Children's Meals Research Articles

An Inventory of Proposed and Enacted Sugar-Sweetened Beverage Policies at the State, Local, and Tribal Levels in the United States, 2014‒2023.

Objectives. To inventory and describe trends in proposal and enactment of US sugar-sweetened beverage (SSB) policies at state, local, and Tribal levels, 2014-2023. Methods. We systematically searched 6 policy databases in 2021 (updated May 2023) using SSB-related search terms, identifying additional policies through snowball and online searches and a survey of food-policy experts. We reviewed 10 821 policies for inclusion and quantitatively coded included policies. Results. The inventory included 400 (321 unique [i.e., excluding companion]) policies meeting criteria: 335 (256 unique) state-, 63 local-, and 2 Tribal-level policies. From 2014 to 2023, 11% of unique state-, 92% of local-, and 100% of Tribal-level proposed policies were enacted. Across jurisdictions, the most frequently proposed policies related to excise taxes, restaurant children's meals, nutrition standards, and the Supplemental Nutrition Assistance Program, while the largest proportions of enacted policies related to restaurant children's meals, nutrition standards, education, and procurement. More policies were proposed and enacted in California and New York than other states, and in 2017 (proposed) and 2016 (enacted). Conclusions. This comprehensive inventory of US SSB policies provides information to inform future SSB policy development and diffusion. (Am J Public Health. Published online ahead of print October 17, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307855).

Qualitative Study of the Role of Fathers in Stunting Incidence in South Central Timor Regency

Stunting is a condition of chronic malnutrition accompanied by disease complications, which has negative impacts, both short and long term. In the short term, children will be at risk and susceptible to infectious diseases, while in the long term, in adulthood they will be at risk of suffering from chronic diseases. Low income affects household nutrition. The incidence of stunting cannot be separated from habits, cultural beliefs, knowledge and perceptions of local communities regarding fulfilling family nutrition. These beliefs have an influence on child care. The aim of this research is to identify the role of fathers in the incidence of stunting in South Central Timor Regency. This type of qualitative research uses focus group discussion (FGD) methods and in-depth interviews. The respondents involved for the qualitative approach were government figures (village heads and sub-district heads), religious leaders, traditional leaders, health services, community health centers and fathers with toddlers totaling 7 people from each village. The results obtained on average are that fathers know the direct causes of stunting, not because of their knowledge but because fathers are less aware of their child's parenting patterns. Parenting patterns regarding monitoring children's meal times, personal hygiene and providing diverse and nutritious food are lacking. On average, a father is busy earning a living, many even work outside the city so their children are entrusted to their grandparents, there is a lack of control in the family so there are many early marriages under the age of 20, the family economy is weak so people have less purchasing power to earn money. nutritious food ingredients. The conclusion from this research is that the role of fathers is one of the causes of stunting in South Central Timor Regency.

Associations between child eating behaviors with eating patterns and diet quality in preschool-aged children

Childhood eating behaviors are associated with weight status and laboratory assessments of dietary intake. However, little is known about how eating behaviors relate to the eating patterns and diet quality of children from marginalized populations when assessed in their natural environments. Therefore, we examined the association of food avoidant (e.g., food fussiness and satiety responsiveness) and food approach (e.g., food responsiveness and enjoyment of food) eating behaviors with children's meal size, eating frequency, and diet quality. We analyzed data from 61 predominately low-income Hispanic/Latinx preschool-aged children. Caregivers completed the Childhood Eating Behavior Questionnaire and two 24-h dietary recalls. From the recalls, we calculated meal size, eating frequency, and modified Diet Quality Index Scores (DQIS), and evaluated associations with eating behaviors using multivariable linear models. We also explored the relationship between eating behaviors and DQIS components. Food-avoidant subscales were associated with smaller meals and satiety responsiveness were associated with decreased snack frequency. Food approach subscales were not associated with meal size or eating frequency. Both food-avoidant and food-approach behaviors were associated with components of diet quality and caloric beverages outside of meal and snacks. These findings can inform future research on the relationship between child eating behaviors and dietary intake so that we can develop more tailored and effective interventions to promote healthy eating habits for low-income, Hispanic/Latinx preschool-aged children.

Examining child schooling/care location and child temperament as predictors of restaurant-related behaviors during the COVID-19 pandemic: findings from a nationally representative survey.

Emerging research highlights impacts of the COVID-19 pandemic on U.S. families, including changes in eating behavior and increased child body mass index. Aims of the present study were to examine whether child temperament and at-home vs. out-of-home childcare/school predicted families' restaurant-related behaviors during the pandemic. Examining energy balance-related behaviors, like restaurant patronage, during the pandemic can help better understand lasting impacts on child health behaviors and health outcomes. An online survey was administered to U.S. parents with a 4-to-8-year-old child in October 2020 (n = 1,000). Linear and logistic regression examined whether child temperament and at home vs. out-of-home childcare/school predicted: (1) the frequency the child consumed restaurant meals (take-out, delivery, dine-in), (2) who chose the child's restaurant meal, and (3) parent-reported reasons for the child's meal choice. Income, education, employment, race/ethnicity, and regional COVID-19 restrictions were tested as covariates. Parents with children higher on negative affectivity reported more frequent restaurant use in-person (p < 0.05) and via delivery (p < 0.05) compared to parents of children lower on negativity. Child negativity was also linked with parent-reported reasons for children's restaurant meal choices. Parents of children receiving at-home childcare/schooling used delivery services less frequently than those receiving out-of-home care or schooling (p < 0.01). These findings suggest that individual and family factors may impact restaurant use and the meal selection process for children using restaurants during and beyond the COVID-19 era. Continued examination of individual differences in the impacts of the COVID-19 pandemic can facilitate intervention and policy approaches that fit with different families' needs.

Extended Bolus Is No More Needed for Risotto Meal in Children With Type 1 Diabetes Using Automated Insulin Delivery System: A Cohort Study.

Extended Bolus Is No More Needed for Risotto Meal in Children With Type 1 Diabetes Using Automated Insulin Delivery System: A Cohort Study.

Splitting Mealtime Insulin Doses for Mixed Fat and Protein Meals in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injection Regimen: A Randomized Cross-Over Trial

Aims. Assessment of the glycemic outcomes of increasing and splitting mealtime insulin doses for mixed fat and protein meals in pediatric patients with type 1 diabetes mellitus (T1DM) using multiple daily injection regimen and comparing the effects of regular insulin and fast-acting insulin on glycemic outcomes following those meals. Methods. This single-center, randomized, cross-over trial included 43 children and adolescents with T1DM randomly assigned to receive three interventional insulin doses for lunch meals over 3 consecutive days; Intervention A (100% insulin-to-carbohydrate ratio (ICR) dose given as premeal insulin lispro with an additional insulin sensitivity factor-calculated correction dose after 3 hr), Intervention B (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal insulin lispro after 30 min), and Intervention C (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal regular insulin after 30 min). The test meal consisted of two slices of pizza (weight: 150 g, carbohydrates: 40 g, fat: 15 g, protein: 20 g, and calories: 380 kcal). Postprandial blood glucose levels were monitored for 6 hr. Results. There were no significant differences in postprandial blood glucose excursions following the three interventions. However, Intervention C had a significantly lower late (3–6 hr) blood glucose area under the curve ( p = 0.01 ). Postprandial hypoglycemia developed in 12 participants (27.9%) following Interventions A and B and in 17 participants (39.5%) following Intervention C ( p = 0.32 ). Conclusions. Using regular insulin as a postmeal portion of increased and split insulin doses provided better late postprandial glycemic outcomes following mixed fat and protein meals. However, the amount of additional insulin used needs optimization to reduce the frequency of postprandial hypoglycemia. This trial is registered with NCT04783376.

Accuracy of a Web-Based Time-Use Diary (MEDAL) in Assessing Children's Meal Intakes With Food Photography by Parents as Reference: Instrument Validation Study.

My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children. This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children's meals taken by their parents as an objective reference. A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children's reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents. Overall, the match, omission, and intrusion rates were 62% (IQR 46%-86%), 39% (IQR 16%-55%), and 20% (IQR 6%-44%), respectively. Carbohydrate-based items from the food categories "rice and porridge"; "breads, spreads, and cereals"; and "noodles, pasta, and potatoes" were reported most accurately (total match rates: 68%-76%). "Snack and dessert" items were omitted most often (omission rate: 54%). Furthermore, side dishes from "vegetables and mushrooms," "eggs and tofu," "meat and fish," and "curry" food groups were often omitted (omission rates: 42%-46%). Items from "milk, cheese, and yogurt"; "snacks and desserts"; and "drinks" food groups intruded most often (intrusion rates: 37%-46%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69% vs 53%) and lesser omission rates (31% vs 49%; P=.03, respectively). In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children.

Problems of Food and Nutritional Practices of Children in Precarious Areas of Port-Bouët in Abidjan

Food and nutritional security is a major and topical concern in the world.This study aims to present the food practices of children in precarious neighborhoods of Port-Bouët. The methodology was based on (1) surveys of 400 children (7 to 12 years old), (2) interviews with managers of the health centers of Gonzaqueville, Vridi Canal and Port-Bouët center, (3) the determination of the quantities of the most consumed meals with a scale, (4) calculations of the BMI of children associated with the weight growth curve according to their sex and (5) documentary research to know the chemical compositions of foods. The majority of children eat their meals at home. The structure of children's meals consists of a main course plus water. The most consumed dish is rice with a sauce and little fish (or meat) and attiéké accompanied by fried fish. Meals consumed by children are high in carbohydrates and contain little protein. They eat four times a day and the meal quantities are small. Most of the children are thin and suffer from anemia. Children in the precarious neighborhoods of Port-Bouët have poor dietary and nutritional practices that negatively influence their health. This category of individuals is the most vulnerable.

Adherence to Healthy Default Beverage Laws for Children's Meals in 3 U.S. Cities

Healthy default beverage laws are relatively new interventions designed to improve the healthfulness of children's meals in restaurants. In this study, researchers assessed adherence to healthy default beverage laws among children's meals ordered online in Los Angeles (California statewide law effective from September 2018), Baltimore (effective from April 2018), and New York City (effective from April 2019) compared with that in Boston, where no law existed. Between November and December 2020, researchers ordered children's meals from online ordering platforms (e.g., GrubHub, Uber Eats) from the top-grossing restaurant chains in each location (n=337 meal orders from 106 restaurants), coded these meals using four successively stricter definitions of adherence to the default beverage laws in each respective jurisdiction, and then applied each law to data collected in Boston to simulate different policy scenarios in a city with no such law. The team analyzed these data in late 2021. Differences in adherence existed across jurisdictions, with 15% adherent in Los Angeles, 30% in Baltimore, and 43% in New York City, compared with 7%-30% in Boston, using the most lenient definition of adherence. Fewer than 3% of all meals adhered to laws when applying the strictest definition of adherence. Overall adherence was low and variable across jurisdictions. Adherence may be lower in jurisdictions with fewer allowable default beverages, although more research is needed to assess this potential causal relation. In addition to increased resources and support for restaurants, additional policy design considerations may be necessary to increase adherence to healthy default beverage laws.

The Impact of Misleading Visual Elements on Children’s Food Packaging Design in Retailing Process

In recent years, foods which are mainly consumed by children have sprung up. The cost of children's snacks has become one of the important expenditure items of families, and children's snacks have an increasing proportion of children's meals. The food safety problem has been paid more and more attention by the media and the common people. In an interview with China Press and Publication News, the vice president and secretary-general of the International Food Packaging Association said: "With the deepening of the concept of 'food packaging is equal to food', the safety of food packaging has gradually been paid attention. However, the safety problems of food packaging materials for children are ignored by regulations, standards and the market.” In addition to the packaging materials, the graphic design elements on the packaging are also an important part. Because the design elements on the packaging are the language of communication with consumers, when consumers buy food, they learn about the product through the packaging first, and check the ingredient list or not after. Since Neeley and Petricone studied that Most children do not read products’ nutritional information (unless they are bored while eating them) and do not make choices based on this information (Neeley & Petricone, 2006). Therefore, it is important to generalize which factors are misleading for children.

Designing of Ready to Eat Convenient Mid - Day Meal for Children (5-10 yrs) and Adolescents (11-19 yrs) of Sri Lanka Based on Nutritional Perspective

The most prevalent malnutrition issues in Sri Lanka are the protein-energy malnutrition (PEM), vitamin A deficiency, and iron deficiency. Childhood and adolescence are the crucial stages of life which mostly susceptible to malnutrition since their major physiological and psychological changes take place. Although a balanced, nutritious diet is essential to them, present socio-economical and higher academic expectations have created a complex environment that often pushes them towards junk foods and unhealthy snacks. The objective of the present study was to develop ready-to-reconstitute convenient mid-day meals in three categories of chicken, fish, and soya, which match to the Sri Lankan local culinary style, with acceptable sensory properties to upgrade the nutritional status of school children (5-10 yrs) and adolescents (11-19 yrs). Those mid-day meals were designed according to the Food-Based Dietary Guidelines (FBDG) of Sri Lanka. The selected ingredients were processed; rice to instant rice, vegetables to dehydrated vegetables, and protein source of chicken, fish, and soya to pre-cooked sterilized curry pouches. The convenient mid-day meal packages were prepared using three portions of instant rice containing 10% of green gram flakes, dehydrated vegetables, and retorted curry mix respectively. Labeling was performed according to the type of curry mix inserted into the package as Chicken, Fish, or Soy mid-day meals. Physicochemical and sensorial properties of meals were evaluated. The caloric value of mid-day meals ranged 575 - 640.82 kcal. The protein content of meals ranged from 25.88 g to 32.68g and there was no significant difference (p&lt;0.05) between protein contents in chicken and fish meals. The fat contents and dietary fiber contents significantly (p&lt;0.05) differed and the highest contents of fat (3.15 g) and dietary fiber (4.40 g) were observed in chicken meal and soy meal respectively. The mineral contents of tested meals significantly differed (p&lt;0.05) and the significant highest Ca, Fe, K, Fe, and P were observed in soya mid–day meals. The highest mean rank scores for all sensory attributes in terms of odor, appearance, texture, taste, and overall acceptability were observed in the chicken mid-day meal. Ready-to-reconstitute mid-day meals in three categories of chicken, fish, and soya, which could match to the Sri Lankan local culinary style, were developed with acceptable sensory properties.

Investigating the Feasibility of Remote Recruitment and Data Collection in the Context of an In-Restaurant Intervention Study

ObjectivesConsumption of restaurant food is linked with increased energy intake and poor diet quality among children. Our ongoing cluster-randomized trial is designed to promote healthier eating among children in restaurants, with original plans to recruit families and collect data in local restaurants. Interactions with the first cohort were conducted remotely due to COVID-19, offering the opportunity to examine remote recruitment and data collection in the context of an in-restaurant intervention study.MethodsParents with a 4-to-8-year-old child were recruited from 2 locations (1 intervention, 1 control) of a local, quick-service restaurant chain in Summer 2021. Study information was posted online and in-restaurant. Interested parents contacted study staff via text, phone, or email and completed screening, followed by an online baseline survey if eligible. Participants received study materials (frequent diner card and placemat) via mail. Intervention materials promoted healthful kids’ meals, and control materials promoted kids’ meals generally. Families returned to the same restaurant 6 times during a 2-month exposure period, where placemats were available, and frequent diner cards could be used. In November 2021, families returned for a final restaurant visit, submitting photos of their child's meal and completing a final online survey.ResultsParents responded to study advertisements primarily via text (n = 61, 56% of inquiries) and 26 parents were recruited (17 intervention, 9 control). Twenty-one families (81%) completed final study procedures. Overall, parent comments about the study were positive, including statements such as “clear instructions” and “easy to complete.” Some recommended changes including “make the frequent diner card digital.”ConclusionsRecruitment was slower compared to in-person restaurant studies, but compliance and retention were high. For comparison, our in-person pilot research in this restaurant chain screened 134 families and enrolled 126 in one Summer, with retention just under 50%. Additional research is needed to maximize the feasibility of remote research in restaurants, perhaps leveraging successful remote data collection methods from the present study while returning to in-person recruitment when feasible.Funding SourcesNIH R01HD096748.

Calcium's Role in Child Growth and Development and It's Complications

Calcium (Ca) is an important mineral used to build and maintain the skeletal system. Calcium is the body's most vital mineral. Bone and teeth contain calcium, phosphorus, and the rest of the body's calcium. This mineral aids in the creation of bones and teeth, blood coagulation and muscle contraction as well as nerve transmission and cell metabolism.&#x0D; Calcium deficiency in children causes physical and mental growth problems, as well as the development of Rashitisme, a kind of osteoporosis. This disorder is characterised by deformed bones, big joints, and mobility issues. Calcium shortage in adults produces osteomalacia, which causes hollow and brittle bones due to a reduction in calcium density in the bones.&#x0D; Vitamin D deficiency causes bone mineralization difficulties and severe muscle cramping. Calcium is required for bone and tooth development, blood coagulation, muscle contraction, nerve transmission, and cell metabolism, say the researchers.&#x0D; This study concluded that calcium causes bone strength. Children's meals should include enough calcium to prevent osteoporosis in adults. A new scientific barrier has been published, as well as the importance of calcium's function in the body and the repercussions of its deficiency on children's growth and development.

Development of a mobile application to assess Brazilian schoolchildren's diet: CADE - food consumption at home and at school.

The development of technologies for children's dietary assessment shows important potential for reducing the occurrence of inherent errors in traditional methods. The present study aimed to describe the development of a mobile app for the dietary assessment of Brazilian schoolchildren. The mobile app assesses schoolchildren's diet with self-report by their parents or guardians in the home environment, through multiple-pass 24-hour recall coupled with a food propensity questionnaire; and by an adult in the school environment, through a food record. The tool presents a database of food items usually consumed by Brazilian schoolchildren, including modes of preparation, probing foods and types of food quantification such as digital photos of household measurements and food portions. The CADE app (food consumption at home and at school) contains 2125 food items, 9 options for preparation methods and 18 options for probing items. There are 75 options for household measurements, also including 26 digital photos of four types of household measurements and 440 photos of portion sizes of 90 foods from the Brazilian Manual of Child Food Portion Quantification. Some innovative features include an interface to take photos of the child's meals and report seconds and leftover food consumption, besides the possibility of receiving notifications on the mobile device to remember to report the diet. The CADE app can assist the standardisation and automation of dietary data collection from schoolchildren, support food and nutrition data in childhood and promote research in nutritional epidemiology while reducing data collection costs.

Style of meal service and feeding practices among Mexican American fathers and mothers: An analysis of video-recorded children's evening mealtime at home

The aim of this study was to examine video-recorded observations of evening family mealtime at home among Mexican American children to help elucidate style of meal service, fathers' and mothers' feeding practices and child's eating behavior. Consistent with guidelines for coding behaviors, we analyzed observational data of evening mealtimes of 71 Mexican American children aged eight to 10 years. Regarding style of meal service, in almost all cases (96%), parents plated the child's food, with more available on the table or counter in 40% of the observations. Mothers almost always served the child (94%). Regarding parental feeding practices, parents used positive involvement in meals (80%), pressure to eat (42%) and restriction of food (9%). Using food as a reward to control behavior was never used by either parent. The majority (75%) of children requested or negotiated to eat less food, or only eat certain items. In Mexican American families, both mothers and fathers play a role in family mealtimes and both use positive involvement in child's meals, and to a lesser extent pressure to eat, with their children aged eight to 10 years. To help reduce the obesity epidemic, intervention strategies are needed, which integrate the family, a plating style of meal and parental feeding practices that promote healthy eating in the home. To reduce obesity among Mexican American children, interventions that focus on parental positive involvement in child's meal and maintenance of home cooked meals could have a positive impact on the entire family.

The healthfulness of children's meals when multiple media and devices are present

Although television viewing during mealtime has been shown to associate with greater consumption of energy-dense foods, little is known about how new technological devices may influence children's food consumption. Because the number and type of media accessible to children continue to increase, this study examines the association between the presence of various media (TVs, mobile devices, video games, laptops) during mealtime and the healthfulness of children's meals. In this study, 61 primary caregivers of children ages 3–5 years and 10–13 years old participated in video-recorded dinner meals, which were reliably coded for media use, including number of media present. The overall healthfulness of the meals was coded using the Healthy Meal Index (HMI). Linear regression models were used to examine associations between number of media devices present during the meal and HMI, adjusting for parental education, income-to-needs ratio, and child race. Results indicate that the number of media present during the meal is inversely associated with HMI Total scores (B = -.29, p < .01; F(4, 53) = 9.97, p < .01). In other words, as the number of mealtime media devices increases, the healthfulness of children's meals decreases. These results suggest that media and device use during mealtime may be an additional childhood risk factor for poor meal quality, and parents should make efforts to limit mealtime media and device use.

Switching up sides: Using choice architecture to alter children's menus in restaurants

U.S. children's frequent consumption of restaurant foods has been associated with low vegetable consumption. Use of choice architecture in restaurants has been shown to increase children's orders of healthy sides, but what children consume when healthy sides are included is unknown. The purpose of the present study was to investigate whether altering the choice architecture of children's meals by restructuring the menu, using optimal defaults and vice-virtue bundles, would impact ordering of side dishes and consumption of a vegetable side dish during a restaurant meal. Families with a child between 4-8y attended three dinners at a university-based restaurant. Children's meals included choice of entree (macaroni-and-cheese or chicken tenders) and default side: all carrots (150 g; Menu-1), small fries (50 g)/large carrots (100 g; Menu-2), and small carrots (50 g)/large fries (100 g; Menu-3). Participants could opt-out of the default side for: only fries (Menu-1) or only fries or carrots (Menus-2/3). All foods were pre- and post-weighed to determine consumption. Descriptive statistics examined children's ordering behavior. Repeated measures ANOVA examined differences in consumption of study foods. A paired samples t-test examined differences in french fry consumption (Menus-2/3). Forty-eight children (6.2 ± 1.3 years; 25 male) participated. Most children remained with the default side (Meal-1: 90%; Meal-2: 88%; Meal-3: 85%). Significant differences were seen in children's consumption of french fries (t = −2.57, p = .014) where children ate more during meal 3 compared to meal 2. There were no significant differences in carrot consumption. Use of optimal defaults led to increased orders of healthy sides and steady consumption across the meal conditions. However, use of an optimal, vice-virtue bundle led to a decrease in consumption of french fries. Further investigation of optimal default use on children's menus is warranted.

Soft drinks and premiums with children's meals marketed on the websites of the top restaurant chains worldwide.

To assess the frequency with which soft drinks and premiums are available with children's meals marketed on the top restaurant chains' websites worldwide. Cross-sectional structured observational assessment of secondary information about top international restaurant chain children's meals. Websites of top restaurant chains for 193 countries and five regions of the United Nations. Top restaurant chains (including McDonald's, Subway, Burger King and KFC) across 193 countries. Children's meal images and descriptions were reviewed to determine if the meal was marketed with a soft drink as a beverage option and whether the meal offered a premium. Children's meals were marketed online on restaurant websites by at least one of the four chains in a total of seventy eight of the 193 countries (40·4 %). Overall, 56·3 % of countries with any online children's meal marketing by the four chains included at least one chain that marketed soft drinks and 92·3 % marketed premiums with the meal. Every region in the world includes marketing of children's meals on the websites of the top restaurant chains. The high prevalence of premiums marketed online with children's meals is of concern. Similarly, with over 50 % of countries with online children's meal marketing having at least one chain that offers soft drinks as part of the meals, additional regulation and education may be warranted.

O19 Incorporating Behavioral Economic Strategies into Children's Restaurant Menus to Improve Healthfulness: Parent Perceptions

Background Children's restaurant meals are nutritionally deficient; use of behavioral economic strategies may improve healthfulness. Parents play a role in children's restaurant meal selection, thus understanding parent preferences and potential behavioral economic strategies for healthful children menu options is warranted. Objective To examine parent preferences for 5 children's menu attributes featuring behavioral economic strategies. Study Design, Setting, Participants A descriptive, cross-sectional survey integrating a conjoint design was developed along with 8 children's menus. Menus were manipulated by varying levels of attributes [meal price, healthful side dishes, number of side dish items, healthful entrees, and cost for sugar-sweetened beverages (SSB)]. Parents with children 4–10 years old were recruited via Amazon's Mechanical Turk and asked to rate menus using an 11-point Likert scale (0 = Not at all appealing, 10 = Very appealing). Analysis A conjoint (regression) analysis was conducted to discern parent preference for each attribute and an overall menu preference. Descriptive statistics (means) were used to describe overall parent menu preferences and ratings. Results Ratings were generally high for the menus (µ = 6.7, SD = 2.4). Parents (n = 463) had the strongest preference for choice on side dishes (β = 0.73) and low-priced menus (β = 0.51). Parents reported the weakest preference for inclusion of healthful entrees (β = 0.04) and SSB (β = 0.18). The most preferred menu selected (60.7%, n = 281) included a low price, no bundled side (choice of side dish from multiple options), choice of 2 sides, healthful entree present, and an additional $1 for SSB. Conclusion A discrepancy between derived menu preference and a stated menu preference exists. Parents selected a socially desirable menu with healthful options and cost for SSB, contrary to the conjoint derived menu preferences. This discrepancy, along with derived preferences for multiple side dish options, could have implications for which behavioral economic strategies may be effective to improve quality of children's meals in restaurants, as parents’ true interest in healthful entrees is undetermined. Funding USDA Colorado State University, Departments of Marketing and Food Science and Human Nutrition.

O23 Switching Up Sides: Using Behavioral Economics on Children's Menus to Improve Vegetable Intake

Background Children in the US are eating frequently in restaurants, which is associated with poor dietary quality, including decreased vegetable intake. Behavioral economic strategies, such as optimal defaults, have increased children's orders of healthful sides, but it is unknown what children consume when healthful sides are presented. Objective To investigate whether restructuring the children's menu in restaurants using behavioral economic strategies can alter children's ordering and consumption of vegetable sides. Study Design, Setting, Participants A convenience sample of families with a child between 4-8 years old attended 3 dinners at a university-based, sit-down restaurant. Children's meals included 2 entree choices (macaroni-and-cheese or chicken tenders) and a default side: all carrots (150g; Meal-1), small fries (50g)/large carrots (100g; Meal-2), and small carrots (50g)/large fries (100g; Meal-3). Participants could opt-out of the default side and instead choose: only fries (Meal-1), or only fries or carrots (Meals-2/3). Foods offered were weighed pre- and post-meal to determine consumption. Measurable Outcome/Analysis Descriptive statistics examined children's ordering behavior. Repeated measures analysis of covariance examined the effects on fries and carrot consumption (g) controlling for child weight (lbs). Results Forty-eight children (6.2 ± 1.3 years; 25 male) participated. Most children remained with the default side (Meal-1: 90.2%; Meal-2: 97.6%; Meal-3: 87.8%). A small percentage of children who remained with the default ordered additional fries after receiving their meal (Meal-1, n = 4, 9.8%; Meal-2, n = 3, 7.3%; Meal-3, n = 1, 2.4%). After controlling for child body weight, no significant effect was noted of Meal condition on carrot (P = .39) or french fry consumption (P ≤ .99). Conclusion Use of optimal defaults leads to increased orders of healthful sides, however vegetable and french fry consumption were unchanged. Further investigation of optimal default use on children's menus is warranted. Funding USDA, Colorado State University.