Beverage Choices Research Articles

Brands and Food-Related Decision Making in the Laboratory: How Does Food Branding Affect Acute Consumer Choice, Preference, and Intake Behaviours? A Systematic Review of Recent Experimental Findings

Abstract Background: Several studies have explored factors influencing consumer choice of foods and non-alcoholic beverages (hereafter, foods), and brand information has been shown to affect potential determinants of eating behaviour, such as consumer attitudes. However, experimental studies have yet to fully elucidate the impact of brand information (presence versus absence of brand imagery) on actual behaviour, in terms of acute food-related decision making. This study aimed to review recent developments and identify key methodological considerations and future directions for this field. Methods: This was a systematic review of recent experimental studies in which actual foods were presented to participants, with brand information manipulated at the point of taking an acute outcome measure of preference, choice or intake. Three electronic databases were searched for relevant publications (Web of Science, PubMed and PsycINFO). In order to capture recent research developments, searches were limited to English language papers published in the last five years (2010–) and electronic searches were supplemented by a manual search of reference sections in eligible papers. Results: Ten papers were eligible for inclusion in this review, reporting on eleven experiments. Overall, the results did not show conclusively whether or not brand information affects acute food-related decision making, although effects on food intake were more consistent than effects on preference and choice. Where an impact of brand information was found, it appeared to be moderated by individual differences, specifically weight status, gender and psychological profile (particularly restraint). Conclusion: This study highlighted the small number of relevant recent studies on this topic, and the substantial heterogeneity in design that exists across this literature. There is a clear need for more high quality, methodologically consistent research of branding effects on immediate food-related decisions. Consistent outcome reporting (such as demarcation of reporting across pertinent participant sub-groups) should also be encouraged to enable accurate comparisons and allow reliable conclusions to be drawn.

Assessment of antioxidant capacity of energy drinks, energy gels and sport drinks in comparison with coffee and tea

SummaryAntioxidant capacities of energy drinks (ED) and energy gels (EG) were evaluated by means of Oxygen Radical Absorbance Capacity (ORAC), Trolox Equivalent Antioxidant Capacity (TEAC), Ferric‐ion Reducing Antioxidant Power (FRAP) and 2,2‐Diphenyl‐1‐picrylhydrazyl (DPPH) assays. Values obtained by the four methods linearly correlated and a ranking scale of their antioxidant contributes was drawn. The ORAC values per serving of ED and EG ranged between 100–7610 and 26–404 μmol Trolox Equivalents (TE), respectively, and correlated linearly with the total phenols (TP). TP and ORAC values of ED and EG were compared with a number of coffee, tea and sport drinks (SDR) samples. In coffees and teas, ORAC values ranged from 603 to 2954 and from 594 to 2587 μmol TE per serving, respectively. In SDR, ORAC values ranged between 420 and 1445 μmol TE per serving. The ORAC/TP and ORAC/Kcal ratios were also used to compare antioxidant capacities of the beverages and an optimal range for these ratios was discussed and proposed. Overall, our results supply new information to producers for a better formulation of antioxidant mixtures in ED and EG and also suggest advice to consumers concerning the choice of energy beverages.

Factors influencing women's decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication.

BackgroundDespite Australian guidelines advising abstinence from alcohol during pregnancy, a relatively high number of Australian women continue to drink alcohol while pregnant. While some call for greater advocacy of the need for abstinence, others have expressed concern that abstinence messages may be harmful to pregnant women and their unborn babies due to the anxiety they could provoke. We present findings on women's deliberations over drinking alcohol during pregnancy, particularly their emotional dimensions, to inform debates about public health messages and practitioner-patient discussions regarding alcohol use during pregnancy.MethodsSemi-structured face-to-face interviews were conducted with 40 women in their homes. Our sample comprised women aged 34–39, drawn from the Australian Longitudinal Study on Women’s Health, living in the Greater Brisbane Area who were pregnant, or had recently given birth, in 2009. An inductive qualitative framework analysis approach was used to identify and interpret themes explaining why pregnant women choose to drink or not.ResultsWomen generally described drinking small amounts of alcohol during pregnancy as being a low risk activity and talked about the importance of alcohol to their social lives as a reason for continuing to drink or finding abstinence a burden; sensitisation to the judgements of others was not widespread. Women predominantly assessed the risk of their drinking in terms of the kinds of alcoholic beverages consumed rather than alcohol content. In reflecting on the advice they recalled receiving, women described their healthcare practitioners as being relaxed about the risks of alcohol consumption.ConclusionsThe significance of alcohol to women’s identity appeared to be an important reason for continued alcohol use during pregnancy among otherwise risk averse women. Anxiety about alcohol consumption during pregnancy was not widespread. However, obstetricians were an important mediator of this. Health messages that dispel the notion that wine is a “healthy” choice of alcoholic beverage, that provide women with strategies to help them avoid drinking, that advise the broader public not to pressure women to drink if they do not want to, and educate women about the effects of ethanol on maternal and fetal bodies, should be considered.

Assessing and catalyzing adoption and implementation of the Alberta Nutrition Guidelines for Children and Youth in recreational sports settings

Although the mandate of recreational facilities is to enhance well-being, many have unhealthy food environments that may paradoxically increase obesity risk. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in recreational facilities. The purpose of these studies was to investigate (i) awareness, adoption, and implementation of the ANGCY; (ii) factors that influenced uptake of the ANGCY and the nature of the food environment within 3 cases: an adopter, a semi-adopter, and a non-adopter of the ANGCY; and (iii) practical strategies to support healthy food purchases by patrons in recreational settings. Findings from a provincial survey (n = 151 recreational facilities) showed that one-half of facilities had heard of the ANGCY and only 6% had implemented them 1 year following their release. A multiple case study revealed that managers were nutritional gate-keepers of recreational facility food environments, their nutrition-related knowledge, beliefs, and perceptions shaped their adoption and implementation of the ANGCY. Intersectoral linkages with schools and health-promoting partnerships with industry were also important for adoption and implementation to occur. Financial constraints emerged as a strong and consistent barrier to ANGCY uptake. Managers from industry who adopted the ANGCY took a long-term view of profitability and were willing to take small risks, sacrificing short-term profitability to remain on the leading edge of market trends. An intervention tested the impact of increased availability of healthy items, 2 nudges and an economic incentive on purchase of healthy items by patrons at an outdoor community pool. Food availability proved to be an independent environmental determinant of food purchasing behaviours in this context, while mixed evidence was found for the efficacy of nudging. Price reductions appeared ineffectual in this setting. Overall, findings suggest that ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor and managers fear revenue loss. Multiple strategies will be needed to optimize food selection in recreational settings; however, increasing the availability of healthy foods offers significant potential to improve patrons’ food-purchasing behaviours.

Banking on Strong Bones Curriculum Promotes Behavior Change

The curriculum is designed to increase knowledge/awareness of the role calcium-rich and weight-bearing activities play in building and maintaining strong bones among children and to improve food and beverage choices based on Dietary Guidelines recommendations. Fourth-grade children and their families have participated in the program. Informed by social cognitive theory, this curriculum uses peer modeling, environmental support and goal-setting to promote behavior change. An estimated 70% of pre-teen girls and 60% of pre-teen boys do not meet the daily calcium recommendation, which places them at risk of developing osteoporosis as adults. A 5-lesson curriculum was designed for use in school classrooms during a 5-week time frame. The program includes hands-on activities, calcium tracking, educational displays, follow-up activities for the teacher, participation incentives using “cow coins” and “cow banks”, and optional taste testing activities. Parents/caregivers were provided with weekly newsletters summarizing their child's activities, along with nutrition information, recipes and goal-setting activities. Pre- and post-surveys of children and parents assessed knowledge gain and achievement of nutrition-related goals. Participants (n=9,163; 49.7% male) significantly increased their knowledge of calcium sources, indicated preference for milk over soda/pop, increased their self-reported consumption of calcium-rich foods and decreased their consumption of sweetened beverages (p <.05). About 51% of parents/caregivers reported a positive change in the children's eating habits at home. Classroom nutrition education with parent involvement can promote behavior change to increase calcium consumption.

Consuming calories and creating cavities: beverages NZ children associate with sport

Sugar-sweetened beverages (SSBs) are widely available, discounted and promoted, and despite recommendations to the contrary, frequently consumed by children. They provide few nutritional benefits, and their consumption is implicated in a number of poor health outcomes. This study examined the nature of the beverages that sport-playing New Zealand (NZ) children associate with sport. It assessed how well the beverages aligned with nutrition guidelines and relevant regulations, and their likely impacts on health. Eighty-two children (38 girls and 44 boys) aged 10–12 years were purposively selected from netball, rugby and football clubs in low and high socioeconomic neighbourhoods, in Wellington, New Zealand (NZ). Children photographed beverages they associated with sport. The beverages were then purchased and analysed in accordance with NZ nutrition guidelines, and relevant content and labelling regulations, by: package and serving size; energy, sugar, sodium and caffeine content; pH; and advisory statements. The beverages the children associated with sport overwhelmingly had characteristics which do not support children in adhering to NZ nutrition guidelines. Implementing public health mechanisms, such as healthy food and beverage policies, widely promoting water as the beverage of choice in sport, and implementing healthy eating and drinking campaigns in sports clubs, would assist children who play organised sport to select beverages that are in keeping with children's nutrition guidelines. As part of a comprehensive public health approach they would also reduce the substantial, unnecessary and potentially harmful contribution sugar-sweetened beverages make to their diet.

Contextual Determinants and Alcohol Control Policies in the United Kingdom

In the United Kingdom, between 1960 and the 2000s, there were many sociodemographic and economic factors that played a part in the changing picture of alcohol consumption and its related harm. This paper describes some of these variables along with the political measures that were identified as correlated with changes in consumption and harm. The resulting picture is unclear. No consistent pattern was identified among the variables analyzed. Beverage choice changed over time with a reduction in beer consumption and an increase in wines and spirits. Nevertheless, the overall picture showed an increase in total alcohol consumption and resulting harm.

Pediatric Obesity Update

Pediatric Obesity Update

Consumer Insights from Peer-to-Peer Communication in an Online Health Community of Weight Management

To demonstrate a theory-based method of identifying consumer insights in online peer-to-peer discussion, the present study analyzed posts from The Biggest Loser League, a weight-management online community, and found a considerable proportion of posts revealing negative attitudes toward food and beverage products, a lack of discussion on healthy food and beverage choices, and higher frequencies of content related to verbal persuasion and mastery experience. These findings suggest that sources of self-efficacy are a frequent topic in online discussions. While Bandura's (1997) model theorizes that verbal persuasion is the third most powerful source of self-efficacy, findings from the present study suggest that the sources of self-efficacy communication depend upon the mode of the communication. Specifically, people expect to exchange encouragement (verbal persuasion) more often in online all-peer communication. Practically, the present study suggests that participating online health communities can help to discourage unhealthy eating habits and increase self-efficacy of weight management. However, more information on healthy choices needs to be provided.

Abstract P371: Healthy Clinics, Healthy Kids - Lifestyle Intervention on Cardiometabolic Disease Prevention in Pediatric Clinical Settings

Childhood obesity should be addressed in multiple sectors, including the health services/clinical setting. While many physicians believe it is their responsibility to help adult patients lose weight, the majority feels they are not equipped to manage weight problems of their patients. Healthy Clinics, Healthy Kids (HCHK) was designed to test the impact of addressing obesity, using a lifestyle approach, among pediatric patients and families in a variety of primary care clinical settings. HCHK interventions took place over a 2-year period (2010-2012) in three states (MI, MS and NM). Lifestyle interventions (nutrition, healthy living, physical activity education/technical assistance), targeted children and caregivers in low-income clinical settings that care for children. The goal was to help clinical staff address obesity issues and concerns of patients and families. Impact of interventions was assessed using pre and post surveys. 21 sites completed pre and post surveys (MI (9), MS (9), and NM (3)). Respondents included nurses (14), managers (2), physicians (2), coordinators (1), and a registered dietitian. Prevalence of obesity among children was higher than the national average (respondents reported that only 56% were “normal”, as compared to approximately 66% nationally). 32% indicated private insurance pays for some obesity care, and 42% indicated public insurance. 44% indicated they discuss weight with parents of “normal” weight children, and about 73% indicated they discuss this with parents of “overweight” children. Statistically significantly (at the p&lt;.05 level) more respondents indicated, at the end of the project than at the beginning, that they discuss “the impact of childhood obesity on their future risk for chronic diseases in adulthood” (70% versus 57%). Statistically significantly more indicated that they discuss this topic with parents at the end (76% versus 57%). There was an increase in discussing obesity with patients, topics including exercise and physical activity (+8.5%) and limiting sedentary behaviors (+5.0%). There was an increase in conversations with parents, topics including healthy food and beverage choices (+4.8%), physical activity (+9.4%), limiting sedentary behaviors (+4.7%), “creating a healthy home environment” (+19.1%), and “removing the TV from the bedroom” (+14.3%) Although at baseline it was not discussed much (22.2%), at follow-up, there was an increase in “encouraging breastfeeding for childhood obesity prevention, if pregnant” (38.1%). Regarding parents, although already a topic with high comfort level at baseline, statistically significantly more respondents indicated at the end of the project that they felt comfortable discussing exercise and physical activity (76.2% versus 90.5% respectively). Overall, HCHK showed that implementation of a nutrition and healthy living program for clinics is feasible and effective.

Heavy drinking occasions in Australia: Do context and beverage choice differ from low‐risk drinking occasions?

The aim of the current study is to look for differences in drink choice and drinking location between a recent heavy drinking occasion (RHDO) and usual low-risk occasions among those that recently had both types of drinking occasion. Seven hundred and seventy-four respondents to a population-based survey reported having a RHDO [8 + Australian standard drinks (ASD) for females, 11 + ASD for males] in the past six months also reported that their usual drinking occasion in at least one location involved less than five ASD. Drink choice and drinking locations for the RHDO and usual low-risk occasions were compared using confidence intervals. The RHDO was more likely than usual low-risk occasions to occur away from licensed premises (59%), despite a higher percentage of respondents reporting drinking at a pub, bar or nightclub on a RHDO (28%) than on a usual low-risk night (12%). A higher percentage of respondents nominated bottled spirits (33%) as their main drink for their RHDO, with 11% primarily drinking bottled spirits on a usual low-risk occasion; the converse was true for bottled wine (20% and 33%, respectively). While the high proportion of RHDOs that occurred at least in part at pubs or nightclubs was not surprising, a high proportion also occur in private homes. Previously found links between heavy drinking and beer may be a reflection of the usual drink choice of heavier drinkers, rather a choice specific to a particularly heavy occasion.

The effect of an analytical appreciation of colas on consumer beverage choice

This experiment examined if the analysis of beverage taste changes the favorite drink of a taster. Participants blind-tasted two brands of cola, Coke and Pepsi. Those who were not asked to verbalize their reactions to each tended to prefer Coke over Pepsi; those who expressed them were more likely to favor Pepsi; and those who indicated an aversion to both showed no clear preference. Participants found it easier to describe their predilection for Pepsi than for Coke but experienced equal difficulty in verbalizing their negative reactions to both colas. These findings suggest that when people taste carefully they tend to focus on the attributes of drinks that they find salient and that seem relevant to their preferences, leading them to choose the one with these attributes as their favorite.

Knowledge, perceptions, and behaviors of adults concerning nonalcoholic beverages suggest some lack of comprehension related to sugars

Key recommendations in the 2010 Dietary Guidelines for Americans and US Department of Agriculture's MyPlate are to reduce the intake of added sugars, particularly from sugar-sweetened beverages, and drink water instead of “sugary” beverages. However, little is known about consumer knowledge, perceptions, and behaviors regarding sugars in beverages. We hypothesized that consumers would have limited or inaccurate knowledge of the sugars in beverages and that their beverage consumption behaviors would not reflect their primary concerns related to sugars in beverages. An online survey was completed by 3361 adults 18 years and older residing throughout the United States. Water was consumed in the highest amounts followed by (in descending amounts) other beverages (includes coffee and tea), added sugar beverages, milk, diet drinks, and 100% fruit juice and blends. Participants primarily associated the term “sugary” with beverages containing added sugars; however, almost 40% identified 100% fruit juice as sugary. Some participants misidentified the types of sugars in beverages, particularly with respect to milk and 100% fruit juices. Generally, beverage choices were consistent with stated concerns about total, added, or natural sugars; however, less than 40% of participants identified added sugars as a primary concern when choosing beverages despite public health recommendations to reduce the intake of added sugars and sugar-sweetened beverages. Results suggest that there may be a considerable level of consumer misunderstanding or confusion about the types of sugars in beverages. More consumer research and education are needed with the goal of helping consumers make more informed and healthy beverage choices.

Healthier choices in an Australian health service: a pre-post audit of an intervention to improve the nutritional value of foods and drinks in vending machines and food outlets

BackgroundVending machines and shops located within health care facilities are a source of food and drinks for staff, visitors and outpatients and they have the potential to promote healthy food and drink choices. This paper describes perceptions of parents and managers of health-service located food outlets towards the availability and labelling of healthier food options and the food and drinks offered for sale in health care facilities in Australia. It also describes the impact of an intervention to improve availability and labelling of healthier foods and drinks for sale.MethodsParents (n = 168) and food outlet managers (n = 17) were surveyed. Food and drinks for sale in health-service operated food outlets (n = 5) and vending machines (n = 90) in health care facilities in the Hunter New England region of NSW were audited pre (2007) and post (2010/11) the introduction of policy and associated support to increase the availability of healthier choices. A traffic light system was used to classify foods from least (red) to most healthy choices (green).ResultsAlmost all (95%) parents and most (65%) food outlet managers thought food outlets on health service sites should have signs clearly showing healthy choices. Parents (90%) also thought all food outlets on health service sites should provide mostly healthy items compared to 47% of managers. The proportion of healthier beverage slots in vending machines increased from 29% to 51% at follow-up and the proportion of machines that labelled healthier drinks increased from 0 to 26%. No outlets labelled healthier items at baseline compared to 4 out of 5 after the intervention. No changes were observed in the availability or labelling of healthier food in vending machines or the availability of healthier food or drinks in food outlets.ConclusionsBaseline availability and labelling of healthier food and beverage choices for sale in health care facilities was poor in spite of the support of parents and outlet managers for such initiatives. The intervention encouraged improvements in the availability and labelling of healthier drinks but not foods in vending machines.

The comparative validity of interactive multimedia questionnaires to paper-administered questionnaires for beverage intake and physical activity: pilot study.

BackgroundBrief, valid, and reliable dietary and physical activity assessment tools are needed, and interactive computerized assessments (ie, those with visual cues, pictures, sounds, and voiceovers) can reduce administration and scoring burdens commonly encountered with paper-based assessments.ObjectiveThe purpose of this pilot investigation was to evaluate the comparative validity and reliability of interactive multimedia (IMM) versions (ie, IMM-1 and IMM-2) compared to validated paper-administered (PP) versions of the beverage intake questionnaire (BEVQ-15) and Stanford Leisure-Time Activity Categorical Item (L-Cat); a secondary purpose was to evaluate results across two education attainment levels.MethodsAdults 21 years or older (n=60) were recruited to complete three laboratory sessions, separated by three to seven days in a randomly assigned sequence, with the following assessments–demographic information, two IMM and one paper-based (PP) version of the BEVQ-15 and L-Cat, health literacy, and an IMM usability survey.ResultsResponses across beverage categories from the IMM-1 and PP versions (validity; r=.34-.98) and the IMM-1 and IMM-2 administrations (reliability; r=.61-.94) (all P<.001) were significantly correlated. Paired t tests revealed significant differences in sugar-sweetened beverage (SSB) grams and kcal (P=.02 and P=.01, respectively) and total beverage kcal (P=.03), on IMM-1 and IMM-2; however, comparative validity was demonstrated between IMM-2 and the PP version suggesting familiarization with the IMM tool may influence participant responses (mean differences: SSB 63 grams, SEM 87; P=.52; SSB 21 kcal, SEM 33; P=.48; total beverage 65 kcal, SEM 49; P=.19). Overall mean scores between the PP and both IMM versions of the L-Cat were different (both P<.001); however, responses on all versions were correlated (P<.001). Differences between education categories were noted at each L-Cat administration (IMM-1: P=.008; IMM-2: P=.001; PP: P=.002). Major and minor themes from user feedback suggest that the IMM questionnaires were easy to complete, and relevant to participants' typical beverage choices and physical activity habits.ConclusionsIn general, less educated participants consumed more total beverage and SSB energy, and reported less engagement in physical activity. The IMM BEVQ-15 appears to be a valid and reliable measure to assess habitual beverage intake, although software familiarization may increase response accuracy. The IMM-L-Cat can be considered reliable and may have permitted respondents to more freely disclose actual physical activity levels versus the paper-administered tool. Future larger-scale investigations are warranted to confirm these possibilities.

U.S. Department of Defense's Perspective on Funding for Research on Whole Grains and Health

The mission of military nutrition research is to identify and apply nutritional strategies to sustain and enhance physical and mental performance and maintain the health of military personal conducting extended operations in all environmental extremes. DOD’s nutrition research is conducted at the U.S. Army Research Institute of Environmental Medicine’s (USARIEM) Military Nutrition Division (MND) located in Natick, MA. DOD’s combat ration R&D is conducted by the U.S. Army Natick Soldier RD&E Center in Natick, MA. DOD’s nutrition research and combat ration development programs are highly coordinated and mutually supportive. Combat rations for individual soldiers are designed to be low-weight, low-volume, of high nutrition density, ready-toeat, shelf-stable, and highly acceptable to our war fighters. Because of these design features, combat rations are limited in whole grains but usually contain a bread item. In 1985, the Army leadership requested USARIEM to conduct a series of studies to evaluate the effectiveness of dining facility initiatives to improve soldiers’ eating habits. The focus of the initiatives was to reduce consumption of total fats to not more than 35% of calories. The strategies used included serving low fat milk, educating cooks and diners, and modifying menus, recipes, and food preparation methods. As shown in Table I, these dining facility initiatives were very effective in reducing total fat intakes (% fat calories) in the military dining facilities (DFACs) studied from an average of 45% pre-initiatives to 32% post-initiatives. (1) As shown in Table II, total cholesterol intakes were also greatly reduced and total carbohydrate intakes correspondingly increased in both male and female West Point cadets. (3,4) During the past four years there has been a renewed interest in improving DFACs and the quality of food service. In August 2010, the U.S. Air Force (USAF) awarded a $10.3 M contract to AMARACK for a food transformation initiative (FTI) at six USAF bases. The FTI is a pilot program designed to improve the quality, variety, and availability of food operations and to increase utilization of DFACs by airman and their families. In December 2010, all the Services approved new DOD menu standards with the primary goal of promoting and incorporating healthier foods in the DFACs. All Army DFACs will follow the DOD Menu Standards to include offering sliced bread containing whole grains, whole grain waffles and French toast, whole grain cereals, and whole grain pasta. The Army incorporated the DOD menu standards into a soldier fueling initiative (SFI) announced by LT. General Mark Hertling, Deputy Commanding General for Initial Military Training (IMT) in September 2010. The SFI will modify Army garrison menu standards to promote healthier eating and it will prescribe standardized menus, recipes, preparation methods, and portion sizes at all IMT DFACs. The SFI will also market nutrition awareness and healthier food and beverage choices. A total of twelve Army installations with IMT DFACs will implement the program that is designed to increase IMT soldier fitness and

An Exploratory Study of the Concession Preferences of Generation Y Consumers

Concerns surrounding obesity and overweight youth continue to be in the forefront of issues among the U.S. population. The awareness of this serious issue have contributed to smarter choices in food and beverage selections by Generation Y consumers; however, there is little research present today on their perceptions and satisfaction with the food and beverages being offered in sporting and entertainment venues. This exploratory study examines this dilemma and reveals that Generation Y consumers believe that food and beverages being offered in these venues are of limited variety, overpriced, unhealthy, and low in quality. Generation Y consumers want to see more of a variety of healthier options at a better price. Results from this research may benefit foodservice suppliers by providing suggestive information about preferred food and beverage choices by Generation Y consumers in sporting and entertainment venues.

The CHILD 1 Diet: From Strategy to Practicality

As described by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents report, the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1) is the first-step diet for all children with elevated cardiovascular risk. Although the diet is specifically designed for cardiovascular disease risk reduction, it can also be used for the promotion of healthy dietary habits for children (older than the age of 2 years) and adolescents while still continuing to provide adequate nutrition for optimal growth and development. The diet provides guidance on caloric distribution, offers appropriate beverage and snack choices, and highlights the importance of adequate fruit and vegetable intake. Although the guidelines presented in the CHILD 1 diet provide a framework on which a healthy diet can be built, it can be challenging for some patients and families to put the recommendations into practice. This article focuses on explaining the key nutrition messages within the CHILD 1 diet and includes practical suggestions for meal planning.

Childhood Obesity Risk in Overweight Mothers

Purpose. Family dietary and nutritional behaviors predispose children to obesity. The purpose of this study was to examine the childhood obesity risk among overweight women and to assess feasibility of using a screening tool in a busy clinic setting. Design. A cross-sectional study using the Family Nutrition Physical Activity (FNPA) tool was self-administered by 98 overweight mothers identifying risk factors for childhood obesity. Measures. Mothers completed demographic and a 20-item screening survey with subscales on family meal patterns, family eating habits, food choices, beverage choices, restriction/reward, screen time behavior and monitoring, healthy environment, family activity involvement, child activity involvement, and family routine. After completing the survey, a summary of recommended practices from the American Academy of Pediatrics was provided. Results. Ninety-eight mothers participated (of 172 children between 2 and 18 years old). Lower FNPA scores (obesogenic) were associated were higher body mass index, family income, race/ethnicity, education, and mother’s body mass index. Parents’ and children’s obesity was comparable to what is found in larger populations, whereas obesity in the age-group between 2 and 5 years was doubled. Conclusion. Findings support maternal obesity is significant predictor for the development of child obesity. FNPA identified risk and feasibility of use was demonstrated.

Decision-making throughout the whole process of relapse: a qualitative analysis of problem drinkers’ accounts of recent episodes

Background & Aims: Models of relapse have usually focused on the antecedents to a drinking session. This qualitative study examined themes within the whole process of relapse in alcohol use (including four phases: before, during, ending and following a drinking session).Methods: Fifteen clients from a UK alcohol treatment clinic received a semi-structured interview, and in-depth accounts of their most recent relapse experiences were obtained. Interview transcripts were analysed using thematic analysis.Results: Participants made sense of their relapse as being caused by circumstantial and compelling triggers, over which they perceived having little control. However, less readily identified, the whole process of relapse was underpinned by a sequence of ordinary decisions. Participants selected options in beverage choice, purchasing and drinking behaviour, which minimised anticipated negative outcomes of a relapse. Their continued drinking was reinforced by primary and secondary gains, and beliefs of uncontrollability. Participants were able to stop drinking, without assistance, when they had enough. Negative consequences of relapse were delayed and less serious than drinkers anticipated. Sharing their accounts with supportive others gave them a sense of consolation.Conclusions: Reflecting on the whole process of relapse and building up drinkers’ sense of control may be important components of relapse prevention.