Differences in Children’s Food and Beverage Consumption between School and Summer: Three-year findings from the What’s UP (Undermining Prevention) with Summer Observational Cohort Study

Differences in Children’s Food and Beverage Consumption between School and Summer: Three-year findings from the What’s UP (Undermining Prevention) with Summer Observational Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Differences in Children’s Food and Beverage Consumption between School and Summer: Three-year findings from the What’s UP (Undermining Prevention) with Summer Observational Cohort Study Michael W. Beets, Sarah Burkart, Christopher D. Pfledderer, Elizabeth Adams, and 14 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6255625/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jul, 2025 Read the published version in BMC Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background Summer vacation is a time when youth gain excessive weight. A key driver of unhealthy weight gain is poor dietary quality. The absence of consistent structure (e.g., school), is hypothesized to be one of the reasons for lower diet quality during summer. This study examined differences in school and summer dietary quality among a diverse cohort of children across three years. We also examined the impact of attending structured programs on children’s diets. Methods Parents of 1,298 children (age 5–14 years, 48% girls) completed a time use diary each day for 14-days during school (April/May) and again in summer (July) from 2021 to 2023, for a total of 6 timepoints. The daily diary collected information on the child’s location and dietary intake for that day. Mixed-effects models examined the odds (OR) of consuming a food/beverage (e.g., fruit, vegetable, soda, salty snacks) on a given day during school vs. summer, overall and by income. Models also examined the impact of attending structured programming during summer (e.g., summer day camp) on the likelihood of consumption. Results A total of 39,983 time use diaries were completed. Overall, children were less likely to consume fruit, vegetables, milk, 100% juice, and salty snacks (OR range 0.63 to 0.87), and they were more likely to consume non-carbonated sweetened beverages, soda, frozen desserts, and fast food (OR range 1.17 to 1.63) during the summer compared to school. On summer days with structured programming, children were more likely to consume fruits, vegetables, milk, salty snacks, sweetened beverages (OR range 1.13 to 1.45), and they were less likely to consume frozen desserts, fast food, and soda (OR range 0.63 to 0.90). Few differences were observed between income groups. Conclusions Children were less likely to report consumption of more healthful foods/beverages and more likely to report consumption of less healthful foods/beverages during summer compared to school. Attending structured programming during summer is associated with improved diet – suggesting such settings have potential to modify dietary intake. Diet Vacation Children Poverty Low-Income Figures Figure 1 Figure 2 Figure 3 Background Substantial evidence demonstrates children are vulnerable to excessive weight gain during the summer months as compared to the school year. 1 – 21 One factor contributing to unhealthy weight gain during summer is changes in dietary intake. While some studies 22 – 25 indicate healthful foods (e.g., fruits and vegetables) are consumed less and unhealthful foods/beverages (e.g., added sugars) are consumed more during summer, recent reviews indicate there is inconsistent evidence demonstrating diet is worse in summer for children. 26 , 27 Why children’s diets may be more healthful during school and less healthful during summer is multifaceted. A leading perspective to understand these differences is the Structured Days Hypothesis (SDH). 28 , 29 The SDH posits children’s dietary intake during school is influenced by the consistent, structured environment schools provide to children. For schools in the United States (U.S.), schools are required to adhere to federal nutrition guidelines for meals (breakfasts, lunch, dinners) and snacks. 30 – 32 Consuming school meals is associated with better overall dietary intake. 30 , 33 – 36 During the school week (M-F) children consume a large proportion of their daily caloric intake from foods/beverages served at school and eating opportunities at school are consistent and regulated (i.e., recess, lunch). Although schools allow foods/beverages to be brought from home, a large portion of children consume the foods/beverages provided by a school 37 – 39 and the meals provided by school are generally more healthful than those brought from home (e.g., lunch provided by school vs. lunch brought from home). 40 – 42 Consumption of school meals and the introduction of school meal policies (e.g., Healthy, Hunger-Free Kids Act of 2010) is associated with reductions in zBMI. 36 Evidence suggests foods/beverages consumed outside of school offset the healthfulness of foods/beverages consumed at school for children’s overall dietary intake. 43 Given the home environment may not promote optimal dietary intake, especially in families from low-income households, consuming a large portion of one’s foods/beverages in school can serve as an important contributor to overall improved dietary intake and maintenance of healthy weight. During the summer, the 5 day a week presence of school is removed, leaving children with greater exposure to, and reliance upon, the food available at home. While summer feeding programs (e.g., Summer Food Service Program, Seamless Summer Option) exist to minimize this decline in federally funded meals during the summer months, their reach is significantly limited and often results in limited food access. Thus, the removal of the consistent structure of school and the overarching guidelines for foods/beverages readily available to them in this setting could lead children to consume more unhealthful foods/beverages during summer and can be susceptible to more, unsupervised eating opportunities. 44 However, some children spend time in structured settings during the summer, namely some form of summer programming (e.g., summer school, summer day camps). Such programs often participate in summer feeding programs and thus adhere to federal reimbursement guidelines that govern the types of foods/beverages served. Regular exposure to such settings could lead to improved dietary intake during the summer. 9 , 45 – 48 However, not all youth have equal access to summer programming. National data indicate the majority of children enrolled in summer programming are White and from higher income households. 49 , 50 Disproportionate access to summer programming could lead to greater exposure to the home food environment for children from lower-income households who often experience financial barriers to affording nutrient-rich meals. Extended exposure to the home food environment at a greater frequency during summer could be a primary driver of unhealthy weight gains observed during this time. The purpose of this study was to examine changes in children’s diet from school and summer and to explore the role of attending structured programming on diet quality in the summer. According to the SDH, we hypothesized the following associations: a) Children would be more likely to consume less healthful foods/beverages during summer and more likely to consume unhealthful foods/beverages, as compared to the school year; b) During the 7-day week, children would be more likely to consume less healthful foods/beverages and more likely to consume unhealthful foods/beverages on the weekends, compared to weekdays, during school and summer; and c) During the summer, days where children attended a summer program would be associated with a greater likelihood of consuming healthful foods/beverages and a lower likelihood of consuming unhealthful foods beverages, compared to days where children do not attend a summer program. Methods Study Design and Sample. This study used data from the What’s UP (Undermining Prevention) with Summer study (National Institutes of Health R01DK116665, WUP) designed to understand summer effects on unhealthy weight gain among elementary-aged children in the United States. The design was a longitudinal observational cohort that followed elementary-aged children (5–12 years) across three years (2021, 2022, and 2023) and completed measures during school (April/May) and summer (July) each year. Children were recruited from 17 elementary schools in a mid-sized metropolitan area in the southeastern United States located at 34°N. Invitations to participate in the study were provided to parents via study flyers with a QR code and distributed via school texting services (e.g., Class Dojo). The QR code was linked to an online HIPAA compliant website to provide electronic consent. Children of parents who provided online consent, then provided verbal assent during in-person assessments. Parents and children had the right to discontinue participation in the study at any time and were asked each year if they wanted to continue in the study. Informed consent was obtained from all the participants and/or their legal guardians. The reporting of this study conforms to the STROBE checklist. 51 This study was approved by the lead author's Institutional Review Board (Pro00080382). Child and Household Characteristics. At the school measurement timepoint each year (April/May), parents completed an online survey via their smartphone about the demographics of their child (biological sex and age), information about the total annual household income, and the number of people (adults and children) living in their home. This information was used to calculate the ratio of poverty to income according to U.S. Federal Poverty Guidelines established by the Department of Health and Human Services. 52 Refreshing Longitudinal Cohort. To account for parents/children electing to discontinue in the study, we refreshed the sample 53 – 55 in the early spring (February/March), prior to school data collection in April/May each year. Refreshing the sample replaces students who dropped out of the study with students who had similar demographic characteristics. Refreshing is methodology consistent with other large-scale cohort studies. 54 – 56 Criteria of the refreshment sample was to ensure similar proportions of students were present in the study based on child sociodemographics (i.e., biological sex, race/ethnicity, household income) from the initial year of data collection in 2021 and to replace children based upon the grade as the cohort aged over time. Dietary Measure. The Dietary Screener Questionnaire from the Healthy Communities Study (HCS) 57 was used to collect dietary data on children enrolled in What’s UP. The screener consisted of 23 items from the HCS that assessed children’s intake of fruits and vegetables; dairy; sugar-sweetened beverages; other energy-dense foods of minimal nutritional value (e.g., chocolate/candy, donuts/sweet rolls, cookies/cakes/pies, ice cream/frozen desserts, chips/crackers); and fast food. Parents, along with their child, completed the screener at the end of each day, for a total of 14-days, during school (April/May) and again for 14-days in summer (July), reporting on what their child ate and/or drank that day. Unlike the original screener, which asked respondents about consumption over the past 30 days (e.g., 1 time last month, 2 times per week), only response options referring to the frequency of consumption for that day were included (e.g., 1 time today, 2–3 times today). Parents and their child completed the screener as part of the time use record (described in detail below). Time Use Measure. The time use record was developed in Qualtrics and distributed to parents at 8PM each evening of the 14-day measurement period during school and summer to complete on their smartphone. The time use record was based on the day reconstruction method. 58 The time use record involved parents completing a series of questions about their child’s previous 24hrs. The first question asked about the time their child went to bed the previous night, followed by when their child woke today. The next series of questions asked about whether their child left where they were (e.g., woke up at home, did child leave home today?) and if “yes”, where their child went and at what time (e.g., left home and went to school at 7:15AM). Parents reported time in 15min increments (e.g., 9:00AM, 9:15AM, 9:30AM…). This sequence of questions continued until parents reported the entire day with where their child was and at what times. The time use record provided a list of common locations where a child may be that a parent could select from: home, before school program, school, afterschool program, sports, music/theater/dance, neighborhood pool/water, park/river/lake/beach, park/playground, employment/volunteer, church/synagogue/mosque or other religious activity, friend’s house, relative’s house, restaurant/fast food outlet, errands/shopping/appointments, tagging along/attending family or friend’s event/activity, or summer day camp. There was an additional “other” option for parents to write a specific activity/setting not represented. For the purpose of this study, we classified sports, music/theater/dance, employment/volunteer, places of worship, summer day camps, and summer learning programs as structured settings in the summer. Embedded at the end of the time use record was the dietary screener. Each time use record took an average of 6min to complete (median 4.8min, IQR 3.5 to 7.1min). Statistical Analysis. The primary analysis compared differences in children’s odds of consuming different food/beverage categories on a given day between school and summer. After review of the distribution of the responses, items were dichotomized into “did not eat/drink today” versus “ate/drank today”. Items were collapsed into the following categories for analyses: fruit, vegetables, 100% fruit juice, milk (unflavored and flavored milk), frozen desserts, other desserts (pastries/doughnuts and cookies cakes, pies), non-carbonated sugar-sweetened beverages (non-100% fruit juice, energy drinks, flavored water, sports drinks, coffee drinks), sugar-sweetened and diet soda/pop, and salty snacks (chips/pretzels). A series of multi-level, generalized linear models that accounted for the nesting of days within children, within families, within schools, were examined for each food/beverage dependent variable with the following contrasts of interest. For our main analysis we examined differences in the probability of consuming a food/beverage on a given day between school and summer. Analyses also examined changes in the probability of consuming a food/beverage on a given day between school and summer by each of the 3 poverty to income ratio groups (insert info about 3 groups). To examine the association of exposure to structured programming and dietary intake in the summer, we used the exposure to structure data from the time use record and created two exposure metrics: 1) dichotomized exposure to structure or not on a given day; and 2) exposure to structure in number of minutes per day and categorized this into no (reference group), low (30-60min/d), moderate (> 60, 200min/d) of structured programming attended. All models included biological sex, age, parent education, poverty to income ratio, food insecurity status, and use of either the Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC) program as covariates. Results The number of children by age in years and daily diaries across the 6 assessments are presented in Table 1 . Across the 3-year study, a total of 1,298 children completed an average of 31 days of time diaries each across the 6 measurement occasions. The demographics of the cohort across each assessment period are presented in Table 2 . Table 1 Number of children and daily diaries by assessment year. Number of Children by Age (years) Year Timepoint 5 6 7 8 9 10 11 12 13 14 Total 2021 School 9 69 64 102 123 138 70 19 594 Summer 6 44 68 79 94 116 74 25 506 2022 School 3 29 78 85 109 121 137 59 14 635 Summer 22 54 66 91 85 112 63 18 511 2023 School 1 26 63 73 148 177 150 58 11 707 Summer 20 51 68 117 152 146 73 15 642 Total 18 185 341 463 607 760 716 389 105 11 Number of Daily Diaries by Age (years) Year Timepoint 5 6 7 8 9 10 11 12 13 14 Total 2021 School 109 742 699 1130 1415 1553 778 207 6633 Summer 67 514 733 899 1083 1340 818 309 5763 2022 School 34 339 812 847 1137 1329 1436 600 160 6694 Summer 214 546 726 922 866 1206 671 182 5333 2023 School 14 298 714 844 1723 2029 1749 691 135 8197 Summer 230 557 796 1313 1732 1656 885 194 7363 Total 210 1823 3318 4873 6197 8124 7999 5192 1918 329 Timepoint: School = April/May; Summer = July Table 2 Child demographics by assessment period 2021 2022 2023 School Summer School Summer School Summer Sample (N) 594 506 635 511 707 642 Age (year, M, SD) 8.8 ± 1.7 8.9 ± 1.7 9.5 ± 1.8 9.7 ± 1.8 10.6 ± 1.6 10.8 ± 1.6 Females (%) 48% ± 0.5 48% ± 0.5 49% ± 0.5 49% ± 0.5 47% ± 0.5 47% ± 0.5 Race/Ethnicity (%) Black 35% 33% 44% 42% 38% 38% White 57% 60% 45% 48% 53% 54% Other 3% 3% 3% 3% 2% 2% Hispanic 6% 5% 8% 8% 7% 7% Poverty to Income Ratio (M, SD) 2.6 ± 1.1 2.7 ± 1.1 2.3 ± 1.1 2.4 ± 1.0 2.4 ± 1.1 2.5 ± 1.0 200% or Below Pov (%) 35% 33% 38% 35% 36% 34% Food Insecure (%) 14% ± 0.4 16% ± 0.4 19% ± 0.4 19% ± 0.4 22% ± 0.4 21% ± 0.4 Supplemental Nutrition Assistance Program (%) 9% ± 0.3 10% ± 0.3 12% ± 0.3 10% ± 0.3 10% ± 0.3 9% ± 0.3 Women, Infants, and Children (%) 5% ± 0.2 6% ± 0.2 4% ± 0.2 3% ± 0.2 3% ± 0.2 3% ± 0.2 Avg. Number of Time Use Diaries (M, SD) 12.4 ± 2.7 12.4 ± 2.5 11.9 ± 2.7 11.5 ± 2.4 12.7 ± 2.4 12.5 ± 2.4 Avg. Days with Structure Reported (M, SD) 2.9 ± 3.1 3.9 ± 3.3 2.9 ± 3.2 Avg. Minutes per day of Structure during Summer (M, SD) 59.0 ± 153.3 61.2 ± 152.9 65.4 ± 152.9 Avg. Minutes per day of Structure for Children Reporting going to Structure during Summer (M, SD) (does not include ZERO structure) 321.2 ± 209.5 298.6 ± 208.1 308.2 ± 187.9 School vs. Summer. The comparison between foods/beverages consumed during school compared to summer can be found in Fig. 1 and supplemental Table 1 . For the entire sample and by each of the three income-subgroups, children were, in general, more likely to consume unhealthful foods/beverages (e.g., frozen desserts, soda/pop) and less likely to consume healthful foods/beverages (e.g., fruits, dairy) during the summer in comparison to when they were in school. However, during summer, children tended to consume fewer non-frozen desserts and salty snacks (overall sample and high-income group). Of the 40 comparisons, 30 supported the SDH. Of the remaining 10, 5 did not support the SDH (i.e., in the opposite direction of the SDH) and 5 were not statistically significant. Weekdays vs. Weekend Days: School and Summer, separately. For school timepoints, in the entire sample children were more likely to consume healthful foods/beverages (e.g., fruit, dairy) and less likely to consume unhealthful foods (e.g., fast food, soda/pop) on weekdays (M-F) compared to weekend days (Sat-Sun) – see Fig. 2 and supplemental Table 1 . Subgroup analysis by income demonstrated the same pattern. During weekdays in the overall sample and children in the middle- and high-income groups were more likely to consume salty snacks compared to the weekend days, whereas children from low-income households were less likely to consume salty snacks. During the summer, similar associations were observed, with more healthful dietary patterns during weekdays vs weekend days. However, these associations tended to be smaller in magnitude compared to weekday vs weekend day comparisons during school - for example OR 2.07 school compared to OR 1.25 summer for weekdays vs weekend days for fruit consumption. Separate comparisons across income groups indicated children in the low- and high-income groups exhibited more healthful dietary patterns on summer weekdays vs weekend days, while children from middle-income households had more similar dietary intakes on weekdays and weekend days in the summer. Structure during the Summer. In the summer, on days when children attended some form of structured programming (binary variable attended vs did not attend), they tended to exhibit more healthful dietary patterns compared to days without attending structured programming (Fig. 3 A and supplemental Table 1 ). This pattern was similar for each income subgroup. When examining exposure to structure based on minutes spent in a structured setting each day, a dose response association emerged (Fig. 3 B and supplemental Table 1 ). As children spent more time in a structured setting in the summer, their dietary pattern improved. The greatest improvements were observed for children spending 200 or minutes per day in a structured setting in the summer. Discussion Summer is increasingly being recognized as a period of time where children are at a greater risk for unhealthy weight gain. 1 – 21 Generally, it is well established that diet is a leading behavioral contributor to unhealthy weight gains in children, however, evidence regarding whether children’s dietary patterns during the summer are different than their dietary intake during school are mixed. 26 , 27 According to the SDH, children should consume more unhealthful foods during summer, compared to school, given 1) limited access to federally funded meals that adhere to nutritional guidelines in the summer, and 2) increased freedoms (e.g., more snacking opportunities) that may operate during summer when days may be less-structured with the removal of school. The findings in this study indicate children exhibit more unhealthy dietary patterns during summer, compared to school, and on weekend days, compared to weekdays, both during school and summer. Importantly, during the summer, attending structured programming was associated with a more healthful dietary pattern, compared to days without structure. Overall, these findings have important implications for establishing summer as time with increased risk for unhealthful dietary intake, as well as providing additional theoretical support for the SDH of the importance of structured programming (school and summer programs) on beneficially influencing children’s dietary intake. The main findings were that children were more likely to consume unhealthful foods during the summer, compared to school. These effects were consistent across income groups, indicating summer had a similar effect on dietary intake regardless of socioeconomic status. This shows schools provide a seemingly equitable impact on child diet intake and conversely, when children are removed from the almost daily exposure to the school environment and with that the nutrition regulations that govern the nutritional quality of foods/beverages readily available, they are at a greater risk of consuming less healthful foods/beverages and consuming more unhealthful foods/beverages. 31,35,36,38,39,41–43 The importance of the school food environment is further highlighted in the comparison of consumption between weekdays and weekend days where the largest odds were observed for school days vs weekend days when children were in school. A similar, albeit smaller, effect was observed for summer weekdays vs weekend days. Analyses indicated on days when children attended a summer program (e.g., day camp), they were more likely to consume healthful foods/beverages and less likely to consume unhealthful foods/beverages. When considering the amount of time spent at a summer program, the longer attendance at a summer program during a day was associated with a greater odds of consuming healthful foods/beverages and a lower odds of consuming unhealthful foods beverages. These findings from summer, along with those during the school year, although observational, provide empirical support for the impact of spending time in a structured setting and the association with improved dietary behaviors. 26 , 28 While most associations were in the direction hypothesized by the SDH, there were several food/beverage items that demonstrated associations in the opposite direction. Specifically, in the summer, attending a summer program was associated with an increased odds of consuming salty snacks and non-carbonated flavored beverages. A plausible reason for these associations could be salty snacks are items that are reimbursable via federal nutrition programs, such as the Summer Food Service Program ( https://www.fns.usda.gov/summer/sunmeals ). Thus, salty snacks would likely be served on a regular basis in summer programs, leading to an increase in their consumption for children attending. Secondly, during the summer, due to temperature and humidity, there is an added need to ensure appropriate hydration. With this, children bring sports drinks and other flavored beverages when attending a summer program. 59 – 61 These factors could explain why attending a summer program was associated with increased odds of consuming these items. There are a number of strengths to this study. These include the large and diverse sample of children participating, the longitudinal design, the assessment of diet during school and summer, and the large number of days collected during both school and summer. There are several weaknesses. One is the use of a dietary screener to measure dietary intake. While this measure is not as comprehensive as a 24hr dietary recall, this tool facilitated a quick and lower-burden assessment of dietary intake on a daily basis, which in turn, allowed for the comparison of weekdays vs weekend days, as well as days during the summer where children did and did not attend a summer program. This tool also limited the ability to quantify the amount consumed and reduced our ability to quantify macro- and micro-nutrients. Another weakness is the limited geographical location where these data were collected. Summer at other latitudes would be associated with varying temperatures, thereby changing the experiences of children during this time. Nevertheless, this study was conducted in the southeastern United States which has among the highest rates of obesity and obesogenic behaviors 62 and thus, the findings from this study, at minimum, generalize to this geographical area. In summary, children were more likely to consume unhealthful foods/beverages and less likely to consume healthful foods/beverages during summer, compared to when they are in school. Evidence of the importance of structured environments was observed when examining weekdays vs weekend days during school and summer, separately. Importantly, we observed an association between attending summer programming and consuming more healthful and less healthful foods/beverages during the summer, suggesting such programming during the summer could play an important role in promoting a healthful diet during the summer. Declarations Ethics approval and consent to participate This study was approved by the lead author's Institutional Review Board at the University of South Carolina (Pro00080382). All study procedures adhered to the Declaration of Helsinki. Consent for publication NA Availability of data and materials The datasets generated and/or analyzed in the current study are not publicly available because additional analyses are ongoing. Data will be made available from the corresponding author on reasonable request at the time the primary outcome papers are published. Competing Interests The authors’ declare no competing interests. Funding : Research reported in this publication was supported by the National Institute Of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health under Award Number R01DK116665. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Grant No. R01DK116665 Authors' contributions MWB led the project, secured the funding, and led the analysis and writing of the manuscript. All authors contributed to the writing, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work. Acknowledgements : We would like to thank all the families and school personnel who helped makes this project successful! References Beckerman-Hsu JP, Aftosmes-Tobio A, Lansburg K, et al. Summer Weight Gain Among Preschool- Aged Children With Obesity: An Observational Study in Head Start. Preventing Chronic Disease. Apr 2021;18. Brusseau TA, Burns RD, Fu Y, Weaver RG. Impact of Year-Round and Traditional School Schedules on Summer Weight Gain and Fitness Loss. Child Obes. Dec 2019;15(8):541-547. Carrel AL, Clark RR, Peterson S, Eickhoff J, Allen DB. School-based fitness changes are lost during the summer vacation. Arch Pediatr Adolesc Med. Jun 2007;161(6):561-564. Chen TA, Baranowski T, Moreno JP, et al. 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Oct 18 2024;21(1):119. Brazendale K, Beets MW, Weaver RG, et al. Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act. Jul 26 2017;14(1):100. Zosel K, Monroe C, Hunt E, Laflamme C, Brazendale K, Weaver RG. Examining adolescents' obesogenic behaviors on structured days: a systematic review and meta-analysis. Int J Obes (Lond). Mar 2022;46(3):466-475. Adams EL, Raynor HA, Thornton LM, Mazzeo SE, Bean MK. Nutrient Intake During School Lunch in Title I Elementary Schools With Universal Free Meals. Health Educ Behav. Feb 2022;49(1):118-127. Gearan EC, Fox MK. Updated Nutrition Standards Have Significantly Improved the Nutritional Quality of School Lunches and Breakfasts. J Acad Nutr Diet. Mar 2020;120(3):363-370. Vericker TC, Gearing ME, Kim SD. Updated Nutrition Standards for School Meals Associated With Improved Weight Outcomes for Boys in Elementary School. J Sch Health. Nov 2019;89(11):907-915. Berger AT, Widome R, Erickson DJ, Laska MN, Harnack LJ. Changes in association between school foods and child and adolescent dietary quality during implementation of the Healthy, Hunger-Free Kids Act of 2010. Ann Epidemiol. Jul 2020;47:30-36. Cohen JFW, Hecht AA, McLoughlin GM, Turner L, Schwartz MB. Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review. Nutrients. Mar 11 2021;13(3). Kinderknecht K, Harris C, Jones-Smith J. Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program. JAMA. Jul 28 2020;324(4):359-368. Richardson AS, Weden MM, Cabreros I, Datar A. Association of the Healthy, Hunger-Free Kids Act of 2010 With Body Mass Trajectories of Children in Low-Income Families. JAMA Netw Open. May 2 2022;5(5):e2210480. Cullen KW, Chen TA. The contribution of the USDA school breakfast and lunch program meals to student daily dietary intake. Prev Med Rep. Mar 2017;5:82-85. Gordon AR, Crepinsek MK, Briefel RR, Clark MA, Fox MK. The third School Nutrition Dietary Assessment Study: summary and implications. J Am Diet Assoc. Feb 2009;109(2 Suppl):S129-135. Story M. The third School Nutrition Dietary Assessment Study: findings and policy implications for improving the health of US children. J Am Diet Assoc. Feb 2009;109(2 Suppl):S7-13. Song S, Ishdorj A, Dave JM. Gender Differences in Nutritional Quality and Consumption of Lunches Brought from Home to School. Int J Environ Res Public Health. Dec 14 2021;18(24). Song S, Tabares E, Ishdorj A, Crews M, Dave J. The Quality of Lunches Brought from Home to School: A Systematic Review and Meta-Analysis. Adv Nutr. Aug 2024;15(8):100255. Jeans MR, Landry MJ, Asigbee FM, et al. Comparison of School vs Home Breakfast Consumption with Cardiometabolic and Dietary Parameters in Low-Income, Multiracial/Ethnic Elementary School-Aged Children. J Acad Nutr Diet. Apr 2022;122(4):833-847. Gearan EC, Monzella K, Jennings L, Fox MK. Differences in Diet Quality between School Lunch Participants and Nonparticipants in the United States by Income and Race. Nutrients. Dec 2020;12(12). Soldavini J, Ammerman AS. Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer. J Acad Nutr Diet. Apr 2021;121(4):728-737. Evans EW, Bond DS, Pierre DF, Howie WC, Wing RR, Jelalian E. Promoting health and activity in the summer trial: Implementation and outcomes of a pilot study. Prev Med Rep. Jun 2018;10:87-92. Evans EW, Wing RR, Pierre DF, Howie WC, Brinker M, Jelalian E. Testing the effect of summer camp on excess summer weight gain in youth from low-income households: a randomized controlled trial. BMC Public Health. Nov 17 2020;20(1):1732. Larose D, Chih-Shing Chen M, Panahi S, Yessis J, Tremblay A, Drapeau V. Interventions to promote healthy lifestyle behaviors in children and adolescents in summer day camps: a scoping review. BMC Public Health. Apr 26 2023;23(1):773. Weaver RG, Brazendale K, Chandler JL, et al. First year physical activity findings from turn up the HEAT (Healthy Eating and Activity Time) in summer day camps. PLoS One. 2017;12(3):e0173791. America After 3pm. Time for a Game-Changing Summer, With Opportunity and Growth for All of America’s Youth : Afterschool Alliance;2021. Spielvogel B, Warner R, Sibthorp J. National Camp Impact Study 2017-2022 Final Report. Salt Lake City, UT: American Camp Association;2022. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. Dec 2014;12(12):1495-1499. U.S. Department of Health and Human Services. U.S. Federal Poverty Guidelines Used to Determine Financial Eligibility for Certain Programs. the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2). [2024; https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/poverty-guidelines-api. Accessed 03/01/2024, 2024. Deng YT, Hillygus DS, Reiter JP, Si YJ, Zheng SY. Handling Attrition in Longitudinal Studies: The Case for Refreshment Samples. Stat Sci. May 2013;28(2):238-256. Heath K, Samji H, Nosyk B, et al. Cohort profile: Seek and treat for the optimal prevention of HIV/AIDS in British Columbia (STOP HIV/AIDS BC). Int J Epidemiol. Aug 2014;43(4):1073-1081. Steptoe A, Breeze E, Banks J, Nazroo J. Cohort profile: the English longitudinal study of ageing. Int J Epidemiol. Dec 2013;42(6):1640-1648. Cornman JC, Glei DA, Goldman N, et al. Cohort Profile: The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. Int J Epidemiol. Sep 8 2014. Hewawitharana SC, Thompson FE, Loria CM, et al. Comparison of the NHANES dietary screener questionnaire to the Automated Self-Administered 24-Hour Recall for Children in the Healthy Communities Study. Nutr J. Nov 27 2018;17(1):111. R. Gordon Rinderknecht1, Long Doan, Sayer LC. MyTimeUse: An Online Implementation of the Day-Reconstruction Method. Journal of Time Use Research. 2022;1:45-72. Beets MW, Tilley F, Weaver RG, Turner-McGrievy GM, Moore JB. Increasing fruit, vegetable and water consumption in summer day camps--3-year findings of the healthy lunchbox challenge. Health Educ Res. Oct 2014;29(5):812-821. Tilley F, Beets MW, Jones S, Turner-McGrievy G. Evaluation of compliance to national nutrition policies in summer day camps. Public Health Nutr. Jun 2015;18(9):1620-1625. Tilley F, Weaver RG, Beets MW, Turner-McGrievy G. Healthy eating in summer day camps: the Healthy Lunchbox Challenge. J Nutr Educ Behav. Mar-Apr 2014;46(2):134-141. U.S. Centers for Disease Control and Prevention. DNPAO Data, Trends, and Maps Database. 2025; https://www.cdc.gov/dnpao-data-trends-maps/database/index.html. Accessed 08/01, 2024. Additional Declarations No competing interests reported. Supplementary Files SupplementalTables.docx Cite Share Download PDF Status: Published Journal Publication published 10 Jul, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 16 May, 2025 Reviews received at journal 08 May, 2025 Reviews received at journal 02 May, 2025 Reviewers agreed at journal 16 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviewers agreed at journal 11 Apr, 2025 Reviewers invited by journal 03 Apr, 2025 Editor assigned by journal 03 Apr, 2025 Editor invited by journal 23 Mar, 2025 Submission checks completed at journal 22 Mar, 2025 First submitted to journal 22 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Yaroch","email":"","orcid":"","institution":"Center for Nutrition and Health Impact","correspondingAuthor":false,"prefix":"","firstName":"Amy","middleName":"L.","lastName":"Yaroch","suffix":""},{"id":446091482,"identity":"e2f191b4-be02-4b36-81fa-b11f8ffd2c9b","order_by":16,"name":"Emily Eglitis","email":"","orcid":"","institution":"University of South Australia","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"","lastName":"Eglitis","suffix":""},{"id":446091483,"identity":"f2f81029-4491-4161-9878-c51d30e5e07c","order_by":17,"name":"Anthony J. Holmes","email":"","orcid":"","institution":"University of South Carolina","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"J.","lastName":"Holmes","suffix":""}],"badges":[],"createdAt":"2025-03-18 18:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6255625/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6255625/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-23446-0","type":"published","date":"2025-07-10T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82131615,"identity":"98517a17-59e9-4c0f-97e7-e9d234ba1927","added_by":"auto","created_at":"2025-05-07 05:38:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54214,"visible":true,"origin":"","legend":"\u003cp\u003eOdds of consuming a food or beverage during the summer, compared to when children are in school\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6255625/v1/982f47baeb02202f81c489a9.jpg"},{"id":82130763,"identity":"4a3e06d8-9478-41df-9fd1-64f44d4d18c9","added_by":"auto","created_at":"2025-05-07 05:30:00","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":63611,"visible":true,"origin":"","legend":"\u003cp\u003eOdds of consuming a food or beverage on a weekdays, compared to weekend days, during school (blue) and summer (orange), separately\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6255625/v1/a534c8fbe655affb62f1c5d6.jpg"},{"id":82131616,"identity":"de834cb5-5cde-4a20-8a03-1ff32791ef29","added_by":"auto","created_at":"2025-05-07 05:38:00","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":94457,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation of days spent in structure to the odds of consuming a food or drink on that day during summer.\u003c/p\u003e\n\u003cp\u003eA: Odds of consuming on a given day when attending any structure (binary) during summer\u003c/p\u003e\n\u003cp\u003eB: Odds of consuming for days when attending structure based on time (minutes) during summer\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6255625/v1/984e5cfa52e0819d4b4556de.jpg"},{"id":86699484,"identity":"2e661cbf-0280-47c7-9f92-7386489ae8cf","added_by":"auto","created_at":"2025-07-14 16:10:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1355787,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6255625/v1/2dc31126-2c1d-41c6-bb91-4e2c6d3c7e59.pdf"},{"id":82130764,"identity":"ed9e3337-5dc9-4c7b-95d3-9bdff1ecc20e","added_by":"auto","created_at":"2025-05-07 05:30:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":40511,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6255625/v1/d47de557f21bb4ebbca7be3d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Differences in Children’s Food and Beverage Consumption between School and Summer: Three-year findings from the What’s UP (Undermining Prevention) with Summer Observational Cohort Study","fulltext":[{"header":"Background","content":"\u003cp\u003eSubstantial evidence demonstrates children are vulnerable to excessive weight gain during the summer months as compared to the school year.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e One factor contributing to unhealthy weight gain during summer is changes in dietary intake. While some studies \u003csup\u003e\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e indicate healthful foods (e.g., fruits and vegetables) are consumed less and unhealthful foods/beverages (e.g., added sugars) are consumed more during summer, recent reviews indicate there is inconsistent evidence demonstrating diet is worse in summer for children.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhy children\u0026rsquo;s diets may be more healthful during school and less healthful during summer is multifaceted. A leading perspective to understand these differences is the Structured Days Hypothesis (SDH).\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e The SDH posits children\u0026rsquo;s dietary intake during school is influenced by the consistent, structured environment schools provide to children. For schools in the United States (U.S.), schools are required to adhere to federal nutrition guidelines for meals (breakfasts, lunch, dinners) and snacks.\u003csup\u003e\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Consuming school meals is associated with better overall dietary intake.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan additionalcitationids=\"CR34 CR35\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e During the school week (M-F) children consume a large proportion of their daily caloric intake from foods/beverages served at school and eating opportunities at school are consistent and regulated (i.e., recess, lunch). Although schools allow foods/beverages to be brought from home, a large portion of children consume the foods/beverages provided by a school\u003csup\u003e\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e and the meals provided by school are generally more healthful than those brought from home (e.g., lunch provided by school vs. lunch brought from home).\u003csup\u003e\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Consumption of school meals and the introduction of school meal policies (e.g., Healthy, Hunger-Free Kids Act of 2010) is associated with reductions in zBMI.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Evidence suggests foods/beverages consumed outside of school offset the healthfulness of foods/beverages consumed at school for children\u0026rsquo;s overall dietary intake.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Given the home environment may not promote optimal dietary intake, especially in families from low-income households, consuming a large portion of one\u0026rsquo;s foods/beverages in school can serve as an important contributor to overall improved dietary intake and maintenance of healthy weight.\u003c/p\u003e \u003cp\u003eDuring the summer, the 5 day a week presence of school is removed, leaving children with greater exposure to, and reliance upon, the food available at home. While summer feeding programs (e.g., Summer Food Service Program, Seamless Summer Option) exist to minimize this decline in federally funded meals during the summer months, their reach is significantly limited and often results in limited food access. Thus, the removal of the consistent structure of school and the overarching guidelines for foods/beverages readily available to them in this setting could lead children to consume more unhealthful foods/beverages during summer and can be susceptible to more, unsupervised eating opportunities.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e However, some children spend time in structured settings during the summer, namely some form of summer programming (e.g., summer school, summer day camps). Such programs often participate in summer feeding programs and thus adhere to federal reimbursement guidelines that govern the types of foods/beverages served. Regular exposure to such settings could lead to improved dietary intake during the summer.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e However, not all youth have equal access to summer programming. National data indicate the majority of children enrolled in summer programming are White and from higher income households.\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e Disproportionate access to summer programming could lead to greater exposure to the home food environment for children from lower-income households who often experience financial barriers to affording nutrient-rich meals. Extended exposure to the home food environment at a greater frequency during summer could be a primary driver of unhealthy weight gains observed during this time. The purpose of this study was to examine changes in children\u0026rsquo;s diet from school and summer and to explore the role of attending structured programming on diet quality in the summer.\u003c/p\u003e \u003cp\u003eAccording to the SDH, we hypothesized the following associations: a) Children would be more likely to consume less healthful foods/beverages during summer and more likely to consume unhealthful foods/beverages, as compared to the school year; b) During the 7-day week, children would be more likely to consume less healthful foods/beverages and more likely to consume unhealthful foods/beverages on the weekends, compared to weekdays, during school and summer; and c) During the summer, days where children attended a summer program would be associated with a greater likelihood of consuming healthful foods/beverages and a lower likelihood of consuming unhealthful foods beverages, compared to days where children do not attend a summer program.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStudy Design and Sample.\u003c/span\u003e This study used data from the What\u0026rsquo;s UP (Undermining Prevention) with Summer study (National Institutes of Health R01DK116665, WUP) designed to understand summer effects on unhealthy weight gain among elementary-aged children in the United States. The design was a longitudinal observational cohort that followed elementary-aged children (5\u0026ndash;12 years) across three years (2021, 2022, and 2023) and completed measures during school (April/May) and summer (July) each year. Children were recruited from 17 elementary schools in a mid-sized metropolitan area in the southeastern United States located at 34\u0026deg;N. Invitations to participate in the study were provided to parents via study flyers with a QR code and distributed via school texting services (e.g., Class Dojo). The QR code was linked to an online HIPAA compliant website to provide electronic consent. Children of parents who provided online consent, then provided verbal assent during in-person assessments. Parents and children had the right to discontinue participation in the study at any time and were asked each year if they wanted to continue in the study. Informed consent was obtained from all the participants and/or their legal guardians. The reporting of this study conforms to the STROBE checklist.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e This study was approved by the lead author's Institutional Review Board (Pro00080382).\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChild and Household Characteristics.\u003c/span\u003e At the school measurement timepoint each year (April/May), parents completed an online survey via their smartphone about the demographics of their child (biological sex and age), information about the total annual household income, and the number of people (adults and children) living in their home. This information was used to calculate the ratio of poverty to income according to U.S. Federal Poverty Guidelines established by the Department of Health and Human Services.\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRefreshing Longitudinal Cohort.\u003c/span\u003e To account for parents/children electing to discontinue in the study, we refreshed the sample\u003csup\u003e\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e in the early spring (February/March), prior to school data collection in April/May each year. Refreshing the sample replaces students who dropped out of the study with students who had similar demographic characteristics. Refreshing is methodology consistent with other large-scale cohort studies.\u003csup\u003e\u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e Criteria of the refreshment sample was to ensure similar proportions of students were present in the study based on child sociodemographics (i.e., biological sex, race/ethnicity, household income) from the initial year of data collection in 2021 and to replace children based upon the grade as the cohort aged over time.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDietary Measure.\u003c/span\u003e The Dietary Screener Questionnaire from the Healthy Communities Study (HCS)\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e was used to collect dietary data on children enrolled in What\u0026rsquo;s UP. The screener consisted of 23 items from the HCS that assessed children\u0026rsquo;s intake of fruits and vegetables; dairy; sugar-sweetened beverages; other energy-dense foods of minimal nutritional value (e.g., chocolate/candy, donuts/sweet rolls, cookies/cakes/pies, ice cream/frozen desserts, chips/crackers); and fast food. Parents, along with their child, completed the screener at the end of each day, for a total of 14-days, during school (April/May) and again for 14-days in summer (July), reporting on what their child ate and/or drank that day. Unlike the original screener, which asked respondents about consumption over the past 30 days (e.g., 1 time last month, 2 times per week), only response options referring to the frequency of consumption for that day were included (e.g., 1 time today, 2\u0026ndash;3 times today). Parents and their child completed the screener as part of the time use record (described in detail below).\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTime Use Measure.\u003c/span\u003e The time use record was developed in Qualtrics and distributed to parents at 8PM each evening of the 14-day measurement period during school and summer to complete on their smartphone. The time use record was based on the day reconstruction method.\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e The time use record involved parents completing a series of questions about their child\u0026rsquo;s previous 24hrs. The first question asked about the time their child went to bed the previous night, followed by when their child woke today. The next series of questions asked about whether their child left where they were (e.g., woke up at home, did child leave home today?) and if \u0026ldquo;yes\u0026rdquo;, where their child went and at what time (e.g., left home and went to school at 7:15AM). Parents reported time in 15min increments (e.g., 9:00AM, 9:15AM, 9:30AM\u0026hellip;). This sequence of questions continued until parents reported the entire day with where their child was and at what times. The time use record provided a list of common locations where a child may be that a parent could select from: home, before school program, school, afterschool program, sports, music/theater/dance, neighborhood pool/water, park/river/lake/beach, park/playground, employment/volunteer, church/synagogue/mosque or other religious activity, friend\u0026rsquo;s house, relative\u0026rsquo;s house, restaurant/fast food outlet, errands/shopping/appointments, tagging along/attending family or friend\u0026rsquo;s event/activity, or summer day camp. There was an additional \u0026ldquo;other\u0026rdquo; option for parents to write a specific activity/setting not represented. For the purpose of this study, we classified sports, music/theater/dance, employment/volunteer, places of worship, summer day camps, and summer learning programs as structured settings in the summer. Embedded at the end of the time use record was the dietary screener. Each time use record took an average of 6min to complete (median 4.8min, IQR 3.5 to 7.1min).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStatistical Analysis.\u003c/span\u003e The primary analysis compared differences in children\u0026rsquo;s odds of consuming different food/beverage categories on a given day between school and summer. After review of the distribution of the responses, items were dichotomized into \u0026ldquo;did not eat/drink today\u0026rdquo; versus \u0026ldquo;ate/drank today\u0026rdquo;. Items were collapsed into the following categories for analyses: fruit, vegetables, 100% fruit juice, milk (unflavored and flavored milk), frozen desserts, other desserts (pastries/doughnuts and cookies cakes, pies), non-carbonated sugar-sweetened beverages (non-100% fruit juice, energy drinks, flavored water, sports drinks, coffee drinks), sugar-sweetened and diet soda/pop, and salty snacks (chips/pretzels). A series of multi-level, generalized linear models that accounted for the nesting of days within children, within families, within schools, were examined for each food/beverage dependent variable with the following contrasts of interest. For our main analysis we examined differences in the probability of consuming a food/beverage on a given day between school and summer. Analyses also examined changes in the probability of consuming a food/beverage on a given day between school and summer by each of the 3 poverty to income ratio groups (insert info about 3 groups). To examine the association of exposure to structured programming and dietary intake in the summer, we used the exposure to structure data from the time use record and created two exposure metrics: 1) dichotomized exposure to structure or not on a given day; and 2) exposure to structure in number of minutes per day and categorized this into no (reference group), low (30-60min/d), moderate (\u0026gt;\u0026thinsp;60, \u0026lt;\u0026thinsp;200min/d) and high (\u0026gt;\u0026thinsp;200min/d) of structured programming attended. All models included biological sex, age, parent education, poverty to income ratio, food insecurity status, and use of either the Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC) program as covariates.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe number of children by age in years and daily diaries across the 6 assessments are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Across the 3-year study, a total of 1,298 children completed an average of 31 days of time diaries each across the 6 measurement occasions. The demographics of the cohort across each assessment period are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of children and daily diaries by assessment year.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c12\" namest=\"c3\"\u003e \u003cp\u003eNumber of Children by Age (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTimepoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e594\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e506\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e635\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e511\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e707\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e642\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e185\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e341\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e463\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e607\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e760\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e716\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e389\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e105\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c12\" namest=\"c3\"\u003e \u003cp\u003eNumber of Daily Diaries by Age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTimepoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e6633\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e5763\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e6694\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e5333\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e8197\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e7363\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e210\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1823\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3318\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4873\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6197\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e8124\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e7999\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e5192\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e1918\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e329\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eTimepoint: School\u0026thinsp;=\u0026thinsp;April/May; Summer\u0026thinsp;=\u0026thinsp;July\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChild demographics by assessment period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"18\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c18\" namest=\"c14\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year, M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/Ethnicity (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoverty to Income Ratio (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e200% or Below Pov (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood Insecure (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupplemental Nutrition Assistance Program (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen, Infants, and Children (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvg. Number of Time Use Diaries (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvg. Days with Structure Reported (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvg. Minutes per day of Structure during Summer (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;153.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e61.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;152.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;152.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvg. Minutes per day of Structure for Children\u003c/p\u003e \u003cp\u003eReporting going to Structure during Summer (M, SD)\u003c/p\u003e \u003cp\u003e(does not include ZERO structure)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e321.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;209.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e298.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;208.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e308.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;187.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eSchool vs. Summer.\u003c/b\u003e The comparison between foods/beverages consumed during school compared to summer can be found in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cb\u003esupplemental Table\u0026nbsp;1\u003c/b\u003e. For the entire sample and by each of the three income-subgroups, children were, in general, more likely to consume unhealthful foods/beverages (e.g., frozen desserts, soda/pop) and less likely to consume healthful foods/beverages (e.g., fruits, dairy) during the summer in comparison to when they were in school. However, during summer, children tended to consume fewer non-frozen desserts and salty snacks (overall sample and high-income group). Of the 40 comparisons, 30 supported the SDH. Of the remaining 10, 5 did not support the SDH (i.e., in the opposite direction of the SDH) and 5 were not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cb\u003eWeekdays vs. Weekend Days: School and Summer, separately.\u003c/b\u003e For school timepoints, in the entire sample children were more likely to consume healthful foods/beverages (e.g., fruit, dairy) and less likely to consume unhealthful foods (e.g., fast food, soda/pop) on weekdays (M-F) compared to weekend days (Sat-Sun) \u0026ndash; see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cb\u003esupplemental Table\u0026nbsp;1\u003c/b\u003e. Subgroup analysis by income demonstrated the same pattern. During weekdays in the overall sample and children in the middle- and high-income groups were more likely to consume salty snacks compared to the weekend days, whereas children from low-income households were less likely to consume salty snacks.\u003c/p\u003e \u003cp\u003eDuring the summer, similar associations were observed, with more healthful dietary patterns during weekdays vs weekend days. However, these associations tended to be smaller in magnitude compared to weekday vs weekend day comparisons during school - for example OR 2.07 school compared to OR 1.25 summer for weekdays vs weekend days for fruit consumption. Separate comparisons across income groups indicated children in the low- and high-income groups exhibited more healthful dietary patterns on summer weekdays vs weekend days, while children from middle-income households had more similar dietary intakes on weekdays and weekend days in the summer.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStructure during the Summer.\u003c/b\u003e In the summer, on days when children attended some form of structured programming (binary variable attended vs did not attend), they tended to exhibit more healthful dietary patterns compared to days without attending structured programming (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and \u003cb\u003esupplemental Table\u0026nbsp;1\u003c/b\u003e). This pattern was similar for each income subgroup. When examining exposure to structure based on minutes spent in a structured setting each day, a dose response association emerged (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB and \u003cb\u003esupplemental Table\u0026nbsp;1\u003c/b\u003e). As children spent more time in a structured setting in the summer, their dietary pattern improved. The greatest improvements were observed for children spending 200 or minutes per day in a structured setting in the summer.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSummer is increasingly being recognized as a period of time where children are at a greater risk for unhealthy weight gain.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Generally, it is well established that diet is a leading behavioral contributor to unhealthy weight gains in children, however, evidence regarding whether children\u0026rsquo;s dietary patterns during the summer are different than their dietary intake during school are mixed.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e According to the SDH, children should consume more unhealthful foods during summer, compared to school, given 1) limited access to federally funded meals that adhere to nutritional guidelines in the summer, and 2) increased freedoms (e.g., more snacking opportunities) that may operate during summer when days may be less-structured with the removal of school. The findings in this study indicate children exhibit more unhealthy dietary patterns during summer, compared to school, and on weekend days, compared to weekdays, both during school and summer. Importantly, during the summer, attending structured programming was associated with a more healthful dietary pattern, compared to days without structure. Overall, these findings have important implications for establishing summer as time with increased risk for unhealthful dietary intake, as well as providing additional theoretical support for the SDH of the importance of structured programming (school and summer programs) on beneficially influencing children\u0026rsquo;s dietary intake.\u003c/p\u003e \u003cp\u003eThe main findings were that children were more likely to consume unhealthful foods during the summer, compared to school. These effects were consistent across income groups, indicating summer had a similar effect on dietary intake regardless of socioeconomic status. This shows schools provide a seemingly equitable impact on child diet intake and conversely, when children are removed from the almost daily exposure to the school environment and with that the nutrition regulations that govern the nutritional quality of foods/beverages readily available, they are at a greater risk of consuming less healthful foods/beverages and consuming more unhealthful foods/beverages.\u003csup\u003e31,35,36,38,39,41\u0026ndash;43\u003c/sup\u003e The importance of the school food environment is further highlighted in the comparison of consumption between weekdays and weekend days where the largest odds were observed for school days vs weekend days when children were in school.\u003c/p\u003e \u003cp\u003eA similar, albeit smaller, effect was observed for summer weekdays vs weekend days. Analyses indicated on days when children attended a summer program (e.g., day camp), they were more likely to consume healthful foods/beverages and less likely to consume unhealthful foods/beverages. When considering the amount of time spent at a summer program, the longer attendance at a summer program during a day was associated with a greater odds of consuming healthful foods/beverages and a lower odds of consuming unhealthful foods beverages. These findings from summer, along with those during the school year, although observational, provide empirical support for the impact of spending time in a structured setting and the association with improved dietary behaviors.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile most associations were in the direction hypothesized by the SDH, there were several food/beverage items that demonstrated associations in the opposite direction. Specifically, in the summer, attending a summer program was associated with an increased odds of consuming salty snacks and non-carbonated flavored beverages. A plausible reason for these associations could be salty snacks are items that are reimbursable via federal nutrition programs, such as the Summer Food Service Program (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.fns.usda.gov/summer/sunmeals\u003c/span\u003e\u003cspan address=\"https://www.fns.usda.gov/summer/sunmeals\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Thus, salty snacks would likely be served on a regular basis in summer programs, leading to an increase in their consumption for children attending. Secondly, during the summer, due to temperature and humidity, there is an added need to ensure appropriate hydration. With this, children bring sports drinks and other flavored beverages when attending a summer program.\u003csup\u003e\u003cspan additionalcitationids=\"CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e These factors could explain why attending a summer program was associated with increased odds of consuming these items.\u003c/p\u003e \u003cp\u003eThere are a number of strengths to this study. These include the large and diverse sample of children participating, the longitudinal design, the assessment of diet during school and summer, and the large number of days collected during both school and summer. There are several weaknesses. One is the use of a dietary screener to measure dietary intake. While this measure is not as comprehensive as a 24hr dietary recall, this tool facilitated a quick and lower-burden assessment of dietary intake on a daily basis, which in turn, allowed for the comparison of weekdays vs weekend days, as well as days during the summer where children did and did not attend a summer program. This tool also limited the ability to quantify the amount consumed and reduced our ability to quantify macro- and micro-nutrients. Another weakness is the limited geographical location where these data were collected. Summer at other latitudes would be associated with varying temperatures, thereby changing the experiences of children during this time. Nevertheless, this study was conducted in the southeastern United States which has among the highest rates of obesity and obesogenic behaviors \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e and thus, the findings from this study, at minimum, generalize to this geographical area.\u003c/p\u003e \u003cp\u003eIn summary, children were more likely to consume unhealthful foods/beverages and less likely to consume healthful foods/beverages during summer, compared to when they are in school. Evidence of the importance of structured environments was observed when examining weekdays vs weekend days during school and summer, separately. Importantly, we observed an association between attending summer programming and consuming more healthful and less healthful foods/beverages during the summer, suggesting such programming during the summer could play an important role in promoting a healthful diet during the summer.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthics approval and consent to participate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis study was approved by the lead author's Institutional Review Board at the University of South Carolina (Pro00080382). All study procedures adhered to the Declaration of Helsinki.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsent for publication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvailability of data and materials\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe datasets generated and/or analyzed in the current study are not publicly available because additional analyses are ongoing. Data will be made available from the corresponding author on reasonable request at the time the primary outcome papers are published.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCompeting Interests\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe authors\u0026rsquo; declare no competing interests.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFunding\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearch reported in this publication was supported by the National Institute Of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health under Award Number R01DK116665. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrant No.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR01DK116665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAuthors' contributions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMWB led the project, secured the funding, and led the analysis and writing of the manuscript. All authors contributed to the writing, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcknowledgements\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWe would like to thank all the families and school personnel who helped makes this project successful!\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBeckerman-Hsu JP, Aftosmes-Tobio A, Lansburg K, et al. Summer Weight Gain Among Preschool- Aged Children With Obesity: An Observational Study in Head Start. \u003cem\u003ePreventing Chronic Disease. \u003c/em\u003eApr 2021;18.\u003c/li\u003e\n\u003cli\u003eBrusseau TA, Burns RD, Fu Y, Weaver RG. 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DNPAO Data, Trends, and Maps Database. 2025; https://www.cdc.gov/dnpao-data-trends-maps/database/index.html. Accessed 08/01, 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diet, Vacation, Children, Poverty, Low-Income","lastPublishedDoi":"10.21203/rs.3.rs-6255625/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6255625/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSummer vacation is a time when youth gain excessive weight. A key driver of unhealthy weight gain is poor dietary quality. The absence of consistent structure (e.g., school), is hypothesized to be one of the reasons for lower diet quality during summer. This study examined differences in school and summer dietary quality among a diverse cohort of children across three years. We also examined the impact of attending structured programs on children\u0026rsquo;s diets.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eParents of 1,298 children (age 5\u0026ndash;14 years, 48% girls) completed a time use diary each day for 14-days during school (April/May) and again in summer (July) from 2021 to 2023, for a total of 6 timepoints. The daily diary collected information on the child\u0026rsquo;s location and dietary intake for that day. Mixed-effects models examined the odds (OR) of consuming a food/beverage (e.g., fruit, vegetable, soda, salty snacks) on a given day during school vs. summer, overall and by income. Models also examined the impact of attending structured programming during summer (e.g., summer day camp) on the likelihood of consumption.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 39,983 time use diaries were completed. Overall, children were less likely to consume fruit, vegetables, milk, 100% juice, and salty snacks (OR range 0.63 to 0.87), and they were more likely to consume non-carbonated sweetened beverages, soda, frozen desserts, and fast food (OR range 1.17 to 1.63) during the summer compared to school. On summer days with structured programming, children were more likely to consume fruits, vegetables, milk, salty snacks, sweetened beverages (OR range 1.13 to 1.45), and they were less likely to consume frozen desserts, fast food, and soda (OR range 0.63 to 0.90). Few differences were observed between income groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eChildren were less likely to report consumption of more healthful foods/beverages and more likely to report consumption of less healthful foods/beverages during summer compared to school. Attending structured programming during summer is associated with improved diet \u0026ndash; suggesting such settings have potential to modify dietary intake.\u003c/p\u003e","manuscriptTitle":"Differences in Children’s Food and Beverage Consumption between School and Summer: Three-year findings from the What’s UP (Undermining Prevention) with Summer Observational Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 05:29:56","doi":"10.21203/rs.3.rs-6255625/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-16T06:55:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T15:01:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-02T10:55:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281001285211564512856663094079460065488","date":"2025-04-16T09:14:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198397576046525367901303189806830538507","date":"2025-04-15T12:05:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135479538773725164045652880855290343849","date":"2025-04-11T15:21:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-03T05:06:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-03T05:01:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-24T03:29:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-22T14:15:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-22T14:14:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6262b4a0-6392-4887-a41e-c811c90d3736","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T16:05:21+00:00","versionOfRecord":{"articleIdentity":"rs-6255625","link":"https://doi.org/10.1186/s12889-025-23446-0","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-07-10 15:57:25","publishedOnDateReadable":"July 10th, 2025"},"versionCreatedAt":"2025-05-07 05:29:56","video":"","vorDoi":"10.1186/s12889-025-23446-0","vorDoiUrl":"https://doi.org/10.1186/s12889-025-23446-0","workflowStages":[]},"version":"v1","identity":"rs-6255625","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6255625","identity":"rs-6255625","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}