Research ArticleMealtimes at Residential Summer Camps: What Are CampStaff Doing to Promote Campers’ Healthy Eating Behaviors?Alison K. Ventura, PhD1; Stephanie Anzman-Frasca, PhD2; Barry A. Garst, PhD3

1DepartmUniversi2Friedm3AmericAddressCollege1030, Pakventur�2014 Shttp://dx

Journal

ABSTRACT

Objective: To explore camp staff’s reports of their interactions with campers during mealtimes atresidential summer camps.Design: Thirty-minute semistructured, face-to-face interviews with staff.Setting: Two residential summer camps in northeastern Pennsylvania.Participants: Fifty-two adult (>18 years of age) staff.Phenomenon of Interest: Staff’s perceived responsibilities, problems encountered, and feeding practicesused during camp mealtimes.Analysis: Qualitative interviews were analyzed using a hybrid analysis approach that combined deduc-tive directed content analysis with inductive thematic analysis to identify themes and subthemes.Results: The majority of staff indicated their responsibility during mealtimes was to ensure that camperseat. Common problems mentioned were campers’ tendencies toward picky eating and overeating. Staffreported a number of strategies to deal with common mealtime problems including reasoning, modeling,limits or rules, punishment/contingencies, and responding to campers’ needs/preferences.Conclusions and Implications: Most staff expressed concern about promoting campers’ healthy eatingbehaviors. Although staff discussed several mealtime strategies that can be interpreted as adaptive in author-itative contexts, they need more guidance related to what they should and should not do during mealtimes.Avenues for future research to inform the promotion of healthier mealtime behaviors in camps arediscussed.KeyWords: feeding practices, mealtime interactions, summer camp, children, obesity prevention (J NutrEduc Behav. 2014;46:491-498.)

Accepted June 8, 2014. Published online July 23, 2014.

The prevalence of childhood obesityhas increased dramatically over thepast 30 years.1 A major contributorto this trend is poor dietary patterns:80% of school-aged children do notmeet recommendations for fruit orvegetable intakes and over 90%exceed recommended intakes for solidfats and added sugars.2 A large body ofresearch has focused on how schoolenvironments influence children'seating behaviors and obesity riskbecause schools are a place where chil-dren spend the majority of their time.

ent of Nutrition Sciences, College oty, Philadelphia, PAan School of Nutrition Science and Poan Camp Association, Martinsville, INfor correspondence: Alison K. Venturof Nursing and Health Professions, Drhiladelphia, PA 19102; Phone: (215)a@drexel.eduOCIETY FOR NUTRITION EDUC.doi.org/10.1016/j.jneb.2014.06.005

of Nutrition Education and Behav

However, the summer months are atime when children are more inactive,have less access to healthy foods, andshow greater gains in bodymass indexcompared with time in school.3 Thissuggests that the contexts withinwhich children spend their summerbreaks are an important considerationfor obesity prevention efforts.

Few studies have focused on theinfluence of summer camps on chil-dren's obesity risk. However, as aninstitution camps rank second onlyto schools in the number of children

f Nursing and Health Professions, Drexel

licy, Tufts University, Boston, MA

a, PhD, Department of Nutrition Sciences,exel University, 245 N. 15th St, Mail Stop762-3971; Fax: (215) 762-4080; E-mail:

ATION AND BEHAVIOR

ior � Volume 46, Number 6, 2014

who attend, with more than 11million children and adults from theUS attending camps annually.4

Camps also serve children of diverseracial, ethnic, and socioeconomicbackgrounds.5 For example, 28% ofresidential camps serve high-incomefamilies, 40% serve middle-incomefamilies, 19% serve low-incomefamilies, and 14% serve poverty-levelfamilies (note that these classifica-tions are not mutually exclusive).5

Thus, camps provide access to a widearray of children, including thosewith increased obesity risk.6

Residential summer camp pro-grams are immersive and sustainedexperiences. Children are within thecontext of the camp 24 h/d7 andcamp sessions range from 1 to 10weeks (40% of camps offer sessionsof $ 5 weeks, 26% 2–4 weeks, and28% # 1 week8). Previous researchon socioemotional development illus-trates that the intensive nature of theresidential camp experience leads to avariety of benefits for young people.9

491

Table 1. Prompts and Questions Asked During Semistructured QualitativeInterview With Camp Staff Members

1. Tell me about a typical meal with your campers.2. What are your responsibilities during a meal?3. Is there anything about mealtimes or your campers’ eating behaviors that you find

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Thurber et al9 found that a 1-weekexperience was sufficient to signifi-cantly improve campers' positive iden-tity; social, physical, and thinkingskills; and positive values and spiritual-ity; and that these gains were main-tained or showed additional growthduring the 6 months after the campexperience. The residential camp ex-perience may be particularly influen-tial for children's eating behaviorsbecause campers are provided with atleast 3 meals/d and these meals areusually consumed in the presence ofa camp staff member. Thus, campmealtimes provide repeated opportu-nities for exposure to new foods, asso-ciative learning, and modeling ofeating behaviors by adults, all of whichare mechanisms through which chil-dren's eating behaviors are shaped.10

It is important to examine meal-times in residential camps todeterminehow current practices affect children'seatingbehaviors and touncover poten-tial implications for further researchand practice aiming to optimize chil-dren's dietary intake in these settings.The perceptions and experiences ofcamp staff members are an importantplace to begin this research becausestaff are the caregivers during campmealtimes and also the primary influ-ence on camp program quality.11 Theaim of the present studywas to explorecamp staff members' perceptions oftheir interactions with campers duringcamp mealtimes. The researchersadopted an exploratory qualitativeapproach because questionnaires as-sessing caregiver feeding practiceshave not been created for or validatedin camp settings. Thus, qualitativeinterviews were conducted with staffmembers at residential summer campswith the purpose of understandingthe following aspects of their meal-time interactions with campers: (1)perceived responsibilities during campmealtimes, (2) perceived problemsand frustrations related to campereating behaviors during camp meal-times, and (3) self-reported feedingpracticesused (if any) todealwithmeal-time problems and frustrations.

problematic or frustrating?4. Are there any strategies that you use to fix these problems or frustrations?5. Do you talk to your campers about the food served? Why or why not?6. Do you talk to your campers about the way they are eating? Why or why not?7. Do you try to change or influence your campers’ food choices or eating behaviors?Why or why not?

8. Is there anything else you would like to tell me about mealtimes at camp?

METHODSParticipants

A convenience sample of adult ($18years of age) camp staff members

(hereafter referred to as staff) at 2 resi-dential summer camps in the PoconoMountain region of Pennsylvaniawas recruited. Staff were recruitedthrough a short presentation duringstaff orientation (before the start ofthe first camp session). Interested staffsigned up for the study during orien-tation and were later contacted toschedule an interview. They wereinterviewed individually during sched-uled break times. All interviews wereconducted during summer, 2012.

A total of 52 staff members (20% oftotal staff) were interviewed. All parti-cipants were entered into a raffle for 1of 8 $50 gift cards to a local conve-nience store as compensation for theirparticipation. The Drexel UniversityInstitutional Review Board approvedall study protocols before data collec-tion and written consent was obtainedfrom all staff before participation.

MeasuresQualitative interview. The authorsdesigned a semistructured interviewbased on a review of research employ-ing qualitative techniques to studychild feeding practices or eating behav-iors. Interview questions are detailedin Table 1. This script facilitated theinterviewing process and prompts foradditional information were addedon a per-interview basis to clarify anyunclear statements. A single inter-viewer (AKV) administered all inter-views. Responses were documentedthrough notes taken by the interviewerand audio-recording of the interviewsession. Audio records were later tran-scribed for qualitative analysis.

Demographics questionnaire. Parti-cipants were asked to fill out a demo-graphic questionnaire that assessed

sex, age, years of experience workingat camps, years of experience workingwith children (in any context), theage of the campers in bunk, andwhether the participant attendedcamps as a child.

Data Analysis

The researchers analyzed qualitativeinterviews using a hybrid analysisapproach that combined deductivedirected content analysis with induc-tive thematic analysis.12 The directedcontent analysis approach guidedthe initial analysis of the interviewsin which a framework based onprevious research directed the crea-tion of themes.13 Before data analysis,3 themes that encompassed aspectsof caregiver–child mealtime interac-tions highlighted by previous researchon parent feeding practices wereselected10: (1) perceived responsibil-ities during mealtimes, (2) perceivedproblems and frustrations related tochild eating during mealtimes, and(3) feeding practices used to dealwith mealtime problems and frustra-tions. An inductive thematic analysiswas then conducted to identifysubthemes that emerged within thesethemes.12 A coding scheme thatencompassed the themes and sub-themes was created after an initialpass through the data. All membersof the 3-person research teamreviewed the themes and subthemesfor validity and discussed any dis-crepancies in theme or subthemeidentification or coding. A singlecoder (who was also the interviewer[AKV]) then coded all interviews usingthis coding scheme. To establishreliability, the coder randomlyselected 13 interviews (25%) to be

Table 2. Demographic Characteristics for Camp Staff Members (n ¼ 52)

Mean or % SD or n Range

Age, y 21.0 2.3 18–29

Sex, female (%) 64% n ¼ 33

Race/ethnicityNon-Hispanic white 92% n ¼ 48Non-Hispanic black 8% n ¼ 4

Average experience working at camps, y 3.2 2.2 1–10

Average experience working with children, y 5.7 2.8 1–15

Age range of campers in bunk, y7–9 21% n ¼ 1110–11 33% n ¼ 1712–13 23% n ¼ 1214–15 21% n ¼ 11

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nonconsecutively double-coded.Intra-coder reliability for subthemeswas determined to be r(11 degrees offreedom) ¼ 0.97. Themes and sub-themes are described in narrativeform below.

RESULTSSample Characteristics

Table 2 summarizes the sample char-acteristics. Most study participantswere white, female, and between 18and 29 years of age. They had workedat camps for an average of 3 years andhad worked with children (in anycontext) for an average of 6 years.Collectively, the staff were respon-sible for children aged 7–15 years.

Description of CampEnvironments

One camp was a private, for-profitcamp; the other was a not-for-profitcamp. Both offered general (non-specialized) camp programs. Atboth camps, campers and staff ate allmeals (breakfast, lunch, and dinner)together. All meals occurred in adining hall within which 5–10 simi-larly aged campers and 2–3 staff sattogether in small groups based ontheir assigned cabin or bunk. Foodwas served family style for all mealsand menu cycles were weekly withslight variations from week to weekdepending on inventory and specialevents. One camp offered a salad barin addition to the hot meal whereasthe other camp offered peanut butter

and jelly sandwiches as an alternativeto the hot meal. Both camps had acamp store where food and beverages(eg, bottled water, soda, candy) couldbe purchased after the evening activ-ity and allowed campers to receivecare packages containing food. Bothcamps offered 3.5-week or 7-week ses-sions for campers; staff members wereemployed for the entire 7 weeks.

Camp Staff Members’ ReportedMealtime Interactions

The following summarizes the sub-themes that were identified withineach theme. Discussion of subthemeswas not mutually exclusive, meaningthat many staff discussed more than1 subtheme within each particulartheme.

Perceived responsibilities during meal-times. Discussion of perceived respon-sibilities during mealtimes centered on5 major subthemes: (1) ensuringcampers were eating enough/the rightfoods/a variety of foods; (2) managingcamper behavior; (3) helping withserving food; (4) interacting withcampers; and (5) ensuring camperswere not eating too much.

The majority of staff (83%) indi-cated that one of their responsibilitiesduring mealtimes was to make surethe campers ate. There were severalvariations on this subtheme relatedto ensuring campers ate enough(‘‘I try to get them to eat as much asthey can’’), ensuring campers ate theright types of foods (‘‘I always makesure they are eating something of

nutritional value’’), or promotingvaried intakes (‘‘Making sure thatthey are not just eating like what Idid when I was a camper: a plate ofmashed potatoes because I didn'twant to eat other stuff’’). Staff indi-cated that many campers did not eatenough or eat a variety of healthfulfoods at mealtimes because they didnot like the foods served. Many staffwho worked with younger campersalso indicated that they felt thecampers were not responsible enoughto manage their own eating.

Some staff (38%) indicated that itwas their responsibility to managecampers' behavior during mealtimes.Staff who endorsed this subtheme dis-cussed how camp mealtimes wereoften hurried and chaotic and howcampers often lacked manners or theability to remain calm during meal-times. For example, a staff memberexplained:

We like to facilitate, like, good ta-ble manners, like saying ‘‘please’’and ‘‘thank you’’ because thecampers are still learning, [and]so they can take these tools backhome with them.

Almost one third (31%) of the staffindicated that a responsibility duringmealtimes was to help with servingfood, with the similar goal of reducingmealtime chaos and stress. Approxi-mately 21% of staff felt that interact-ing with campers was an importantaspect of their mealtime responsibil-ities. For example, a staff membersaid,

I think a lot of talking and listeningto what their day was like andhearing if there was [sic] any prob-lems. I just think a mealtime isreally important time to talk, likeeven at home with families.

Most staff that discussed this sub-theme shared similar sentiments tothis quotation, indicating that meal-times were an important time to con-nect with campers.

Some staff (19%) shared theperception that their responsibilitywas to ensure campers did not eattoo much. For some, this was dis-cussed as a need to control portionsizes. One of the staff explained,

. I try and control the portion size,which is kind of difficult bearing inmind that, ah, each counselor has

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a different perception as to what aportion size is, um, and obviouslyeach child is different in size, sothat might be different as well.

Other staff took a broader perspective,indicating that they monitored theoverall amount that campersconsumed, as explained by a staffmember: ‘‘. You just have to makesure they are not eating too much.’’

Common problems during meal-times. Perceived mealtime problemsand frustrations centered on 6 sub-themes: (1) camper pickiness, (2)camper overeating, (3) lack of supportfrom other staff, (4) ‘‘I don't have todo this at home’’ mentality, (5)possible disordered eating, and (6)campers with food allergies.

The most common problemmentioned (54% of staff) was diffi-culty encouraging picky eaters to trythe foods offered. For example, amember of the staff discussed how‘‘Sometimes they won't eat the hotmeal. Like, they’ll just eat pasta orpeanut butter and jelly, [especially]when the hot meal is, like, reallynutritious.’’ Many echoed similarfrustrations that campers chose toeat the alternative meals and avoidthe main meal, which was presum-ably healthier and more varied.

The second most common prob-lem discussed (25% of staff) wascamper overeating (note that thiswas the staff members' perception ofovereating). Many viewed the prob-lem of campers' overeating as a sensi-tive issue that was difficult to broachwith campers. For example, a memberof the staff discussed how

One camper tends to overeat. Idon't know how to tell her tostop. She is a big girl, so I don'tknow if she's really hungry.When we have several options shehas to have everything, and she al-ways wants more of everything.She just takes a lot. She ate 6 tacosthe other day. I don't know, I thinkthat is a lot for a 11-year-old.

Some staff (25%) mentioned thatlack of support or consistency fromother staff was a significant problemduring mealtimes. Discussion typi-cally focused on others' lack ofattention to the campers during meal-times (‘‘When other counselors sit

together and don't involve the kids. that's what annoys me.’’) or failureto model healthful behaviors (‘‘If [thecampers] hear the counselors talkingabout how bad a meal is and theyare not eating it, why are [thecampers] going to eat it?’’). Staff feltthat the lack of support from othersimpeded their own efforts to promotecampers' healthy eating behaviors.

Some staff (15%) also indicatedthat they struggled with the campers'‘‘I don't have to do this at home’’men-tality. Specifically, they described situ-ations in which campers argued thattheir parents did not make them eatcertain foods or use certain behaviorsat the table, so they should not haveto do it at camp. For example, a staffmember said,

. A lot of them will tell us thattheir parents don't make them eatthings they don't like. So then,they’ll say, ‘‘Well my mom won'tmake me eat that at home so whyshould I eat that here?’’

Staff indicated that statements such asthese were frustrating because theywere difficult to verify. They also dis-cussed how they were unsure as towhether they should go against whatmight be parents' wishes to try to in-fluence camper behavior in a waythat was more consistent with theirown goals.

Another concern staff (13%) ex-pressed was about eating behaviorsthat appeared to be signs of disorderedeating or an eating disorder. Most ex-amples were related to campers whowere attempting to cover up the factthat they were not eating. Forexample, a staff member said, ‘‘.We had a problem with 1 girl . wekind of were afraid that 1 of my girlsdidn't eat so much. We saw that shecuts her food into tiny pieces but ifyou, like, bonded them together, shejust ate a few bites .’’ Staff who dis-cussed this problem typically indi-cated a link between observed bodyimage issues and eating behaviors.

A small percentage of staff (10%)indicated that meeting the needsof campers with food allergies orintolerances was a notable problemduring mealtime. This problem wascommonly attributed to lack ofcommunication between the kitchenand the staff regarding which foodswere allergen-free or to not being

well informed about a camper'scondition. One staff member noted,

. Lactose [intolerance] can be,like, different for everyone. When[the camper] was trying to putcream cheese on her bagel, youknow, we aren't sure, like, howmuch her body can take before get-ting sick. Because it could be awhole bowl of ice cream or it couldbe a teaspoon of cream cheese.

Strategies used to manage mealtimeproblems. Six subthemes emergedwithin discussion of strategies usedto deal with these problems: (1) talk-ing, encouraging, or reasoning withcampers; (2) modeling desired behav-iors; (3) imposing limits or rules; (4)using punishment or contingencies;(5) responding to campers' needsand/or preferences; and (6) using nostrategies.

Two thirds of staff (67%) indicatedthat they addressed mealtime prob-lems by talking, encouraging, orreasoning with campers. They didthis by talking with campers aboutthe food being served, the benefits ofeating a healthy diet, and the impor-tance of trying new foods. Forexample, a member described how

I encourage them to eat vegetablesat every single meal. ‘‘Go, go upto the salad bar and get some veg-gies’’ . of course, like, in a funnyway, like, ‘‘Dude, start eating vege-tables. It's good for you, and it alsotastes pretty good, trust me.’’

Many also reported reasoning withtheir campers to try to change theireating behaviors. For example, onestaff member reported, ‘‘But I am like‘It's my job. Your parents put me incharge of you to eat and I need tomake sure that you do. You know Icare about you.’’’

The second most common strategystaff reported (56%) was modelinghealthy eating behaviors. They indi-cated that they tried to set a goodexample for their campers using theirown actions and words. Some usedmodeling as an active approach bytelling campers directly about theirown behaviors: for example, ‘‘I’ll tell[the campers] that I ate it when I wasa camper . sometimes I have to eatthings I don't like, but you gotta doit to, you know, set the example.’’

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Others used modeling as a more pas-sive approach, hoping campers wouldnotice and imitate their behaviors: forexample, ‘‘. We were talking [thestring beans] up real big to see if [thecampers] would try them . and wephysically eat them in front of [thegirls].’’

Almost half of the staff (44%) settheir own a priori limits regardinghow much campers had to eat beforethey could be done with a meal orbefore they declared that they didnot like themeal. Themajority of staffwho mentioned this strategy dis-cussed a ‘‘3-bites’’ rule, in whichcampers had to eat 3 bites of mealbefore declaring they did not like itor were full. For example, a staff mem-ber explained,

I micromanage their meals a littlebit . first, I serve it to them. Ifthey say that they don't want it Iput it on their plate myself and Isay, ‘‘You have to have at least 3bites of this.’’

Many variants of this rule were dis-cussed, with almost every staff report-ing a different number of bitesrequired or the number of foods thathad to be tried.

Although the first 3 strategiesmentioned (talking, encouraging, orreasoning with campers; modelingdesired behaviors; imposing limits orrules) were the most frequentlymentioned, a fairly large subset ofstaff members (33%) also whomentioned using punishment and/or contingencies to influence cam-pers' eating behaviors. The mostcommonly reported strategy withinthis subtheme was withholding des-sert, snack time, or preferred activitiesif the camper did not eat the meal orcertain aspects of the meal. Forexample, a member of the staff re-ported: ‘‘My campers are not allowedto play GaGa or have any snacks ifthey don't eat their vegetables duringthe meal.’’

The final 2 subthemes thatemerged represented a more laissez-faire approach to mealtime interac-tions. These subthemes representedstatements related to responding tocampers' needs and/or preferences(19% of staff) (eg, ‘‘We just let themeat as long as they want and howmuch they want’’) or related to theperception that it was not the place

of staff to intervene with campers'eating (13% of staff) (eg, ‘‘I don't tellthem anything about their eating.I'm not their parent . I don't like itwhen people tell others what todo’’). Within this latter subtheme,some staff members also indicatedthat they did not feel they had thetime, knowledge, or confidence totry to change campers' eating behav-iors. For example, one member ofthe staff explained:

It's just kind of how it is . I have,like, 8 kids in my bunk and I can't. like . in order to make him eatanything different I would have tosit down with him and have ahalf hour talk with him . and, Ican't really do that.

Sources of Mealtime Strategies

Of note, 53% of staff discussed thesource of the strategies they used toinfluence campers' eating behaviorsduring mealtimes. The researchersanalyzed these data using a thematicapproach and identified 3 majorthemes. Some of the staff (19%;n ¼ 10) indicated that they employedstrategies that were passed down fromother more experienced staff duringtheir current summer at camp as wellas during previous summers at camp.Others (17%; n ¼ 9) felt that theyfigured their strategies out on theirown, with many indicating that theyjust used common sense. Another17% of staff indicated that theyderived their strategies from their pre-vious experience with camp and/orkids. Neither of the camps offeredtraining related to appropriate meal-time interactions with campers; how-ever, 42% of the staff (n ¼ 22)indicated that they felt they wouldbenefit from this type of training.Only 2 mealtime-related policieswere in place at both camps: (1) staffcould not withhold food fromcampers, and (2) staff could not bringoutside food into the dining hall (per-sonal communication with campdirectors).

DISCUSSION

This qualitative assessment of campstaff members' perceived responsibil-ities during camp mealtimes revealedthat themajority of staff believed their

main responsibility during mealtimeswas to ensure that campers ate enough,ate the right types of foods, and ate avariety of foods. However, less thanonequarter of staff discussed the impor-tance of mealtimes for interacting andconnecting with campers. Previousresearch highlighted mealtimes as anopportunity for positive youth devel-opment14 and as a context in whichchildren can practice routines, rituals,effective communication, task accom-plishment, and positive emotionalexchanges.15 Regular family mealsthat are characterized by positive socialinteractions between children andcaregivers are associated with higherdiet quality,16 lower rates of obesity,17

and fewer depressive symptoms18

among children and adolescents.Staffs' discussions of common

problems during mealtimes provideinsights into how camp mealtimesare both similar to and differentfrom mealtimes in family settingsand other contexts. The most com-mon problems that staff discussedwere pickiness and overeating, prob-lems that have been highlighted inmany other studies of caregiver–childmealtime interactions.10 These prob-lems are characteristic of children toa certain extent,19,20 and thus willlikely be faced in any mealtimeenvironment that involves children.Perceived lack of support from otherstaff and the ‘‘I don't have to do thisat home’’ mentality are problemsthat may also be experienced withinfamily environments (eg, whenparents differ in their parentingphilosophies, divorce), but aspects ofthese problems may be unique tocamp and other extra-familial care-giving environments. Because staffmembers are not able to choose theircoworkers, there may be little overlapamong staff on approaches about howto interact with campers or managecommon mealtime problems. Theresulting inconsistencies among staffmay undermine efforts to promotechildren's healthy behaviors.21

Research in family, child care, andschool contexts indicates that severalof the feeding practices mentionedby staff are healthy, positive strategiesthat likely have a beneficial influ-ence on children's eating behaviors.For example, modeling of desired be-haviors has been linked to positiveimpacts on food selection and

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consumption,22 which suggests thatstaffs' explicit attempts to modelhealthy eating may have the potentialto affect the eating behavior of chil-dren in a positive way. In addition,the impact of modeling appears to begreatest when themodel is in an influ-ential role and/or models the targetbehavior enthusiastically.22 Trainingstaff to model healthy behaviorsenthusiastically during mealtimesmay be an effective strategy for pro-moting healthy eating behaviors forcampers. However, modeling un-healthy behaviors, which was sug-gested in the subtheme of lack ofstaff support/consistency, has the po-tential to be counterproductive interms of promoting healthy dietaryintakes for campers.

Other strategies staff used tomanage mealtime problems alsohave the potential to be positive, butmay also be maladaptive dependingon how they are framed. The basis ofthis dichotomy is the theory that care-giving strategies are enacted within anoverall caregiving style, and this over-all style affects the way that caregivingpractices influence children's out-comes.23 An authoritative style ofcaregiving, characterized by highlevels of both responsiveness anddemandingness, has been linked topositive child outcomes in the eatingdomain24 and more broadly.25

Research on feeding practices withinfamily and school contexts suggeststhat responding to children's needsand preferences, setting limits, andencouraging/reasoning can all bebeneficial strategies if executed withan authoritative caregiving style.26

Responsiveness, or responding tochildren's needs and preferences, canbe a beneficial aspect of mealtimeinteractions because it allows childrento learn to eat in response to their ownhunger and satiation cues.27 Respon-siveness within an authoritative styleof caregiving has been described as adivision of responsibility: Childrendecide ‘‘whether and how much’’ toeat and caregivers determine the‘‘what, when, and where’’ of themeal.27 The benefit of this divisionof responsibility is that it fosters thechild's ability to eat in response tohunger and fullness cues, and it alsolets the child practice making choicesabout what and how much to eatwith an appropriate level of guidance

from the caregiver. This approach isdistinct from a laissez-faire or indul-gent style, in which children's needsand preferences are paramount,without accompanying structure orguidance from caregivers.26 Childrenof parents with indulgent styleshave the most energy-dense diets28

and higher risk for obesity.29 Withinresidential camps, staff have little con-trol over the ‘‘what, when, andwhere’’ of mealtimes but they dohave control over their level ofresponsiveness to campers' levels ofhunger and satiation and the extentto which they allow campers to eatin response to these internal cues. Inthe present study, only one fifth ofstaff discussed letting campers eat inresponse to their levels of hunger andfullness, which suggests that staffmay need guidance regarding respon-sive feeding.

Setting limits allows caregivers toguide children's behaviors and bestpromotes children's developing abili-ties to make healthful choices whencaregivers communicate the rationalebehind their limits and allow the chil-dren some autonomy within thelimits. It would be expected, then,that the tendency for over two thirdsof the staff to talk, encourage, orreason with their campers to addressmealtime problems would be a benefi-cial aspect of mealtime interactionsbecause it illustrates that they recog-nize the benefits of communicationand flexibility when trying to setlimits and influence campers'behaviors. At the same time, there isconsistent evidence that settinglimits is maladaptive when it is notpaired with communication andopportunities for child autonomy.30

Caregivers' micromanagement ofmeal-times, as was found to be thepractice of many staff in this study,has the potential to diminish chil-dren's autonomy and ability to learnhow to manage a situation on theirown. When a caregiver dictateswhen and how much a child needsto eat, this increases the likelihoodthat a child will learn to eat inresponse to external cues (eg, theamount of food on the plate) and notin response to internal cues (eg, levelsof hunger and fullness), an eatingstyle predictive of the development ofobesity.31 Thus, the common ten-dency of staff to set a priori limits

regarding what foods campers couldchoose and/or how much campershad to eat during mealtimes maylead to decreases in campers' prefer-ences for the foods served andincreases in campers' tendencies toeat in the absence of hunger.30,31

One third of the staff in this studyused punishment and/or contin-gencies, both of which may decreasemealtime positivity and convey themessage that healthy food is undesir-able but should be eaten to obtain areward or avoid a punishment.32

Although punishment and contin-gencies may increase children's intakein the short term, these strategies candecrease children's preferences forhealthy foods in the long term.33

This study fills a research gap byproviding information about themealtime behaviors of camp staff butshould be interpreted in the contextof its limitations. This research wasconducted at a limited number ofcamps (2) within the same region ofthe US and with a fairly homogeneoussample (predominantly non-Hispanicwhite); the findings may not gener-alize to other camps or more diversesamples. Only 20% of available stafftook part in the study, which mayfurther limit the generalizability ofthe findings. In addition, interviewswere conducted with a script to facili-tate the interviewing process withprompts for additional informationon a per-interview basis. The aim ofthe prompts for additional informa-tion was to clarify any unclear state-ments; however, these prompts mayhave biased the data because theymay have encouraged some of thestaff to discuss subthemes thatthey might not have discussed ifunprompted. Despite these limita-tions, the current results have a num-ber of implications for subsequentresearch and practice.

IMPLICATIONS FORRESEARCH ANDPRACTICE

The current study demonstratednumerous avenues for future researchto inform the promotion of healthiermealtime behaviors in camps. First,these data suggest that promotion ofhealthy eating behaviors in childrenmay not be an intentional aspect of

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many camp programs, and staff mem-bers are left to develop their ownmealtime strategies, which may ormay not be based on an understand-ing of what constitutes healthy eatingbehaviors in children. Interventionsand trainings that draw from theextant research on caregiving moregenerally and the development ofeating behaviors more specificallycould be developed to communicateoptimal ways to execute the practicesthat are already in staffs' repertoires,including modeling, responding tocampers' needs and preferences,setting limits, and encouraging/reasoning. Evaluation of such inter-vention efforts can inform the extentto which caregiving advice from theparenting literature may need to beadapted for camp settings. Descriptiveresearch on the foods currentlyoffered, staffs' understanding of whatconstitutes a healthy meal, children'sacceptance of foods offered at camp,and the extent to which practicessuch as food-based contingencies (eg,pizza parties as a reward for goodbehavior) are part of camp culture isalso needed to inform such efforts.Finally, after acceptable interventionefforts are developed, evaluationsshould assess whether effects carryover after summer camp ends orwhether carryover needs to be pro-moted by intentional communicationbetween camp authorities and parentsabout their children's eating behav-iors. The current study provides initialinformation about staffs' perceptionsof camp mealtimes, which can serveas a starting point for future researchrelated to understanding the potentialrole of camps for obesity preventionefforts.

ACKNOWLEDGMENTS

This researchwas supported by a grantfrom the American Camp Association.The authors also thank the camps thatparticipated in this study.

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