UMass Chan Medical School Faculty Publications


Racial/Ethnic Disparities in Meeting 5-2-1-0 Recommendations among Children and Adolescents in the United States

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Graduate School of Biomedical Sciences, Clinical and Population Health Research Program; UMass Worcester Prevention Research Center

Publication Date


Document Type



OBJECTIVE: To evaluate racial/ethnic disparities among children and adolescents in meeting the 4 daily 5-2-1-0 nutrition and activity targets in a nationally representative sample. The 5-2-1-0 message summarizes 4 target daily behaviors for obesity prevention: consuming > /=5 servings of fruit and vegetables, engaging in < /=2 hours of screen time, engaging in > /=1 hour of physical activity, and consuming 0 sugar-sweetened beverages daily. STUDY DESIGN: The National Health and Nutrition Examination Survey (2011-2012) data were used. The study sample included Hispanic (n = 608), non-Hispanic black (n = 609), Asian (n = 253), and non-Hispanic white (n = 484) youth 6-19 years old. The 5-2-1-0 targets were assessed using 24-hour dietary recalls, the Global Physical Activity Questionnaire, and sedentary behavior items. Outcomes included meeting all targets, no targets, and individual targets. Multivariable logistic regression models accounting for the complex sampling design were used to evaluate the association of race/ethnicity with each outcome among children and adolescents separately. RESULTS: None of the adolescents and <1% of children met all 4 of the 5-2-1-0 targets, and 19% and 33%, of children and adolescents, respectively, met zero targets. No racial/ethnic differences in meeting zero targets were observed among children. Hispanic (aOR, 1.76 [95% CI, 1.04-2.98]), non-Hispanic black (aOR, 1.82 [95% CI, 1.04-3.17]), and Asian (aOR, 1.48 [95% CI, 1.08-2.04]) adolescents had greater odds of meeting zero targets compared with non-Hispanic whites. Racial/ethnic differences in meeting individual targets were observed among children and adolescents. CONCLUSIONS: Despite national initiatives, youth in the US are far from meeting 5-2-1-0 targets. Racial/ethnic disparities exist, particularly among adolescents.


5-2-1-0, NHANES, children, disparities, nutrition, physical activity

DOI of Published Version



J Pediatr. 2016 Aug;175:188-194.e1. doi: 10.1016/j.jpeds.2016.03.055. Epub 2016 Apr 23. Link to article on publisher's site


First author Christina Haughton is a doctoral student in the Clinical and Population Health Research Program in the Graduate School of Biomedical Sciences (GSBS) at UMass Medical School.

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

The Journal of pediatrics

PubMed ID