Healthy Snack Choices Research Articles

Using Food Odor to Prime Healthy Snack Choices

Using Food Odor to Prime Healthy Snack Choices

The impact of nutritional labeling on adult snack choices: A controlled field experiment in a non-commercial professional setting

Each year, 2.8 million people die because of comorbidities associated with being overweight. Snacking substantially contributes to people’s calorie intake. One way to nudge consumers towards healthier alternatives is the implementation of nutritional labeling. This study reports on a controlled field experiment that evaluates the effect of two nutritional labels on free snack choices (n = 739). Participants at a conference could choose between nuts, cookies, and candy bars as a snack, presented at the bar at six different locations across 2 bar counters. The labels were set up in front of each snack in three conditions: no labeling (control), a calorie label, or a traffic light label (i.e., the Nutri-Score). The location of the snacks on the counter (Either side of the counter; Center, Right, Left) and the time-of-day (Morning (=reference) vs Afternoon) were statistically controlled for. The results show that calorie labels could not successfully nudge consumers toward healthier snack choices (nuts instead of candy bars or cookies). In contrast, the Nutri-Score label significantly increased the probability of choosing nuts over candy bars. The Nutri-Score also increased the chance of choosing nuts over cookies, but the difference was not significant.No prior studies to our knowledge have directly compared calorie labels to the Nutri-Score. This study suggests that the Nutri-Score label can be a more successful intervention than calorie labels to nudge consumers towards healthier choices in situations were free snacks are offered, like many modern workplaces. Changing snacking behavior is challenging and naturalistic field experiments like this one are needed to translate the theory from previous laboratory studies to real-life settings.

Snacking Patterns of Filipino Children: Frequency and Contribution to Energy and Dietary Intakes

Snacking can be defined as eating outside the three main meals in a day, regardless of the amount or type of foods consumed. Snacking patterns vary between developing and developed countries, and across nations around the globe. Utilizing data from the Philippine ENNS collected in 2018 and 2019, the authors were able to determine the distribution and frequency of snacking among Filipino children, the type of snack foods consumed, and the contribution of snack foods to their energy and dietary intakes. Results revealed that around 70% of Filipino children consume snacks once a day, usually as afternoon snacks.Moreover, consumption of snack foods decreases as the age of children increases. The snack foods frequently consumed are pastries and cookies, bread, crackers, and biscuits, along with sugar-sweetened beverages – with an average energy intake of 300.0 kcal from snack foods. Snack foods contributed 31.2% of the total daily energy intake for Filipino children aged 3–5 yr old, 25.1% in 6–9 yr old, and 21.6% in 10–12 yr old. The nutrient content of the snack foods ranged from 29.5–46.7 g protein, 295.4–347.8 mcg RE vitamin A, 5.4–7.7 mg iron, and 272.3–381.7 mg calcium. More than half of Filipino children consumed snack foods at least once a day, with a higher proportion of snackers meeting the recommended energy intakes and estimated average requirements than non-snackers. However, the promotion of healthy snack choices such as fruits and vegetables and other nutrient-dense foods needs to be strengthened. Findings support the need to develop guidance on healthy snacking among Filipino children and represent a key target for food and nutrition policies to improve the dietary quality of snacks in this population.

Effects of food nutrition labels on the health awareness of school-age children

BackgroundOverweight and obesity have been described as a global epidemic that seriously affects the health of adults and children. Front of Package (FOP) Nutrition Labeling can increase consumers’ awareness of unhealthy foods. The purpose of this study is to find effective deterrence and improve children’s health awareness via the FOP.MethodsThis study examined children’s health awareness of snack packaging using the four labels: guideline daily amounts (GDA), traffic light system (TLS), Apple label (designed in this study), and Warning label. This study recruited 343 children in the sixth grade, including 223 children living in cities and 120 children living in rural areas. First, 30 children in grades 3 to 6 selected 8 snacks that they often buy. Then, each snack was synthesized into these four labels according to their nutritional content for a total of 32 samples. Finally, a questionnaire was used to evaluate the health of snack packaging and the visibility of nutrition labels.ResultsFour results can be drawn: (1) GDA, Apple label and TLS can help children determine healthier snack choices, (2) black Warning label cannot induce children to make healthier choices, (3) children who often buy snacks have low health awareness, and (4) rural children have weak health awareness of snack packaging.ConclusionsThese results can provide a packaging label design, which can effectively improve children’s health awareness.

Snacking pattern of college students in Saudi Arabia: a cross-sectional study

BackgroundAlthough unhealthy snack foods are commonly consumed by college students, snacking patterns among college students have not been comprehensively examined in Saudi Arabia. In our study, we aimed to investigate snacking patterns among Saudi college students and to assess sociodemographic data that affect adherence to these snacking patterns.MethodsBetween January 2021 and March 2021 in Jeddah, Saudi Arabia, an online survey was conducted with 662 college students from a Saudi university. The survey included sociodemographic questions and a short food frequency questionnaire (FFQ) regarding the consumption of common snack foods. Snacking patterns were generated from the FFQ using the factor analysis method.ResultsFactor analyses generated seven snacking patterns, which explained 64.5% of the variance in snacking. Students in their early academic years (1–3 years) had a higher score for the convenience snack and fast-food pattern (0.22 ± 0.48 and 0.31 ± 0.52, respectively) than senior students (4–6 years) (P = 0.03 and 0.04, respectively). Healthy snacks patterns were higher among students at higher income levels (P = 0.006) and active students (P < 0.001) than among students at low- or mid-income levels and inactive students. Higher adherence to the beverages pattern was observed among male students (P = 0.03), active students (P = 0.01), and students with obesity than their counterparts (P = 0.02). The dairy products pattern was higher among male students (P = 0.04), students at higher income levels (P = 0.04), and students with obesity (P = 0.03) than their counterparts.ConclusionsMost snacking patterns identified among the study participants were considered unhealthy. Adherence to healthy snacks is influenced by physical activity and family income. These findings may be helpful in the future for developing adequate nutrition education programs that promote health by adhering to healthy snack choices in this critical age group. Further studies are needed to confirm these findings and to investigate snacking patterns among other age groups in Saudi Arabia.

Nutritious mushroom protein crisp \u2013 healthy alternative to starchy snack

Global salty snacks category had reached USD 137 billion in sales in 2018. Due to growing health concerns and awareness, consumers are looking for healthy snack choices by avoiding ingredients such as fat, sugar, cholesterol, and sodium and selecting baked and salt free multigrain chips. A sizable number of consumers are concerned about snack nutrition and look for quality ingredients and minimally processed foods called as “Good Health Snack (GHS)”. In this work, we present the development of method of producing and testing mushrooms protein crisps (MPC), a healthy alternative to conventional starchy snacks that are rich in protein, nutraceutical compounds, minerals, vitamin, dietary fiber, and immunity inducing beta-glucans. The methods of producing MPC with different seasoning and hydrolyzed protein, calorie, nutritional and chemical composition, consumer response, shelf life after packing and market analysis are described. These systematic studies will help to market potential of this product which is a healthy alternative to other calorie rich snacks sold in the market benefiting the consumers.Graphical abstract

Gamified Nutrition Education with Mastery Learning and Spaced Repetition Theory – Can Improve Nutrition Knowledge

ABSTRACT Background: Children often consume up to 30% of calories from snacks that are usually low in nutrient value. Over time, poor dietary choices can contribute to an increased risk of obesity and related health problems. Purpose: Describe the development and utilization of the Self-paced Nutrition Activity on Choices for Knowledge (S.N.A.C.K.) nutrition education game to elicit and reinforce healthier snack choices by children aged 9 to 13 years. Methods: Children engaged in S.N.A.C.K. on a provided tablet for 15 to 25 minutes, at week 0 and 4. The game was self-paced, providing education about the Nutrition Facts Label, and consisted of three assessments to evaluate knowledge and application. Results: Data from 41 children, 59% normal weight, and 41% overweight/obese, were included in the analysis. Significant improvements in knowledge and utilization of the Nutrition Facts Label were observed immediately after education, with further advancement after a second session four weeks later. Discussion: In this study, children immediately improved, and sustained, their newly acquired nutrition knowledge with a single 15 to 25 minute session with S.N.A.C.K. Translation to Health Education Practice: Educators could incorporate this consistent and accurate education into their curriculum to reinforce a child’s nutrition knowledge over time. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI)http://portal.shapeamerica.org/trn-Webinars

Impact of a Series of Educational Talks Taught by Health Professionals to Promote Healthy Snack Choices among Children

Background: One of the great challenges facing today’s society is the need to combat overweight and obesity in schoolchildren. This study aimed to analyze the impact of a cycle of didactic talks—given to families by a specialist in pediatrics, a specialist in nutrition and dietetics and a specialist in physical exercise—on childrens’ snack choices and nutrition quality. Methods: A longitudinal, quasi-experimental and quantitative investigation was designed, working with a total sample of 50 students divided into control and experimental groups. The nutritional quality of daily snacks was recorded during the month before and the month after the cycle of talks given by health experts. Results: An increase in the nutritional quality of the snacks was observed in the days after the talk—but, after a week, values returned to normal. Conclusions: The giving of educational talks to promote healthy habits may have a positive impact on the nutritional quality of school snacks in the days immediately following the talks. However, some forgetfulness was detected over time, which reduced the nutritional quality of the snacks once more. For future work, it is recommended that researchers measure the impact produced by giving regular talks.

Digital food marketing to children: How an influencer's lifestyle can stimulate healthy food choices among children

While influencer marketing has been shown to be effective at promoting food low in nutritional value among children, it is less clear whether influencers can also be used to promote healthy nutrition. This article reports on the results of an experimental study on whether and how influencer marketing on Instagram can be deployed to stimulate healthy eating behavior among children. In particular, the study examines whether signaling a healthy, athletic lifestyle can affect children's healthy snack choice (i.e., choice of a snack high in nutritional value). To do so, a two (influencer lifestyle: sedentary versus athletic) by two (snack type: low in nutritional value versus high in nutritional value) between-subjects experiment was conducted among 190 children between eight and 12 years. The results show that promoting a sedentary lifestyle (compared to an athletic lifestyle) resulted in more children choosing the product high in nutritional value. In addition, the children chose a healthy snack more frequently when an influencer portraying a sedentary lifestyle (compared to an athletic lifestyle) promoted a product low in nutritional value. There were no significant interaction effects of influencer lifestyle and snack type on the evaluation of the influencer. However, the study did show that there was less admiration for the influencer when they portrayed a sedentary lifestyle versus an athletic lifestyle.

DD Williamson supports development of Fermentalg's natural blue food colorants

The prevalence of unhealthy dietary behaviors among adolescents is high. We examined the effect of having health-oriented food rules at home on the healthiness of adolescents' independent food choices, and the necessity of parental oversight for such rules to be effective.We surveyed a socioeconomically and racially diverse San Francisco Bay Area public high school in May 2017 (N = 1,246). We used ordinal logistic regressions to assess the relationships between adolescent-reported presence of health-oriented food rules at home and the healthiness of snacks selected by adolescents in a raffle, which included a randomized controlled experiment to manipulate the level of parental approval students needed to pick up their snacks.Adolescents reporting at least one health-oriented food rule at home were significantly more likely to choose healthier snacks in the raffle (adjusted odds ratio, 1.85; 95% confidence interval [CI] 1.41–2.45). Telling adolescents that a parent needed to approve the snacks did not have a significant effect on snack choice healthiness relative to a no-approval baseline condition (adjusted odds ratio, 1.01; 95% CI .55–1.86). Post hoc analyses suggest that rules may affect adolescent food-related attitudes and perceptions of parental reactions; for example, adolescents with rules reported that their parents would be more disappointed (adjusted mean difference on five-point scale, .5; 95% CI .36–.64) if they made an unhealthy food choice.Having health-oriented food rules at home is associated with healthier snack choices. Findings suggest that adolescents with rules also hold beliefs that may correspond to healthier independent dietary choices.

Using visual stimuli to promote healthy snack choices among children.

Most interventions against obesity use information to persuade people to change their behavior, with moderate results. Because eating involves automatic routines, new approaches have emerged appealing to non-reflective cognitive processes. Through a randomized controlled trial, we evaluated the impact of visual stimuli (positive and negative) on children's snack-choices at school. Results showed that the negative stimulus had no effect, while the positive stimulus increased the probability among girls of choosing a healthy snack. We also found that children with excess weight had a larger baseline probability of choosing the healthy snack than those without. We conclude that happy emojis, used to nudge non-reflective processes, can steer children towards healthy choices.

Effects of determinants of dried fruit purchase intention and the related consumer segmentation on e-commerce in China

PurposeIn this study, a comprehensive theoretical framework was developed to investigate the influence of the determinants of online dried fruit purchase intention in China.Design/methodology/approachThe dried fruit eating experiences of 1,160 participants from China were collected using an online survey.FindingsSignificant differences were noted in the sociodemographic distributions among three age-based consumer segments. Furthermore, the cost of the marketing strategy had the strongest effect on online dried fruit purchase intention. Finally, different patterns of online dried fruit purchase intention were observed among the three consumer segments: consumers aged below 24 years regarded dried fruits as a new and healthy snack choice and favoured companies with high-quality communication with consumers; consumers aged 25–29 years viewed dried fruits as a healthy eating habit, reflecting their strong self-control over their lifestyle; and consumers aged over 30 years valued the convenience marketing strategies applied by dried fruit manufacturers.Originality/valueOverall, the results indicate that dried fruits are considered a niche market of snacks that provides added value for core products in the Chinese e-commerce (EC) market; therefore, developing cost-effective strategies to raise consumer awareness of dried fruits is crucial. Furthermore, marketing strategies should target different consumer segments.

Smart snacks in universities: possibilities for university vending.

Background: The study goal was to evaluate the nutritional impact of a healthy snack intervention on a southern university campus. Methods: This quasi-experimental study was conducted during the fall 2017 semester weekly for 14 weeks in a large southern U.S. university. For the intervention, half of vending snacks in four campus residential halls (housing from 216 to 361 students) were substituted with snacks complying with federal Smart Snacks in School nutrition standards for K-12 schools. For analysis, data from the Nutrition Facts labels of 14 vending machines or from manufacturer’s websites was collected by trained graduate and undergraduate researchers. Results: On average, for each Smart Snack sold, there was a statistically significant reduction of 99.38 calories (CI=42.32, 156.43), 4 g saturated fat (CI = 2.23, 5.75), and 10.06 g of sugar(CI=2.92, 17.20). An average reduction of 41.88 mg in sodium and an increase of 0.81g in fiber was also found, but was not statistically significant. There was a significant difference (t(16)=3.02, P < 0.025, 95% CI = 10.77, 55.79) between the Quality Score of Smart Snacks (M=59.13,SD= ± 36.50) and that of non-compliant snacks (M=25.85, SD= ± 24.72). Conclusion: The nutritional impact with even a 50% Smart Snack replacement is promising. Many available comparable snacks mimic the mouthfeel, taste, and appearance of their original full-fat, full-sodium, and full-sugar counterparts. Including healthier snack choices in vending machines may be a viable option for universities to transform the campus eating environment.

PENGARUH MEDIA TEBAK GAMBAR TERHADAP PENGETAHUAN JAJANAN SEHAT SISWA SDN 001 TERATAK KABUPATEN KAMPAR

A lot of students consumed snack that has imbalanced food quality and nutritional values. Preliminary study showed that 54,5% students at 001 Teratak elementary school had low level of knowledge on healthy snack choice. Nutrition education is needed with efficient and simple method such as guessing picture. The aim of this study was to analyze the effect of guessing picture media method on student’s knowledge on healthy snack choice in 001 Teratak Elementary School. This was quasy experimental study with a pre-test post-test control group design. 42 samples selected from 46 students in class 5 by purposive sampling technique with inclusion and exclusion criteria. Samples divided into intervention (n=21) and control group (n=21). The intervention group had guessing healthy snack choice picture while the control group had guessing ordinary pictures. Research variables were the level of knowledge in intervention and control group based on the value of the pre-test and post-test. The results showed that there was significant increase of knowledge that were given nutritional education of healthy snack choice using guessing picture media method (p

Relationship between the nutritional status and food consumption inside the school in adolescents of Mexico City

AbstractThere is a concern that the bad habits and lifestyles of adolescents such as the consumption of foods rich in sugars and fats in free moments, like school recess acts as a factor that intervenes in the increase of weight. The aim of this study was to determine the relationship between the nutritional status and the food consumption inside the school in adolescents of Mexico City. A sample of 1457 first-grade adolescents from high schools was obtained. A food consumption frequency questionnaire was applied inside the school. Likewise, anthropometric measures were taken and through the use of Who Anthro Plus program, the nutritional status diagnosis was obtained. The obtained data was analyzed with the statistical package IBM SPSS Statistics® version 20.0 for Windows. It was found that adolescents who frequently consume sweets, snacks, flavored waters, bottled juices, confectionery products and ice cream have a higher prevalence of obesity (15.2%, 17.4%, 21.4%, 17.7%, 16.2% and 19.9%, respectively), compared to adolescents who never consume these products (11.6%, 12.6%, 11.9%, 10.5%, 14.6%, and 12.1%, respectively). Likewise, it was found that adolescents who frequently consume fruit, water, yogurt, vegetables and milk have a lower prevalence of obesity (10.2%, 12.2%, 10.3%, 10.1% and 9.35, respectively) in comparison with adolescents who never consume these foods during school hours (19.1%, 18.6%, 17.8%, 15.9% and 16.3%, respectively), finding a highly significant difference (p &lt; 0.01) in the consumption of flavored water, fruit, natural water and yogurt. It was found that the food consumed during school hours has an impact on the nutritional status of adolescents, similar to the results found in the literature, so it is suggested to promote healthy habits and lifestyles at school and at home so that adolescents opt for healthy snack choices.

P40 Smart Snacks in College: How Do They Match Up to Popular Alternatives?

Background Snacking has been increasing for decades, and snacks are often high in solid fats and added sugars. College campuses provide numerous and overwhelming snacking options that may factor into college weight gain such as vending machines. The Social Cognitive Theory postulates that many factors drive health behaviors. The food environment can strongly influence snacking behaviors of students. Objective The goal of this study was to evaluate the nutritional impact of a healthy snack intervention on a southern college campus. Study Design, Settings, Participants This quasi-experimental study took place in a southern college campus and is part of a larger study evaluating the efficacy of a healthy snack initiative in four residential halls. Half of vending snacks were substituted with snacks complying with federal Smart Snacks in School nutrition standards for K-12 schools. Smart Snacks must meet caloric, fat, sodium, and sugar guidelines. Measurable Outcome/Analysis Data collected in fall 2017 included sales, waste, and stock of snacks in 12 vending machines. Descriptive statistics were computed from the sales data and nutrition information collected through manufacturer's websites.. Results Average sales per week were 427 Smart Snacks and 775 standard non-compliant snacks. On average, each Smart Snack sold offered a reduction of 122 calories, 135.7 mg of sodium, 3.4 g saturated fat, and 8.6 grams of sugar and an increase of 1.1 grams of fiber. Despite overall lower sales of Smart Snacks relative to non-compliant counterparts, 14.9 caloric pounds, calculated from calorie differences, were saved each week in vending sales over a semester-long 50% Smart Snacks intervention. Conclusion The potential nutritional benefit with even a 50% Smart Snack replacement is promising. There are many comparable snacks for vendors to consider that mimic the mouthfeel, taste, and appearance of their original full-fat, full-sodium, and full-sugar counterparts. A vending machine snack adaptation to healthier snack choices may be a viable option for universities to transform the campus eating environment. Funding None.

Exercise and the Timing of Snack Choice: Healthy Snack Choice is Reduced in the Post-Exercise State.

Acute exercise can induce either a compensatory increase in food intake or a reduction in food intake, which results from appetite suppression in the post-exercise state. The timing of food choice—choosing for immediate or later consumption—has been found to influence the healthfulness of foods consumed. To examine both of these effects, we tested in our study whether the timing of food choice interacts with exposure to exercise to impact food choices such that choices would differ when made prior to or following an exercise bout. Visitors to a university recreational center were equipped with an accelerometer prior to their habitual workout regime, masking the true study purpose. As a reward, participants were presented with a snack for consumption after workout completion. Participants made their snack choice from either an apple or chocolate brownie after being pseudo-randomly assigned to choose prior to (“before”) or following workout completion (“after”). Complete data were available for 256 participants (54.7% male, 22.1 ± 3.1 years, 24.7 ± 3.7 kg/m2) who exercised 65.3 ± 22.5 min/session. When compared with “before,” the choice of an apple decreased (73.7% vs. 54.6%) and the choices of brownie (13.9% vs. 20.2%) or no snack (12.4% vs. 25.2%) increased in the “after” condition (χ2 = 26.578, p < 0.001). Our results provide support for both compensatory eating and exercise-induced anorexia. More importantly, our findings suggest that the choice of food for post-exercise consumption can be altered through a simple behavioral intervention.

How Food Rules at Home Influence Independent Adolescent Food Choices

PurposeThe prevalence of unhealthy dietary behaviors among adolescents is high. We examined the effect of having health-oriented food rules at home on the healthiness of adolescents' independent food choices, and the necessity of parental oversight for such rules to be effective. MethodsWe surveyed a socioeconomically and racially diverse San Francisco Bay Area public high school in May 2017 (N = 1,246). We used ordinal logistic regressions to assess the relationships between adolescent-reported presence of health-oriented food rules at home and the healthiness of snacks selected by adolescents in a raffle, which included a randomized controlled experiment to manipulate the level of parental approval students needed to pick up their snacks. ResultsAdolescents reporting at least one health-oriented food rule at home were significantly more likely to choose healthier snacks in the raffle (adjusted odds ratio, 1.85; 95% confidence interval [CI] 1.41–2.45). Telling adolescents that a parent needed to approve the snacks did not have a significant effect on snack choice healthiness relative to a no-approval baseline condition (adjusted odds ratio, 1.01; 95% CI .55–1.86). Post hoc analyses suggest that rules may affect adolescent food-related attitudes and perceptions of parental reactions; for example, adolescents with rules reported that their parents would be more disappointed (adjusted mean difference on five-point scale, .5; 95% CI .36–.64) if they made an unhealthy food choice. ConclusionsHaving health-oriented food rules at home is associated with healthier snack choices. Findings suggest that adolescents with rules also hold beliefs that may correspond to healthier independent dietary choices.

The Effectiveness of Brief Information and Self-Efficacy-Based Interventions in Influencing Snack Choices in Homeless Individuals.

Homeless adults frequently experience poor nutrition. Research suggests raising self-efficacy and nutritional knowledge can increase healthy eating but that the choice of specific behavioral change techniques (BCTs) is also critical. This study investigated how BCTs, operationalized to increase nutrition knowledge and self-efficacy, might influence the choice of homeless adults when presented with a "healthy" and an "unhealthy" snack. A total of 125 homeless adults were randomly allocated to watch 1 of 4 brief films: "control," "[nutrition] information only," "self-efficacy" (aimed at increasing self-efficacy and general healthy eating knowledge), and "enhanced self-efficacy" (as "self-efficacy," but the presenter identified themselves as a homeless adult). Post-film, participants were invited to choose between a healthy and an unhealthy snack. Data were analyzed using ANOVA and chi square. Participants in the "enhanced self-efficacy" condition were significantly more likely to choose the healthy option compared to those in the control condition; for the "self-efficacy" condition, the difference was marginally significant. Perceived knowledge and self-efficacy were significantly associated and those with high self-efficacy were significantly more likely to choose a healthy snack regardless of condition. Homeless adults are more likely to make healthy snack choices if their nutritional self-efficacy is increased through encouragement by a peer.

Behaviorally oriented nutrition education at a Russian summer camp improves children\u2019s dietary choices: a quasi-experimental study

BackgroundIt is presently unknown whether behaviorally oriented, theory-based nutrition education from a Western context could be effective for improving healthy eating behavior and its psychosocial determinants among Russian children. Effective nutrition education delivered in summer programs could potentially impact dietary patterns and play an important role in efforts to reduce childhood obesity. We hypothesized that nutrition education including an additional behavioral skills component would be superior to nutrition education without this component and that boys and girls would differ in their response to nutrition education.MethodsBoys (n = 19) and girls (n = 21), aged 8–12 years, were assigned to one of two conditions receiving 15 daily sessions of behaviorally oriented, theory-based nutrition education. One condition received an additional skills training component, including activities such as snack preparation, role-playing, and games. An innovative objective measure was used to assess change in healthy snack choices. Psychosocial determinants of healthy eating (i.e., healthy eating knowledge, fruit self-efficacy, vegetable self-efficacy, healthy eating attitudes, and fruit and vegetable enjoyment) were assessed via questionnaire.ResultsAcross both educational conditions, there were significant improvements in healthy snack choices (p < .001; Cohen’s d effect size = 1.33), attitudes (p = 0.001; d = 0.55), and knowledge (p < 0.001; d = 0.80), but not self-efficacy for fruit (p = 0.822; d = 0.04), vegetables (p = 0.118; d = 0.25), or enjoyment of fruits and vegetables (p = 0.472; d = 0.12). Contrary to our hypothesis, there were no significant differences in any change scores by nutrition educational condition (p > 0.05). Among the six outcomes, there was one significant sex difference for fruit and vegetable enjoyment change score (p = 0.002), as girls showed a larger increase in enjoyment over time compared to boys, and the overall nutrition education effects differed by sex (F = 3.03, p = 0.019).ConclusionsNutrition education, with or without behavioral skills training, was associated with improved healthy snack choices, healthy eating attitudes, and knowledge, but the impact differed by sex. Future research should evaluate the long-term impacts of behaviorally oriented nutrition education among Russian boys and girls.Trial registrationClinicalTrials.gov NCT03077464