A qualitative study of the factors that influence mothers when choosing drinks for their young children

ABSTRACT

Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?

Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.

Socio-economic disparities in Australian adolescents' eating behaviours

Objective: To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary school students.
Design: Cross-sectional survey of students’ vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.
Setting: Secondary schools across all Australian states and territories.
Subjects: Secondary-school students (n 12 188; response rate: 54 %) aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey.
Results: Overall, 25% of students reported consuming <1 serving of vegetables/d and 29% reported eating <1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1–2 cups of sugar-sweetened beverages/d while 9% reported eating fast food <3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F (4, 231) = 3.61, P = 0.007) and high frequency of consumption of sugar-sweetened beverages (F (4, 231) =8.41, P < 0.001) and fast food (F (4, 231) = 4.59, P =0.001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F (4, 231) = 4.20, P = 0.003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F (4, 231) = 5.80, P, < 0.001).
Conclusions: Results suggest that socio-economic disparities in Australian adolescents’ eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight.

We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento-structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento-structural type interventions, remains crucial.

Nutrient and core and non-core food intake of Australian schoolchildren differs on school days compared to non-school days.

Overall the diets of Australian schoolchildren are suboptimal, but differences in nutrient and food intake on school versus non-school days have not been assessed. The aim of this study was to examine differences in nutrient and core and non-core food intake on school days versus non-school days in Australian schoolchildren aged 6-16 years. Cross-sectional analysis of the 2007 Australian Children's Nutrition and Physical Activity Survey. Dietary intake was assessed via one 24-h dietary recall. A school day was defined as Monday-Friday, a non-school day included Saturday, Sunday and public/school holidays. Independent t-tests and χ(2) tests were used to assess differences in continuous and categorical variables, respectively. Multiple linear and logistic regression was used to adjust for confounders. Forty-eight per cent of recalls were completed on a non-school day. On non-school days primary schoolchildren aged 6-11 years (n = 1334) and secondary schoolchildren aged 12-16 years (n = 1362) had significantly higher absolute intakes of sugars, total fat and saturated fat (all P < 0.05). In addition the energy density of foods consumed was greater (P < 0.001), but there was no difference in the energy density of fluids. The sodium density of the diet did not differ across day types. On non-school days, total core food intake was ~30% higher and children were more likely to consume sugar-sweetened beverages, fried potatoes and take-away pizzas and burgers (all P < 0.05). Important differences in the intake of sugar, total fat, and saturated fat and noncore foods exist on non-school days compared to school days in Australian schoolchildren. To improve the diets of schoolchildren there is scope for strategies that target non-school day eating practices.

Using a qualitative vignette to explore a complex public health issue

This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique.

Caffeine increases sugar-sweetened beverage consumption in a free-living population: a randomised controlled trial

Excessive sugar-sweetened beverage (SSB) consumption has been associated with overweight and obesity. Caffeine is a common additive to SSB, and through dependence effects, it has the potential to promote the consumption of caffeine-containing foods. The objective of the present study was to assess the influence that caffeine has on the consumption of SSB. Participants (n 99) were blindly assigned to either a caffeinated SSB (C-SSB) or a non-caffeinated SSB (NC-SSB) group. Following randomisation, all participants completed a 9 d flavour-conditioning paradigm. They then completed a 28 d ad libitum intake intervention where they consumed as much or as little of C-SSB or NC-SSB as desired. The amount consumed (ml) was recorded daily, 4 d diet diaries were collected and liking of SSB was assessed at the start and end of the intervention. Participants (n 50) consuming the C-SSB had a daily SSB intake of 419 (sd 298) ml (785 (sd 559) kJ/d) over the 28 d intervention, significantly more than participants (n 49) consuming the NC-SSB (273 (sd 278) ml/d, 512 (sd 521) kJ/d) (P< 0·001). A trained flavour panel (n 30) found no difference in flavour between the C-SSB and NC-SSB (P>0·05). However, participants who consumed the C-SSB liked the SSB more than those who consumed the NC-SSB (6·3 v. 6·0 on a nine-point hedonic scale, P= 0·022). The addition of low concentrations of caffeine to the SSB significantly increases the consumption of the SSB. Regulating caffeine as a food additive may be an effective strategy to decrease the consumption of nutrient-poor high-energy foods and beverages.

Visible and UV functionality of TiO2 ternary nanocomposites on cotton

This research intends to increase the photocatalytic efficiency of cotton fabrics coated with TiO2-based nanocomposites under illumination particularly visible light. The fabrics were functionalized using a low-temperature sol-gel method of TiO2/Metal/SiO2 nanocomposite systems. Integrating silica and noble metals into TiO2 sol was put forth for boosting its functionality. Three noble metals (gold (Au), platinum (Pt) and silver (Ag)) with four different concentrations were employed. The photocatalytic activity of the functionalized fabrics was assessed through coffee stain-removal test and photodecomposition of methylene blue (MB) under UV and visible light. The impact of coating layers on fabrics' hydrophilicity was analyzed through measuring the water contact angle as well as the water absorption time. The fabrics were characterized using XRD, SEM and EDS. It was corroborated that the presence of silica enhanced the self-stain-removal capability of fabrics under UV. Moreover, the self-cleaning property of fabrics improved under both UV and visible light after integrating the metals into the colloids. In the same line, the self-cleaning activity threshold of fabrics was shifted to visible region.

A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol

Background: The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'.Methods/design: The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using logistic regression models adjusting for baseline values.Discussion: The proposed trial will represent a novel contribution to the literature, being the first randomised trial internationally to examine the effectiveness of an intervention to facilitate implementation of a healthy canteen policy.

Are food brands that carry light claims different?

Little is known about the market performance of brands that carry light claims (for example low fat, low sugar) in comparison to their regular counterparts. In order to fill this gap, we explore whether light brands perform similarly to regular brands in terms of (a) brand performance measures (BPMs), such as market share (MS) and penetration, (b) loyalty levels, and (c) customer sharing. We analyse three product categories (cola, flavoured carbonated beverages and margarine) using UK household panel data provided by Kantar. The results show that when considering standard BPMs (that is MS, penetration and purchase frequency), regular brands receive higher BPMs than light brands. However, when considering repeat purchase loyalty, light brands achieve greater levels of loyalty than their regular counterparts. Finally, light brands share their buyers more with each other than expected, suggesting the existence of market partitions, although these are not isolated as buyers of these brands still buy regular brands. © 2014 Macmillan Publishers Ltd.

Unhealthy food, integrated marketing communication and power: a critical analysis

Public health advocates have repeatedly highlighted parallels between food marketing and childhood obesity. Yet existing literature has not explored the connection between the promotion of unhealthy foods and beverages, certain characteristics of integrated marketing communication (IMC) and the power of multinational food and beverage companies. This is problematic because IMC represents the dominant marketing paradigm in use today. This article draws on critical theory and literature from across public health, marketing, business and related fields. By focusing on macro-level antecedents and interactions, this discussion highlights a previously unarticulated dimension of the promotion of unhealthy foods and beverages to children and adolescents. In doing so, this discussion aims to generate greater recognition of the broader environmental circumstances and processes that surround food marketing tactics and their consequences for public health nutrition. This perspective will also contribute to an expanded understanding of unhealthy food marketing and its unintended consequences, among an audience of nutrition, public health and policy communities.

Nature of crystalline particle assembly in ring shaped colloidal stains from concentrated dispersions

The drying of colloidal droplet suspensions is important in many realms of practical application and has sustained the interest of researchers over two decades. The arrangements of polystyrene and silica beads, both of diameter 1 μm, 10% by volume of solid deposited on normal glass (hydrophilic), and silicone (hydrophobic) surfaces evaporated from a suspension volume of 3 μL, were investigated. Doughnut shape depositions were found, imputing the influence of strong central circulation flows that resulted in three general regions. In the central region which had strong particle build-up, the top most layers of particle arrangement was confirmed to be disordered using power spectrum and radial distribution function analysis. On closer examination, this appeared more like frustrated attempts to crystallize into larger grains rather than beads arranging in a disordered fashion throughout the piling process. With an adapted micro-bulldozing operation to progressively remove layers of particles from the heap, we found that the later efforts to crystallize through lateral capillary inter-particle forces were liable to be undone once the particles contacted the disorganized particles underneath, which were formed out of the jamming of fast particles arriving at the surface. © 2014 Elsevier B.V.

A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial.

BACKGROUND: There is a paucity of studies evaluating targeted obesity prevention interventions in pre-school children. OBJECTIVES: We conducted a randomized controlled trial to evaluate the efficacy of a parent-based obesity prevention intervention for pre-schoolers - MEND (Mind, Exercise, Nutrition … Do It!) 2-4 on child diet, eating habits, physical activity/sedentary behaviours, and body mass index (BMI). METHODS: Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition, physical activity and behaviours, including guided active play and healthy snack time. Assessments were conducted at baseline, immediately post-intervention, and 6 and 12 months post-intervention; child intake of vegetables, fruit, beverages, processed snack foods, fussiness, satiety responsiveness, physical activity, sedentary behaviour and neophobia were assessed via parent proxy report. Parent and child height and weight were measured. RESULTS: Two hundred one parent-child dyads were randomized to intervention (n = 104) and control (n = 97). Baseline mean child age was 2.7 (standard deviation [SD] 0.6) years, and child BMI-for-age z-score (World Health Organization) was 0.66 (SD 0.88). We found significant positive group effects for vegetable (P = 0.01) and snack food (P = 0.03) intake, and satiety responsiveness (P = 0.047) immediately post-intervention. At 12 months follow-up, intervention children exhibited less neophobia (P = 0.03) than controls. CONCLUSION: Future research should focus on additional strategies to support parents to continue positive behaviour change. ACTRN12610000200088.

BMI and healthcare cost impact of eliminating tax subsidy for advertising unhealthy food to youth

INTRODUCTION: Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. METHODS: We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. RESULTS: We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. CONCLUSIONS: Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.