Purpose: The use of lifelogging device in dietary assessments can reduce misreporting and underreporting of foods, which are common in previous studies using conventional method among adults. However, no similar study among children has been conducted. This is the first study in Chinese children that applied the wearable cameras in assisting dietary recall, and exploring dietary risk factors for childhood obesity.

Method: Children (n=52) wore the wearable cameras (Narrative Clip 2) for seven consecutive days, during which they completed a 3-day 24-h dietary recall at home (DR). Then children modified their dietary recalls at school by reviewing the photos taken by the wearable camera, with the assistance of the investigator, and generated the camera-assisted 24-h dietary recalls (PDR). Children’s satisfaction with the wearable camera was measured by a short questionnaire at the end of the study. Foods consumed, energy and nutrients intakes recorded by DR were compared against that from PDR. Binary logistic regressions were performed on the PDR data, to identify the dietary risk factors for childhood obesity.

Results: Compared with PDR, 8% (n=160) and 1% (n=11) of food items were underreported  and misreported  by dietary recalls without camera-assistance (DR), respectively. DR underestimated daily energy intake by 149 ± 182 kcal/d (8%) in comparison to the PDR results. Foods consumed on the snacking occasions (40%) were more likely to be underreported than those consumed at main meals (P<0.001). Beverages (37%), fruits (30%), snacks and desserts (16%) were foods most likely to be inaccurately reported. Children were satisfied with the wearable cameras, with a median score of of 5.0 for most features. Children who were infrequent to dine with family members had higher risk of obesity (OR=14.59, 95% CI: 1.83, 116.22), after controlling for potential confounders.

Conclusions: Wearable cameras hold promise for improving accuracy of dietary intake assessment in children, providing rich objective information on dietary behaviours, and received high level of satisfaction and compliance of the users. Our results suggest that eating with others may be a protective factor for childhood obesity.

Purpose: Childhood obesity and physical inactivity are major public health issues.  Almost every second household in Australia has a dog. Dog ownership leads to greater physical activity (PA) in adults and school-aged children. We examined if dog ownership and dog-facilitated PA was associated with higher PA in pre-schoolers.

Methods: A secondary data analysis of the ‘Play Spaces & Environments for Children’s Physical Activity’ study cohort (2015-2018) was undertaken. Data was collected for 1490 children 2-5 years from 122 long day-care centres in Perth, Western Australia. Parent-report surveys measured socio-demographic factors, dog ownership, child-dog play and dog walking, structured and unstructured PA and sedentary screen time.

Results/findings: Compared with non-dog owners, dog-owning pre-schoolers did 6 minutes/day more home yard play, 5 minutes/day less park play and 8 times/week more unstructured PA (all p<0.05). Dog-owning pre-schoolers who played with their dog 3≥ times/week did 25 minutes/week more structured PA, 12 times/week more unstructured PA, 31 minutes/day more home yard play and 8 minutes/day more park play (all p<0.05). Pre-schoolers who walked their dog ≥ 1 time/week did 8 times/week more unstructured PA, 12 minutes/day more home yard play and 17 minutes/day more park play (all p<0.05). Pre-schoolers walking the dog ≥ 1 time/week did 126 mins/week less sedentary screen time (p=0.003).

Conclusions: Findings suggest family dog ownership is associated with outdoor play, structured and unstructured PA and screen time, and indicates dog play and dog walking may be viable strategies for increasing pre-schoolers’ PA levels.

Purpose: Understanding the relative accuracy of dietary instruments to assess what children eat at school is critical to evaluate the impact of school-based nutrition programs. We examined the validity of a self-reported, web-based, time-use diary that records dietary intakes of children from a local primary school in Singapore.

Methods: Children were trained to record their food intake and daily activities on a web-based, time-use diary daily for four days. Pictorial images on the web-based diary were provided for selection of food items and portion sizes that best corresponded to what they consumed. Their school recess meal (includes school-bought foods and/or foods brought from home) was observed using the digital photography method for two of the four days to validate the accuracy of their self-reported records.

Results: Of 36 children (11 year old; 47% males), five children did not report their school recess meals on the web-based diary and were excluded from subsequent analysis. Based on the photographed food images (n=66 food items), 65% of food items were reported in the diaries, of which 23% were inaccurately reported (e.g. incorrect cooking method, type of juice). The remaining one-third (35%) of food items photographed were omitted from the self-report and were typically ingredients of a composite dish, such as ‘Meat and Fish’ and ‘Vegetables and Mushroom’ food items.  From diary records (n=59 food items), around one in four food items reported (27%) were not captured in the photographed food images, and were mostly single items such as bread with spreads, snacks, and drinks. Portion sizes of 50% of food items were accurately reported in the diaries. Composite foods from the ‘Noodles, pasta and potatoes’ and ‘Rice and porridge’ category tended to be overestimated, while beverage portions were mostly well-estimated.

Conclusion: This study suggests that 11-year-old children could report 65% of food items consumed and correctly report portion sizes for 50% of food items through the web-based diary. This is comparable to other web-based questionnaires administered to children of similar age, where reporting accuracy ranged from 43% to 81.4%. The present web-based diary is thus a promising tool for assessing dietary intake among children of this age.

Purpose:                      Cooking research has been criticised for its lack of systematic measurements. While progress has been made in the adult measurement area through the development and validation of cooking/food related tools, issues remain in relation to children, where parent-report measures are commonly used. Therefore, this research aimed to develop an evidence-based, age appropriate perceived cooking competence measure for children.

Methods:                     Publically available cooking recommendations were sourced, critically reviewed and deconstructed for underpinning motor skills, numeracy and literacy skills and safety concerns. From this, 14 culturally neutral skills were identified as frequently occurring in the publically available recommendations. An expert panel including an educational researcher, a primary school teacher, an early year’s educator, movement scientist and Home Economists, reviewed the skills for age appropriateness and level of difficulty and proposed an age range for each skill and level of difficulty. A published perceived motor competence measure was used as the template for the developmental assessment of each skill. Illustrations showing each skill performed by a child-friendly character, was drawn by a graphic designer in consultation with a chef and reviewed by the research team for accuracy in an iterative process. The developed measurement tool was piloted with over 1000 primary school children, with 6-7 year olds shown 10 skills and 10-11 years olds shown 14 skills. The tool items were presented to the children from easiest to hardest. Psychometric properties, internal consistency reliability, temporal stability, as well as construct validity were investigated using SPSS V25. User feedback was also collected.

Results/Findings:        Findings indicate that the measure has a good internal consistency and reliability in the different age ranges and had a high level of construct validity for older age children, which significantly correlated (P<0.001) with an adult cooking measure. Positive feedback was received from users in the different age ranges.

Conclusions:               The perceived children’s cooking competence measure is a positive step in the development and validation of child measures in nutrition which traditionally has limited validated measures. This novel measure is applicable to different age groups and can be used in both survey and intervention studies.

Purpose: Most actions targeting children’s health behaviors have limited involvement of children in the development, potentially explaining the disappointing effectiveness. In the 3-year ‘Kids in Action’ study, 9-12-year old children from a low socioeconomic neighborhood were involved as co-researchers in the development, implementation and evaluation of actions targeting healthy physical activity and dietary behaviors. We will present the process and effect evaluation of ‘Kids in Action’. 

Methods: Children from four intervention and four controls schools participated in the study. We used the RE-AIM framework to assess reach, effectiveness, adoption, implementation and maintenance, including assessments of children’s empowerment, collaboration between researchers and stakeholders, and satisfaction with the actions. Data collection took place in eight focus groups with children (N=40) and eight interviews with community partners (N=11). Content analysis was used where transcripts were analyzed using evaluation and provisional coding. Dietary behavior, sports participation, self-rated health, moderate-to-vigorous physical activity, sedentary time and neuromotor fitness were assessed at baseline, one and two year follow-up using self-report (N=556), accelerometers (N=408) and fitness tests (N=485). Linear mixed model analyses were performed, adjusting for relevant confounders. 

Results: Both children and community partners perceived an improvement in several skills in children who participated in Kids in Action, such as confidence, critical awareness, leadership and collaboration, leading to increased feelings of empowerment. Children felt involved in decision making and enjoyed being part of the development of actions. Children and community partners became more aware of health behavior. Effects on dietary behavior, physical activity, sedentary behavior and fitness, will also be presented. Community stakeholders were eager to continue child participation and focus on health behavior. For successfully conducting YPAR, a strong relationship between researchers, children, and community partners who value child participation is key. Involving more children, parents and school staff in co-creating actions may lead to even more support for the co-created actions and wider empowerment.

Conclusions: Actively taking part in Kids in Action improved children’s empowerment, child participation and awareness of health behavior in the community. YPAR has the potential to improve children’s health behaviors, however, many resources are required to reach effects on a large scale.

Purpose: To assess the provision of food groups in lunchboxes of primary schools aged children, focusing on food groups that have previously been identified of particular concern in childhood nutrition, including fruit, vegetable, dairy/alternatives and discretionary/occasional items. Make a comparison to the Australian Guide to Healthy Eating and current advice recommending that children should consume one third of their daily intake whilst at school.

Methods: A cross-sectional study was conducted in 12 Catholic primary schools in the Hunter region of New South Wales, Australia. Parental consent was gained to photograph children's lunchboxes and analysis was undertaken using a validated lunchbox audit tool, to determine the number of fruit, vegetable, dairy/alternative and discretionary/occasional serves packed in the lunchbox. Results were compared to one third of the Australian Dietaey Guideline recommendations for children aged 4-12 years.

Results: A total of 1799 lunchboxes were analysed across Kindergarten to Grade 6. Fruit was packed in 86.7% (n=1560) of lunchboxes, with 26.7% containing more than one serve, and 8.9% (n=160) exceeding the daily recommendation for this age group. In contrast, only 20.5% (n=369) of lunchboxes contained vegetables, and only 2.8% (n=51) met the minimum calculated recommendation. Similarly, only 21.0% (n=378) of lunchboxes contained dairy/alternatives, with only 19.2% (n=345) meeting the calculated recommendation. Conversely, 86.9% (n=1561) of lunchboxes contained at least on discretionary/occasional item, with 59.5% of lunchboxes exceeding the maximum calculated recommendation. Furthermore, 14.6% of lunchboxes contained more discretionary/occasional items than the maximum daily recommendation for children.

Conclusion: Foods currently being packed in the lunchbox are not meeting the majority of recommendations based on the Australian Dietary Guidelines. Of particular concern is the low provision of vegetables and dairy/alternatives and the likelihood that the by providing of excessive amounts of discretionary/occasional foods core food groups may be displaced in the lunchbox. Interventions seeking to improve the overall nutritional quality of lunchboxes may benefit from exploring barriers to packing certain food groups, particularly vegetables and dairy/alternatives. In addition identifying and addressing enablers to packing discretionary/occasional foods will support the development of programs that adopt a more targeted approach.  

Purpose: Few children in the UK are eating enough fruit and vegetables to support optimum health.  The present study extends the findings of previous research into the effectiveness of choice architecture changes to promote fruit and vegetable consumption in primary schools, to include those children who brought lunch from home, as well as those who consumed school dinners.

Methods: We recruited four primary schools in Conwy, North Wales, and randomly allocated them to either the intervention or control condition. Baseline data were collected over two days in each school. Following this, nudges to promote visibility, accessibility, appearance, and convenience of fruit and vegetable choices were introduced in the intervention schools at lunchtime. No changes were made in the control schools. Data were collected using a validated direct-observation digital photography protocol to approximate fruit and vegetable consumption in grams.

Results: The preliminary data from the first pair of schools indicate that the intervention was effective. At baseline, children who ate school dinners consumed some vegetables but seldom choose fruit; the children who brought their lunches from home often had neither. A significant increase in fruit consumption was identified in those participants consuming school dinners (Z = -3.36, p = .001, r = .75.), whilst a significant increase in vegetable consumption was observed in those participants consuming food from lunchboxes (Z = -2.21, .03, r = .64), in the intervention schools. No differences in consumption were identified in the control schools. 

Conclusions: The present study indicates that choice architecture interventions can be successful in promoting healthful eating behaviour in primary school children. To our knowledge, this is the first school-cafeteria based nudge intervention to also include participants who brought lunch in from home. In both groups, it seems that lack of consumption may in part be attributed to absent or poorly presented fruit and vegetables, and that this can be remedied without much effort or expense. The results also show that vegetables, as well as usually studied fruit, can be successfully targeted by simple behavioural nudge interventions.

PURPOSE: Little is known about family meal characteristics and how these might differ by food security status among diverse populations. Our purpose was to examine family meal characteristics by family food security status in a sample of racially/ethnically diverse and immigrant/refugee families.

METHODS: 149 families with children (5-7 years old; 47% girls; n=~25 each African American, American Indian, Hispanic/Latino, Hmong, Somali, and White) were included in this analytic sample. Using a mixed-methods approach, family food security status was measured by a 6-item validated survey; family meal characteristics were measured via Ecological Momentary Assessment surveys completed by the parent every time they shared a meal with their child; and in-home qualitative interviews were conducted with the parent to explore family meal characteristics. Descriptive statistics assessed family meal characteristics by food security status. Qualitative data analyses were used to synthesize the key themes related to meal characteristics that emerged from the interviews by family food security status.

RESULTS: About a fifth of the families reported being food insecure (FI). FI families were more likely to report serving “only pre-prepared” foods at family meals while food secure (FS) families were more likely to report serving “homemade” foods. Additionally, FI families were more likely to eat “on a couch” compared to “on a table” relative to FS families. FI families were also more likely to report serving less “fruits and vegetables” and more foods with “added sugar” (e.g., sugary drinks) at family meals than FS families. Qualitative data results showed that compared to FS families, FI families had more unhealthy parent feeding practices (e.g., pressure to eat, restriction); served more pre-packaged foods or take-out meals; had “to stretch their money” for family meals; and reported not enough time to eat family meals and having to eat meals quickly (e.g., eating on the go).

CONCLUSIONS: In this sample, FI families reported more unhealthy meal characteristics compared to FS families. Screening families for food insecurity and developing intervention strategies to support FI families are needed to help families cope with economic hardships and associated stressors.

Purpose: The aims of this cross-sectional, mixed-methods study were i) to quantitatively evaluate the home environmental characteristics associated with screen time (mainly television viewing) in pre-school children and ii) to qualitatively explore parents’ perceptions of their children’s screen-related sedentary and eating behaviours. The study contributes to our understanding of the mediating influence of home environmental factors on children’s screen time.

Methods: Children’s screen time (television viewing) and home environmental characteristics (demographic, behavioural and physical) were reported by parents of 332 children aged 3-5 years using validated questionnaires. These quantitative data were analysed using bivariate and multivariate binary logistic regression. An online deliberation platform was used to qualitatively explore 54 of these parents’ attitudes and perceptions about their children’s screen time behaviours. The qualitative data were thematically analysed.

Results/findings: The quantitative, multivariate analysis showed that the home environmental characteristics positively associated with children’s television viewing were: parents own television viewing (OR 1.66, 95%CI 1.09-2.52, p=0.017), parents allowing their children to eat snacks while watching television (OR 2.66, 95%CI 1.17-6.06, p=0.019) and less outdoor play time (OR 2.03, 95%CI 1.05-3.93, p=0.035). The qualitative analysis highlighted parental concerns about the addictive nature of screen behaviours and that screen time should be limited. Positive aspects to screen time were also noted, for example, its use as a safe ‘babysitter’. Although some parents perceived that eating while watching television may result in mindless and/or overeating, others believed that if they offer healthy snacks, such as fruit and vegetables, television viewing does not negatively affect their children’s diet.

Conclusion: The quantitative and qualitative results of this study enhance our understanding of the home environmental factors associated with television viewing and parents’ perceptions of the effects of screen time on the sedentary and eating behaviours of their children. These data can be used to inform interventions aimed at addressing increasing screen time exposure in young children.