Unhealthy Beverages Research Articles

Network spillover effects associated with the ChooseWell 365 workplace randomized controlled trial to promote healthy food choices

Food choices are closely linked to culture, social relationships, and health. Because many adults spend up to half their time at work, the workplace provides a venue for changing population health-related behaviors and norms. It is unknown whether the effects of a workplace intervention to improve health behaviors might spread beyond participating employees due to social influence. ChooseWell 365 was a randomized controlled trial testing a 12-month healthy eating intervention grounded in principles of behavioral economics. This intervention leveraged an existing cafeteria traffic-light labeling system (green = healthy; red = unhealthy) in a large hospital workplace and demonstrated significant improvements in healthy food choices by employees in the intervention vs. control group. The current study used data from over 29 million dyadic purchasing events during the trial to test whether social ties to a trial participant co-worker (n = 299 intervention, n = 302 control) influenced the workplace food choices of non-participants (n = 7900). There was robust evidence that non-participants who were socially tied to more intervention group participants made healthier workplace food purchases overall, and purchased a greater proportion of healthy (i.e., green) food and beverages, and fewer unhealthy (i.e., red) beverages and modest evidence that the benefit of being tied to intervention participants was greater than being tied to control participants. Although individual-level effect sizes were small, a range of consistent findings indicated that this light-touch intervention yielded spillover effects of healthy eating behaviors on non-participants. Results suggest that workplace healthy eating interventions could have population benefits extending beyond participants.

Mandatory nutrition attributes labeling and consumer demand: a structural approach analysis of the US soft drink market

While soft drinks stand out as a major cause of obesity and overweight worldwide, the USA is the country most concerned with this problem. To reverse the situation, experts have agreed that labels and taxes represent promising policy tools. Focusing on the soda market, this paper investigates how consumer demand for nutrient contents responds to the US revised nutrition facts label policy implemented in 2020. Relying on retail scanner data, the study finds after estimation of a discrete choice logit demand model that the change in nutrition labels caused consumers to modify their purchasing behavior. However, they did not systematically switch from unhealthy beverages to healthy ones. The analysis finds evidence that the label revision policy was mostly impactful in decreasing consumers’ preference for soda with superhigh calories and high sugar content. Surprisingly, the joint effect of label and tax did not decrease the sampled consumers’ preference for unhealthy nutrient contents. They still preferred buying soft drinks superhigh in calorie content inside US cities with a tax on sugar-sweetened beverages (SSB), despite the revision of the facts label. Finally, the new nutrition label has improved the average surplus of consumers and total welfare. However, the gain is lower within the cities implementing the sugar tax.

Comparison of Sales From Vending Machines With 4 Different Food and Beverage Messages

Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field. To examine which of 4 food and beverage messages would increase healthier vending machine purchases. This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022. Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories). Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip. Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines. In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices. ClinicalTrials.gov Identifier: NCT06260176.

Effects of traffic light labelling and increased healthy range on beverage choices from vending machines.

To test whether traffic light labels and an increased range of healthy beverages, individually and in combination, can increase healthy beverage choices from vending machines. Two studies (n 558, 420) tested whether the provision of traffic light labels (green, amber and red) and an increased range of healthy beverages (from 20 % to 50 % green options), individually and in combination, could increase healthy beverage choices from a digital vending machine display. The studies used a between-subjects experimental design, and a hypothetical beverage choice, a limitation when considering real-world applicability. Both studies utilised an online Qualtrics survey that featured a digital vending machine display. Both studies (n 558, 420) consisted of university students from Flinders University and individuals from a survey recruitment service. Featuring traffic lights did not significantly influence beverage choices (P = 0·074), while increasing the healthy range (P = 0·003, OR = 3·27), and the combination of both, did significantly increase healthier beverage choices (P < 0·001, OR = 4·83). The results suggest that the traffic light system and increased healthy range are not maximally effective when used on their own, and benefit greatly when combined, to increase healthy beverage choices. It was suggested that the provision of traffic light labels supplied the necessary nutritional information, and the increased healthy range offered greater opportunity to act in accordance with that information. In so doing, the present findings offer a promising pathway for reducing unhealthy beverage consumption.

The role of decision-making and impulsivity in beverage consumption

Soft drink and alcohol consumption have become significant public health issues. This study aimed to explore the mediating role of decision-making processes in the relationship between trait impulsivity and calorie dense beverage consumption. Participants comprised a community sample of 300 adults (aged 19–75). They completed self-report measures assessing impulsivity (SUPPS-P), reward sensitivity (RST-PQ), and participated in decision-making tasks related to risk propensity (BART), short-term strategy preference (IGT), and delay discounting rate. Beverage consumption was calculated using the BEVQ-15. Impulsivity was conceptualised within the framework of the two-factor model as consisting of rash impulsivity and reward sensitivity. Both facets of impulsivity were positively associated with both alcohol and soft drink consumption, and each independently predicted consumption of these beverages. Additionally, there was a significant interaction between rash impulsivity and reward sensitivity on soft drink consumption. Importantly, there were significant indirect effects of both rash impulsivity and reward sensitivity on soft drink consumption via delay discounting. The results support the logic of the two-factor model of impulsivity in the prediction of consumption of unhealthy beverages. Furthermore, the mediating role of delay discounting supports the hypothesis that personality traits can pass through to behaviour via decision-making processes. Further research should extend these findings to other consumption domains in both clinical and non-clinical populations.

Association Between Child Sugary Drink Consumption and Serum Lipid Levels in Electronic Health Records.

Sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption may promote lipid abnormalities in childhood. We examined the association between SSB/FJ intake and lipid levels using electronic health record data for 2816 adolescents. Multivariable logistic regression models treated clinical cutpoints for abnormal lipid levels (triglycerides [TG], high-density lipoprotein (HDL), low-density lipoprotein [LDL], and total cholesterol) as dependent variables. In models not adjusted for adiposity, elevated SSB and FJ consumption was associated with increased odds of having abnormally high TG (SSB: odds ratio [OR] = 1.28 (95% confidence interval [CI] = [1.07-1.52], P = .007); FJ: 1.35 ([1.09-1.69], P = .007)) and abnormally low HDL (SSB: 1.47 ([1.17-1.86], P = .001); FJ: 1.35 ([1.02-1.78], P = .03)). Adjusting for adiposity, a likely mediator of the relationship, attenuated these associations. These findings support the need for identifying unhealthy beverage consumption habits during childhood health care visits as a modifiable behavior associated with cardiometabolic risk.

How has the strict lockdown during the SARS-COV-2 outbreak changed the diet of Spaniards?

PurposeWe investigate the impact of a specific macroeconomic shock that occurred as a response to the SARS-COV-2 outbreak, namely the strict lockdown imposed in Spain on the March 14, 2020. MethodsWe use fortnightly purchase data relating to over 50,000 households from a supermarket chain in Catalonia from March to June in 2019 and 2020. Using a panel data approach, we analyse the impact of the lockdown on the caloric content, sugar composition, and alcohol content in beverages and food purchases bought before and after lockdown. We corrected our results to take into account the likelihood of stockpiling. ResultsThe lockdown is related to an increase in unhealthy beverage and food purchases. We find heterogeneous effects across groups of the sample based on cardholder characteristics. Families with children or babies and those in the upper two income quintiles had the unhealthiest changes. As the lockdown went through phases of relaxation, households made better food decisions but maintained unhealthy beverage choices. ConclusionsThe very restrictive lockdown negatively impacted the characteristics of food and beverage purchases made by Spaniards. However, we are unsure whether there was substitution to restaurant and bar visits. Additional work to find out whether there were permanent changes in purchasing behaviour after lockdown ended is needed in the future.

Do British and Chinese adolescents snack for different reasons? A cross-country study using the Theory of Planned Behaviour and eating styles

Snacking is prevalent in adolescents and can have significant health impacts, but there is considerable individual and cross-country variation in determinants on adolescent snacking. The present study examined the role of eating styles (i.e. restrained eating, emotional eating, external eating, mindful eating) and the constructs of an extended Theory of Planned Behaviour (TPB) (i.e. attitudes, subjective norms, perceived behavioural control, habit strength) in predicting adolescent snacking, and the moderating effects of country. A survey was completed by adolescents aged 16–19 years from China (N = 182; mean age = 16.13, SD = 0.87) and England (N = 96; mean age = 17.04, SD = 0.74). Compared to British adolescents, Chinese adolescents showed higher restrained eating (p = .009), lower external eating (p = .004), less positive attitudes (p < .001) and subjective norms (p = .007) to, and less strong habit strength (p = .005) for unhealthy snacking. Mindful eating significantly predicted lower consumption of unhealthy snacks (p = .008) and beverages (p = .001), while restrained eating predicted higher consumption of fruit (p < .001) and vegetables (p < .001), regardless of country. Country showed significant moderating effects of TPB constructs on unhealthy beverages (p = .008) and fruit (p < .001) consumption, and effects on unhealthy snack (p = .023) and vegetable (p = .015) consumption approaching significance. Subjective norms predicted unhealthy snacking frequency regardless of country (p = .001). Habit strength predicted consumption of beverages (p < .001) and fruit (p < .001) only in English adolescents. Mindful eating may be a positive intervention approach to help reduce adolescent unhealthy snacking. TPB-based snacking interventions should carefully consider the country context. Acknowledging country-specific determinants of snacking are recommended.

Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic.

To assess oral hygiene and dietary patterns in school children participating in a school-based preventive oral health program during the COVID-19 pandemic. In this cross-sectional study, an anonymous questionnaire exploring oral hygiene and dietary patterns during the COVID-19 pandemic was completed by parents of school children. Data were compared among different schools, school years, and between genders using nonparametric tests. Associations among further nominal and categorical variables related to oral hygiene and dietary habits were also assessed using the chi-square test. Only 26% (n = 32) of parents reported that their children brushed their teeth the recommended amount of twice or more per day during the pandemic. In addition, 17.2% of the parents reported less brushing than before the pandemic. A total of 40 parents (32.8%) reported that their child consumed unhealthy beverages once a day or more. Comparison between genders revealed that male participants were drinking significantly unhealthier than female (p = 0.038). Sugary foods were consumed once a day or more by 63.1% of children. No significant differences were found between public and church schools. Significant direct associations were found between changes in dietary habits and brushing frequency (p = 0.017), between parental concern regarding the interruption of the school program and decreased brushing frequency (p = 0.005), and negative changes in dietary habits (p = 0.013). Within the limitations of this study, the present significant findings observed during the pandemic support the importance of school programs in promoting oral hygiene and healthy dietary habits of children. Agius A-M, Gatt G, Cortes ARG, et al. Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic. Int J Clin Pediatr Dent 2023;16(2):205-210.

Overcoming Obesity in Adolescents: The Mere Exposure Effect and Sparkling Water

This study examined how increasing exposure of sparkling water to adolescents would affect their preference for sparkling water, with the value in exploring a substitution to sugar sweetened beverages that highly contribute to the adolescent obesity epidemic. Currently, adolescents have received minimal exposure to sparkling water and continue to consume unhealthy beverages that present themselves in their everyday lives through their schools, home environments, and activities. This study aimed to fill the gap within the Mere Exposure Effect realm where studies have not been conducted on sparkling water as a stimulus with adolescents. Preference survey ratings from 30 subjects over a ten day exposure period were collected to examine the effects that drinking one sparkling water daily had on participants' preference for them. The results from the preference rating showed that as a result of exposure, adolescents' preference of sparkling water experienced a statistically significant increase as a result of exposure. The results reinforced other studies’ findings that the Mere Exposure Effect increases preference as a result of exposure, and proved applicable to the new stimulus of sparkling water directed towards the population of American adolescents. The implications of exposure to sparkling water as a way to create healthier consumption habits for adolescents were discussed, with future research being directed towards finding which flavors would be most effective with implementation.&#x0D;

Should messages discourage sugary drinks, encourage water, or both? A randomized experiment with U.S. parents

Campaigns to improve beverage consumption typically focus on discouraging unhealthy beverages (e.g., soda), encouraging healthy beverages (e.g., water), or both. It remains unclear which of these strategies is most effective. We recruited a national convenience sample of U.S. parents of children ages 2–12 (n = 1078, 48% Latino[a]) to complete an online survey in 2019. We randomly assigned participants to view: 1) a control message, 2) a soda discouragement message, 3) a water encouragement message, or 4) both soda discouragement and water encouragement messages shown side-by-side in random arrangement. Intervention messages mimicked New York City's “Pouring on the Pounds” campaign. Participants rated messages on perceived effectiveness for discouraging soda consumption and encouraging water consumption (1–5 response scales) and reported feelings and intentions about drinking soda and water (1–7 scales). Compared to those with no exposure, participants who viewed the soda discouragement message reported higher perceived discouragement from drinking soda (Average Differential Effect [ADE] = 1.18), more negative feelings toward drinking soda (ADE = 0.83) and stronger intentions to avoid drinking soda (ADE = 0.45) (ps < 0.001). The soda discouragement message also exerted beneficial effects on perceived effectiveness, feelings, and intentions related to water consumption (ADEs = 0.33–0.68; ps < 0.001). Exposure to the water encouragement message had beneficial effects on outcomes related to water consumption (ADEs = 0.28–0.81, ps < 0.001), but limited impact on outcomes related to soda consumption. Across outcomes, results indicated diminishing returns from exposure to both message types. Messaging campaigns discouraging unhealthy beverages may be more promising for improving beverage consumption than messages only promoting healthier beverages.

Receptive to an authoritative voice? Experimental evidence on how patronizing language and stressing institutional sources affect public receptivity to nutrition information

Common strategies to make official nutrition information more persuasive include highlighting its institutional sources and using simple and direct language. However, such strategies may be counterproductive, as institutions are no longer self-evidently deemed to be legitimate in contemporary societies and such language can be viewed as patronizing. Our preregistered, population-based survey experiment fielded among a high-quality Dutch probability sample in February 2022 (n = 1947) 1) examines whether these dominant strategies hold up when tested against suggestions of psychological reactance and source derogation, and 2) scrutinizes if such responses are stronger among less-educated citizens. Our experiment mirrored real-life examples of health-information campaigns concerning healthy and unhealthy beverages, with data collected on seven outcome measures to discern receptivity toward the information and its sources. We found that just highlighting institutional sources in the information did not lead to it being perceived more negatively. This was also the case when the language used could be perceived as patronizing, with reactance only present for one outcome measure. Moreover, while less-educated citizens were generally less receptive to nutrition information (six of seven outcome measures), versions that could possibly be perceived as patronizing or/and highlighted institutional sources did not make them less receptive systematically. Importantly, therefore, while our results show that the dominant health-communication strategies do not increase receptivity either, their use will probably not have a negative effect on the general public and so do not need to be discarded.

Menurunkan frekuensi jajan tidak sehat pada anak dengan ID komorbid ADHD

Children with intellectual disability (ID) are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. ID itself can has comorbidities with any other pathologies, such as attention deficit hyperactivity disorder (ADHD). Based on the assessment data, subject seems to be dependent to her parent, not able to sit quietly, and not able to understand long and complex instructions. Subject complained by her parent because of the high frequencies of snacking unhealthy beverages. Assessment methods were interviews, observation, Wechsler Intelligence Scale for Children (WISC), and Conner’s Parent Rating Scale – Revised (CPRS-R). The intervention given to overcome these problems was negative reinforcement. The results of the intervention showed that the behavior of snacking unhealthy beverages can be reduced.

ÇOCUK VE ADOLESANLARDA HEDONİK AÇLIK İLE OBEZİTE İLİŞKİSİ

Hedonik açlık, fizyolojik olarak açlık oluşmasa bile yemekten zevk alma ve yemek yeme dürtüsü olarak tanımlanmaktadır. Hedonik açlık metabolik ihtiyaç yerine, zevk için diyetle daha fazla enerji alımına neden olmakta ve özellikle çocuk ve adolesan döneminde şişmanlık ve obezite prevelansının artmasına neden olmaktadır. Sağlıklı beslenme davranışlarının adolesan dönemde kazanılması nedeniyle bu dönemde vücut ağırlığı korunumunun sağlanması ve obezitenin önlenmesi amacıyla alınacak önlemler önem kazanmaktadır. Son yıllarda özellikle çocukluk çağında görülen obeziteye, diyetle alınan enerjinin artması ve buna karşın enerji harcamasının azalması neden olduğu belirtilmiştir. Adolesanlarda sağlıksız yiyecek ve içeceklerin fazla miktarda tüketilmesi, diyetle enerji alımında artış, gençlik ve yetişkinlik döneminde vücut ağırlığında artışı ve daha yüksek kronik hastalık riski ile ilişkilendirilmiştir. Bu derlemede, çocuk ve adölesanlarda hedonik açlık ve obezite arasındaki ilişkisinin değerlendirilmesi amaçlanmıştır.

Impact of Maternal Nutrition Education on Dietary Practices of School Going Children (3-6 years of age)

Nutrition (Nutritional) education is a kind of education that is important to improve the health status of people. School children are undergoing rapid mental and physical development. Therefore, an appropriate diet is critical throughout this stage of life to ensure normal and healthy growth. As a result, nutrition education should begin at a young age for children Objective: To evaluate the impact of nutrition education of mothers on the dietary habits of school-going children aged 3-6 years Methods: A Quasi-Experimental study was executed on 77 children of class playgroup to class 1 studying in the Government girl’s school of Garhi Shahu, Lahore. Firstly, anthropometric data were collected through the children and secondly socio-demographic and dietary knowledge of mothers of selected children were noted through pre-designed questionnaires and interview method. The mothers were then given 45 minutes of nutrition education and a dietary change course, and some informative dietary guidelines leaflets and a weekly healthy kid’s school lunch planner were given to the mothers which they were requested to implement in the daily routine of children. After three months again the anthropometrics and questionnaires were assessed and compared with the initial findings Results: After nutrition education, the percentage of children who followed the servings of healthy food groups and avoided consumption of harmful meals (fast, fried, processed foods), unhealthy beverages (carbonated drinks), and intake of fruits and vegetables increased dramatically. After the intervention, the percentage of children who followed recommended nutritional, lifestyle, and physical activity guidelines, as well as healthy school lunch practices, improved statistically significantly (P&lt;0.005). The percentage of children who skipped meals on daily basis was 20% decreased to 8%. Before the intervention, 63% of mothers say that their children consumed breakfast regularly and after the intervention, it increases to 75%. The children's anthropometric status improved significantly, with a P&lt;0.005 significance level Conclusions: In this study, nutrition education had a significant impact on the school-going children in their anthropometry measurements, healthy school lunch boxes, and awareness of their mothers about healthy eating practices. Seminars and camps should be arranged in schools to educate the mothers and the students at a young age regarding their health and healthy eating to reduce the nutritional deficiencies and diseases

How have media campaigns been used to promote and discourage healthy and unhealthy beverages in the United States? A systematic scoping review to inform future research to reduce sugary beverage health risks.

SummarySugary beverage consumption is associated with many health risks. This study used a proof‐of‐concept media campaign typology to examine U.S. beverage campaigns that promoted healthy beverages and encouraged or discouraged sugary beverages. We used a three‐step systematic scoping review to identify, organize, analyze, and synthesize evidence. Step 1 used Preferred Reporting Items for Systematic Review and Meta‐Analysis Extension for Scoping Reviews (PRISMA‐ScR) guidelines to search four electronic databases and gray literature through 2021. Step 2 categorized relevant media campaigns using a media campaign typology. Step 3 examined campaign evaluation outcomes. We identified 280 campaigns organized into six campaign typology categories. The media landscape was dominated by corporate marketing campaigns for branded sugary beverages (65.8%; n = 184) followed by public awareness (9.6%; n = 27), public policy (8.2%; n = 23), social marketing (7.1%; n = 20), corporate social responsibility (5.7%; n = 16), and countermarketing (3.6%; n = 10) campaigns. Evaluations for 20 unique campaigns implemented over 30 years (1992–2021) across 14 states showed reduced sugary beverage or juice and increased water or low‐fat milk sales and intake. Positive short‐term cognitive and mid–term retail and behavioral changes were reported. There was limited evidence for long‐term policy, social norm, and population health outcomes. Future research is needed to use media campaigns in strategic communications to reduce sugary beverage health risks for Americans.

Food Culture in Youth Athletics: Exploration of the Beliefs in USA Stakeholders

Objectives. The present study examined beliefs surrounding food culture in youth athletics. Design. Qualitative research. Methods. Coaches (n = 62), parents (n = 161), and youth athletes (n = 40) in the USA completed questionnaires that explored aspects of the food environment of youth athletics, including practices related to food and beverage consumption and perspectives on the nutritional value of available foods and beverages. Results. Coaches, parents, and athletes all reported a high number of available foods and beverages, and were mixed both about whether these were healthy or unhealthy, and whether the availability of unhealthy foods and beverages was problematic. Conclusions. This study aimed to add to the literature an examination of multiple perspectives on the current food culture in youth athletics. Participant perspectives suggest that the food environment of youth sport may be an unhealthy mismatch with the physical, social, and psychological benefits of participation. Further research could aim to identify optimal environments for promoting health in youth sport. Limitations and additional directions for future research are discussed.

A multi-level, multi-component obesity intervention (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans) decreases soda intake in Native American adults.

To evaluate the impact of a multi-level, multi-component (MLMC) adult obesity intervention on beverage intake in Native American adults living in five geographically and culturally diverse tribal communities. A 14-month, community-randomised, MLMC design was utilised, with three communities randomised to Intervention and two communities randomised to Comparison. FFQ were administered pre- and post-interventions, and difference-in-differences (DiD) analysis was used to assess intervention impact on beverage intake. The intervention took place within food stores, worksites, schools and selected media outlets located in the five communities. Key activities included working with store owners to stock healthy beverages, display and dispersal of educational materials, support of policies that discouraged unhealthy beverage consumption at worksites and schools and taste tests. Data were collected from 422 respondents between the ages of 18 and 75 living in the five communities pre-intervention; of those, 299 completed post-intervention surveys. Only respondents completing both pre- and post-intervention surveys were included in the current analysis. The DiD for daily servings of regular, sugar-sweetened soda from pre- to post-intervention was significant, indicating a significant decrease in Intervention communities (P < 0·05). No other changes to beverage intake were observed. Large, MLMC obesity interventions can successfully reduce the intake of regular, sugar-sweetened soda in Native American adults. This is important within modern food environments where sugar-sweetened beverages are a primary source of added sugars in Native American diets.

Using Community-Based Prevention Marketing to Generate Demand for Healthy Diets in Jordan.

Jordan has been experiencing a nutrition transition with high rates of micronutrient deficiencies and rising overweight and obesity rates. This highlights the need to generate demand for healthy diets. This study used a community-based prevention marketing approach and worked with local communities as partners to develop a set of behavior change interventions to improve healthy eating within vulnerable communities. Individual, family, and paired-friendship interviews, and co-creation workshops were conducted with 120 people. The aim of these interviews was to gain an in-depth understand of school-aged children and their families’ nutrition knowledge, attitudes, and practices, including social and cultural norms and behavioral determinants, and then use this information to co-create interventions, activities and materials targeted at supporting school-aged child nutrition. Analysis of the interviews revealed that dietary habits are both deeply personal and profoundly entwined by emotions and social norms, and that parents often gave in to their children’s demands for unhealthy foods and beverages due to their perception of what a ‘good parent’ looks like and the desire to see their child ‘smile’. These key insights were then shared during the co-creation workshops to develop behavior change interventions—ensuring that interventions were developed by the community, for the community.

Correlates of food intake and mealtime behaviors among Kuwaiti adolescents.

Eating meals with the family improves the food choices of adolescents. Studies conducted on Kuwaiti adolescents have reported suboptimal dietary intake; however, it is unclear what meal-related behaviors and family dynamics influence dietary choices in young Kuwaiti adolescents.This study explored the food intake and meal-related behaviors of young adolescents in relation to their mother's educational level, parental employment, and family size and to identify meal-related behaviors associated with poor dietary choices. A cross-sectional survey was conducted using a modified and validated version of the International Health Behavior in School Children questionnaire recruiting 774 adolescents aged 14-16 years from all six governorates of Kuwait. A higher level of the mother's education was associated with higher odds of eating fruits and breakfast. A stay-at-home mother was associated with higher odds of consuming milk and home-made desserts. Larger family size was associated with higher odds of eating fruits, and a higher frequency of family meals was associated with higher odds of consuming vegetables and whole grain bread. All unhealthy snacks, including sweets, potato chips, french fries, home-made desserts, and sugar-sweetened beverages, were associated with higher odds of watching TV during mealtime. A higher level of mother's education level, large family size, and family meals encouraged consuming fruits, vegetables, whole grain bread, milk, and breakfast, but consuming empty calorie snacks is very common. Family involvement in developing healthy meal-related behaviors is imperative for shaping healthy eating habits of adolescents.