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A Review of Family and Social Determinants of Children’s Eating Patterns and

Diet Quality

Article  in  Journal of the American College of Nutrition · May 2005

DOI: 10.1080/07315724.2005.10719448 · Source: PubMed

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Review

A Review of Family and Social Determinants of

Children’s Eating Patterns and Diet Quality

Heather Patrick, PhD, Theresa A. Nicklas, DrPH

Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Key words: children’s eating patterns, children’s dietary quality, determinants of children’s eating patterns, review

With the growing problem of childhood obesity, recent research has begun to focus on family and social
influences on children’s eating patterns. Research has demonstrated that children’s eating patterns are strongly
influenced by characteristics of both the physical and social environment. With regard to the physical environ-
ment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater
quantities when larger portions are provided. Additionally, characteristics of the social environment, including
various socioeconomic and sociocultural factors such as parents’ education, time constraints, and ethnicity
influence the types of foods children eat. Mealtime structure is also an important factor related to children’s
eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether
families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also
play a direct role in children’s eating patterns through their behaviors, attitudes, and feeding styles. Interventions
aimed at improving children’s nutrition need to address the variety of social and physical factors that influence
children’s eating patterns.

Key teaching points:

• Importance of the physical and social environment in children’s eating patterns.
• Physical environment includes food availability, accessibility, and portion size.
• Social environment includes socioeconomic and sociocultural factors and mealtime structure.
• Parents’ behaviors, attitudes, and feeding styles also contribute to the social environment.
• Nutrition interventions should address a variety of characteristics that influence children’s eating.

“If we could give every individual the right amount of nour-
ishment and exercise, not too little and not too much, we would
have found the safest way to health.” Hippocrates 460 –377 BC.
INTRODUCTION AND BACKGROUND
Childhood obesity has become a serious public health prob-
lem. According to 2003 data, one in four children under the age
of 18 are at risk for overweight, and 15% are overweight [1].
The prevalence of overweight among 4- and 5-year olds in-
creased from 5% to 10.4% from 1976 to 2000 [2]. Obese
children tend to become obese adults, putting them at greater
risk for heart disease, hypertension, diabetes, and cancer [3].
Thus, researchers have begun to examine factors that influence
eating behaviors and dietary quality, particularly in young
children. By the time children are 3 or 4 years old, eating is no
longer deprivation-driven but is influenced by their responsive-
ness to environmental cues about food intake. Thus, a variety of
family and social factors influence children’s eating behaviors.
Eating behavior has been conceptualized as a function of the
social and physical environment [4]. The development of eating
behaviors is affected by factors such as availability of and

Address correspondence to: Heather Patrick, PhD, Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030.
E-mail: hpatrick@bcm.tmc.edu
Presented at the 44th Annual Meeting of the American College of Nutrition, Nashville, TN, October 9 –12, 2003.
This work is a publication of the United States Department of Agriculture (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College
of Medicine, Houston, Texas. The contents of this publication do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial
products, or organizations imply endorsement from the U.S. Government. Partial support was received from the National Dairy Council.

Journal of the American College of Nutrition, Vol. 24, No. 2, 83–92 (2005)
Published by the American College of Nutrition

83
Determinants of Children’s Eating Patterns
preference for particular foods, portion size, cultural values
regarding food types and preparation, parents’ beliefs and prac-
tices, mealtime structure, and feeding styles. Research has
shown that the family strongly influences childhood eating
practices, including children’s attitudes toward food [5] and
children’s assessment of satiety [6], factors which may later
influence children’s weight. Clearly the family and other social
factors influence children’s eating patterns which may subse-
quently influence the onset of obesity. The purpose of this
paper is to highlight some of the family and social factors that
influence children’s eating patterns and diet quality. Eating
patterns have been defined in a number of ways, and definitions
typically reflect characteristics of meals and/or food combina-
tions. Diet quality typically reflects how one’s diet conforms to
nutrient and food-based guidelines and recommendations.
Family and social factors to be discussed include: food avail-
ability, preferences, accessibility, and portion size; modeling;
mealtime structure; parent attitudes and behaviors regarding
food; feeding styles; and socioeconomic and cultural factors.
Research referenced includes samples of various ages (i.e.,
children, adolescents), ethnicities, income and education back-
grounds. The review concludes with a call to researchers to
develop interventions that address a variety of these family and
social factors when attempting to improve or promote healthier
eating patterns and diet quality among children.
DESCRIPTION OF SUBJECT
Preferences, Food Availability and Accessibility
Children’s Preferences. Children do not eat foods they do
not like [7]. Food acceptance patterns develop early in life, and
childhood is a time of particular sensitivity for developing food
preferences [8–10]. Indeed, food preferences developed during
infancy remain relatively stable and are reflected in food
choices made later in life [11–15]. The development of food
preferences can be explained in part by Rozin’s [16] concept of
food neophobia. Research has demonstrated that food neopho-
bia is an important predictor of fruit and vegetable intake.
Children who are reluctant to try new foods generally have
lower intakes of fruit and vegetables [17]. However, research
has demonstrated that exposure to foods is key to developing
preferences [18–22] and that repeated exposure can overcome
dislike of foods [23]. In one study with elementary school-aged
children, 10 daily exposures to an unfamiliar vegetable was
associated with a significant increase in children’s liking and
consumption of that vegetable [24].
Food Availability and Accessibility. In general, children
choose to eat the foods that they are served most often, and they
tend to prefer to eat foods that are readily available in the home
[22]. For example, when fruit and vegetables are available,
children are more likely to eat fruit and vegetables [25–29].
Thus, the foods to which children are routinely exposed shape
84
preferences and consumption [18–19,21]. Adolescents also report
that one of the most influential factors in their food choices is food
availability [30]. Because parents are responsible for making foods
available to children and adolescents, they can have a profound
impact on preferences and, hence, consumption.
Other research has demonstrated the importance of not only
availability but also accessibility of healthier foods [29]. That
is, when foods are easily accessible and ready to be eaten,
children are more likely to eat them. For example, Baranowski
and colleagues [29] found that, among school children, fruit
and vegetable intake is higher when these foods are not only
available but also provided in accessible locations (i.e., easy for
the child to reach) and in accessible sizes (e.g., apple wedges,
carrot sticks). Thus, although children are not especially likely
to get a carrot from a bag of full-sized carrots, they are more
likely to eat carrots that have been cleaned and cut to age-
appropriate sizes.
Parents’ Preferences, Beliefs and Attitudes. Related to
children’s preferences and food availability are parents’ pref-
erences. Indeed, children’s food-related knowledge, prefer-
ences, and consumption are related to parents’ preferences,
beliefs, and attitudes toward food [7,31–33]. Research has
demonstrated that in children as young as two years old, food
preferences were associated with their mothers’ food prefer-
ences [34]. This may be due, in part, to the fact that parents tend
to have foods in the home that they like and eat [7]. Parents’
beliefs about which foods were healthy and their own food
experiences were also related to children’s intake. For example,
Dennison, Erb, and Jenkins [35] found that parents who be-
lieved that whole milk had more calcium and vitamins than
reduced fat milk, that whole milk was healthier for children,
and who had never tried reduced fat milk themselves were
more likely to serve their children whole milk.
Modeling
Parents. Children learn about eating not only through their
own experiences but also by watching others [36]. A growing
body of research demonstrates similarities between parents’
and children’s food acceptance and preferences, intake, and
willingness to try new foods. Mothers and children show sim-
ilar patterns of food acceptance and food preferences [37–38].
Children’s intake of fruit and vegetables was positively related
to parents’ intake of fruit and vegetables [39–40], and parents’
modeling of healthful dietary behaviors was associated with
low-fat eating patterns and lower dietary fat intake [41]. Rozin
and colleagues demonstrated that, in Mexican families, chil-
dren became more accepting of spicy foods when older mem-
bers of the family modeled eating spicy foods [42]. Children
are more likely to sample unfamiliar foods after they have seen
an adult eating the food, and they are more likely to eat when
they see their mother eating rather than a stranger [43]. Other
research has shown that children model dieting behaviors as
well. For example, dieting daughters were more likely to have
VOL. 24, NO. 2

dieting mothers [44], and parents who reported dietary inhibi-
tion or problems controlling their own intake were likely to
have daughters who showed similar patterns [45]. Thus, par-
ents’ behaviors with regard to dietary characteristics, food
preferences, and intake regulation (e.g., dietary inhibition) are
related to these same behaviors in children.
Peers. Although parents provide the strongest influence on
children’s health beliefs and behaviors [46], they are not the
only people to model eating behaviors. Children and adoles-
cents alike are also influenced by what their peers eat. In a
study of preschool children, Birch [47] found that when chil-
dren saw other children choosing and eating vegetables the
observing children did not like, preferences for and intake of
disliked vegetables increased. Peers are considered to be par-
ticularly influential in adolescent eating behavior [46,48–52].
In a study of adolescents, Feunekes and colleagues [53] found
that, on food frequencies, 19% of foods consumed by adoles-
cents were similar to those consumed by their friends. More
specifically, associations with peer intake were found for type
of milk used in coffee, alcoholic drinks, and several snack
foods including French fries [53]. In a study of Costa Rican
adolescents, peer influence was shown to significantly influ-
ence intake of foods rich in saturated fats [54]. Another study
on adolescent girls’ eating behaviors found that peer pressure
was a strong predictor of eating behavior, even after controlling
for other interpersonal variables [54].
Mealtime Structure
The Family: The Social Context of Meals. Whether a
family eats together can have important effects on children’s
food consumption patterns. A growing body of research dem-
onstrates that children who eat meals with other family mem-
bers consume more healthy foods and nutrients. Overall, chil-
dren who have companionship at mealtimes tend to eat more
servings of the basic food groups [55]. Neumark-Sztainer,
Hannan, Story, Croll, and Perry [56] found that frequency of
eating meals as a family was positively associated with intake
of fruit, vegetables, grains, and calcium-rich foods, and with
intake of protein, calcium, iron, folate, fiber, and vitamins A, C,
E, and B-6. Frequency of eating meals as a family was nega-
tively associated with soft drink consumption. In adolescents,
the presence of the family at the dinner meal has been posi-
tively associated with consumption of fruit, vegetables, and
dairy foods, and lower likelihood of skipping breakfast [57].
TV-Viewing. By age 17, the average U.S. child has spent
15,000 to 18,000 hours watching television compared to 12,000
hours in school [58]. TV-viewing has been linked to children’s
food consumption patterns. Research has demonstrated that,
relative to those who do not watch TV during meals, children
who are part of families in which TV-viewing is a normal part
of the eating experience tend to consume fewer fruit and
vegetables and more pizza, snack foods, and sodas [59]. Some
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
Determinants of Children’s Eating Patterns
researchers have speculated that these difference in food con-
sumption patterns as a function of TV-viewing may be the
result of advertising. Food is the most heavily advertised prod-
uct during children’s television programming, and many of
these products are fast foods or high in sugar [60]. One study
showed that, during 12 hours of Saturday morning children’s
television, a total of 225 commercials were broadcast; 71% of
these commercials were for food products and 80% were ads
for foods of low nutritional value [61]. Ads for cookies, candy,
gum, popcorn, and snacks make up more than 1/3 of all food
ads [62–63]. Food products that are most intensely advertised
tend to be over-consumed, whereas food products that are less
intensely advertised or not advertised at all (e.g., fruit, vegeta-
bles) are under-consumed [64]. Indeed, research has docu-
mented that children’s TV-viewing is positively associated
with requests for and consumption of advertised foods, and
parents’ willingness to purchase foods children request [65–
71]. Further research has shown that TV-viewing during meals
is associated with greater risk for nutritional deficiencies in
people ranging in age from 2–24 years [72].
Eating Out. In 1970, only 34% of a family’s food budget
was accounted for by foods consumed outside the home [73],
but by the late 1990s this had risen to more than 47% [74].
Eating out has been associated with higher intake of dietary fat
and energy compared to eating at home [75–77], and as fre-
quency of eating at fast-food restaurants has increased, con-
sumption of fruit, vegetables, and dairy has decreased [78].
Portion Size. In a trend that has been termed “the super-
sizing of America” it is clear that everything in America is
getting bigger. On average, adults are 25% heavier than they
were in 1990, and children are 30% heavier than they were in
1980 [79–80]. At restaurants, patrons eat nearly 350 calories
per meal more than they did 15 years ago [81]. Fast food
restaurants have introduced “big kids meals” which include
adult-sized portions. Pizza franchises such as Domino’s and
Pizza Hut no longer offer a “small” pizza [82–83]. In a survey
of foods sold for immediate consumption in popular take-out
restaurants published in 2002, all food portions except sliced
white bread exceeded USDA and FDA standard portions, and
these portions represented a substantial increase from those
offered in the past [84]. For example, current sizes of common
fast food items such as French fries, hamburgers, and soft
drinks were two to five times larger than when the items were
originally marketed [84]. Between 1977 and 1998, energy
intake for soft drinks increased by 49 kcal, for hamburgers by
97 kcal, and for French fries by 68 kcal [85]. Data from the
Bogalusa Heart Study showed that the average gram amount of
foods consumed outside the home for lunch and dinner in-
creased substantially from 1973 to 1993 [86]. Thus, larger
portions not only contain more energy but also encourage
people to eat more [87–89].
In children aged four to six years, Rolls, Engell and Birch
[89] found a positive linear relationship between larger portion
sizes (e.g., small, medium, and large) and intake. Additionally,
85
Determinants of Children’s Eating Patterns
Orlet Fisher, Rolls and Birch [90] found that doubling an
age-appropriate portion of an entrée increased intake by 25%
and that children who were served larger portions tended to
take larger bites of the entrée. Together, the findings from these
studies suggest that larger portions influence children’s eating
by promoting intake.
School Meals. School-based breakfast and lunch programs
aim to promote healthy eating among children and adolescents,
and have been largely successful [91–92]. However, the avail-
ability of competitive foods from vending machines and a la
carte programs challenges the nutritious selections available in
school meals. Nearly 25% of middle schools, 23% of high
schools, and 9% of elementary schools serve name brand fast
foods [93]. Most secondary schools (78%) have student-acces-
sible vending machines, while 15% of middle schools and 34%
of high schools permit students to use vending machines at any
time [94]. Foods available from these a la carte programs and
vending machines are typically higher in fat and lower in
overall nutritive value than those foods served through the
school lunch program. Some research estimates that only 36%
of foods in a la carte programs and 35% of foods in vending
machines meet the lower-fat criterion of 5.5 grams of fat per
serving or less [95]. Additionally, research has now demon-
strated that the presence of these alternatives has adverse ef-
fects on the quality of foods school children and adolescents
consume. For example, Kubik, Lytle, Hannan, Perry, and Story
[96] found that a la carte availability was inversely associated
with fruit and vegetable consumption and positively associated
with total and saturated fat intake. As vending machine avail-
ability increased, fruit consumption decreased. Thus, the types
of foods available to children at school can also impact the
types and quality of foods consumed.
Feeding Styles
Dietary guidelines convey the importance of consuming
certain types of foods (e.g., fruit and vegetables) and limiting
other types of foods (e.g., salty or sweet snack foods) [7,97].
Thus, parents may attempt to restrict children’s intake of “bad”
foods and encourage their intake of “good” foods. Feeding
styles represent the caregiver’s approach to maintain or modify
children’s behaviors with respect to eating. Birch and Fisher
[98] identified three child-feeding patterns that map on to
Baumrind’s [99] taxonomy of parenting styles: authoritarian,
permissive, and authoritative. Authoritarian feeding includes
behaviors such as restricting the child from eating certain foods
(e.g., desserts) and forcing the child to eat other foods (e.g.,
vegetables). Thus, authoritarian feeding is characterized by
attempts to control the child’s eating with little regard for the
child’s choices and preferences. Permissive feeding is charac-
terized by what might be termed “nutritional neglect,” whereby
the child is allowed to eat whatever he or she wants in whatever
quantities he or she wants. With permissive feeding, little or no
structure is provided, and choices are limited only by what is
86
available. Finally, authoritative feeding represents a balance
between authoritarian and permissive feeding such that the
child is encouraged to eat healthy foods but is also given some
choices about eating options. With authoritative feeding, adults
determine which foods are offered, and children determine
which foods are eaten.
Feeding styles have been associated with both dietary intake
and weight status. With regard to dietary intake, authoritarian
feeding has been associated with lower intake of fruit, juices,
and vegetables [100]. Children who were told to “clean their
plates” were less sensitive to physiological cues of satiety
[101], and when parents restricted their child’s consumption of
foods high in fat and sugar, children were more likely to fixate
on these items and consume the “forbidden foods” even when
they were full [102]. Permissive feeding has been associated
with drinking less milk and lower consumption of all nutrients
except fat [103–104]. Authoritative feeding has been associated
with greater fruit and vegetable availability, higher intake of
fruit and vegetables, and lower intake of junk food [105].
Among adolescents, authoritative feeding was associated with
more positive cognitions about fruit and more consumption of
fruit [106], whereas permissive feeding has been associated
with greater intake of fat and sweet foods, more snacks, and
fewer healthy food choices [107–109]. In terms of the associ-
ation between feeding styles and weight status, authoritarian
practices such as restricting and monitoring the child’s intake
have been associated with higher body mass, as indicated by
both body mass index [102,110] and total fat mass [111].
Parents’ attempts to restrict some foods and encourage
others have also been related to children’s preferences and
intake. For example, feeding strategies that involve encourag-
ing children to eat a particular food was associated with in-
creased dislike for that food [112–114], and Hertzler [115]
noted that the more parents encouraged children to eat vegeta-
bles, the lower children’s preferences for vegetables were.
Parents may also try to limit children’s consumption of “bad”
foods like salty and sweet snacks. In fact, in a 1989 study, 40%
of parents believed that restricting or forbidding consumption
of certain foods was effective for decreasing children’s prefer-
ences for these foods [116]. However, research does not sup-
port this belief. For example, Birch and colleagues [33] found
that limiting the availability of foods high in fat, sugar, and
energy that had been used previously as a reward was associ-
ated with increased liking for the limited foods. Fisher and
Birch [98] found that restricting children’s access to certain
foods may actually promote overconsumption of these “forbid-
den” foods.
Socioeconomic and Cultural Factors
Time Constraints, Education, and Income. Today’s par-
ents have longer work hours, and many families consist of only
one parent or of two parents who are both working outside the
home. Thus, parents increasingly rely on convenience foods
VOL. 24, NO. 2

[117]. In a nationally-representative survey, the NPD Group
reported that time spent preparing meals declined more than
10% from 1994 to 1999, while home meal replacement such as
restaurants and pre-packaged foods have become increasingly
popular [118]. In addition to time constraints, various other
sociodemographic factors influence the dietary quality of chil-
dren and adolescents including parents’ education level and
family income.
Higher parental education has been associated with health
consciousness in food choices [119]. Adolescents whose par-
ents were relatively more educated had higher intakes of car-
bohydrates, protein, fiber, folate, vitamin A, and calcium;
higher consumption of vegetables; and greater likelihood of
consuming the recommended servings of dairy products [120].
Mothers’ education level was inversely related to preschool
children’s added sugar intake [121] and adolescent’s percent-
age of energy from fat [122]. Exclusive use of whole milk was
highest in families in which parents had less than a high school
education, and use of reduced-fat milk was highest among
children who had college-educated parents [123].
Income is also an important predictor of eating patterns. The
diets of individuals in relatively lower socioeconomic groups
tend to be characterized by higher intake of foods such as meat
products, full cream milk, fats, sugars, preserves, potatoes, and
cereals, and relatively low intake of vegetables, fruit, and whole
wheat bread [124]. Children and adolescents in relatively high-
er-income families had greater intake of polyunsaturated fats,
protein, folate, calcium, and iron, and were more likely to meet
the recommended number of daily servings for dairy products
[120]. Other research has reported that as many as 40% of
lower income adolescents do not meet recommended daily
consumption of fruit and vegetables [125]. Among rural Afri-
can-American children in single parent families, relatively
higher income was associated with greater likelihood of the
child taking vitamin supplements and eating patterns more
consistent with recommendations for total dietary intake (i.e.,
nutrients and food) [126]. Children in low-income families in
Mexico were less likely to meet recommendations for total
dietary intake, and calcium intake was low [127]. British chil-
dren in lower socioeconomic groups had significantly lower
daily intakes of many micronutrients, a higher percentage of
energy from fat, and a tendency to consume more full fat milk
and receive a greater proportion of energy and nutrients from
snacks than children in higher socioeconomic groups [128].
Ethnicity and Culture. Ethnic groups have also been
shown to differ in dietary quality and nutrient intake. This may
be due to sociodemographic differences or cultural differences
in the types of foods served and methods of preparation. Data
from the Bogalusa Heart Study have shown that African-
American children and adolescents had higher total energy
intake and greater consumption of cholesterol, fat, and carbo-
hydrates compared to Euro-Americans [129]. African-Ameri-
cans also had higher percentage of energy from fat compared to
Euro-Americans [129]. A recent study found that fat intake was
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
Determinants of Children’s Eating Patterns
lowest in Asian-Americans and highest in African-Americans,
that Asian-Americans had significantly lower intakes of dairy
products compared to African-Americans, Hispanics, and non-
Hispanic Whites, and that of these ethnic groups Hispanics had
lower intakes of vegetables [120]. In contrast, other research
has shown that American Indians are at greater risk for inade-
quate fruit consumption and that African-Americans are at
greater risk for inadequate vegetable consumption when com-
pared to other racial/ethnic groups in the United States [125].
CONCLUSION
The research presented in this review speaks to the growing
body of evidence supporting the notion that family and social
environments play an important role in the development of
children’s eating patterns and diet quality. Busy families rely
on convenient foods which often come from fast food estab-
lishments, other restaurants, and the frozen and pre-packaged
food sections of the grocery store. Hurried families no longer
have time to sit down to eat meals together, even though eating
together has been associated with greater intake of foods from
the basic food groups in both children and adults. There have
also been substantial changes with regard to portion sizes. What
was once a single serving is now “super-sized,” and what was
once moderation is now an all you can eat buffet. Research has
consistently demonstrated that people eat more when more
food is placed in front of them. Thus, changing portion sizes
may have contributed to today’s obesity levels. Other charac-
teristics of the family influence children’s eating patterns as
well. Family income often presents a barrier to healthy eating,
with children in lower socioeconomic groups eating fewer fruit
and vegetables and having higher intake of fat compared to
children in relatively higher socioeconomic groups. Families
who do not eat meals together or who have TV on during meals
tend to have children who eat fewer fruit and vegetables and
more snack foods.
Promoting healthier eating patterns among children requires
a multi-faceted approach targeting children, parents, families,
and schools. Much of the research summarized in this review
highlights the ways in which characteristics of the social and
physical environments contribute to less than optimal eating
patterns. And some of these characteristics are more easily
addressed through interventions than are others. For example,
in the research on feeding styles, well-intentioned parents who
are attempting to control their child’s eating by restricting
intake of “bad” foods and encouraging the intake of “good”
foods may actually foster the eating patterns they are trying to
prevent. Satter [130,131] has suggested that one way to address
this issue might be to develop a division of labor between
parents and children: parents provide a healthful array of foods
(i.e., availability) and the context that is conducive to children
eating these foods (i.e., accessibility, modeling), and children
87
Determinants of Children’s Eating Patterns
decide when and how much to eat. Additionally, parent edu-
cation classes that focus on developing more authoritative
approaches to feeding (e.g., providing reasons and rationales
for why children should eat more fruit and vegetables) could be
beneficial.
Other research cited in this review points to the importance
of early food experiences, particularly in terms of exposure to
new foods and foods that they otherwise would not like (e.g.,
vegetables). Thus, interventions geared toward young children
are particularly important. These interventions could be tar-
geted at parents, including providing information about how
children’s food preferences are formed, and providing concrete
examples of how to make foods like vegetables both available
and accessible (e.g., cutting up celery stalks into smaller pieces
and putting them in single-serving containers or bags).
Other interventions could target day care centers and
schools. Increasingly, schools and day care centers play an
important role in the development of children’s eating, as
children are spending more of their time and consuming more
of their calories in these settings [132–139]. These interventions
could focus on issues such as providing age-appropriate portion
sizes, making healthful food choices like fruit and vegetables not
only available and accessible but also appealing, and providing
lower fat, lower sugar items in vending machines.
Because children’s eating patterns are influenced by such a
range of characteristics of the social and physical environment,
it is important to develop interventions that target the different
levels at which these influences occur. At the level of the
individual child, interventions that focus on increasing prefer-
ences for healthy foods like fruit and vegetables could be
developed. At the level of the family, interventions that address
issues such as feeding styles and mealtime structure could have
a positive impact on children’s diet quality. Finally, at the level
of the community, interventions that target schools and school
meal programs are important for fostering healthy eating pat-
terns among children when they are not at home. Clearly, this
area is fertile ground, not only for individual researchers but
also for multidisciplinary research teams to address multiple
influences on children’s eating patterns.
ACKNOWLEDGMENTS
The authors wish to thank the Behavioral Nutrition Group at
the Children’s Nutrition Research Center for their assistance in
the preparation of this manuscript. Debby Demory-Luce,
Sheryl Hughes, Sandra Jaramillo, Nilda Micheli, Miriam Mo-
rales, and Rajeshwari Ranganathan provided helpful comments
on previous versions of the manuscript. Pamelia Harris pro-
vided valuable assistance in collecting references. Partial sup-
port for this project was received from the National Dairy
Council.
88
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