The purpose of the present study was to develop and assess the construct validity of a tool to measure knowledge, attitudes and practices of registered dietitians/nutritionists (RD/N) regarding an intuitive eating lifestyle.

Cross-sectional study design that utilized a survey administered to a random sample and remaining full population of RD/N.

A national survey conducted via online survey software.

A random sample of 10 % of all RD/N in the USA (n 8834) was invited to participate. Survey completion rate was 22·2 % (n 1897). After initial validation, the survey was distributed to the remaining 90 % of RD/N to confirm validation.

After removing items with insufficient factor loadings, results were consistent with a four-factor solution: (i) knowledge of intuitive eating; (ii) attitudes towards intuitive eating; (iii) traditional and restrictive practices; and (iv) non-restrictive and intuitive eating practices. Confirmatory factor analysis provided further evidence of the validity of the four factors and the factors had strong reliability.

Unlike the hypothesized three-factor solution (knowledge, attitudes and practices), validation analysis revealed that the survey measures knowledge of intuitive eating, attitudes towards intuitive eating, use of traditional and restrictive weight-management practices, and use of non-restrictive and intuitive eating practices. With the landscape of weight management and health promotion undergoing a shift towards a health centred, size acceptance approach, this instrument will provide valuable information regarding the current knowledge, attitudes and practices of RD/N and other health promotion professionals.

The use of smaller dishware as a way of reducing food consumption has intuitive appeal and is recommended to the general public. Recent experimental studies have failed to find an effect of plate size on food intake, although the methods used across studies have varied. The aim of the present study was to examine the effect that bowl size had on snack food consumption in a ‘typical’ snacking context (snacking while watching television).

Between-subjects.

Laboratory experiment.

Sixty-one adult participants served themselves and ate popcorn while watching television. Participants were randomly assigned to serve themselves with and eat from either a small or a large bowl.

The use of a smaller bowl size did not reduce food consumption. Unexpectedly, participants in the small bowl condition tended to consume more popcorn (34·0 g) than participants in the large bowl condition (24·9 g; 37 % increase, d=0·5), although the statistical significance of this difference depended on whether analyses were adjusted to account for participant characteristics (e.g. gender) associated with food intake (P=0·02) or not (P=0·07).

Counter to widely held belief, the use of a smaller bowl did not reduce snack food intake. Public health recommendations advising the use of smaller dishware to reduce food consumption are premature, as this strategy may not be effective.

Employing Rothschild’s Motivation–Opportunity–Ability framework, the present study examines the extent to which heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. Furthermore, the study investigates which dominant barrier profiles can be discerned.

Data were obtained from a survey about participants’ motivation, opportunity and ability to choose low-calorie over high-calorie snacks and an FFQ that measured habitual consumption of snack foods and beverages. Data were analysed using R packages lavaan and NbClust, and IBM SPSS Statistics.

A representative sample (n 1318) of the Dutch population based on gender (686 women), age and education level.

For both snack foods and beverages, motivation to choose low-calorie over high-calorie snacks was associated strongest with proportions of low-calorie choices. The perceived ability and perceived opportunity were also associated with proportions of low-calorie choices, albeit to a lesser extent. Furthermore, three dominant profiles of barriers were identified: the no-barrier profile, the lack-of-opportunity profile and the lack-of-motivation profile. These profiles differed significantly on proportions of low-calorie snack choices, daily meal consumption and sociodemographic characteristics.

Heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. By identifying and appreciating heterogeneity in barriers, the present study provides further incentives for the tailoring of intervention strategies.

To examine the relationships of monetary value of diets with sociodemographic and lifestyle characteristics and dietary intake among Japanese adults.

Cross-sectional study based on two nationally representative surveys: the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, 2013. Dietary intake was assessed by a 1 d semi-weighed household dietary record with information on individual proportion of intakes. Diet cost was estimated by linking dietary data with retail food prices. A wide variety of sociodemographic and lifestyle variables were obtained from the two surveys.

A random sample of nationally representative households in Japan.

Japanese adults aged 20 years or older (n 4658).

Lower energy-adjusted diet cost (Japanese yen/4184 kJ) was significantly associated with being younger, having a lower education, less equivalent monthly household expenditure, large household size, less physical activity and living in rented houses. Lower diet cost was associated with a lower intake of pulses, vegetables, fruits, fish, meat and dairy products, and a higher intake of grain, eggs, and fats and oils. At the nutrient level, lower diet cost was associated with a lower intake of protein, alcohol, dietary fibre, cholesterol and all vitamins and minerals examined, and a higher intake of carbohydrate. Diet cost was inversely associated with dietary energy density.

These data suggest that certain low socio-economic subgroups in Japan consume diets of lower monetary value, resulting in a lower quality of food and nutrient intake pattern except for lower sodium, cholesterol and alcohol consumption.

There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children’s non-core food and sweetened drink intakes and unhealthy dietary behaviours.

Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income.

Twenty-six primary schools in South Australia, Australia.

Children aged 9–13 years and their parents (n 395).

Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls’ sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys’ non-core food intake with monitoring, parent’s self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents’ self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment.

Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake.

To examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity.

Weight and height measurements were extracted from all visits for a sample of 0–4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity.

Baltimore, MD, USA.

Latino (n 210) and non-Latino (n 253) children, born in 2003–2004.

An increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth.

An increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.

To examine the weight-loss success associated with distinct dietary patterns and to determine changes of these dietary patterns during participation in a web-based weight-reduction programme.

Factor analysis was used to identify the dietary patterns of twenty-two food groups that were administered in 14 d dietary protocols at baseline and after 3 months. Successful weight loss (≥5 % of initial weight) and BMI were calculated. Logistic regression analyses were used to assess the rates of weight-loss success from each dietary pattern and changing or remaining in the initial dietary pattern. A generalised linear mixed model was used to estimate the effects of changing or staying in a dietary pattern on change in BMI.

Adults (n 1635) aged 18–81 years.

Users of a web-based weight-reduction programme (2006–2012).

Participants who aligned to a healthful dietary pattern at baseline (OR=1·8; 95 % CI 1·5, 2·3) and after 3 months (OR=1·5; 95 % CI 1·2, 1·9) had a greater chance of successfully losing weight. After adjusting for age, sex, initial dietary pattern and BMI, participants who started with or changed to the healthful dietary pattern had a greater chance of being successful (OR=1·4; 95 % CI 1·1, 1·7) and a higher BMI reduction of 0·30 (95 % CI 0·2, 0·5) kg/m2 compared with those who started with or changed to the energy-dense or high-carbohydrate dietary pattern.

A favourable healthful dietary pattern at the beginning and after 3 months was positively associated with anthropometry. However, successful weight loss was feasible in each dietary pattern.

The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels.

Descriptive statistics of trends and patterns in MF sales volume per infant/child for the years 2008–2013 and projections to 2018, using industry-sourced data.

Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations.

MF categories included total (for ages 0–36 months), infant (0–6 months), follow-up (7–12 months), toddler (13–36 months) and special (0–6 months).

In 2008–2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/child was positively associated with country income level although with wide variability between countries.

A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems.

To examine associations between food insecurity, excess body weight, psychosocial factors and food behaviours among low-income African-American families.

Cross-sectional survey of participants in the baseline evaluation of the B’More Healthy Communities for Kids (BHCK) obesity prevention trial. We collected data on socio-economic factors, food source destinations, acquiring food, preparation methods, psychosocial factors, beliefs and attitudes, participation in food assistance programmes, anthropometry and food security. We used principal component analysis to identify patterns of food source destinations and logistic regression to examine associations.

Fourteen low-income, predominantly African-American neighbourhoods in Baltimore City, MD, USA.

Two hundred and ninety-eight adult caregiver–child (10–14 years old) dyads.

Of households, 41·6 % had some level of food insecurity and 12·4 % experienced some level of hunger. Food-insecure participants with hunger were significantly more likely to be unemployed and to have lower incomes. We found high rates of excess body weight (overweight and obesity) among adults and children (82·8 % and 37·9 % among food insecure without hunger, 89·2 % and 45·9 % among food insecure with hunger, respectively), although there were no significant differences by food security status. Food source usage patterns, food acquisition, preparation, knowledge, self-efficacy and intentions did not differ by food security. Food security was associated with perceptions that healthy foods are affordable and convenient. Greater caregiver body satisfaction was associated with food insecurity and excess body weight.

In this setting, obesity and food insecurity are major problems. For many food-insecure families, perceptions of healthy foods may serve as additional barriers to their purchase and consumption.

To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand.

Cross-sectional surveys.

The two largest supermarket chains of each country in 2012/2013.

Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904).

For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.

At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices.

To introduce the concept ‘nutrition activation’ (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities.

Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes.

USA.

Adult participants (n 7825) in the 2007–2010 National Health and Nutrition Examination Survey.

Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger ‘spike’ in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d).

Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.

The goal of the present study was to apply experimental economic methods in an online supermarket to examine the effects of nutrient profiling, and differential pricing based on the nutrient profile, on the overall diet quality, energy and macronutrients of the foods purchased, and diet cost.

Participants were provided nutrient profiling scores or price adjustments based on nutrient profile scores while completing a hypothetical grocery shopping task. Prices of foods in the top 20 % of nutrient profiling scores were reduced (subsidized) by 25 % while those in the bottom 20 % of scores were increased (taxed) by 25 %. We evaluated the independent and interactive effects of nutrient profiling or price adjustments on overall diet quality of foods purchased as assessed by the NuVal® score, energy and macronutrients purchased and diet cost in a 2×2 factorial design.

A large (>10 000 food items) online experimental supermarket in the USA.

Seven hundred and eighty-one women.

Providing nutrient profiling scores improved overall diet quality of foods purchased. Price changes were associated with an increase in protein purchased, an increase in energy cost, and reduced carbohydrate and protein costs. Price changes and nutrient profiling combined were associated with no unique benefits beyond price changes or nutrient profiling alone.

Providing nutrient profile score increased overall NuVal® score without a reduction in energy purchased. Combining nutrient profiling and price changes did not show an overall benefit to diet quality and may be less useful than nutrient profiling alone to consumers who want to increase overall diet quality of foods purchased.

Conflicting data are available on the prevalence of binge eating behaviour (BE) in individuals seeking to lose or maintain weight. The present study aimed to estimate the prevalence of and the risk factors for BE in a large sample of men and women starting a weight loss or maintenance programme.

Cross-sectional study. BE was defined as a Binge Eating Scale (BES) score ≥18. The State-Trait Anxiety Inventory and the Italian Depression Questionnaire were used to assess anxiety and depression. Besides sex, age and BMI, marital status, educational level, smoking and physical activity were evaluated as potential risk factors for BE. Uni- and multivariable Poisson working regression models were used to estimate prevalence ratios (PR) and marginal probabilities.

Nutritional research centre.

Adults (n 6930; 72 % women) with a median age of 46 years (range 18–81 years) were consecutively studied.

BE prevalence in the pooled sample was 17 %. At multivariable analysis, being a woman (PR=2·70), smoking (PR=1·15) and increasing BMI (PR=1·05 for 1 kg/m2 increase) were risk factors for BE. On the contrary, being older (PR=0·99 for 1-year increase), performing physical activity (PR=0·89) and being married (PR=0·88) were protective factors for BE. Anxiety and depression were more common in subjects with BE.

BE is common in individuals seeking to lose or maintain weight. The prevalence of BE is higher in young obese women. However, BE is present also in men, elders and normal-weight subjects.

The purpose of the present paper is to examine the prevalence of metabolic syndrome (MetS) and its components using the harmonized definition in an interviewed sub-sample of diverse, low-income, adult South Asians (SA) of both sexes residing in Maryland. We also wanted to derive a BMI cut-off value that was highly correlated with the recommended waist circumference (WC) that we could apply to a larger sample of SA Americans for whom only BMI values were available from clinic files. We also examined differences in MetS prevalence among various Asian ethnic groups (defined by country of origin) and the clustering pattern of their MetS components.

Clinical data extraction on subjects (n 1002) and interviewees (n 401) were used in a cross-sectional study of SA Americans.

Two community health centres in Montgomery and Baltimore County, MD, USA.

SA adult males and females (n 1403) aged 20–68 years.

The prevalence of MetS using harmonized WC cut-offs (90 cm in men and 80 cm in women) was 47 % in men and 54 % in women. Using a BMI of 23·0 kg/m2 gave a similar prevalence of MetS for males (48 %) and females (47 %). Of the five MetS components, the prevalence pattern differed among the ethnic groups, particularly for SA Indians.

The prevalence of MetS in a diverse, low-income, SA American immigrant group using the harmonized definition was 51 %. Derived lowered BMI cut-off of 23·0 kg/m2 should be used by clinicians in studies on SA when WC values are not available for detecting metabolic risk. SA Indians had a higher prevalence of abnormal TAG and blood glucose values compared with other SA, and therefore results for SA Indians should not be generalized to all SA ethnic groups.

To investigate the nutritional status of North African (NA) immigrant women in Italy, analysing their body size, adiposity and body image perception in comparison to Italian natives and NA residents.

The study utilized a cross-sectional design. Anthropometric traits were directly measured and a few indices were computed as proxy measures of nutritional status and adiposity. Body image perception was assessed using silhouette drawings. ANCOVA, adjusted for age, was used to compare anthropometric traits among different groups of women and the χ2 test to analyse differences in the prevalence of nutritional status.

Italy and North Africa (Tunisia, Morocco).

A sample of 433 women aged 18–60 years old: NA immigrants (n 105); Italians (n 100); Tunisians (n 104); Moroccans (n 124).

Overweight/obesity prevalence was very high in immigrants (79·8 %). Immigrants had the highest BMI value, the greatest hip circumference and mid upper-arm circumference. Their triceps skinfold thickness was significantly higher than that of Italians, but lower than that of NA residents.

NA immigrant women in Italy showed a higher incidence of overweight compared with Italians and NA residents. All groups showed a preference for a thinner body in comparison to their actual bodies and the immigrants are the most dissatisfied. Immigrants remain a high-risk group for obesity. Assessment of their body composition and health risk profile should be improved by using specific anthropometric measures that are easy to collect even in the case of large migration flows.

The current study investigates (i) the extent to which breast-feeding and non-breast-feeding mothers follow the Canadian Nutrition for Healthy Term Infants (NHTI) recommendations; (ii) the first complementary foods given and the differences by breast-feeding status; (iii) whether any breast-feeding is associated with earlier introduction to complementary foods relative to non-breast-feeding, after controlling for potentially confounding factors; and (iv) the need for improvements in timing and resources of interventions by examining breast-feeding rates over time and information sources used by mothers.

Longitudinal data from the Kingston, Frontenac, and Lennox & Addington (KFL&A) Infant Feeding Survey were used. Mothers completed a survey at the end of their hospital stay and were interviewed by telephone at 2, 4, 6 and 12 months thereafter.

The study took place in the KFL&A region of Ontario, Canada.

The sample consisted of 325 mothers who gave birth to a live infant of at least 36 weeks’ gestation and a birth weight of at least 1500 g at Kingston General Hospital between January and July of 2008.

Four in five mothers introduced complementary foods prior to 6 months. Mothers not breast-feeding at 6 months introduced water, juice, infant cereals, fruit and vegetables, and foods not recommended by Canada’s Food Guide sooner than breast-feeding mothers. Breast-feeding mothers were more likely to introduce milks appropriately, but had low adherence to giving their infants vitamin D supplements.

To support adherence to NHTI recommendations, interventions should be conducted during early infancy and deliver consistent, evidence-based recommendations.

Both physical activity (PA) and diet are important contributors to health and well-being; however, there is limited information on the association of these behaviours and whether observed associations differ by weight. The present study aimed to evaluate whether nutrient intake is associated with PA and if this association varies by weight in young adults.

Cross-sectional study to analyse the association between PA and nutrient intake.

Participants were stratified as normal weight (18·5 kg/m2 <BMI <25·0 kg/m2) and overweight/obese (BMI≥25·0 kg/m2). PA level (PAL) was calculated (PAL=total daily energy expenditure/RMR) and used to stratify groups (PAL<1·6, 1·6≤PAL<1·9, PAL≥1·9).

Adults (n 407; age 27·6 (sd 3·8) years, 48 % male), with BMI between 20 and 35 kg/m2, having at least two 24 h diet recalls and at least 5 d (including two weekend days) of valid, objectively measured PA data were included in the analysis.

In normal-weight participants, higher PAL was associated with higher intakes of minerals (except Ca, Fe and Zn), B-vitamins and choline (P for trend <0·05). In the overweight/obese group, higher PAL was associated with higher intakes of fibre, K, Na and Cu (P for trend <0·05). These differences, however, were no longer significant after additionally controlling for total energy intake.

More active young adults have higher intakes of essential micronutrients. The benefits of PA may be predominantly due to a higher overall food intake while maintaining energy balance rather than a healthier diet.

To evaluate the reliability and validity of the FFQ administered to participants in the follow-up of the Melbourne Collaborative Cohort Study (MCCS), and to provide calibration coefficients.

A random sample stratified by country of birth, age, sex and BMI was selected from MCCS participants. Participants completed two FFQ and three 24 h recalls over 1 year. Reliability was evaluated by intraclass correlation coefficients (ICC). Validity coefficients (VC) were estimated from structural equation models and calibration coefficients obtained from regression calibration models.

Adults born in Australia, Greece or Italy.

Nine hundred and sixty-five participants consented to the study; of these, 459 participants were included in the reliability analyses and 615 in the validity and calibration analyses.

The FFQ showed good repeatability for twenty-three nutrients with ICC ranging from 0·66 to 0·80 for absolute nutrient intakes for Australian-born and from 0·51 to 0·74 for Greek/Italian-born. For Australian-born, VC ranged from 0·46 (monounsaturated fat) to 0·83 (Ca) for nutrient densities, comparing well with other studies. For Greek/Italian-born, VC were between 0·21 (Na) and 0·64 (riboflavin). Calibration coefficients for nutrient densities ranged from 0·39 (retinol) to 0·74 (Mg) for Australian-born and from 0·18 (Zn) to 0·54 (riboflavin) for Greek/Italian-born.

The FFQ used in the MCCS follow-up study is suitable for estimating energy-adjusted nutrients for Australian-born participants. However, its performance for estimating intakes is poorer for southern European migrants and alternative dietary assessment methods ought to be considered if dietary data are to be measured in similar demographic groups.

The formation of food brand associations and attachment is fundamental to brand preferences, which influence purchases and consumption. Food promotions operate through a cascade of links, from brand recognition, to affect, and on to consumption. Frequent exposures to product promotions may establish social norms for products, reinforcing brand affect. These pathways signify potential mechanisms for how children’s exposure to unhealthy food promotions can contribute to poor diets. The present study explored children’s brand associations and attachments for major food brands.

A cross-sectional online survey was conducted. Fourteen study brands were used, with each child viewing a set of seven logos. The questionnaire assessed perceptions of food brands and perceptions of users of brands, using semantic differential scales, and perceived brand ‘personalities’, using Likert scales.

New South Wales, Australia, October–November 2014.

Children aged 10–16 years (n 417).

Children demonstrated strong positive affect to certain brands, perceiving some unhealthy food brands to have positive attributes, desirable user traits and alignment to their own personality. Brand personality traits of ‘smart’ and ‘sporty’ were viewed as indicators of healthiness. Brands with these traits were ranked lower for popularity.

Children’s brand associations and attachments indicate the potential normative social influences of promotions. While children are aware of brand healthiness as an attribute, this competes with other brand associations, highlighting the challenge of health/nutrition messaging to counter unhealthy food marketing. Restricting children’s exposure to unhealthy food marketing and the persuasive nature of marketing is an important part of efforts to improve children’s diet-related health.

Although television (TV) viewing is frequently paired with snacking among young children, little is known about the environment in which caregivers promote this behaviour. We describe low-income pre-schoolers’ snacking and TV viewing habits as reported by their primary caregivers, including social/physical snacking contexts, types of snacks and caregiver rationales for offering snacks. These findings may support the development of effective messages to promote healthy child snacking.

Semi-structured interviews assessed caregiver conceptualizations of pre-schoolers’ snacks, purpose of snacks, snack context and snack frequency.

Interviews occurred in Boston, Massachusetts and Philadelphia, Pennsylvania, USA.

Forty-seven low-income multi-ethnic primary caregivers of children aged 3–5 years (92 % female, 32 % Hispanic/Latino, 34 % African American) described their child’s snacking in the context of TV viewing.

TV viewing and child snacking themes were described consistently across racial/ethnic groups. Caregivers described snacks offered during TV viewing as largely unhealthy. Labels for TV snacks indicated non-nutritive purposes, such as ‘time out’, ‘enjoyment’ or ‘quiet.’ Caregivers’ primary reasons for providing snacks included child’s expectations, behaviour management (e.g. to occupy child) and social time (e.g. family bonding). Some caregivers used TV to distract picky children to eat more food. Child snacking and TV viewing were contextually paired by providing child-sized furniture (‘TV table’) specifically for snacking.

Low-income caregivers facilitate pre-schoolers’ snacking and TV viewing, which are described as routine, positive and useful for non-nutritive purposes. Messages to caregivers should encourage ‘snack-free’ TV viewing, healthy snack options and guidance for managing children’s behaviour without snacks or TV.