Measuring Children’s Food Preferences Leann L. Birch, Susan A. Sullivan

M

ost people would like to eat nothing but their favorite foods. Liking is a primary determinant of intake patterns and nutritional status, and therefore needs to be addressed in the study of patterns of human food intake. However, as adults, an increasing number of considerations other than liking influence food consumption patterns. At least three categories of factors influence adult intake: 1) concerns about procuring food such as costs and ease of obtaining and preparing the food, 2) concerns about the consequences of eating such as healthfulness, fat content, satiety value, and other anticipated consequences of ingestion, and 3) cultural rules about what constitutes food within the culture, rules of cuisine, and food taboos. Concerns about procuring food, consequences of ingesting it, and knowledge of the cuisine rules of one’s culture result from socialization, including the acquisition of information about food and eating, that continues throughout childhood. These concerns appear late in development relative to affective reactions to food, which the infant shows from birth.’J In the early years of life, food likes and dislikes are the primary determinants of food intake.’ Children are not yet influenced by many of the considerations that influence adult food acceptance patterns. However, likes and dislikes are not fixed, but are modified by early socialization and experience. Parental concerns regarding procuring food, consequences of ingesting it, and rules of cuisine have an indirect effect on children’s food preferences and consumption These parental concerns influence whether or not a food is made available to the child. This, in turn, influences frequency and quality of exposure, both important determinants of liking. Given the primacy of children’s likes and dislikes, measures of preference can be especially useful as predictors of food consumption patterns. The child’s affective response to food and how to measure it are the focus of this paper.

DEFINITION OF TERMS Preference involves choice of one thing over others, In the strict behavioral sense, preference as choice implies nothing about the motivational process that leads to the choice. Defining preference in terms of behavioral choice has a history in the animal literature on learning and motivation.’ A definition of preference as behavioral choice is, however, unnecessarily restrictive. It ignores verbal or gestural indicators of children’s likes or dislikes, which often are given readily and spontaneously. For example, using a behavioral choice definition of preference, a child prefers liver over spinach, while other aspects of the child’s behavior, including verbal responses and facial expression, reveal that both are disliked. For these reasons, a definition of preference that ~

Leann L . Birch, PhD, Division of Nutritional Science, and Division of Human Development and Family Studies; and Susan A . Sullivan, MS, Division of Human Development and Family Studies, University of Illinois at Urbana-Champaign, Urbana, IL 61801.

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May 1991,Vol. 61,No. 5

encompasses affect as a basis for choice is appropriate. Throughout this review, preference refers both to 1) a continuum of hedonic response ranging from positive to negative, and 2) the relatively positive end of this continuum. Aversion refers to the negative end of the continuum. This approach moves beyond simple choice procedures, but makes measurement of preference less well defined. In measures of preference developed for children, the child is asked to make behavioral choices among foods based on affective reaction to the food. Because of the relatively direct relationship between preference and food intake in ~ h i l d h o o dinformation ,~ about children’s food preferences should predict whether a food made available to a child will be consumed.

PRE FE RE NCE ASSE SSME NT The preference assessment procedure was developed to obtain information from young children on their likes and dislikes for small numbers of foods. Most three-year-olds and nearly all older children can perform well in this task. Prior to actual assessment, performance of younger children can be improved by using a training procedure that involves a group demonstration of the procedure and one brief, individual training session. The session can be used to screen children, based on their ability to comprehend the task. In the preference assessment procedure, children are individually presented with a tray of no more than sevennine foods, small samples of which are contained in separate transparent cups. The child tastes each item in a self-selected order. After tasting a food, the child is asked to place it in front of one of three cartoon faces that corresponds to the child’s affective response to the food: a smile (like), a frown (dislike), or a neutral expression. In the second phase of the procedure, the child focuses on each category (like, dislike, and neutral) separately and rank orders the foods within the category: “Which of these foods do you like the very best?” That food is removed and the question is asked with respect to the remaining items. This procedure is repeated for each of the three categories. Rank ordering within categories can be combined to comprise a complete rank order on the foods. This two-part procedure yields both rank order and category data, and divides the rating task into two parts, making it easier for the younger child to complete successfully. This individualized assessment procedure has been used primarily to investigate how food preferences are shaped and modified by learning and experience.8 PSYC H O METRlC C HARACTE RIST ICS In early studies, each child was seen for a series of assessments, usually over a period of several days or weeks, thereby providing information on the reliability

American School Health Association

1990 Annual Review

FOREWORD The American School Health Association entered the 1990s with an impressive record of service and a strong commitment to the membership'scentral goal of promoting the development of healthy children and youth. ASHA's commitments to putting the membership first, and to providing superior services,programs and publications,were again evident. We are taking a number of steps to ensure that the Association's leadership continues in the years ahead. In 1990. we launched an aggressive membership serviceseffort aimed at both increasing the number of members and expanding servicesfor them. During the year, our new organizationalstructure for the first time linked members with similar professional interests to establish their own agendas.All told, 1,585members elected to join the newly formed sectionsand membership on the issue-orientedcouncils reached 3.208. Externally, the ASHA formed new or renewed partnerships with other organizationsinterested in the health of children and youth. Evidencing its growing reputation in child healthrelated research, the Association in 1990 secured four contracts for sponsored programs totaling $479,223. Through these and other achievements chronicled in the pages that follow, the ASHA truly has positioned itself for continued leadership in this new decade. We are proud to share our accomplishments with you. Working together has made us strong. Lloyd J. Kolbe. PHD, FASHA President Dana A. Davis Executive Director

SPONSORED PROGRAMS: ADVANCING THEORY AND PRACTICE Over the past decade, ASHA'S boldest advancement was its emergence as a significant force in child health-related research.Sponsored program support grew from virtually no activity in 1980 to $479,223in external funding during 1990 alone.

A study, funded by a $82,058grant from the American Foundation for AIDS Research,compared the effectivenessof using a widely-usedHIV curriculum alone to more comprehensive interventions incorporating it with other resources serving the school and community. Another project, funded by a $24,000 "Project Reach" grant from the Metropolitan Life Foundation,produced AIDS education materials which will be distributed free to 5.000 school districtsserving K-6 students.The materials range from student workbooks to guides for teachers and parents.

HW Education and Prevention Through a broad range of sponsored projects,the Association has taken national leadership in the fight against HW infection and AIDS among children and youth. ASHA'S largest and most comprehensive project, entitled "School-BasedHIV Education:A Multidisciplinary Approach to Prevention," is funded with a five-year, $5oo.O0O grant from the National AIDS Education Program. Center for Chronic Disease Control. It targets children and youth K-12 to avoid lifestyle behaviors that place them at risk for contracting the Human Immuno-DeficiencyVirus, or HIV. During 1990, the third year of the project,ASHA led development of elementary-level HIV-related materials for students,parents and teachers. Other partners in this project were the National P'L4 and the National Education Association Health Information Network. Three manuals providmg practical approaches to HW education in schools,coalition building throughout the community,and specific issues for school nurses were drafted and currently are under CDC review. For 199I , the Association vnll strive to reach more schools and professionals with HIV education.Some 5.000 elemen-

tary schools will receive ASHA's HIV prevention cumculum. New materials will be released to better prepare school nurses for dealing with HIV infection in the school setting.In addtion, a popular school health cumculum index will be revised to include AIDSRIIV content and resources, and an instrument was developed to assess the status of comprehensive school health and HIV education programs in local schools. In addition to the CDC project, ASHA completed two other important contributions to the cause of HIV prevention during the year.

ComprehensiveSchool Health Programs ASHA also is striving to shape the future model of comprehensive health education programs under a two-year,$227,342 award from the US.Department of Education,Secretary'sFund for Innovation in Education. Reflecting the Association'smultidisciplinary thrust, the project involves teams of personnel from three participating schools in developing comprehensive school health programs for their students. Each team is comprised of an administrator. school nurse, counselor,health educator, physical educator, food service director, parent representative and director of health promotion for faculty and staff. The first year focused on inservice training and assessment of local programs. During the 1990-91 and 1991-92school years,action plans developed during the training will be implemented,evaluated and re-implemented.

ASHA ANNUAL REVIEW

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Governance New structure empowers membership to mold ASHA agenda, pursue specific professional concerns

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ASHA ANNUAL REVIEW

In its first year of operation, ASHA'Snew organizational structure stimulated greater collaboration among members, thereby expanding the Association'sagenda and its capacity to respond to far-reaching issues affecting school health professionals, children and youth. All told, 1,585 members elected to join newly formed sections and membership in councils topped 3,208. During the year, groups completed organizational activities, and produced conference presentations and program proposals. One section, International Health,successfully launched a new center on international school health. The center, a two-year joint venture by ASHA and the University of Toledo,will collect and categorize information on international school health issues. ASHA'S new governing system was adopted in 1989 after several years of planning. It expands participation in decision making by including representatives from constituent groups, sections, councils,and affiliates on the new Board

of Directors. The new thrust also aims to expand ASHA membership beyond the traditional base of health professionalsto administrators, school board members, parents and other school-siteprofessionals concerned about the health and well being of youth. Three sections, or discipline-oriented subgroups, represent health educators. physicians and school nurses. Ten constituent groups hold voting representation in proportion to their dual membership. Constituentsinclude the Arizona School Health Association,Connecticut Association for School Health, Illinois School Health Association, Kentucky Association for School Health, Maryland State School Health Council, Massachusetts School Health Association - COHES, Pennsylvania School Health Association, Texas School Health Association, West Virginia School Health Association and Wisconsin State School Health Council. Councils,formed around specific school health issues, include: early childhood health education and services. health behaviors, international health, nutrition education and school-based food services,physical education and physical activity program administration, research, school-basedprimary health care, school health instruction and cumculum, sexuality education, and young professionals. During 1990,the number of affiliates grew from two to 10. Currently,affiliates with nonvoting privileges include:Center for Population Options, Council of Health Education Programs in Higher Education. Florida Association of Professional Health Educators,Florida School Health Association, Health Educators Association of Alabama, Indiana Association of Educators, Michigan School Health Association, National Association of State School Nurse Consultants, National PTA, and the School Health Association of Washington.

In keeping with its collaborativespirit. ASHA'S 64th Annual Convention carried the theme, "Partnershipsfor School Health:' Held October 17-20in Long Beach, California, the convention offered more than 100 workshops, educational sessions, roundtable and research presentations offering diverse perspectivesand new ideas for linking school health professionals, concerned organizationsand families toward the goal of improving the health of America's youngsters.The program also featured 4 1 exhibitors,seven career displays. and 1 1 literature displays. Keynote speaker for the conference was J. Michael McGinnis, MD. one of the nation's highest ranking policy makers in the area of disease prevention and health promotion. Dr. McGinnis is deputy assistant secretaryfor health and director of the US.Office of Disease Prevention and Health Promotion.He also holds the rank of assistant surgeon general. Dr. McGinnis described three broad health-relatedgoals for the nation issued in the forward-lookinggovernment

report, Healthy People 2000: National Health Promotion and Diseare Prevention Objectives. Its general aims are to increase the span of healthy life for Americans, to reduce health disparities among the population, and to achieve universal access to preventive services. He noted that successful school health programs are a key to attaining these goals. "Planned and sequential health education in the school setting is crucial for helping children and youth develop the increasinglycomplex knowledge and skills they need to avoid health risks of childhood and adolescence," Dr. McGinnis said. He stressed that school health programs have the potential to make an even greater impact by enabling individuals to make informed choices about behaviors that will affect their own health, as well as the health of their families and the communitiesin which they live. The 1991 conventionwill be held October 17-20at the Hyatt Regency Dearbom in Dearbom,Michigan. Its theme is "Promoting an International Responsibility for Healthy Children."

ASHA ANNUAL REVIEW

TOOLS OF THE TRADE ExpandingASHA libraykeeps members

abreast of new developments

4

A S H A ANNUAL R E V I E W

ASHA publicationsserve as primary tools for professionals interested in developing, implementing,evaluating and promoting effective school health programs in their communities.In 1990, several new publications- as well as some longstandingfavorites - were developed or revised to include the latest information affecting school health. ASHA'S flagship publication, the Journal of SchoolHealth enables professionals to share their practice success,research findings and insights.It is published 10 times annually and circulates in the US. and 56 foreign countries. With theJoumal4 growing stature in the school health field,ASHA has been successful in garnering external support for supplemental issues examining pivotal issues and concerns. During 1990, two supplementalissues were published. An April 1990 supplement, funded by the Metropolitan Life Foundation,examined "Comprehensive School Health Programs: Current Status and Future Prospects." A September 1990 supplement,funded by the MacArthur Foundation, explored the topic of "International Perspectives and Comparison of School Health Programs:' In January 1% 1, the Centers for Disease Control sponsored a %-page insert providing a teen-age teaching module study. Planned for May 1991 is a special issue focusing on physical activity and diet assessment in school-ageyouth. To provide members with a convenient, low-cost way to study specific topics. ASHA also offers collectionsof recent joumal articles on timely and important issues in the health professions.The collections, known as topical packages, cover subjects such as alcohol and tobacco use, human sexuality,AIDS, teaching techniques,and health services applications.Topical packages are the ;t-dlingof all ASHA public:ations.

Also among 1990'sbestsellers were: 0Science and Health Expenments and Demonstrations in Smoking Education. a 1989publication presenting 39 teachertested experiments which convey scientific methods as well as important health topics related to smoking.ASHA published the manual for teachers K- 12 in cooperation with the U.S. Office on Smoking and Health, Centers for Disease Control. 0Achieving the I 990 Health Objectives for the Nation: Agendafor the Nation 3 Schook, a 1988 publication which defines the role of schools in obtaining national initiatives to improve the health and wellbeing of Americans. The manual was developed under a three-year,$133,000 cooperativeagreement with the Office of Disease Prevention and Health Promotion. 0Evaluating School Nursing Practice:A Guidefor Administratorsand Standard of School Nursing Practice continued to be popular with ASHA members. These works admse readers how to improve nursing practice in school settings. Several new works are in the publication process as this report goes to press: 0National AdolescentStudent Health Survq.:Summau of Findings and Replication Package, which describes results of the first national survey in more than 20 years to determine the behavior, knowledge and attitudes of America's teens on health and sex-relatedissues.The 1988 study was cosponsored by ASHA. the Association for the Advancement of Health Education and the Society for Public Education under a U S . Department of Health and Human Servicesgrant.

Additional HIV education materials under development: Building Efective Coalitions to Prevent the Spread of H N a manual instructing readers how to organize broad-based efforts for preventing HIV infection and AIDS: and HA7 Jnfection and the School Settihg A Guide for School Nursing Practice, a publication for nurses dealing with HIVinfected persons in schools. 0School Health in America: An Assessment of Policies to Protect and Jmprove the Health of Students, the fifth edition of a landmark study first published by ASHA in 1976.A cooperative venture with the University of Texas Health Sciences Center at Houston, the new fifth edtion will give expanded coverage to state policies regarding physical education, counseling, psychology and school food services,as well as the traditional elements of health instruction,health services and the school environment. 0 Eaching Human Sexualits: a practical guide providmg grade-appropriateconcepts, content and resources, as well as suggested steps for implementation, communication strategies, handling controversial issues, adapting to individual school or community needs, and evaluating sexuality education programs. 0Health Counselihg which provides school-basedprofessionals with information regarding the counseling process, as well as health issues such as substance abuse. human sexuality,loss, and personal health that can be positively impacted by counseling strategies.

0School Health Marketing Kit, an innovative package offering admce and examples to use in promoting school health. The kit includes tools to increase community awareness of the value of school health programs such as school health support statements, program planning guidelines, community program ideas, and publicity information. 0 The Role ofthe Nurse in the School Settihg A Historical VimasRejected in the Literature, which traces the evolution of the profession from 1902 through 1982.

JOURNAL OF SCHOOL HEALTH Topical Packets 1984 - 1988

17School-BasedHJVEducation: A MultidisciplinazyApproach to Prevention, a manual addressing strategies, classroom activities across the curriculum. and other issues in the fight against AIDS.The manual is being prepared under a fiveyear, $500,000cooperative agreement between ASHA and the Centers for Disease Control.

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Scholarships

During 1990,five task forces directed their talents toward specific issues that ultimately may assist in promoting healthy youth. 0The Taslz Force on Gay Youth in Schools drafted a position statement on gay and lesbian youth in schools,which was adopted at the national convention in October. The statement urges schools to create educational environments demonstratingrespect for the dignity and worth of all students.It promotes equal educational opportunity and use of nondiscriminatory curriculum materials,teaching strategiesand school policies. Further, schools are encouraged to provide access to professional counselingfor students who may be concerned about their sexual orientation. 0The Universal Student Health Record Task Force, with representationfrom other organizations,confirmed the need for a standardized record which would allow student health data to be transferred among schools.In I 99 1, ASHA will pursue external support to develop a pilot effort. 6

ASHA ANNUAL REVIEW

for Research and Development Task Force developed and won approval of an admsory board to ASHA'SOff ice of Sponsored Programs. The board assists the Association staff in identifyng research and development priorities and potential funding sources.The task force also supported continued work on yet-to-be funded projects concerning drug abuse prevention, continuing education for RNs. the administrationof medications within schools,and updating of the highly successfulwork, The Role of Schools in Achimihg the Health OLjecfivesfor rhe Nation-Year 2000. 17 The Task Force on

ASHNUniversityKoUege Partnerships, as its name suggests,is exploringways that ASHA may forge stronger ties with university-basedmembers, both professionals and students. 0Also during 1990, the Task Force on Corporate Partnerships developed guidelines and criteria for establishing appropriateand effective linkageswith the private sector. Group members hope their efforts will attract more corporate sponsors to the cause of improving school health education and services.

During 1990,ASHA awarded scholarshipsto three exceptional college students pursuing studies in medicine, health education,and nursing. Designed to support professionals-to-befrom the Association's three primary disciplines, the scholarshipprogram annually provides three $500 merit-basedawards. The 1990 scholarshiprecipients were Yolimar Canahuate. a senior at Rutgers University who will be attendingTemple University School of Dental Medicine; Judy Jackson,a junior at Norfolk State University majoring in health education; and Nancy Zaneski. a graduate student in the school nurse certification program at Pacific Lutheran University ASHA offers full-timestudents a reduced annual membership fee of $25. compared to $70 for regular status.

Sexuality Education During the year, ASHA joined the newly formed National Coalition to Support Sexuality Education,a broad-basedcoalition aiming to ensure that all children and youth receive comprehensive sexualityeducation by the year 2000. To reach this goal, the coalition advocatessupportive public policy at federal and state levels, assists youth-concemed organizationsin implementing policies and programs, provides opportunitiesfor networking,resource sharing and collaboration on a national level, and develops strategiesfor assuring local implementation of sexuality education initiatives and efforts.

1990 ASHA Award Recipients Guy S. Parcel, PhD. FASHA WilliamA. Howe Award Melody Powers Noland. PHD, FASHA Dirtinguished Service Award James H. Price. PhD. MPH, FASHA Distinguished ServiceAward Barbara A. Rienzo. PhD. FASHA Distinguished Service Award Susan (Seffrin) Thomas, MS, FASHA Distinguished Service Award Genie L. Wessel, RN. MS, FASHA Distinguirhed Service Award Cheryl L. Perry, PhD Research CouncilAward Doris M. Cullen. RN. BA OutstandingSchool Nurse AchievementAward Shem Reynolds, BSN. Ms Outstanding School Health EducatorAward

1990 Life Members William B. Cissell. MSPH. PhD. CHES Denton. TX James Eitner, DO Phoenix, AZ Tetsuro Kawabata Kobe Hyogo. Japan Christine A. Mulligan. EdD Coventry, RI Barbara A. Rienzo, PhD. FASHA Gainesville. FL Delmar J. Stauffer. MS Oakbrook. IL Jill W. Vames. EdD Gainesville. FL

1990 Fellows Jeffrey Black, MD. FASHA Dallas, TX Wanda H. Jubb. EdD Langsing. MI Patrick K. Tow, PhD Norfolk, VA Genie L. Wessel. RN. MS. FASHA Baltimore. MD

Sustaining Members These institutions and corporations have expressed their commitment to. and support of, high-quality comprehensive school health programs by enrolling in the American School Health Association as sustaining members. The contributions of these organizations support Association activities that provide children and adolescents with the programs, services.and environment necessary to promote health and to improve learning.

SAVORING THE SPOTLIGHT Among the 1990 awardees were GwParcel. PhD. FASHA. Recipient of the 1990 WilliamA. Howe Award, and Chegl L. P e g PhD, recipient of the 1990 Research CouncilAward.Presented annually in memog of ASHA3founder andfirstpresident.the Howe award honors outstandingcontn3utiomto the health of America 3 children.

Endowment Club Burroughs Wellcome, Co.. Research Triangle Park. NC; McGovern Fund for the Behavioral Sciences,Houston. TX; LeeminglPacquin Divisions of Pfizer, Inc.. New York. NY: Personal Products, Milltown, NJ: Tambrands, Inc.. Lake Success, NY.

Century Club Center for Health Promotion Research and Development, University of Texas Health Science Center, Houston, TX; Commercial Press Inc.. Kent, OH; Dept. of Applied Health Science, Indiana University, Bloomington,IN: Dept. of Health Science Education, University of Florida. Gainesville. FL: Rohrich Corp.. Akron, OH.

ASHA ANNUAL REVIEW

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Board of Directors 1990-91

Executive Committee Larry K. Olsen. DrPH. FASHA Resident Professor Dept. of Health Education The PennsylvaniaState University University Park, PA

1991Resident Long K Oken

May L. Michal. MD. FASHA Resident-elect Associate Professor Dept. of Pediatrics Eastem Tennessee State University Johnson City. TN Alicia A. Snyder,MA, RN, FASHA Kce President Nursing Services Albuquerque Public Schools Albuquerque, NM Lloyd 1. Kolbe. PhD. FASHA Immediate Past Resident Director Div. of Adolescent and School Health Centers for Disease Control Atlanta. GA Susan Thomas,MS Chait; Bu&et and finance Committee Chicago. IL Elaine J. Stone. PhD Chait; Editonal Board Health Scientist Administrator National Heart. Lung and Blood Institute Rockville, MD John Santelli.MD. MPH Board of Directors Representative Baltimore City Health Dept. Baltimore. MD

Hollie Walker. Jr. PhD Board of Directors Representative Dept. of Health, Physical Education and Recreation Memphis State University Memphis,TN

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ASHA ANNUAL REVIEW

AtLmge

TernExpiring I991

John Santelli.MD, MPH Physicians Baltimore City Health Dept. Baltimore, MD

Bernice ?! Baxter, RN, MEd Philadelphia, PA

Lenore Zedosky RN. BSN. MN School Nursa West Virginia Dept. of Education Charlestown. WV

Elaine E Brainerd. RN. MA, CSN Middletown. CT

Councils

Bette L. Denlinger. RN. BS. MA Mesa, AZ

Joann Gephart. RN. MSN Rockville, MD Cynthia Wolford Symons, DEd Kent, OH

Ern Expiring I992 Claudia Talbert Bays, RN. BSN. MA Sacramento. CA Jeffrey Black, MD. FASHA Dallas, TX Joyce W. Hopp. RN. MPH, PhD. FASHA Loma Linda, CA Dorothy S. Oda. MS. RN. DNSC San Francisco. CA Barbara A. Rienzo, PhD. FASHA Gainesville, FL

TernExpiring 1993 Rosemary K. Gerrans, BS, RN. MPH Elgin. 1L Robert S. Gold, PhD. DrPH Arlington,VA Janice M. Ozias. RN. BSN. MA Austin,TX David L. Poehler, PhD Atlanta. GA

Charlotte M. Hendricks. HSD Ear& Childhood Health Education and Services University of Alabama at Birmingham Birmingham,AL David K. Lohrmann. PhD. CHES Health Behaviors Troy School District Troy, MI Charles E Kegley. PhD. FASHA. CHES International Health Kent State University Kent, OH Hoke Walker, Jr., PhD Nutntion Education and School-basedFood Services Memphis State University Memphis. TN Joann Owens-Nausler.MPE Physical Education and Physical ActiviQ Nebraska Dept. of Education Lincoln, NE LuAnn Nauman. RN. MSEd. FASHA Program Administration Topeka Public Schools Topeka. KS Guy Parcel. PhD Research University of Texas Health Science Center for Health Promotion Houston, TX

Genie L. Wessel, RN. BSN, MS, FASHA Baltimore.MD

R. Morgan Pigg. Jr.. HSD. MPH. FASHA Editor Journalof School Health

Richard Fopeano. PhD School-based Primary Health Care Atlantic City Mental Health Center Atlantic City, NJ

SeCtiOnS

Dana A. Davis. MEd. FASHA Executive Director American School Health Association

Malcolm Goldsmith,PhD, CHES Health Educators Southem Illinois University Edwardsville. IL

Susan K. Telljohann School Health Instruction and Cumculum Toledo. OH

James 1. Neutens. PhD SexualityEducation University of Tennessee Knoxville, TN C. Greg Wojtowicz. PhD

Poung Professionals University of Alabama at Birmingham Station Birmingham. AL

Affiliates”

ASHA staff

Jean Hyche Williams. M S N EdD Centerfor Population Options Support Center for School-BasedClinics Washington,DC

National Oflice Stafi-

constituents

Richard St. Pierre, PhD Council of Health Education Progam in Higher Education The Pennsylvania State University University Park. PA

Dons Cullen. RN. BA 4rizona School Health Association Monterey Park School Phoenix. AZ

Steve M. Dorman. PhD Florida Association of Professional Health Educators Gainesville. FL

Diane Celeste lbnnecticutAssociationjor Tchool Health Zhesire. CT

Shem Reynolds, BSN. MS, CHES Florida School Health Association Sarasota. FL

Lois Frels. RN. MA, PhD. FASHA UinoisSchool Health Association Hillsdale. IL

Steve Nagy, PhD Health Educators Association of Alabama Tuscaloosa. AL

Melody I? Noland. MS. PhD rlentuckyAssociationfor School Health University of Kentucky Lexington. KY

Kelly Bishop. MA Indiana Association of Health Educators Indiana State Board of Health Indianapolis,IN

lohn Krager. MD Maryland State School Health Ibuncil Baltimore County Health Dept rowson. MD

Sharon Cobb. BS. MA Michigan School Health Association Ypsilanti. MI

mchael Gill MassachusettsSchool Health 4ssociation-COHES Cohassett Senior High Cohassett.MA

Lon Bechtel Penmylvania School Health Association Altoona. PA Josey Davenport. RN Pxas School Health Association Meadows Elementary School Sugarland.TX

Bernice Baxter, RN. MEd National Association of State School Nurse Consultants Philadelphia. PA Millie Waterman National PTA Chicago, IL Corine J. Olson School Health Association of Wahington Seattle, WA “withoutvotingprivilem

Diane D. Allensworth.RN. PhD. Associate Executive Director for Programs; Faye Bell, Administrative AssistantlMembership Sewices: Dana A. Davis, Executive Director; Betty L. Fowler, Receptionistlkcretary to Editorial Sewices; Kathleen Hogan, Administrative AssistantlMarketing Services: Dianne L. Kerr. MA. MEd. Director of AIDS Programs; Sara B. Kline. Bookkeeper; Lisa E. Noland. Administrative Assistant and Secretary of the Board of Directors; Thomas M. Reed. Director, Editorial Services and Managing Editor,Journal of School Health; Michael 1. Schilling, Director, Marketing Services: Robert J. Synovitz.HSD. FASHA, Director, Membership Services;Sally Lou White, Membership Records Secretary;Mark A. Williamson. Editorial Services Associate and Assistant Managing Editor.Journal of School Health;and Suzanne Youngblood.Administrative AssistantlSponsoredPrograms.

1990 President Lloyd/.Kolbe

Fiejd StaJ R. Morgan Pigg. Jr., HSD. MPH. FASHA. Editor, and Rick Gabler. Advertising Sales Representative, Journal of School Health;and Patricia A. Millhoff. Association Counsel.

IndepndentAuditon Donald A. Wetzel, CPA, and Midcap. Simpson & Company, CPA. Coppriting Desw. Production: CharleneK. Reed Photography pages 2 & 6. Prince George’sCountyPublic Schools / James Shemood;p a g 3. Mark A. Williamson.

Helen D. Diserio, RN WfitVirpiniaSchool Health Association Wellsburg.WV Ken R. Wagner. MS Wisconsin State School Health Council Waunakee. WI

ASHA ANNUAL REVIEW

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The American School Health Association- the only multidsciplinary association dedicated to promoting the health of children and youth through high-qualityschool health programs - serves a membership of educatorsat all levels.nurses, physicians,researchers, students and other school-based professionals. Association policy and direction is enacted by a so-memberBoard of Directors.The Board meets annually and empowers interim authority in the ASHA Executive Committee.The Association'svarious committees and task forces examine current issues and recommend action. The Association's annual operating budget is approximately$800.000.

American School Health Association 7263 State Route 43 PO. BOX 708 Kent, Ohio 44240-0708 2161678-1601

FAX 2 161678-4526

of the preference measure. When rank orders obtained for the same foods on successive occasions were correlated, the mean tau value was .58.9 Older children’s preferences showed more stability over time; 80% of the four-year-olds’ tau values were significant, while only 35% of the three-year-olds were significant. Lack of stable preferences does not necessarily reflect error of measurement. Preferences vary systematically with time of daylo and through the course of a meal.” Validity of this preference method as a predictor of intake was assessed using preference and consumption data from the same children.’ Preference data were obtained as described, while consumption data were based on preweighing and postweighing of ad libitum consumption in a self-selection snack setting in which the children could select from the array of foods used in the preference assessment. The multiserial correlation was .80 (p c .01). Using survey methodology, correlations between preference measures and consumption in studies of adult civilian and military personnel ranged between .30 and .80.’* The stronger relationship for children may reflect a developmental difference in the importance of liking as a determinant of food intake between the two groups, as discussed in the introductory section, or it may result from differences in method. In the initial ~ t u d i e s , ~using . ~ multidimensional scaling of the preference indicators, two dimensions emerged that accounted for more than 60% of the variance in the preference data, in about equal proportions. These two dimensions were identified as sweetness and familiarity. Sweetness as an important determinant of children’s food preferences was not surprising; liking for sweet appears to be unlearned and present at birth.” However, the finding that familiarity was so central to the children’s preferences was unexpected; familiarity is not a characteristic of a food but a function of the child’s early experience.

DISCUSSION Alternatives for Measuring Preference

The categorization portion of the children’s procedure is analogous to a category scale with three values. For older children who understand and can use the number system in an adult manner, visual analog scales with more values could be used instead of this simple, three-valued system. However, this procedure has had limited application2 and no data on reliability or validity are available. Another feature of the preference assessment procedure is that it involves actual tasting of food samples as the basis for the child’s judgment. This practice can be an advantage or disadvantage. On the positive side, tasting of foods as the base for preference judgments produces high predictive validity with respect to consumption patterns. However, use of real foods as stimuli becomes increasingly difficult logistically as the numbers of children and foods increases. Even for the older school-aged child, who can tolerate a longer session involving a greater number of stimuli, this method is not feasible for obtaining preference data on a large array of food items. Use of stimuli other than real foods can allow the investigator to obtain information on many more foods, from a larger sample of children for the same invest-

ment of resources. Food models, photographs, or drawings of food, as well as verbal descriptors occasionally have been used to elicit preferences.14J5 No data are available regarding reliability and validity of such procedures. While such procedures are more manageable, error is introduced and probably increases if food models, photographs, and verbal descriptions of foods are substituted for real foods. Potential shortcomings of procedures that do not involve tasting real foods are indicated by preferences for foods based on one modality (visual judgments) that are not strongly related to taste preference.I6 Reliability and validity data on such alternative procedures are needed to make informed decisions about the most appropriate method for a particular research question. It is possible that surveys developed for use with military recruits could be adapted for use with school-aged children.” Uses for Preference Measures

Preference data could be useful in constructing menus for school feeding programs that would maximize consumption, thereby minimizing waste. Measures of food preference also could provide valuable information in evaluating nutrition education programs for children. The relationship between knowledge (of nutrition in this case) and behavior (consumption) is especially problematic for nutrition educators. Preference information could help to tease out these relationships. For example, while nutrition information might produce changes in intake of foods that are hedonically neutral, it is less likely that nutrition information alone will lead to increased consumption of nonpreferred foods or to restrictions on intake of highly preferred foods.

CONCLUSION Because of the centrality of preference to food acceptance for children, measures of preference can be particularly valuable in understanding their food acceptance patterns. The methodology developed has proven useful in investigating factors influencing development of preferences and food acceptance patterns during the first years of life. Results of research comparing preference data and consumption measures indicate young children can provide reliable, valid information about their preferences, and these preferences can be modified through a variety of processes. However, there are limitations accompanying to methodology, and alternative assessment procedures remain to be developed for use with older children and with larger samples. References 1. Fallon AE, Rozin P, Pliner P. The child’s conception of food:

The development of food rejections with special reference to disgust and contamination sensitivity. Child Dev. 1984;55:566-575. 2. Rozin P. The acquisition of food habits and preferences. In: Matarazzo J, Weiss SM, Herd JA, Miller NE, Weiss SM, eds. Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. New York, NY: Wiley and Sons; 1984:590-607. 3. Birch LL. Preschool children’s food preferences and consumption patterns. J Nutr Educ. 1979;11:189-192. 4. Birch LL. The relationship between children’s food preferences and those of their parents. J Nutr Educ. 1980;12:14-18. 5 . Pugliese MT, Weyman-Daum M, Moses N, Lifshitz F. Parental health beliefs as a cause of nonorganic failure to thrive. Pediatrics. 1987;80:175-182.

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6. Costanzo PR, Woody EZ. Domain-specific parenting styles and their impact on the child’s development of particular deviance: The example of obesity proneness. J Soc & Clin Psychol. 1985;3: 425-445. 7. Young PT. Role of hedonic processes in the development of sweet taste preferences. In: Weiffenbach JM, ed. Taste and Development: The Genesis of Sweet Preference. Bethesda, Md: US Dept of Health, Education, and Welfare; 1977. Publication no NIH 77-1068. 8. Birch LL. Children’s food preferences: Development patterns and environmental influences. In: Vasta R, ed. Annals of Child Development. Greenwich, Conn: JAI Press; 1987: 131-170. 9. Birch LL. Dimensions of preschool children’s food preferences. J Nutr Educ. 1979;11:91-95. 10. Birch LL, Billman J, Richards S. Preschool children’s food sharing with friends and acquaintances. Child Dev. 1984;57:387-395. 1 1 . Rolls BJ, Hetherington M. The role of the variety in eating and body weight regulation. In: Shepard R, ed. Handbook of the Psychophysiology of Human Eating. New York, NY: Wiley and Sons;

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198957-84. 12. Peryam DR, Pilgrim FJ. Hedonic scale method of measuring food preferences. Food Techno1 Sympos. 1957:9-14. 13. Steiner JE. Facial expressions of the neonate infant indicating the hedonics of food-related chemical stimuli. In: Weiffenbach JM, ed. Taste and Development: The Genesis of Sweet Preference. Bethesda, Md: US Dept of Health, Education, and Welfare; 1977:173-188. Publication no NIH 77-1068. 14. Fischler C, Chiva M. Food likes, dislikes and some of their correlates in a sample of French children and young adults. In: Diehl JM, Leitzmann C, eds. Measurement and Determinants of Food Habits and Food Preferences. Wageningen, The Netherlands; EuroNut Report 7; 1985:137-156. 15. Pliner P, Pelchat ML. Similarities in food preferences between children and their siblings and parents. Appetite. 1986;7:333-342. 16. Birch LL, McPhee L, Shoba BC, Steinberg L, et al. “Clean up your plate:” Effects of child feeding practices on the development of intake regulation. Learn Motiv. 1987;18:301-317.