Children's Healthy Eating Research Articles

Differences in parental behaviour, emotions, and cognitions between children's eating profiles

A variety of parent psychological characteristics (e.g., wellbeing) have been related to children's eating behaviour. However, parent-child feeding interactions are reciprocal and complex, including relationships between parental cognitions, emotions, as well as the influence of children's varying appetitive traits. Using a person-centred approach, children's appetitive traits can be clustered into meaningful eating profiles. To date, no research has examined whether parental behaviours, emotions, and cognitions differ depending on a child's eating profile. Hence, this study recruited parents/primary caregivers from the APPETItE project, whose child had previously been identified as having an avoidant, typical, happy, or avid eating profile. Parents/primary caregivers of children (3–6 years; N = 632) completed online questionnaires examining broader parenting behaviour (parenting styles), parental emotions (stress, wellbeing), and parental cognitions (goals, self-efficacy, time and energy for meal planning and preparation, and perceptions about children's body size). Findings showed significant differences in parent responses to the questionnaires based on children's eating profiles. Parents of children with a happy eating profile reported better psychological wellbeing and greater parenting time and energy for meal planning and preparation, as well as being less likely to report goals of avoiding mealtime stress and conflict. In contrast, parents of children with an avoidant eating profile reported poorer psychological wellbeing. Children with an avid eating profile were perceived by parents as having a higher body weight, whereas children with an avoidant eating profile were perceived as having a lower body weight. Overall, these findings demonstrate that differences in parental characteristics and perceptions exist between children's eating profiles and thus should be considered in the development of tailored interventions to support children's healthy eating.

Improvement of Adherence to the Mediterranean Diet through a Nutrition Education Teaching Pack for Teachers within the "School Fruit Scheme" Program: An Italian Long-Term Trial in School Children.

A previous short time span study related to the effectiveness of a teaching pack (TP) in improving the adherence to the Mediterranean Diet (MD) showed positive results. The present study was aimed at investigating and confirming those results, with a follow up data collection, in the same sample, a year after the baseline intervention. Pre- and post-intervention assessments were conducted. Weight and height were measured. Eating patterns/lifestyle were assessed by the KIDMED test and questionnaires. Thirteen schools in three areas with low, medium and high prevalence of overweight/obesity (North, Center and South respectively) were involved, with a representative baseline cluster sample of 494 fourth class children (8-10 years old) in 2015. An intervention group and a control group were recruited in each school; the intervention group (n = 395) got the intervention, the control group (n = 99) did not. The children's KIDMED score changes were the main outcome measures. Differences in percentages of adherence and in yes/no answers on the KIDMED test, at baseline and after one year, for both the intervention and the control groups, were assessed through contingency tables and statistical tests. Improvements in the high and low adherence rates to MD were observed (high adherence: 24.4% to 43.3%; low adherence: 15.0% to 3.9%, p < 0.0001). The percentages of subjects with optimal adherence improved in both sexes (females: 25.5% to 49.5%, p < 0.0001; males: 23.1% to 36.6%, p < 0.0001) in all the geographical areas and ponderal status classes. Accompanying free distribution of fruit and vegetables with a nutritional intervention led by trained teachers with a cross-curricular approach can be successful in promoting healthy eating in children.

The Importance of Social Projects Associated with Healthy Eating for Children and Seniors

This scientific article investigates the relationship of direct health benefits, these projects foster social inclusion by providing nutritional education and living spaces that strengthen the community and promote a sense of belonging. Effective implementation of these projects requires strategic partnerships, ongoing education, accessibility, and active community involvement, ensuring a positive and lasting impact on the quality of life of children and older adults.

Associations of Broader Parental Factors with Children's Happiness and Weight Status through Child Food Intake, Physical Activity, and Screen Time: A Longitudinal Modeling Analysis of South Korean Families.

This study investigated how broader parental factors including parental happiness, parental play engagement, and parenting stress are related to Korean children's happiness and weight status across three years via indirect pathways through the children's energy-related behaviors of healthy and unhealthy food intake, physical activity, and screen time. Data from 1551 Korean parent pairs and 7-year-old children in the Panel Study on Korean Children were analyzed. A path analysis and gender-based multi-group analysis were conducted. Maternal happiness was negatively related to child screen time. Maternal play engagement showed positive concurrent associations with child healthy food intake and physical activity and negative associations with screen time. Maternal parenting stress was negatively related to child healthy eating. There was one significant finding related to fathers' role on children's energy-related behaviors, happiness, and weight status: the positive association between parental happiness and boys' unhealthy food intake. Child screen time was positively related to child weight status and negatively to child happiness at each age. Broader maternal parenting factors can serve as a protective factor for childhood happiness and weight status in 7-to-9-year-olds through being associated with a reduction in child screen time.

Association of dietary diversity of 6–23 months aged children with prenatal and postnatal obstetric care: evidence from a nationwide cross-sectional study

BackgroundDietary diversity is a key determinant of infant and young child eating patterns for a variety of food groups taken by children between the ages of 6–23 months. The study aimed to examine the association between prenatal and postnatal obstetric care factors of mother and child’s dietary diversity, and specific food practices in Bangladesh.MethodsThis study analyzed the data of 2497 children between the age of 6–23 extracted from the latest countrywide Bangladesh Demographic Health Survey 2017–2018 and explored relationships between prenatal and postnatal obstetric care received by mother and dietary diversity score (DDS), minimum dietary diversity (MDD), and introduction of solid, semi-solid, and soft foods (ISSSF) of their children.ResultsFindings revealed that ≥ 4 antenatal care (ANC) visits care visits increased the DDS (adjusted beta: 0.32, 95% CI [0.21, 0.43]), increased the likelihood of MDD (AOR 1.54, 95% CI [1.23, 1.93]), and ISSSF (AOR 1.24, 95% CI [1.08, 1.48]), consuming eggs (AOR 1.47, 95% CI [1.23, 1.76]), and vitamin A vegetables and fruits (AOR 1.38, 95% CI [1.15, 1.66]). Moreover, DDS (adjusted β: 0.05, 95% CI [0.00, 0.11]) and MDD (AOR 1.66, 95% CI [1.31, 2.11]) are linked to childbirth in a medical facility. The C-section delivery influences the DDS (adjusted beta: 0.05, 95% CI [0.00, 0.10]), MDD (AOR 1.39, 95% CI [1.10, 1.75]), and ISSSF (AOR 1.22, 95% CI [1.02, 1.48]). Besides, postnatal visits within 48 h of delivery linked to MDD (AOR 0.66, 95% CI [0.49, 0.89]) and ISSSF (AOR 0.76, 95% CI [0.59, 0.97]), and physicians or professionals providing postnatal checkups were significantly associated with DDS (adjusted beta: 0.09, 95% CI [0.02, 0.16]), MDD (AOR 1.69, 95% CI [1.26, 2.26]), and ISSSF (AOR 1.30, 95% CI [1.04, 1.62]).ConclusionKnowledge of child nutritional feeding should emphasize during prenatal and postnatal obstetric care of mother, particularly during antenatal and postnatal visits, C-section delivery, and birth in a healthcare facility to eradicate malnutrition and establish healthy child feeding practices.

Exploring the feasibility of using evidence-based feeding practices to promote children's healthy eating in holiday clubs.

Encouraging healthy eating is a public health priority in the United Kingdom (UK), given the high prevalence of poor diet and overweight/obesity among school-aged children. Holiday clubs are organisations providing childcare and activities during the school holidays and frequently provide food to children at risk of food insecurity, primarily through government-funded programmes like the Holiday Activities and Food programme. However, the research suggests that holiday clubs could do more to maximise opportunities to promote children's healthy eating by using evidence-based feeding practices. During August-September 2020, video-based interviews were conducted exploring staff perceptions of the feasibility of using four evidence-based feeding practices to promote children's healthy eating: modelling; involvement in food choice; involvement in food preparation and cooking and involvement in meal planning. Feasibility was assessed using four dimensions of a feasibility framework (acceptability, demand, practicality and implementation). UK holiday clubs. Twenty-five staff actively involved in delivering UK holiday clubs (project leaders, coordinators, cooks and coaches/youth workers). Staff generally reported good acceptability (dimension 1) and demand (dimension 2) for the feeding practices. However, the practicality (dimension 3) of using the practices was dependent on various factors (logistics, resources, staff readiness, children, peers and parents). Promisingly, in the fourth feasibility dimension (implementation), staff provided numerous practical solutions to overcome these barriers. Evidence-based feeding practices can be implemented in numerous ways and are therefore generally feasible in holiday clubs. Holiday clubs should be empowered to use evidence-based feeding practices through training resources, sharing networks and provision of sustainable funding.

Inequalities in availability and compliance of school food programs in Canadian elementary schools

Abstract Background School food programs (SFP) are essential to promoting healthy eating in children. Canada lacks a federally funded and standardized SFP, resulting in a patchwork of SFP offerings. We examined SFP availability and compliance with Alberta Nutrition Guidelines for Children and Youth (ANGCY) in elementary schools from different socioeconomic settings. Methods Data were collected from 2 repeat cross-sectional surveys between 2008-2021: (1) REAL Kids Alberta (Raising healthy Eating and Active Living Kids in Alberta), a provincially representative population-based survey; and (2) APPLE Schools (A Project Promoting healthy Living for Everyone in Schools), a health promotion intervention targeting elementary schools in socioeconomically disadvantaged settings. School principals reported on availability and compliance of breakfast/snack and lunch programs with ANGCY. School-level socioeconomic characteristics included: Pampalon index (from Census data) and rural/small vs. large population centre (PC). Results Provincially, less than 50% schools offered breakfast/snack program. Lunch program was offered in over 85% schools. Over half of SFP complied with ANGCY by including 3-4 food groups (breakfast/snack: 62%, lunch: 52%). SFP availability in more vs. less deprived schools increased over time (2008: 25% vs. 26%, 2014: 58% vs. 40%). More schools located in rural/small vs. large PC offered SFP and availability increased over time (2008: 29 % vs. 18%, 2014: 56% vs. 46%). There were no consistent trends in compliance of SFP by socioeconomic characteristics. SPF availability and compliance in APPLE Schools improved from 68% to 73% and 53% to 68%, respectively. SPF availability was higher in more vs. less deprived APPLE schools (Y1: 85% vs. 54%, Y6+: 78% vs. 69%). Conclusions Higher availability and compliance of SFPs with nutrition guidelines in deprived and rural settings emphasize the critical role of SFPs in mitigating socioeconomic inequalities in healthy eating. Key messages • School food programs are essential to promoting healthy eating in children. • School food programs may play a critical role in mitigating socioeconomic inequalities in healthy eating.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system.

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focusing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children, through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Associations between parental and pre-adolescents' physical activity and diet quality: The role of parental child care involvement and child's sex

BackgroundResearch has demonstrated the importance of the family environment in the eating and activity levels of offspring. We examined the cross-sectional associations between moderate-to-vigorous physical activity (MVPA) and diet quality of parents and the MVPA and diet quality of pre-adolescents. Interactions were tested to assess whether the child's sex and the parental level of involvement in daily child care moderated these associations. MethodsData from 2467 pre-adolescents (age 11.5 ± 0.2 years; collected in 2015–2016) and their parents or caregivers from a large-scale prospective birth cohort study in Amsterdam (ABCD-study) was used. Parents and pre-adolescents individually reported their diet quality and physical activity. Child care involvement was assessed using the Caregiver Child Interaction Scale. With hierarchical linear regression analyses, we assessed the independent contribution of fathers and mothers. ResultsAn association between mother-child MVPA was found (β = 0.013; 95 % CI: 0.006;0.021). The association between father-child MVPA was only significant for highly involved fathers (β = 0.014; 95 % CI: 0.004;0.023). The child's sex did not change these MVPA associations. Regarding diet quality, associations were found between mother-child diet quality score (DQS) (β = 0.254; 95 % CI: 0.192;0.316) and father-child DQS, with stronger associations between fathers and sons (β = 0.234; 95 % CI: 0.169;0.298) than between fathers and daughters (β = 0.114; 95 % CI: 0.047;0.181). Parental levels of involvement did not change these associations. ConclusionThese findings demonstrate that both parental behaviours represent an important factor in physical activity and diet quality in pre-adolescents in a sex-specific manner. As such, it is essential to include both parents in research to obtain the necessary insights for developing effective interventions to promote children's healthy eating and physical activity behaviours.

Exploring grandparents’ receptivity to and preferences for a grandchild nutrition-focused intervention: A qualitative study

ObjectiveInterventions promoting healthy eating in children typically overlook the critical role of grandparent caregivers. Utilising a co-design approach, this study (i) assessed the receptiveness of grandparents to a nutrition-focused resource aimed at promoting healthy eating in their grandchildren and (ii) explored grandparents’ preferences for resource delivery and dissemination. MethodsSeventy-nine grandparents (58% female; mean age=69.37 years) who were secondary carers to a grandchild aged 3-12 years participated in one of 10 focus groups. Focus group transcripts were imported into NVivo for coding and semantic thematic analysis. ResultsThe vast majority of focus groups (n=9) were receptive to receiving a nutrition-focused resource. Participants indicated that such a resource should contain strategies that help grandparents promote healthy eating in their grandchildren rather than outline what grandchildren should be fed. A range of delivery (pamphlets, seminars and fridge magnets) and dissemination (online, email) methods were suggested. ConclusionsA nutrition resource that equips grandparents with the strategies they need to promote healthy eating in their grandchildren would likely be welcomed. Implications for public healthResults provide program developers with the preliminary information required to tailor childhood lifestyle interventions to the needs of grandparents, thus helping increase acceptability and uptake.

Exploring the understanding of how parenting influences the children's nutritional status, physical activity, and BMI.

Parental behaviors and the home environment are two of the most effective ways to adopt healthy eating and active lifestyles. For this reason, it is crucial to understand children's nutritional habits, analyze the dynamics related to parental factors, diagnose and treat childhood obesity in the early period, and prevent adulthood obesity. This study aimed to explore how parenting influences children's nutritional status, physical activity, and BMI. The study involved 596 children with their parents. The data were collected through face-to-face interviews using the survey method. The survey consists of descriptive information (age, gender, educational status), anthropometric measurements, nutritional habits, Family Nutrition and Physical Activity Scale (FNPA), International Physical Activity Questionnaire, and 24-h dietary recall. The Mean Adequacy Ratio (MAR) was applied to assess dietary adequacy. Most mothers and fathers were overweight or obese (61.6 and 68.7%, respectively). 38.6% of boys and 23.1% of girls were overweight or obese. The FNPA score was positively correlated with MAR (p < 0.05). Multiple linear regression analysis revealed that children's BMI was negatively correlated with FNPA score, while maternal BMI and father's BMI were positively correlated (p < 0.05). Furthermore, dietary energy was not associated with the child's BMI but with dietary adequacy (p < 0.05). There was no evidence that family impacted children's physical activity. This study supports that parenting influences children's dietary intake and BMI. Adequate and balanced nutrition, regardless of dietary energy, may affect children's body weight. Family plays a significant role in influencing and forming children's lifestyle-related behaviors. Children's healthy eating and physical exercise habits can be encouraged through school-based programs involving families.

Development of the Children's Body Satisfaction Scale: Its psychometric characteristics for children.

Body satisfaction is a key factor in children's healthy eating and self-perception. This study aims to develop The Children's Body Satisfaction Scale to measure body image satisfaction in children, which consists of three sub-dimensions ('acceptance of physical appearance', 'weight satisfaction' and 'flexibility in the importance attached to the ideal'). The study was conducted with 473 primary school students in Ankara in 2021. The mean age of the participants, of whom 44.6% were female and 55.4% were male, was 9.38 ± 0.65 (between 8 and 10 years old). Socio-demographic Information Form, the Children's Body Satisfaction Scale (CBSS), the Children's Body Image Scale and 'physical appearance' and 'general self-esteem' sub-scales of the Self-Perception Profile for Children were used for the data collection. CBSS consists of 3 sub-dimensions and 18 items. Calculated to be 0.84, the Cronbach alpha coefficient of the scale was found to be quite high. The item-total correlations were determined to be higher than 0.20 for all the items in the scale, and the t values of the comparison of the lower and upper 27% of all the items were significant. A high level (r > 0.70) positive and significant relationship was found in the test-retest reliability of the CBSS total and sub-dimension scores. A positive and significant relationship was found between CBSS total and general self-esteem and body size satisfaction. The validity and reliability analyses of the CBSS applied as part of the study show that it has strong psychometric properties in determining the level of body image satisfaction for children aged between 8 and 10. The sub-dimensions of CBSS provide a comprehensive measure to understand body dissatisfaction in children and to test the effectiveness of intervention programmes.

Socioeconomic vulnerabilities and food intake in European children: The Feel4Diabetes Study

ObjectivesSocioeconomic inequalities create substantial burdens influencing children's health status and diet quality. The aim of this study was to investigate the association between cumulative socioeconomic vulnerabilities and differences in the food intake of children. MethodsThis was a cross-sectional analysis of baseline data from 12 041 European parent–child dyads (children were 5–12 y of age with 49% boys) enrolled in the Feel4 Diabetes study. Parents completed standardized questionnaires to record details on socioeconomic status (SES), demographic, and children's frequency of food and beverage intake. Vulnerable groups were defined as children whose parents had <12 y of education, were unemployed, or reported difficult household income security. A cumulative SES vulnerability score (range 0–4) was created by adding the number of vulnerabilities a child was exposed to. ResultsLogistic regression showed that children with the highest SES vulnerability score were less likely to consume water (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.30–0.59), fresh fruit (OR, 0.66; 95% CI, 0.56–0.78) and vegetables (OR, 0.67; 95% CI, 0.56–0.81) daily in comparison with those with no SES vulnerabilities, whereas they were more likely to consume canned fruit (OR, 2.30; 95% CI, 1.64-3.24), fruit juice (OR, 1.42; 95% CI, 1.14-1.77), soft drinks (regular: OR, 4.85; 95% CI, 3.85-6.10; diet: OR, 4.81; 95% CI, 3.28-7.06), and salty snacks/fast food (OR, 3.92; 95% CI, 3.05-5.04) daily, after adjusting for children's age, sex, country, and weight status. ConclusionThe findings of this study highlighted that an unhealthy dietary profile was characteristic of European children in families with a high number of SES vulnerabilities. School-based public health programs promoting healthy eating in children should prioritize families with cumulative SES vulnerabilities.

Digital Interventions to Promote Healthy Eating in Children: Umbrella Review.

BackgroundeHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children.ObjectiveThe aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support).MethodsWe conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion.ResultsIn total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results.ConclusionsOwing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children.

Low-income mothers' perspectives on the involvement of family members in child feeding

Nearly all research on child feeding has focused on mothers. Very little is known about other family members' roles in feeding children nor how mothers engage with these family members regarding child feeding. The objective of this study was to examine mothers' perceptions of other family members' child feeding roles and practices within low-income families, including the challenges experienced and strategies employed by mothers when sharing responsibility for child feeding. Low-income mothers (n = 100) of pre-adolescent children participated in semi-structured interviews regarding child feeding including shared responsibility for child feeding. A content analysis was then conducted to identify main themes in mothers' responses, with three main themes arising from the interviews. First, many family members were actively involved in child feeding and food-related decision-making. The majority of mothers (85%) reported that another family member was involved in feeding their child including fathers and father figures, who were involved in feeding in 63% of families. Other family members, mainly grandparents, were involved in feeding in 35% of families. Mothers identified several concerns regarding their child's eating when with other family members, particularly when grandparents fed children. Finally, mothers employed several strategies to control their children's eating when children were cared for by other family members. Future interventions to promote healthy child feeding among low-income families may benefit from helping mothers negotiate child feeding with other family members, particularly grandparents, and supporting family members' engagement in child feeding.

A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity

Parents and childcare providers play a substantial role in the development of health behaviours among the children they care for. In order to ensure the optimal growth and development of children, communication and family engagement in childcare is critical. Previous studies examining parent or provider perceptions about healthy eating or physical activity have explored these concepts individually and/or have only included only parents or providers. Therefore, the purpose of this study was to compare childcare provider and parent perceptions of communication regarding healthy eating and physical activity as well as use of best practice strategies on family engagement for these topics. Childcare providers (n = 12) in childcare centres or a family childcare home and a parent (n = 12) of a child they provide care for participated in a semi-structured interview guided by the Social Ecological Model. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. Data were analysed using a directed content analysis. Three trained qualitative researchers developed a codebook and then compared responses between parents and providers. Similarities in provider and parent responses included agreement on healthy eating; influences on child development; parents being the most influential on children's healthy eating; how they identified physical activity opportunities; and the use of family engagement principles. Differences that arose included parents' roles in promoting children's physical activity; challenges for parents in promoting healthy eating and physical activity; and providers' encouragement of physical activity. Importantly, few parents mentioned providers were top influences on their child's healthy eating or physical activity. Providers also mentioned having difficult conversations with parents was challenging. Future efforts are needed to (1) help parents understand the providers' role in the development of their child's health behaviours and (2) strengthen efforts to engage families in healthy behaviours outside of childcare facilities.

Exploring Maternal and Children Perspectives Towards Healthy Eating and Active Living in Lebanon: A Qualitative Study

ObjectivesTo explore the perspectives and experiences of children and their mothers towards healthy eating habits and regular physical activity in Lebanon and to identify potential strategies that can be recommended for future interventions to promote healthy lifestyles among children.MethodsQualitative research methodology and the social cognitive theory were used. Focus group discussions and in-depth interviews were conducted with children (aged 10–11 years) and their mothers, respectively, from two private and one public schools in Beirut, Lebanon. Thematic inductive analytical approach was adopted.ResultsA total of six FGDs and 11 in-depth interviews with mothers were conducted from February till November 2020. Four main overarching themes emerged. Theme 1 pertained to the different views of children and mothers regarding the meaning of healthy eating and physical activity and their perceived impact on children's wellbeing. Theme 2 revealed a set of intrapersonal, social, and environmental determinants, which were reported differently between children and their mothers. Participants in our study who were interviewed after the COVID-19 pandemic talked about how their eating habits were adversely affected as a result of the sudden changes in daily schedules, boredom and anxiety. Theme 3 reflected the role of schools and sports facilities in setting a good example for children's healthy eating and active behaviors. Theme 4 revolved around participants’ suggestions to receive support for healthy eating and lifestyle habits at multiple levels, including intrapersonal, family/social, community, and policy-level strategies. Our findings highlight the importance of using theory-driven interventions, such as the social cognitive theory, to improve long-term health behaviors.ConclusionsFindings highlight the multiple influences that pertain to children's eating and activity habits and shed light on the need to use child- and parental-driven strategies in the planning and development of programs to promote children's health and wellbeing.Funding SourcesThis study was partially funded by the Department of Nutrition and Food Sciences at the American University of Beirut.

Fidelity and factors influencing implementation of Healthy Me, Healthy: process evaluation of a social marketing campaign for diet and physical activity behaviors of children in childcare.

The effectiveness of interventions targeting children's eating and physical activity behaviors through childcare settings is inconsistent. To enhance public health impact, it is imperative to evaluate fidelity of implementing complex interventions in real-world settings. This study evaluated fidelity and contextual factors influencing implementation of Healthy Me, Healthy We (HMHW). HMHW was an 8-month social marketing campaign delivered through childcare to support children's healthy eating and physical activity. HMHW required two levels of implementation support (research team and childcare providers) and two levels of campaign delivery (childcare providers and parents). Process evaluation was conducted among childcare centers in the intervention group (n=48) of the cluster-randomized control trial. Measures included attendance logs, self-report surveys, observation checklists, field notes, and semi-structured interviews. A 35-item fidelity index was created to assess fidelity of implementation support and campaign delivery. The fidelity with which HMHW was implemented by childcare providers and parents was low (mean 17.4 out of 35) and decreased between childcare providers and parents. Childcare providers had high acceptability of the program and individual components (80 - 93%). Only half of parents felt intervention components were acceptable. Frequently cited barriers to implementation by childcare providers included time constraints, parent engagement, staff turnover, and restrictive policies. The lack of observable effect of HMHW on children's dietary or physical activity behaviors may be due to inadequate implementation at multiple levels. Different or additional strategies are necessary to support implementation of multilevel interventions, particularly when individuals are expected to deliver intervention components and support others in doing so.

Improving Healthy Eating in Children: Experimental Evidence

We present a field experiment to study the effects of non-monetary incentives on healthy food choices of 282 children in elementary schools. Previous interventions have typically paid participants for healthy eating, but this often may not be feasible. We introduce a system where food items are graded based on their nutritional value, involving parents or classmates as change agents by providing them with information regarding the food choices of their children or friends. We find parents' involvement in the decision process to be particularly beneficial in boosting healthy food choices, with very strong results that persist months after the intervention.

Improving Healthy Eating in Children: Experimental Evidence

We present a field experiment to study the effects of non-monetary incentives on healthy food choices of 282 children in elementary schools. Previous interventions have typically paid participants for healthy eating, but this often may not be feasible. We introduce a system where food items are graded based on their nutritional value, involving parents or classmates as change agents by providing them with information regarding the food choices of their children or friends. We find parents’ involvement in the decision process to be particularly beneficial in boosting healthy food choices, with very strong results that persist months after the intervention.