions were conducted for blood cadmium and mercury. Results : Median (5%, 95% range) BLLs were 1.01 (0.39, 3.21) µg/dL. Majority of food groups (7 of 10) showed little association with BLLs. Compared to no intake, cereal [tertile 3: β (95% CI) = -0.22 (-0.41, -0.02)] and milk (P trend 0.11 µg/dL [tertile 3 OR: 0.05 (0.01, 0.36)]. No associations were observed with blood mercury. Conclusions : Among young children, consumption of iron-, calcium-, and vitamin C-rich foods showed weak or no association with BLLs. Few associations were observed for blood cadmium or mercury. Food-based approaches to BLL management may have limited utility when exposure is low.
Gauri Desai; Stephanie Anzman-Frasca; Jacqueline A. Vernarelli; Julia Ravenscroft; Janet Yang; Gale Burstein; Katarzyna Kordas. Examining Links Between Diet and Lead Exposure in Young Children: 2009 to 2014 National Health and Nutrition Examination Survey. Academic Pediatrics 2020, 1 .
AMA StyleGauri Desai, Stephanie Anzman-Frasca, Jacqueline A. Vernarelli, Julia Ravenscroft, Janet Yang, Gale Burstein, Katarzyna Kordas. Examining Links Between Diet and Lead Exposure in Young Children: 2009 to 2014 National Health and Nutrition Examination Survey. Academic Pediatrics. 2020; ():1.
Chicago/Turabian StyleGauri Desai; Stephanie Anzman-Frasca; Jacqueline A. Vernarelli; Julia Ravenscroft; Janet Yang; Gale Burstein; Katarzyna Kordas. 2020. "Examining Links Between Diet and Lead Exposure in Young Children: 2009 to 2014 National Health and Nutrition Examination Survey." Academic Pediatrics , no. : 1.
Background Children's vegetable acceptance increases following repeated exposure and associative conditioning pairing a target vegetable with a well‐liked food. Yet traditional pairings may increase energy intake when well‐liked foods are calorie‐rich. Objectives To examine whether pairing a non‐food stimulus with target vegetables increases children's vegetable acceptance and whether effects exceed those of repeated exposure. Methods Twenty‐three 6‐to‐8‐year‐old children participated in twice‐weekly sessions across 6 weeks of a summer camp serving children from low‐income families. First‐ and second‐grade camp classrooms were randomly assigned to associative conditioning and repeated exposure groups, respectively. Liking and preference were assessed for seven vegetables at pre/post‐test. For each child, two non‐preferred vegetables were randomly assigned as the target or control. During exposures, associative conditioning group children experienced a positive peer context (involving group games) paired with tasting their target vegetable. The repeated exposure group received only taste exposures; target vegetable liking was assessed. Results Preferences for target vegetables increased from pre‐ (Median = 6.00) to post‐test (Median = 3.00) overall (P = .007), but did not differ by group (P = .59). Group, time and interaction effects on vegetable liking were non‐significant overall (P ≥ .29), with some evidence of group differences when examining select time points. Conclusions Findings can inform future research aiming to increase vegetable preferences in community settings.
Sara Tauriello; Julie Bowker; Gregory Wilding; Leonard Epstein; Stephanie Anzman‐Frasca. Examining associative conditioning with a positive peer context as a strategy to increase children's vegetable acceptance. Pediatric Obesity 2020, 15, e12660 .
AMA StyleSara Tauriello, Julie Bowker, Gregory Wilding, Leonard Epstein, Stephanie Anzman‐Frasca. Examining associative conditioning with a positive peer context as a strategy to increase children's vegetable acceptance. Pediatric Obesity. 2020; 15 (10):e12660.
Chicago/Turabian StyleSara Tauriello; Julie Bowker; Gregory Wilding; Leonard Epstein; Stephanie Anzman‐Frasca. 2020. "Examining associative conditioning with a positive peer context as a strategy to increase children's vegetable acceptance." Pediatric Obesity 15, no. 10: e12660.
The relative reinforcing value (RRV) of food captures individual differences in the motivation to eat and is associated with weight status among infants, children, and adults. Currently, there is no concurrent measure of the RRV of food versus a non-food alternative for 4-to-5-year-old children. The present study aimed to develop and validate a measure of the RRV of food versus time spent interacting with a parent in the context of reading among 4-to-5-year-old children. The first phase of the study involved an online survey. Parents of 4-to-5 year olds (n = 102) reported their children's consumption frequency and liking for thirty-six snack foods. A priori criteria were used to identify snacks that were well-liked and served at least sometimes for use in the subsequent laboratory study. Then, a validation study was conducted in the laboratory to examine the construct validity of the finalized RRV task. Thirty-one parent-child dyads completed a laboratory visit, in which children's RRV of food versus time spent reading with a parent was measured concurrently on a progressive ratio reward schedule. Linear regression was used to assess validity of the task. Children's RRV of food positively and significantly predicted BMI z-scores among children with complete data (B = 0.41, p < 0.05, n = 28). Maximum schedules reached for food also positively and significantly predicted BMI z-scores (B = 0.30, p < 0.05). The relationship between maximum schedules reached for parent-child reading and BMI z-scores was in the expected direction, but this relationship was non-significant. Results support the validity and feasibility of the RRV paradigm used in the present study. Future research could continue to examine the measurement properties of this paradigm, as well as the potential for positive parent-child interactions to serve as a novel alternative to food.
Malena Savell; Rina Das Eiden; Kai Ling Kong; Sara Tauriello; Leonard Epstein; Gregory Fabiano; Kaley Reardon; Stephanie Anzman-Frasca. Development of a measure of the relative reinforcing value of food versus parent-child interaction for young children. Appetite 2020, 153, 104731 .
AMA StyleMalena Savell, Rina Das Eiden, Kai Ling Kong, Sara Tauriello, Leonard Epstein, Gregory Fabiano, Kaley Reardon, Stephanie Anzman-Frasca. Development of a measure of the relative reinforcing value of food versus parent-child interaction for young children. Appetite. 2020; 153 ():104731.
Chicago/Turabian StyleMalena Savell; Rina Das Eiden; Kai Ling Kong; Sara Tauriello; Leonard Epstein; Gregory Fabiano; Kaley Reardon; Stephanie Anzman-Frasca. 2020. "Development of a measure of the relative reinforcing value of food versus parent-child interaction for young children." Appetite 153, no. : 104731.
Background Child emotional overeating is a risk factor for obesity that is learned in the home environment. Parents' use of food to soothe child distress may contribute to the development of children's emotional overeating. Objectives To examine the effect of a responsive parenting (RP) intervention on mother‐reported child emotional overeating, and explore whether effects are mediated by mother‐reported use of food to soothe child distress. Methods The sample included primiparous mother‐infant dyads randomized to a RP intervention (n = 105) or home safety control group (n = 102). Nurses delivered RP guidance in four behavioral domains: sleeping, fussy, alert/calm, and drowsy. Mothers reported their use of food to soothe at age 18 months and child emotional overeating at age 30 months. Mediation was analyzed using the SAS PROCESS macro. Results RP intervention mothers reported less frequent use of food to soothe and perceived their child's emotional overeating as lower compared to the control group. Food to soothe mediated the RP intervention effect on child emotional overeating (mediation model: R2 = 0.13, P < .0001). Conclusions Children's emotional overeating may be modified through an early life RP intervention. Teaching parents alternative techniques to soothe child distress rather than feeding may curb emotional overeating development to reduce future obesity risk.
Holly A. Harris; Stephanie Anzman‐Frasca; Michele E. Marini; Ian Paul; Leann L. Birch; Jennifer S. Savage. Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT. Pediatric Obesity 2020, 15, e12645 .
AMA StyleHolly A. Harris, Stephanie Anzman‐Frasca, Michele E. Marini, Ian Paul, Leann L. Birch, Jennifer S. Savage. Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT. Pediatric Obesity. 2020; 15 (10):e12645.
Chicago/Turabian StyleHolly A. Harris; Stephanie Anzman‐Frasca; Michele E. Marini; Ian Paul; Leann L. Birch; Jennifer S. Savage. 2020. "Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT." Pediatric Obesity 15, no. 10: e12645.
Nutrition plays an important role in proper physical and cognitive functioning. However, there is limited evidence on the relationship between overall diet, cognition, and academic success in children, particularly among low-income and diverse groups. The objective of this study was to examine the relationships between healthful versus less healthful food group intake, cognitive performance, and academic achievement in a diverse sample of schoolchildren. 868 urban schoolchildren (age 8 to 10 years) participated in the study. Intake of healthful (fruits, vegetables, unsweetened beverages) and less healthful (sweet and salty snacks, sugar-sweetened beverages) food groups was determined via a food frequency questionnaire. Digit Span and Stroop test scores were used to assess cognitive performance. Academic achievement was assessed via standardized test scores. Multiple Poisson and multiple linear regression were used to test the associations between diet and cognitive scores. Multiple ordered logistic regression was used to assess the associations between diet and academic achievement. Potential confounders (age, sex, body mass index (BMI) z-score, race/ethnicity, English language learner status, individualized education plan enrollment, physical activity, and parent education level) were tested for inclusion in all models. The sample included 868 children (56.7% girls; 33.2% non-Hispanic white, 26.2% Hispanic, 17.1% multiracial/other, 8.3% non-Hispanic black; 40.5% overweight/obese). The most frequently consumed foods were fruits and sweet snacks (1.9 and 1.6 servings per day, respectively). There were no statistically significant associations between diet and cognitive test scores. Greater intake of less healthful food groups (sweet snacks, salty snacks, and sweetened beverages) was associated with lower math (OR = 0.91, CI [0.84, 0.98], p = 0.014) and English standardized test scores (OR = 0.87, CI [0.80, 0.94, p = 0.001). Greater intake of sweet snacks and fruits was associated with lower English scores (OR = 0.72, 95% CI [0.59, 0.88] p = 0.001; and OR = 0.75, 95% CI [0.72, 0.94] p = 0.003, respectively). Consumption of less healthful food groups was associated with poorer academic achievement. Further research may shed light on unexpected associations between fruit consumption and achievement. Policies targeting multiple dietary components may positively influence child academic achievement and development.
Rachel Bleiweiss-Sande; Kenneth Chui; Catherine Wright; Sarah Amin; Stephanie Anzman-Frasca; Jennifer M. Sacheck. Associations between Food Group Intake, Cognition, and Academic Achievement in Elementary Schoolchildren. Nutrients 2019, 11, 2722 .
AMA StyleRachel Bleiweiss-Sande, Kenneth Chui, Catherine Wright, Sarah Amin, Stephanie Anzman-Frasca, Jennifer M. Sacheck. Associations between Food Group Intake, Cognition, and Academic Achievement in Elementary Schoolchildren. Nutrients. 2019; 11 (11):2722.
Chicago/Turabian StyleRachel Bleiweiss-Sande; Kenneth Chui; Catherine Wright; Sarah Amin; Stephanie Anzman-Frasca; Jennifer M. Sacheck. 2019. "Associations between Food Group Intake, Cognition, and Academic Achievement in Elementary Schoolchildren." Nutrients 11, no. 11: 2722.
Few children in the United States meet national fruit and vegetable intake recommendations, highlighting a need for interventions. Children's food preferences act as a barrier to fruit and vegetable consumption, but prior research has demonstrated that repeated taste exposures can increase children's acceptance of these foods. Prior research in this area has typically utilized controlled procedures in which children sample small tastes of target foods over repeated occasions. The primary aim of the present pilot study was to test whether children's preferences for target fruits and vegetables increased following repeated taste exposures to them through hands-on cooking in a community setting. Seventeen 6-to-8-year-old children participated in biweekly study sessions during six weeks of a summer camp serving lower-income families. Liking of (yummy, just OK, yucky) and rank-ordered preferences for nine fruits and vegetables were measured before and after exposure sessions (pre-test and post-test). Based on pre-test assessments, four relatively less liked foods (two fruits, two vegetables) were chosen to become target foods. Children were then exposed to target foods during nine hands-on cooking sessions; liking of target foods was also measured at a midpoint assessment. At each exposure session, children assisted with preparation of a different snack using a recipe involving target foods and then ate the prepared snack together. Preferences for target foods increased from pre-test (Median = 5.8) to post-test (Median = 5.5; p < 0.05). On average, the majority of children rated the prepared snacks favorably. Results from this pilot study demonstrate the potential of applying repeated exposure techniques via hands-on cooking in a community setting.
S. Ehrenberg; L.A. Leone; B. Sharpe; K. Reardon; S. Anzman-Frasca. Using repeated exposure through hands-on cooking to increase children's preferences for fruits and vegetables. Appetite 2019, 142, 104347 -104347.
AMA StyleS. Ehrenberg, L.A. Leone, B. Sharpe, K. Reardon, S. Anzman-Frasca. Using repeated exposure through hands-on cooking to increase children's preferences for fruits and vegetables. Appetite. 2019; 142 ():104347-104347.
Chicago/Turabian StyleS. Ehrenberg; L.A. Leone; B. Sharpe; K. Reardon; S. Anzman-Frasca. 2019. "Using repeated exposure through hands-on cooking to increase children's preferences for fruits and vegetables." Appetite 142, no. : 104347-104347.
Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012–2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale.
Christina D. Economos; Stephanie Anzman-Frasca; Alyssa H. Koomas; Peter J. Bakun; Clarissa M. Brown; Diane Brown; Sara C. Folta; Karen J. Fullerton; Jennifer M. Sacheck; Shanti Sharma; Miriam E. Nelson. Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis. Preventive Medicine 2018, 119, 37 -43.
AMA StyleChristina D. Economos, Stephanie Anzman-Frasca, Alyssa H. Koomas, Peter J. Bakun, Clarissa M. Brown, Diane Brown, Sara C. Folta, Karen J. Fullerton, Jennifer M. Sacheck, Shanti Sharma, Miriam E. Nelson. Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis. Preventive Medicine. 2018; 119 ():37-43.
Chicago/Turabian StyleChristina D. Economos; Stephanie Anzman-Frasca; Alyssa H. Koomas; Peter J. Bakun; Clarissa M. Brown; Diane Brown; Sara C. Folta; Karen J. Fullerton; Jennifer M. Sacheck; Shanti Sharma; Miriam E. Nelson. 2018. "Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis." Preventive Medicine 119, no. : 37-43.
Children's consumption of restaurant foods is associated with higher energy intake and lower nutritional quality compared to foods prepared at home. The aim of this pilot study was to test whether an in-restaurant intervention promoting healthy children's meals (i.e. two meals that met nutrition recommendations and were thus healthier than typical children's meal offerings across leading restaurants) affected children's meal selection and intake. Families with 4-to-8-year-old children were recruited from one location of Anderson's Frozen Custard, a regional quick-service restaurant chain. Families were randomly assigned to return to the restaurant during an intervention or control period and were blinded to group assignment. All families received free meals. During the intervention period families also received placemats featuring two healthy “Kids' Meals of the Day” upon restaurant entry. After families finished dining, researchers recorded children's orders and collected leftovers for quantifying dietary intake via weighed plate waste. Poisson regression and chi-square tests were used to compare children's orders between study groups, and t-tests were used to test for differences in dietary intake among children ordering a promoted healthy entrée (main dish) versus those who did not. Fifty-eight families participated. Children who were exposed to the study placemats prior to ordering ordered a significantly greater number of healthy food components compared to controls (p = 0.03). Overall, in the intervention group, 21% of children ordered a healthy entrée or side dish, versus 7% of controls. Children who ordered one of the promoted healthy entrées consumed less saturated fat across the total meal compared to those who did not (p = 0.04). Manipulating the prominence of healthy choices in restaurants may shift children's meal selections. Future research should build on these initial promising results, aiming to increase the potency of the intervention to achieve more widespread effects.
Stephanie Anzman-Frasca; Aaron Braun; Sarah Ehrenberg; Leonard H. Epstein; April Gampp; Lucia A. Leone; Anita Singh; Sara Tauriello. Effects of a randomized intervention promoting healthy children's meals on children's ordering and dietary intake in a quick-service restaurant. Physiology & Behavior 2018, 192, 109 -117.
AMA StyleStephanie Anzman-Frasca, Aaron Braun, Sarah Ehrenberg, Leonard H. Epstein, April Gampp, Lucia A. Leone, Anita Singh, Sara Tauriello. Effects of a randomized intervention promoting healthy children's meals on children's ordering and dietary intake in a quick-service restaurant. Physiology & Behavior. 2018; 192 ():109-117.
Chicago/Turabian StyleStephanie Anzman-Frasca; Aaron Braun; Sarah Ehrenberg; Leonard H. Epstein; April Gampp; Lucia A. Leone; Anita Singh; Sara Tauriello. 2018. "Effects of a randomized intervention promoting healthy children's meals on children's ordering and dietary intake in a quick-service restaurant." Physiology & Behavior 192, no. : 109-117.
Humans readily accept sweet tastes and reject those that are sour or bitter. While these predispositions were adaptive in earlier periods of human history, motivating humans to seek out calories and avoid potential poisons, they can set the stage for unhealthy eating habits in the modern obesogenic environment. Correspondingly, many children are not meeting dietary recommendations. Yet children's food preferences are malleable. In this chapter, we explore repeated exposure as a simple and promising technique for promoting healthy food preferences during infancy and childhood, as well as additional learning paradigms that have been studied alongside it. Based on the evidence supporting the roles of repeated exposure and other types of learning in the establishment of healthy food preferences, we conclude with recommendations of ways that caregivers and broader environments can support the development of healthier eating among children.
Stephanie Anzman-Frasca; Sarah Ehrenberg. Learning to Like: Roles of Repeated Exposure and Other Types of Learning. Pediatric Food Preferences and Eating Behaviors 2018, 35 -52.
AMA StyleStephanie Anzman-Frasca, Sarah Ehrenberg. Learning to Like: Roles of Repeated Exposure and Other Types of Learning. Pediatric Food Preferences and Eating Behaviors. 2018; ():35-52.
Chicago/Turabian StyleStephanie Anzman-Frasca; Sarah Ehrenberg. 2018. "Learning to Like: Roles of Repeated Exposure and Other Types of Learning." Pediatric Food Preferences and Eating Behaviors , no. : 35-52.
We present a custom-made device that enables the study of food reinforcement in infants younger than nine months. This device called INFERS (INfant FEeding Reinforcement System) consists of a smart feeding controller and milk delivery components which has been constructed using custom and off-the-shelf components. Testing on three infants to date shows that INFERS functions properly and enables us to collect data on infant feeding activity and correlate this with the amount of effort infants must expend to get the milk.
Poornima Dharmavaram; Kai Ling Kong; Stephanie Anzman-Frasca; Leonard Epstein; Albert H. Titus. Development of a Human Infant Feeding Reinforcement System. 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) 2018, 2018, 3914 -3917.
AMA StylePoornima Dharmavaram, Kai Ling Kong, Stephanie Anzman-Frasca, Leonard Epstein, Albert H. Titus. Development of a Human Infant Feeding Reinforcement System. 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). 2018; 2018 ():3914-3917.
Chicago/Turabian StylePoornima Dharmavaram; Kai Ling Kong; Stephanie Anzman-Frasca; Leonard Epstein; Albert H. Titus. 2018. "Development of a Human Infant Feeding Reinforcement System." 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) 2018, no. : 3914-3917.
The palatable, energy-dense foods that characterize modern environments can promote unhealthy eating habits, along with humans' predispositions to accept sweet tastes and reject those that are sour or bitter. Yet food preferences are malleable, and examining food preference learning during early life can highlight ways to promote acceptance of healthier foods. This narrative review describes research from the past 10 years focused on food preference learning from the prenatal period through early childhood (ages 2–5 years). Exposure to a variety of healthy foods from the start, including during the prenatal period, early milk-feeding and the introduction to complementary foods and beverages, can support subsequent acceptance of those foods. Yet development is plastic, and healthier food preferences can still be promoted after infancy. In early childhood, research supports starting with the simplest strategies, such as repeated exposure and modelling, reserving other strategies for use when needed to motivate the initial tasting necessary for repeated exposure effects to begin. This review can help caregivers and practitioners to promote the development of healthy food preferences early in life. Specific implementation recommendations, the role of individual differences and next steps for research in this area are also discussed.
S. Anzman-Frasca; A. K. Ventura; S. Ehrenberg; K. P. Myers. Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood. Obesity Reviews 2017, 19, 576 -604.
AMA StyleS. Anzman-Frasca, A. K. Ventura, S. Ehrenberg, K. P. Myers. Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood. Obesity Reviews. 2017; 19 (4):576-604.
Chicago/Turabian StyleS. Anzman-Frasca; A. K. Ventura; S. Ehrenberg; K. P. Myers. 2017. "Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood." Obesity Reviews 19, no. 4: 576-604.
Findings can inform the development of restaurant interventions that are effective in promoting healthier eating and are acceptable to parents, children, and restaurant personnel.
Stephanie Anzman-Frasca; Sara C. Folta; Meaghan E. Glenn; Anita Jones-Mueller; Vanessa M. Lynskey; Anjali A. Patel; Lisa L. Tse; Nanette V. Lopez. Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders. Journal of Nutrition Education and Behavior 2017, 49, 285 -295.e1.
AMA StyleStephanie Anzman-Frasca, Sara C. Folta, Meaghan E. Glenn, Anita Jones-Mueller, Vanessa M. Lynskey, Anjali A. Patel, Lisa L. Tse, Nanette V. Lopez. Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders. Journal of Nutrition Education and Behavior. 2017; 49 (4):285-295.e1.
Chicago/Turabian StyleStephanie Anzman-Frasca; Sara C. Folta; Meaghan E. Glenn; Anita Jones-Mueller; Vanessa M. Lynskey; Anjali A. Patel; Lisa L. Tse; Nanette V. Lopez. 2017. "Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders." Journal of Nutrition Education and Behavior 49, no. 4: 285-295.e1.