Diet- and Body Size-related Attitudes and Behaviors Associated with Vitamin Supplement Use in a Representative Sample of Fourth-grade Students in Texas

Abstract

Objective

To examine diet- and body size-related attitudes and behaviors associated with supplement use in a representative sample of fourth-grade students in Texas.

Design

Cross-sectional data from the School Physical Activity and Nutrition study, a probability-based sample of schoolchildren. Children completed a questionnaire that assessed supplement use, food choices, diet-related attitudes, and physical activity; height and weight were measured.

Setting

School classrooms.

Participants

Representative sample of fourth-grade students in Texas (n = 5967; mean age = 9.7 years standard error of the mean [SEM] = .03 years, 46% Hispanic, 11% African-American).

Main Outcome Measures

Previous day vitamin supplement consumption, diet- and body size-related attitudes, food choices, demographic factors, and physical activity.

Analysis

Multivariable logistic regression models, P < .05.

Results

The prevalence of supplement use was 29%. Supplement intake was associated with physical activity. Girls who used supplements were more likely to report positive body image and greater interest in trying new food. Relative to nonusers, supplement users were less likely to perceive that they always ate healthful food, although supplement use was associated with more healthful food choices in boys and girls (P < .001).

Conclusions and Implications

The widespread use of supplements and clustering of supplement use with healthful diet and greater physical activity in fourth graders suggest that supplement use be closely investigated in studies of diet–disease precursor relations and lifestyle factors in children.

Introduction

Dietary behavior during childhood impacts optimal growth and development and influences age-associated risk of chronic diseases/conditions, including cardiovascular disease, type 2 diabetes, cancer, osteoporosis, and obesity.1, 2 Dietary patterns of children can include food choices, breakfast and meal patterns, school meal participation,¹ dieting,³ and the use of vitamin and mineral supplements.⁴

Previous research indicates that vitamin supplement use is associated with healthful food choices among infants/toddlers,5, 6 preschoolers,⁷ early elementary school-aged children,⁸ and adolescents.9, 10, 11 However, to the authors' knowledge, no information exists on the relation between vitamin supplement use and food choices in population-based samples of older elementary schoolchildren in the United States, especially those populations with significant Latino and African-American representation.

Since vitamin supplements are purchased and offered to elementary schoolchildren by their parents, consumption of vitamin supplements by children can be viewed as part of the dietary and/or health environment for that child. Prior research has shown that vitamin supplement use in adults is associated with better food intake, increased physical activity, and better body image and dietary habits,4, 12 but it is not known if this association is seen in elementary schoolchildren as well.

The purpose of the current study was to examine diet- and body size-related attitudes and behaviors associated with vitamin supplement use in a representative sample of fourth-grade elementary schoolchildren in Texas. With this research it can be determined if vitamin supplement use is associated with other environmental and intrapersonal factors, or if supplement use can be viewed as a separate construct. The conceptual framework for this article examines constructs from the Theory of Planned Behavior¹³ and the Social Ecological Model,¹⁴ such as intrapersonal behavioral (diet, physical activity), attitudinal (body image satisfaction, perceived healthfulness of diet, interest in trying new food), and sociodemographic (gender, race/ethnicity, socioeconomic status, overweight status) factors related to vitamin supplement use in children. We acknowledge that parental/environmental variables (role modeling of behaviors considered to be healthful, gate keeping regarding purchasing and offering vitamins to children, menu planning and shopping practices determining availability of healthful food, norms for taking vitamins) may also constitute important determinants of elementary schoolchildren's vitamin supplement use, diet-related attitudes, and food choices, as posited by the Social Ecological model.¹⁴ However, in this study, the authors focused on selected intrapersonal factors that may be related to vitamin supplement use in elementary schoolchildren.