title: Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: mediation analysis from the Healthy Habits cluster randomised controlled trial.
abstract: BACKGROUND
  The home food environment can influence the development of dietary behaviours in children, and interventions that modify characteristics of the home food environment have been shown to increase children's fruit and vegetable consumption. However to date, interventions to increase children's fruit and vegetable consumption have generally produced only modest effects. Mediation analysis can help in the design of more efficient and effective interventions by identifying the mechanisms through which interventions have an effect. This study aimed to identify characteristics of the home food environment that mediated immediate and sustained increases in children's fruit and vegetable consumption following the 4-week Healthy Habits telephone-based parent intervention.
  
  
  METHODS
  Analysis was conducted using 2-month (immediate) and 12-month (sustained) follow-up data from a cluster randomised control trial of a home food environment intervention to increase the fruit and vegetable consumption of preschool children. Using recursive path analysis, a series of mediation models were created to investigate the direct and indirect effects of immediate and sustained changes to characteristics of the home food environment (fruit and vegetable availability, accessibility, parent intake, parent providing behaviour, role-modelling, mealtime eating practices, child feeding strategies, and pressure to eat), on the change in children's fruit and vegetable consumption.
  
  
  RESULTS
  Of the 394 participants in the randomised trial, 357 and 329 completed the 2- and 12-month follow-up respectively. The final mediation model suggests that the effect of the intervention on the children's fruit and vegetable consumption was mediated by parent fruit and vegetable intake and parent provision of these foods at both 2- and 12-month follow-up.
  
  
  CONCLUSIONS
  Analysis of data from the Healthy Habits trial suggests that two environmental variables (parental intake and parent providing) mediate the immediate and sustained effect of the intervention, and it is recommended these variables be targeted in subsequent home food environment interventions to bring about immediate and sustained changes in child fruit and vegetable intake.
  
  
  BACKGROUND
  ACTRN12609000820202 .
authors.affiliation: University of Newcastle, Callaghan, NSW, Australia. rebecca.wyse@hnehealth.nsw.gov.au.|Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia. rebecca.wyse@hnehealth.nsw.gov.au.|Hunter Medical Research Institute, Newcastle, NSW, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wyse
authors.affiliation: University of Newcastle, Callaghan, NSW, Australia. luke.wolfenden@hnehealth.nsw.gov.au.|Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia. luke.wolfenden@hnehealth.nsw.gov.au.|Hunter Medical Research Institute, Newcastle, NSW, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfenden
authors.affiliation: University of Newcastle, Callaghan, NSW, Australia. alessandra.bisquera@hmri.com.au.|Hunter Medical Research Institute, Newcastle, NSW, Australia. alessandra.bisquera@hmri.com.au.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bisquera
mesh_terms: D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D016000:Cluster Analysis; D004032:Diet / Q000523:psychology*; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D005638:Fruit; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D014675:Vegetables