Food availability, modeling and restriction: How are these different aspects of the family eating environment related to adolescent dietary intake?

Healthcare Service Providers' Perspectives on Sociocultural Aspects Affecting Weight Management Activities Amongst People with Obesity in Taiwan-A Qualitative Study

The prevalence of obesity and morbid obesity in Taiwan has risen sharply in recent decades, as in other parts of the world, necessitating urgent action to prevent and curb its detrimental effects. Asian populations are susceptible to the repercussions of obesity at a lower body weight. A higher BMI is associated with more frequent outpatient visits, in-hospital admissions, higher medical costs, and a lower quality of life. However, effective weight management approaches are unlikely to be maintained in the long term without assimilation into daily lifestyle practices. This qualitative study, based on semi-structured interviews with 14 doctors, dieticians, and nurses who work to control the weight of people with obesity, explored and identified multilevel barriers in the context of daily life to improve the efficacy and execution of weight management strategies. They considered diets, physical activity, and sleep as key weight management activities. The cultural and psychosocial aspects of daily life were observed to have an impact upon weight management, particularly family conflicts due to cultural dynamics and socially and culturally reinforced food practices. To improve population weight, less-recognised aspects need to be addressed alongside the inclusion of mental health specialists in weight management protocols and policy interventions to minimise obesogenic practices and create environments conducive to weight management.

The Impact of Caregiver Pressure to Eat on Food Neophobia in Children with Autism Spectrum Disorder: A Cross-Sectional Study

(1) Background: With autistic children's high pervasiveness of eating problems and inappropriate feeding behaviors by their caregivers, this study wanted to inspect the connection between caregivers' pressure to eat and food neophobia in these children. (2) Methods: Cross-sectional overview of 160 guardians of kids aged 2 to 7 years. After one-on-one questioning by the researcher, the collected information on the socio-demographic characteristics of the children with autism, caregiver feeding behavior, and new food neophobia (FN) scores was entered into the Questionnaire Star system. (3) Results: The mean FN score was 25.56 ± 6.46. The caregiver's pressure to eat positively related to children's FN (β = 0.164 95% CI, 0.078, 2.163). In these children, we found a negative correlation between FN score and the frequency of vegetable intake (p ≤ 0.001), fruit intake (p ≤ 0.05), aquatic product intake (p ≤ 0.05), and dietary diversity score (p ≤ 0.01), and positively correlated with the frequency of snack intake (p ≤ 0.05). (4) Conclusions: Caregiver pressure to eat was positively associated with high levels of FN in Chinese kids with ASD, which in turn negatively impacted dietary quality. To improve eating habits, caregivers should reconsider their feeding strategies and avoid using forceful methods to ease food neophobia in these children.

Associations between parental engagement in disordered eating behaviors and use of specific food parenting practices within a racially, ethnically, and socioeconomically diverse sample

Parents influence their children's eating behaviors through their use of food parenting practices, or goal-directed behaviors that guide both what and how they feed their child. Prior research suggests that parents who engage in disordered eating behaviors are more likely to use coercive food parenting practices, which are known to be associated with the development of maladaptive eating behaviors in young people. The present study sought to extend our current understanding by examining the association between parental engagement in disordered eating behaviors and use of a broader range of food parenting practices in a socioeconomically and racially diverse, population-based sample (n = 1306 parents/child dyads). Parents self-reported their disordered eating behaviors, as well as use of coercive and structure-based food parenting practices. A series of separate linear regression models, adjusting for parent and child sociodemographic and anthropometric characteristics, revealed that parents engaging in restrictive disordered eating behaviors and binge eating reported significantly higher levels of coercive food parenting practices, including pressure-to-eat, restriction, threats and bribes, and using food to control negative emotions. Parental engagement in restrictive disordered eating behaviors was also associated with significantly higher use of food rules and limits. Overall, parental engagement in compensatory disordered eating behaviors was significantly associated with higher levels of restrictive and emotional feeding practices, as well as with lower levels of monitoring. Given prior research supporting a relationship between exposure to coercive control food parenting practices and the development of maladaptive eating behaviors in young people, results from the current study provide support for the role that food parenting practices might play in the intergenerational transmission of disordered eating behaviors.

Children's perception of food parenting practices: adaptation and validation of the comprehensive feeding practices questionnaire in Chilean adolescents

Introduction

Assessment of the Comprehensive Feeding Practices Questionnaire in adolescents (CFPQ-Teen) is still limited, with no evaluation of the measurement invariance. The participants comprised 473 Chilean adolescents of both sexes from dual-income nuclear families. The aims of this study were: (1) to adapt to Spanish and validate a model of five-factor version the CFPQ-Teen; (2) to examine the psychometric properties, (3) to evaluate the measurement invariance according to the adolescents' gender; and (4) to compare the scores of each factor between female and male adolescents.

Methods

The instrument was translated, back-translated, and adapted from the CFPQ-Teen, confirming the equivalence, conceptual, and face validity in a pilot sample of 40 adolescents. An exploratory factor analysis was performed on the five-factor model of the CFPQ-Teen: Monitoring, Adolescent Control, Restriction for weight control, Parental Modeling, and Environment. The Environment factor was eliminated as a result.

Results

The confirmatory factor analysis presented good reliability, convergent, discriminant, and concurrent validity values. In addition, medium to high goodness-of-fit levels were obtained by eliminating an item from the Adolescent Control factor. These results confirm a final 20-item model representing four factors. The multigroup invariance analysis of the measurement model verified configural, metric, scalar, and partial strict invariance. No significant differences were found between females and males in the scores on the four factors.

Discussion

These results enable comparisons by sex on the perceptions of Food Parenting Practices from the analyzed factors, primarily within the context of the Chilean sample.

Longitudinal changes in home food availability and concurrent associations with food and nutrient intake among children at 24-48 months

OBJECTIVES

To describe changes in home food availability during early childhood, including modified, developmentally sensitive obesogenic scores, and to determine whether home food availability is associated with food and nutrient intakes of children concurrently, over time.

DESIGN

Data were drawn from the STRONG Kids 2 longitudinal, birth cohort to achieve the study objectives. Home food availability was assessed with the Home Food Inventory (HFI) and included fifteen food groups (e.g. fruit and vegetables) and three obesogenic scores (one original and two modified). Food and nutrient intakes were measured using the Block FFQ and included twenty-seven food groups and eighteen nutrients (e.g. vitamins A and C, protein). HFI and FFQ were completed by trained researchers or mothers, respectively, at 24, 36 and 48 months. Repeated-measures ANOVA and Spearman's correlations were used to achieve the study objectives.

SETTING

Central Illinois, USA.

PARTICIPANTS

Participants were 468 children at 24, 36 and 48 months of age.

RESULTS

Availability of less nutritious foods and obesogenic foods and beverages increased as children aged, and availability of both nutritious and less nutritious foods were associated with child food and nutrient intake. The three obesogenic scores demonstrated similar, positive associations with the intake of energy, saturated fat, added sugars and kilocalories from sweets.

CONCLUSION

These findings offer novel insight into changes in home food availability and associations with food and nutrient intake during early childhood. Additional attention is needed examining antecedents (e.g. built environments, purchasing behaviours) and consequences (e.g. child diet quality and weight) of home food availability.

Food fussiness is associated with family environmental factors in 1-3-year-old children: A large-scale cross-sectional study

The effects of environmental factors on eating behavior and food intake are not well-known during toddlerhood. This is a cross-sectional study exploring the association between family environmental factors, food fussiness and poorly diversified diet. N = 1679 healthy children aged 1-3 years were recruited by general practitioners and pediatricians. Two validated questionnaires were used: the Children's Eating Behavior Questionnaire (CEBQ), which includes a food fussiness (FF) dimension, and the Infant and Child Feeding Index (ICFI) which assesses diet diversification. Factors associated with FF and diet diversification were identified by multivariate logistic regression. Of the 1356 analyzed children, 19.5% were fussy (CEBQ-FF subscore >3). Food fussiness was significantly more common in older children (25.1% of 2-3-year-olds, versus 15.2% of 1-2-year-olds; OR = 1.7) and those conceived with medical assistance (OR = 3.2). Food fussiness was also observed more often in children exposed to distractions during meals (OR = 1.8), rewarded by parents to finish meals (OR = 3.9), free to eat at will (OR = 3.7), or who ate only occasionally with the whole family (OR = 2.0). Unsatisfactory dietary diversification (ICFI≤13.8) was observed in 21.8% of children and was not significantly associated with any variable. No association was found between eating behavior and dietary diversification level. This study showed that food mistrust tends to increase with age in 1-3-year-old children. It highlighted the influence of environmental factors on FF, including family habits during meals. Assisting parents with child food fussiness may help reduce later unhealthy dietary patterns.

Longitudinal changes in home food availability across the first 3 years of life and associations with family context predictors

Background

There is limited research tracking changes in home food availability during the first 3 years of life and whether the family context influences these changes.

Objective

This study examined changes in and predictors of home food availability across the first 3 years of life.

Design

This study utilized longitudinal data from the STRONG Kids2 birth cohort from the target child at 6 weeks to 36 months postpartum.

Participants

Mothers of 468 children were surveyed at 6 weeks, 3, 12, 24, and 36 months postpartum.

Methods

Home observations were completed by trained research assistants to complete the presence of foods in the home. The primary outcomes were the availability of 10 food groups and scores from the Home Food Inventory (HFI), including dairy (regular fat), dairy (reduced fat), processed meats, other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and three obesogenic scores. Repeated measures ANOVA were used to examine changes in the HFI food groups and obesogenic scores over time. Multilevel regressions were conducted to examine whether the presence of an older sibling, entry into childcare, and mother's return to full-time work were associated with the HFI.

Results

Significant changes were detected for dairy (regular fat), other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and all obesogenic scores across time. A linear trend occurred for most HFI groups, however, the third obesogenic score (without milk and cheese) was highest at 3 months, declined at 12 months, and then slowly increased from 12 to 36 months years. The presence of an older sibling was a consistent predictor of the HFI groups over time. Entry into childcare was only associated with the availability of processed meats.

Conclusion

The availability of food types shift as children age and their dietary needs alter. It is important to consider the whole family context such as the presence of older siblings whose dietary needs may differ from younger children. Future efforts are warranted to consider changes in food availability among diverse samples and different family structures.

Real-time predictors of food parenting practices and child eating behaviors in racially/ethnically diverse families

BACKGROUND

Prior research has shown associations between controlling food parenting practices (e.g., pressure-to-eat, restriction) and factors that increase risk for cardiovascular disease in children (e.g., low diet quality, obesity). This study aimed to examine associations between real-time parental stress and depressed mood, food parenting practices, and child eating behaviors in a longitudinal cohort study.

METHODS

Children ages 5-9 years and their families (n = 631) from six racial/ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited for this study through primary care clinics in a large metromolitan area in the US (Minneapolis/St. Paul, MN) in 2016-2019. Ecological momentary assessment was carried out over seven days with parents at two time points, 18 months apart. Adjusted associations between morning stress and depressed mood of parents on food parenting practices and child eating behaviors at the evening meal were examined. Interactions tested whether food security, race/ethnicity and child sex moderated associations.

RESULTS

High levels of parental stress and depressed mood experienced earlier in the day were associated with controlling food parenting practices and child food fussiness at dinner the same night. Results were dependent on food security status, race/ethnicity, and child sex.

CONCLUSIONS

Health care professionals may want to consider, or continue, screening parents for stress, depression, and food insecurity during well-child visits and discuss the influence these factors may have on food parenting practices and child eating behaviors. Future research should use real-time interventions such as ecological momentary intervention to reduce parental stress and depressed mood to promote healthy food parenting practices and child eating behaviors.

Is intuitive eating a privileged approach? Cross-sectional and longitudinal associations between food insecurity and intuitive eating

OBJECTIVE

To examine: (1) cross-sectional and longitudinal associations between measures of food insecurity (FI; household status and youth-reported) and intuitive eating (IE) from adolescence to emerging adulthood; and (2) the association between FI persistence and IE in emerging adulthood.

DESIGN

Longitudinal population-based study. Young people reported IE and FI (two items from the US Household Food Security Module) in adolescence and emerging adulthood. Parents provided data on household FI via the six-item US Household Food Security Module in adolescence.

SETTING

Adolescents (Mage = 14·3 ± 2 years) and their parents, recruited from Minneapolis/St. Paul public schools in 2009-2010 and again in 2017-2018 as emerging adults (Mage = 22·1 ± 2 years).

PARTICIPANTS

The analytic sample (n 1372; 53·1 % female, 46·9 % male) was diverse across race/ethnicity (19·8 % Asian, 28·5 % Black, 16·6 % Latinx, 14·7 % Multiracial/Other and 19·9 % White) and socio-economic status (58·6 % low/lower middle, 16·8 % middle and 21·0 % upper middle/high).

RESULTS

In cross-sectional analyses, youth-reported FI was associated with lower IE during adolescence (P = 0·02) and emerging adulthood (P < 0·001). Longitudinally, household FI, but not adolescent experience of FI, was associated with lower IE in emerging adulthood (P = 0·01). Those who remained food-insecure (P = 0·05) or became food-insecure (P = 0·02) had lower IE in emerging adulthood than those remaining food-secure. All effect sizes were small.

CONCLUSIONS

Results suggest FI may exert immediate and potentially lasting impacts on IE. As evidence suggests IE is an adaptive approach conferring benefits beyond eating, it would be valuable for interventions to address social and structural barriers that could impede IE.

Intergenerational Pathways Between Parental Experiences of Adverse Childhood Experiences (ACEs) and Child Weight: Implications for Intervention

BACKGROUND/OBJECTIVE

Prior research suggests an association between parental experiencing of 1 or more adverse childhood experiences (ACEs) and increased risk for overweight/obesity in children. However, the pathways through which parental experiences of ACEs lead to child weight are unclear.

METHODS

Participants were parent and child dyads from racially/ethnically diverse and low-income households in Minneapolis and St. Paul, Minnesota, in 2015. Parents completed an online survey regarding their own adverse experiences in childhood, their height and weight, parenting practices, and mental health. Child height and weight were obtained from electronic medical records. Structural equation modeling was used to examine the extent to which parent mental health and parenting practices mediate associations between parental ACEs and child body mass index (BMI) percentile.

RESULTS

The parent mental health pathway was statistically significant in explaining the intergenerational transmission of parental ACEs to child weight. Parent ACEs were positively associated with low parent mental health, parent low mental health was correlated with higher parent BMI > 25, and parent overweight was positively related to higher child BMI percentile.

CONCLUSIONS

Study findings suggest that intervening on parent low mental health may be a key factor in reducing the intergenerational transmission between parental ACEs and child weight.

Measurement invariance of the comprehensive feeding practices questionnaire in dual-earner parents with adolescent children in Chile

The Comprehensive Feeding Practices Questionnaire (CFPQ) has been evaluated in international studies, but the evaluation of its psychometric properties in Spanish, and in particular for parents of adolescents is still limited, and the invariance of measurement according to gender has not been evaluated. Therefore, the objectives of this study were: (1) To adapt the five-factor model of the CFPQ instrument to Spanish; (2) To examine the psychometric properties of this adaptation; and (3) To evaluate the measurement invariance of the model to verify the equivalence of measurement of the perceptions of food parenting practices between mothers and fathers belonging to nuclear, dual-earner families with adolescent children. Participants were 946 mothers and fathers from Southern Chile. Results showed that the conceptual equivalence for the CFPQ was achieved. An exploratory factor analysis was performed for a five-factor model: Monitoring, Child control, Restriction for weight control, Modeling and Environment. Horn's parallel analysis identified four factors, while factor loading analysis determined the removal of the environment factor. Confirmatory factor analysis presented good reliability values. Convergent and discriminant validity was confirmed, and medium-to-high levels of goodness of fit were obtained, eliminating two items. Results supported a final model of four factors and 19 items. Multigroup analysis of the measurement model verified the configural and metric invariance between fathers and mothers, while the scalar and strict partial invariance was verified. These findings are a relevant guide to measure factorial scores in the four-factor model of the CFPQ, establishing a characterization of feeding practices of parents and adolescents.

Children's Influence on Parents: the Bidirectional Relationship in Family Meal Selection

Feeding a child in the 21st century can be challenging. A child's diet is thought to be a parent's responsibility, and numerous studies have explored how parents influence their child's food intake through food availability, feeding practices, and modeling. However, this relationship is likely bidirectional such that the child influences the parent as well (sometimes called "pester power"). Pester power has been studied in grocery stores and restaurants. However, no research to date investigates how children influence parent's food selection when eating at home. This study addresses this gap by asking parent and child dyads (N = 79, 95% white) to create meals together and separately. Forty 6-8 and thirty-nine 13-15 year-olds participated. Most of the parents (97.5%) and children (49.4%) who participated were female; and parents reported an average annual income of over 80,000 dollars (68.3%). Mean differences in the nutrient content of the meals were analyzed using repeated measures ANOVAs to examine the strength of influence in the bidirectional relationship. Results suggested when children were present for meal selection, they exerted influence over their parents for more palatable items. When choosing foods as a dyad versus when the parent selected meals for the family, the foods contained more calories, sugar, and less fiber. Protein was the only nutrient that parents influenced in their child's selections. These findings have important implications for understanding the often-overlooked bidirectional dynamic of the feeding relationship, and the accompanying health outcomes of child dietary intake.

The association of problematic gaming characteristics with dietary habits among Finnish vocational school students

Digital gaming is a popular pastime among young people, but its links to dietary habits have been little studied. The purpose of the study was to describe dietary habits and to examine their associations to problematic gaming behavior with regard to the degree of daily digital gaming time and the overall levels of disordered-like gaming behavior among students in vocational education in the Oulu region of Finland. This cross-sectional study consisted of a total of 773 first-year vocational school students who had played digital games regularly. Data was collected by using an online survey measuring sociodemographic information, dietary habits, amount of digital gaming time, and symptoms of problematic gaming behavior. Most prevalent weekly consumed food types were chicken (90.1%), chips (87.7%), and sausages/cold cuts (85.4%). Around one-fourth of students skipped breakfast on weekdays and at weekends. A higher amount of digital gaming time was associated with skipping breakfast on weekdays. More elevated levels of disordered gaming behavior were particularly associated with the use of a group of food types encompassing carbohydrate-dense and fast food. Current research provides indications that digital gaming may have an impact on youths' dietary habits, while at the same time, however, emphasizing that the issue can be affected by several interrelated and complex factors.

Association between Parental Feeding Styles and Excess Weight, and Its Mediation by Diet, in Costa Rican Adolescents

Background. Whereas parental feeding styles (PFS) influence children’s diet, less is known about this relationship in adolescents. Methods. A cross-sectional study in 686 Costa Rican adolescents (13–18 years) evaluated 4 validated PFS scores: healthy eating verbal encouragement; scolding; directly controlling diet; instrumental/emotional. Diet was evaluated through 3-day food records, deriving a Traditional Costa Rica Adolescents Diet Score (TCRAD). Excess weight (EW) measured by BMI was dichotomized following standards. Regression-based mediation analysis estimated the overall and sex-stratified odds ratios of EW for natural direct (NDE), natural indirect (NIE), and total effects (TE) of the pathway PFS→TCRAD→EW. Results. A one-unit increase in the direct control PFS score was associated with higher EW odds overall [(TE: 1.55; 95% CI: 1.04–2.31; p-value = 0.033), (NDE: 1.52; 95% CI: 1.02–2.27; p-value = 0.039)], and in boys [(TE: 2.13; 95% CI: 1.04–4.38; p-value = 0.039), (NDE: 2.10; 95% CI: 1.03–4.31; p-value = 0.042)]. Non-significant mediation by TCRAD was observed for the healthy eating verbal encouragement PFS overall (p-value = 0.06). Associations for the instrumental/emotional and scolding PFS were not significant. Conclusions. Direct diet control from parents may contribute to adolescents’ excess weight, particularly among boys. Parents encouraging healthy eating might support adolescents’ healthy weight through a healthy diet. Longitudinal research should clarify the association between PFS and diet-related outcomes among diverse adolescents.

Parents' Modeling During the COVID-19 Pandemic: Influences on Family Members' Diet Quality and Satisfaction With-Food-Related Life in Dual-Earner Parents With Adolescent Children

Reciprocal family influences in the food domain have been little explored, particularly during the COVID-19 pandemic. To fill in this gap, this study explored actor and partner effects between parents' food modeling and parents' and their adolescent children's diet quality and satisfaction with food-related life (SWFoL); and the mediating role of diet quality between modeling and SWFoL. This study used a cross-sectional design. A sample of 430 different-sex dual-earner parents and one adolescent child were recruited in Rancagua, Chile, between March and June 2020. Parents answered the modeling dimension of the Comprehensive Feeding Practices Questionnaire. Parents and adolescents answered the Adapted Healthy Eating Index (AHEI) and the SWFoL Scale. Analyses were conducted using the Actor-Partner Interdependence Model and structural equation modeling. Results showed that one parent's modeling enhanced diet quality for themselves, their partner, and the adolescents. Parents' modeling was associated with their own SWFoL, directly and via their own diet quality. There were positive associations between mothers' modeling and adolescents' SWFoL; between mothers' diet quality and fathers' SWFoL; and between mothers' modeling and fathers' SWFoL via the fathers' diet quality. Parents' modeling can improve the three family members' diet quality, while mothers' modeling and diet quality showed to improve fathers' and adolescents' SWFoL.

"You know what, I'm in the trend as well" - Understanding the inter-play between digital and real-life social influences on the food and activity choices of young adults

OBJECTIVE

To understand young adults' perceptions of online and real-life social influences on their food and activity choices.

DESIGN

A qualitative study involving seven focus groups. Thematic analyses using both deductive and inductive techniques were performed.

SETTING

A polytechnic and a university in Singapore.

PARTICIPANTS

A total of 46 full-time students, 19-24 years of age.

RESULTS

Participants revealed that social media meets multiple needs, contributing to its ubiquitous use and facilitating content spread between social networks. Food-related content shared on social media were mostly commercial posts, marketing foods and eateries showcasing price-promotions, emphasizing sensory properties of foods, or creating narratives that activated trends. Subsequently, real-life social activities frequently revolve around marketed foods that were not necessarily healthy. In contrast, physical activity posts were rarely being followed up in real life. Portrayals describing a toxic gym culture could contribute to negative perceptions of peers' physical activity posts and a disinclination towards sharing such posts. Participants expressed that close, supportive social networks in real-life strongly influenced initiating and maintaining healthy lifestyles. However, in a society that highly values academic achievements, participants prioritized studying and socializing over healthy eating and physical activity.

CONCLUSIONS

Overall, our findings reveal that virtual and real-life social influences have complex interactions affecting Asian young adults' behavioral choices and should be considered when designing interventions for this group. Regulations related to the digital marketing of unhealthy food, and improving the availability, accessibility, and affordability of healthier food options, particularly in the foodservice sector, would be of value to consider.

Adolescents' proxy reports on obesity-related parenting practices: factorial validity and reliability across four behavioral domains

Background

Adolescents’ energy balance behaviors are precursors to obesity shaped by the practices or strategies that many parents implement. Although key stakeholders to their families, adolescents are rarely considered to report on these obesity-related parenting practices. The aim of this study is to assess the factorial and predictive validity of adolescents’ proxy-report of parents’ obesity-related parenting across four behavioral domains.

Methods

This study used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study. This study tests whether adolescents’ proxy reports about their parents’ obesity-related parenting are significantly associated with parents’ responses on their own obesity-related parenting, as well as whether these reports are significantly associated to parent-adolescent energy balance behaviors. Factorial validity was assessed using linear regression and Confirmatory Factor Analysis (CFA), whereas predictive validity was assessed using Actor-Partner Interdependence Modeling (APIM).

Results

Regression results indicated that adolescents’ proxy report is significantly associated with parents’ report of their own parenting in all four domains (β = .59—.71; p < 0.05). CFA results indicated a final factor structure that loaded significantly onto hypothesized obesity-related parenting domains (β > .30) in both adolescents and parents. APIM results indicated that both parent- (β = .32; p < 0.05) and adolescent-(β = .21; p < 0.05) reported obesity parenting for fruit and vegetable consumption were associated with their own fruit and vegetable intake. In addition, adolescent-reported physical activity parenting was significantly associated with adolescent physical activity (β = 0.23; p < 0.05). Regarding partner effects, only parent-reported parenting for fruit and vegetable consumption were significantly associated with adolescent intake of fruit and vegetables (β = 0.15, p < 0.05) and adolescent-reported physical activity parenting was significantly associated with parental physical activity (β = 0.16, p < 0.05). Neither adolescent nor parent reported parenting were significantly associated with screen time or junk food intake outcomes. Each final obesity-related parenting scale had good internal consistency (a = .74-.85).

Conclusions

We found that adolescent- and parent-reported obesity-related parenting were significantly associated, while adolescent-reported parenting were more explanatory of fruit and vegetable intake and physical activity than parent-reported parenting. These findings suggest that adolescent proxy reports may be a valid source of information on obesity-related parenting.

Transformation in culinary behaviour during the COVID-19 pandemic: In-depth interviews with food gatekeepers in urban India

COVID-19 and its associated regulatory measures including lockdowns, curfews, and physical distancing norms have significantly affected individual's dietary and culinary behaviours. Although there is ample empirical evidence available on dietary changes within the Indian context, very limited evidence exists about the factors influencing these dietary modifications and changes in culinary behaviours during COVID-19 lockdown. Therefore, the aim of this qualitative study was to explore the views of Indian household food gatekeepers towards meal planning, food purchasing, and meal preparation during the pandemic and its associated lockdowns. A convenience sample of 34 female gatekeepers from the Mumbai metropolis participated in online interviews. Interviews were conducted in English and Hindi (then translated in English), audio-recorded and transcribed verbatim. Underpinned by Template Analysis technique, transcribed data were analysed manually and using the NVivo software program. The interview structure guided the development of themes. The emerging themes included were: Increased household cooking; Involvement of children and male members in food-related activities; Experimentation in the kitchen; Adoption of meal planning skills; Increase in online food shopping; Bulk buying; Shortage of food items; Reduced consumption of outside home food; Increased variety of home-cooked meals; Increase in snacking and overall food intake; Determinants of food choices; and Family meals-a new norm. In the light of these findings, developing family-focussed, web-based nutrition programs to enhance gatekeepers' and their families' food literacy including declarative and procedural nutritional knowledge would be beneficial. The importance of organisational culinary behaviours such as planning meals in advance, shopping with a food list should be promoted to prevent hoarding and subsequently reduce strain on the food supply system. With a surge in domestic cooking, low cost nutritious recipes with the use of local and seasonal produce should be emphasized promoting healthy eating among the gatekeepers and their family members. The inclusion of food studies in the school curriculum will facilitate the development of culinary skills among children and youth. Also, there is a need for further research and surveillance to strengthen understanding of sustainability of healthy culinary behaviours practiced during the pandemic.

Promoting Healthier Eating via Parental Communication: Development and Validation of the Active and Restrictive Parental Guidance Questionnaire (PARQ)

Parents are important sources of influence in the development of healthy eating among children and adolescents. Besides gatekeeping and modeling, parents serve as health educators and promoters, using intentional and persuasive communication to encourage healthier eating preferences and behaviors in children. Despite this, a lack of reliable and valid measures has limited the research on how parent-driven interpersonal communication about foods influence child food consumption outcomes. Building on the research in parental mediation of media consumption, and parenting practices in public health nutrition, this study details the development and validation of the active and restrictive parental guidance questionnaire with a sample of 246 children and adolescents at the scale development phase and another sample of 1,113 children and adolescents at the scale validation phase. Findings show that parents employ four communicative strategies to encourage a healthier diet: active guidance, general discussion, preventive restrictive guidance, and promotive restrictive guidance. The new measure was shown to have good validity and measurement model fit. Implications for future research are discussed.

Healthy eating strategies: Individually different or context-dependent?

Individuals can apply different healthy eating strategies to help them make healthy eating choices. Previous research showed that individuals differ in their preferred strategy, but also that a mix of strategies is often applied by a single person across contexts. The current research investigated the extent to which differences within an individual across contexts (i.e., meal moments, social environment and physical environment) predicted openness to healthy eating strategies in addition to personal predictors that differ between individuals (i.e., intrinsic motivation, self-efficacy, physical opportunity and social opportunity). A representative sample of the Dutch adult population was recruited (N = 892). The within-individual (contextual) predictors were measured nine times just before a meal moment over a period of three weeks, by means of a smartphone application. The between-individual (personal) predictors were administered with a baseline questionnaire. Exploratory factor analysis distinguished three healthy eating strategies: Increasing healthy foods, Limiting unhealthy foods and consuming Light products. A random intercept model, in which within-individual predictors and between-individual predictors were entered successively, showed that context matters for openness to all three strategies, but is most important for increasing healthy foods and least important for light products. Individuals are most open to increase healthy foods at dinner as compared to breakfast, whereas the opposite is true for limiting unhealthy foods and consuming light products. Eating at home is beneficial for openness to all three strategies and eating with others positively influences openness to increase healthy foods but has no effect on the other strategies. Insights gained from this research increase our understanding of an individual's openness to apply healthy eating strategies.

Are there protective associations between family/shared meal routines during COVID-19 and dietary health and emotional well-being in diverse young adults?

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This study found that family/shared meal routines increased from pre-COVID to during COVID-19.

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Engaging in family/shared meals during COVID-19 was associated with well-being in young adults.

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Engaging in family/shared meals was associated with healthy dietary consumption in young adults.

Background

This study examined who is engaging in family/shared meals and associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being among young adults during the COVID-19 pandemic.

Methods

A rapid-response online survey was sent to participants in a ten-year longitudinal study (Eating and Activity over Time: EAT 2010–2018). A total of 585 young adults (mean age = 24.7 ± 2.0 years, 63.3% female) living with at least one family member completed the COVID-EAT (C-EAT) survey during the U.S. outbreak of COVID-19. Items assessed changes in family/shared meal frequency, eating behaviors, and emotional well-being. Regression models adjusting for sociodemographic characteristics examined associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being.

Results

Participants reported an average of 4.6 ± 3.4 family/shared meals per week during COVID-19, a 0.5 meal/week increase from prior to the pandemic (p = .002). Family/shared meal frequency during COVID-19 differed by race/ethnicity, with Asian American participants being most likely to report only 1–2 family/shared meals per week. Family/shared meals during COVID-19 were associated with higher vegetable intake, greater availability of fruits, vegetables, and whole wheat bread in the home, lower levels of depressive symptoms and perceived stress, and greater perceived ability to manage stress in young adults.

Conclusions

Results suggest that engaging in a regular routine, such as family/shared meals, during COVID-19 may have protective associations with dietary health and emotional well-being for young adults. Results may inform practices/routines to offer protective benefits during public health crises such as the current pandemic.

Caregiver Feeding Practices as Predictors for Child Dietary Intake in Low-Income, Appalachian Communities

The Appalachian region of the U.S. is disproportionately impacted by poverty, obesity, and nutrition-related chronic diseases. Evidence suggests that caregiver feeding practices may promote healthful eating behaviors among children; however, this has not been examined in low-income, rural, Appalachian populations. This study examines caregiver feeding practices as predictors for child diet in low-income Appalachian families, using a cross-sectional analysis of 178 caregivers of young children (ages 2–10 years old), that were recruited from low-income, rural communities in East Tennessee, from November 2017 to June 2018. Caregivers self-reported measures of demographics, feeding practices, and child dietary intake. Multiple linear regression analyses were run, and found that higher use of caregiver modeling positively predicted child vegetable consumption (Beta = 1.02; p = 0.04). Higher caregiver intake of fruits and vegetables positively predicted child fruit consumption (Beta = 0.29; p = 0.02) and vegetable consumption (Beta = 1.56; p < 0.001), respectively. Higher home availability of healthier foods positively predicted child fruit consumption (Beta = 0.06; p = 0.002) and vegetable consumption (Beta = 0.09; p = 0.05). Higher home availability of less healthy foods positively predicted child consumption of high-sugar/high-fat snack foods (Beta = 0.59; p = 0.003). The findings of this study indicate that caregiver modeling, healthy caregiver dietary intake, and healthful home food availability are associated with healthier child dietary intake among young children in low-income, rural, Appalachian areas. Promoting these practices among caregivers may be an important strategy to enhancing dietary intake of children in this hard-to-reach, underserved population.

Adolescent-Reported Latino Fathers' Food Parenting Practices and Family Meal Frequency Are Associated with Better Adolescent Dietary Intake

Most studies of food-related parenting practices, parental meal involvement, and adolescent dietary intake have focused on maternal influences; studies of paternal influences, particularly among marginalized groups, are lacking. This study examined lower-income, Latino fathers' food parenting practices and involvement in planning meals, buying/preparing foods, and family meal frequency, separately and in combination, to identify relationships with adolescent food intake. Baseline data were used from Latino adolescents (10-14 years, n = 191, 49% boys) participating with their fathers in a community-based overweight/obesity prevention intervention. Fathers reported sociodemographic characteristics. Adolescents reported frequency of fathers' food parenting practices, fathers' food/meal involvement, and family meals and participated in 24 h dietary recalls. The analysis included regression models using GLM (generalized linear mixed model) and PLM (post GLM processing) procedures. Most fathers were married, employed full-time, and had annual incomes below USD 50,000. Favorable fathers' food parenting practices were associated with adolescent intake of more fruit and vegetables and fewer sugar-sweetened beverages, sweets/salty snacks, and less fast food (p < 0.05 or p < 0.01). No independent effects of family meal frequency or fathers' food/meal involvement were observed on adolescent dietary outcomes. Additional analyses showed favorable food parenting practices in combination with frequent family meals were associated with adolescents having a higher intake of fruit (p = 0.011). Latino fathers can have an important positive influence on adolescent dietary intake.

Factors That Influence Maternal Feeding Decisions for Toddlers: Extending the Theory of Planned Behavior

OBJECTIVE

To use the Theory of Planned Behavior (TPB) to assess mothers' behavioral intentions to provide toddlers with a healthy diet and see if the addition of the parental role construction (PRC) variable strengthened the TPB.

DESIGN

An online survey using data gathered from preliminary research and a previously validated survey.

PARTICIPANTS

The final sample consisted of 148 mothers. The mean age was 32.8 (SD = 6.16) years. Most participants were married (87.2%), had earned a college degree or higher (79.7%), held part-time or full-time employment (60.8%), and were White (90.3%).

MAIN OUTCOME MEASURES

The TPB constructs, PRC, and the mothers' behavioral intentions surrounding toddler feeding.

ANALYSIS

The determinants of intention per the TPB were explored using descriptive statistics and multiple linear regression.

RESULTS

The TPB model predicted 53% of the variance in mother's behavioral intention to provide their toddler with a healthy diet. The addition of the PRC variable added 6% more predictive power to the model.

CONCLUSIONS AND IMPLICATIONS

Mothers' behavioral intentions surrounding feeding their toddlers were strongly influenced by the TPB constructs and their perceptions of the maternal role. Health promotion efforts should aim to increase the mother's sense of behavioral control and parental responsibility rather than focusing on the benefits of healthy eating.

Intersectionality between parenting styles, area of residence and gender on food group consumption among Costa Rican adolescents

Little is known about how parenting styles can influence the adolescent's consumption of sugar-sweetened beverages (SSB), fruits and vegetables (FV) and beans in Latin America. This study uses hierarchical moderated regression models to examine such association by area of residence, sex of the parent and of the adolescent in Costa Rica. Results showed that fathers' authoritarian style was significantly associated with lower intake of sugar-sweetened beverages (SSB) among boys (b = -0.163, p = 0.050), but not girls (b = 0.097, p = 0.114) while mother's authoritarian style was associated with lower SSB intake among girls (b = -0.138, p = 0.031), but not boys (b = 0.159, p = 0.059). Fathers' authoritative style was associated with higher consumption of fruits and vegetables (FV) among boys in rural areas (b=0.440, p= 0.017), but this association was not significant for girls (b=-0.033, p= 0.800) in rural areas or for either gender in urban areas. Parenting styles of the mothers' and fathers' were not significantly associated with Costa Rican adolescent bean consumption, in general or for any of the subgroups. Findings suggest an intersectionality in the effects of parentchild interactions by child and parent sex, cultural and geographic context, and the eating behaviors examined.

Gender and racial/ethnic differences in food selectivity in children with intellectual disabilities

BACKGROUND

We examined differences in food selectivity by gender and parent race/ethnicity in children with intellectual disabilities.

METHOD

A convenience sample of 56 children with intellectual disabilities was analysed. A modified Youth/Adolescent Food Frequency Questionnaire and a 3-day food record were used to measure child food refusal rate and food repertoire, respectively.

RESULTS

Boys were about twice as likely to refuse total foods (rate ratio = 2.34, 95%CI = 1.34-4.09) and fruits (rate ratio = 2.03, 95%CI = 1.04-3.95) and 54% more likely to refuse vegetables (rate ratio = 1.54, 95%CI = 0.93-2.54). Children with Hispanic parents were twice as likely to refuse vegetables compared to children with non-Hispanic White parents (rate ratio = 2.00, 95%CI = 1.03-3.90). In analyses stratified by the presence or absence of co-occurring probable autism spectrum disorder, boys had greater food selectivity than girls.

CONCLUSIONS

This study expands our understanding of food selectivity in children with intellectual disabilities.

Dutch Preadolescents' Food Consumption at School: Influence of Autonomy, Competence and Parenting Practices

Eating habits appear to become less healthy once children move into adolescence. Adolescence is characterized by increasing independence and autonomy. Still, parents continue influencing adolescents' eating habits. This cross-sectional study used a Self-Determination Theory perspective to examine how parents can support preadolescents' food-related autonomy and competence and how these factors are associated with healthy eating motivation and food consumption at school. In addition, the effect of relative healthy food availability at home on preadolescents' food consumption at school was explored. In total, 142 Dutch preadolescents (mean age 12.18) and 81 parents completed questionnaires. The results showed that preadolescents perceived themselves as having higher food-related autonomy and lower competence to eat healthily as compared to their parents' perceptions. A path analysis was conducted to test the hypothesized model. Although parental support was positively associated with food-related autonomy, higher food-related autonomy was related to less healthy food intake at school. On the other hand, competence to eat healthily indirectly affected preadolescents' healthy intake ratio through their healthy eating motivation. Finally, the relative availability of healthy options at home was positively associated with preadolescents' healthy intake ratio outside the home. Findings from the study advance the understanding of individual and environmental factors that influence eating habits during the key life period of early adolescence. The results may inform interventions aiming to guide preadolescents to make healthy food choices on their own.

Relationships Among the Physical and Social Home Food Environments, Dietary Intake, and Diet Quality in Mothers and Children

BACKGROUND

Both the physical and social home food environment (HFE) are believed to influence dietary intake and diet quality, but few studies have examined both aspects together.

OBJECTIVE

The purpose of this study was to examine the relationships among the physical and social HFE, dietary intake, and diet quality in mothers and children.

DESIGN

This was a cross-sectional substudy of a larger study.

PARTICIPANTS/SETTING

The study included 24 mothers (aged ≥30 years) with a biological child aged 6 to 12 years living in the Newark, DE, area between June and November 2018.

MAIN OUTCOME MEASURES

The outcome measures of interest included the physical HFE (ie, home food availability); aspects of the social HFE (ie, parenting styles, family meal frequency, and policies); maternal and child intake of fruits, vegetables, sugar-sweetened beverages, and snacks; and diet quality using the 2015 Healthy Eating Index total score.

STATISTICAL ANALYSIS

Pearson correlations were used to examine the relationship between physical HFE and dietary intake as well as social HFE and dietary intake in both mothers and children. The relationships were further examined through exploratory regression analyses.

RESULTS

In mothers, fruit availability in the physical HFE was correlated with fruit intake (r = 0.50; P = 0.02). Fruit and vegetable availability in the physical HFE were correlated with 2015 Healthy Eating Index total score in both the mother and child. Family meals participation was correlated with dietary intake (vegetable intake in children, r = 0.44; P = 0.04; and snack intake in mothers, r = -0.74; P < .001). Exploratory regression analysis showed vegetables in the HFE was associated with vegetable intake and 2015 Healthy Eating Index total score in mothers, and fruits and vegetables in the HFE were associated with child 2015 Healthy Eating Index total score. Family meals participation was negatively associated with maternal snack intake and child sugar-sweetened beverages intake. Authoritative parenting was negatively associated with child snack intake and permissive parenting was negatively associated with mother's fruit intake.

CONCLUSIONS

Both the physical and social HFE are associated with maternal and child dietary intake, but only the physical HFE was associated with dietary quality. Although preliminary, these data indicate the importance of future studies that include measures to assess both the physical and social HFE to better elucidate the influences of the HFE on dietary intake.

Longitudinal Associations between Food Parenting Practices and Dietary Intake in Children: The Feel4Diabetes Study

Food parenting practices (FPPs) have an important role in shaping children’s dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children’s dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (β = 0.492 in girls and β = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children’s fruit intake (β = 0.431 in girls and β = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children’s dietary intake.

Parental reward-based eating drive predicts parents' feeding behaviors and Children's ultra-processed food intake

Reward-based eating drive is associated with individual consumption, but there has been a paucity of research on the relationships between parental reward-based eating, child feeding behaviors, and child food consumption. Child feeding behaviors likely to be associated with parental reward-based eating drive include the provision of ultra-processed foods, as they are designed to be hyperpalatable and are associated with disordered food intake. The present study uses a virtual reality (VR) buffet restaurant environment to examine parents' food choice behaviors for their children and a food frequency assessment to measure the children's reported consumption over the course of a week. Results found that parental reward-based eating drive significantly predicted ultra-processed calories chosen by parents for their children in the VR Buffet, as well as the amount of ultra-processed food children ate according to the food frequency assessment. Both of these effects were significantly mediated by the healthfulness of the home food environment. This study is among the first to demonstrate associations between parental reward-based eating drive and child-focused food behavior and to elucidate a mediating effect of the home food environment on such relationships. These findings may be useful for the development of family-based interventions to improve child feeding and ultimately child health.

Parental Feeding, Child Eating and Physical Activity: Differences in Children Living with and without Asthma

This study aimed to establish the differences in parental attitudes toward feeding and activity, as well as child eating and activity levels, between families of children living with and without asthma. Parents of children and young people aged between 10 and 16 years living both with asthma (n = 310) and without asthma (n = 311) completed measures for parental feeding, parental attitudes toward child exercise, child eating, child activity level and asthma control. Children living with asthma had a significantly higher BMIz (BMI standardised for weight and age) score, were significantly more likely to emotionally overeat and desired to drink more than their peers without asthma. Parents of children with asthma reported greater use of food to regulate emotions, restriction of food for weight control, monitoring of child activity, pressure to exercise and control over child activity. When asthma symptoms were controlled, parental restriction of food for weight management predicted greater child BMIz scores, and higher child activity predicted lower child BMIz scores. These relationships were not found to be significant for children with inadequately controlled asthma. Differences in parental attitudes toward feeding and exercise, and child eating and exercise behaviors, between families may help to explain the increased obesity risk for children with asthma.

eHealth Intervention to Improve Health Habits in the Adolescent Population: Mixed Methods Study

Background

Technology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents.

Objective

The purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app.

Methods

The BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants’ diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the “degree” measure, which was used as an indicative parameter of centrality.

Results

The sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app.

Conclusions

The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity.

Associations between parental perception of- and concern about-child weight and use of specific food-related parenting practices

Little is known about the association between parental perception of their child's weight as well as parent's current and future concerns regarding their child's weight and a broad range of food-related parenting practices. This study used the first wave of cross-sectional data from the longitudinal Family Matters study to examine the relationships between parental perception of child weight status, parent concern for child's current and future weight and parent use of different types of food-related practices. Parent/child dyads (n = 150) were recruited from primary care clinics. Multiple regression models were fit to examine cross-sectional relationships between parental perception and concern for their child's weight and food-related parenting practices (food restriction, pressure-to-eat, food control, food monitoring, nutrition education, and parent modeling). Parents who perceived their child to be underweight had lower scores for food restriction than parents who perceived their child to be overweight. Parents who reported concern about their child's current weight reported higher scores for food restriction and monitoring than parents who were not currently concerned. Parents who reported concern about their child's future weight status reported higher scores for pressure-to-eat and monitoring than parents who were not at all concerned about their child's future weight status. The relationship between parental perception of child's current weight status and parent use of food restriction, pressure-to-eat, and overall food control was modified by child sex. Overall, results suggest that parent's perceptions of and concerns about their child's current and future weight status were correlated with their feeding approaches. Health care providers may want to consider providing anticipatory guidance for parents that have concerns about their child's weight by teaching them about positive, evidence-based ways they can engage in healthy food-related parenting practices.

First-year college students' weight change is influenced by their randomly assigned roommates' BMI

BACKGROUND

There is ongoing debate about whether friends' greater similarity in Body Mass Index (BMI) than non-friends is due to friend selection, shared environments, or peer influence.

METHODS

First-year college students (n = 104) from a southwestern U.S. university were randomly assigned roommates during the university's housing process, effectively removing friend selection effects. Participant BMI was measured up to four times (T1-T4) across 2015-2016. The influence of roommate baseline BMI (T1) on change in participant BMI over time (T2-T4) was analyzed using a linear mixed effects model adjusted for individual socio-demographics, linear time trends, baseline BMI, and physical clustering of students. A sensitivity analysis examining floormates was also conducted.

RESULTS

Consistent with roommate influence, participants randomized to roommates with a higher BMI gained more weight between times T2 and T4 (β = 0.06; 95% CI = 0.02, 0.10). No shared environment effects (shared campus or floor) were found.

CONCLUSIONS

Randomly assigned roommates influenced each other's weight trajectories. This clarifies that BMI convergence can occur outside of friend selection or shared environments mechanisms.

Parenting Practices, Autonomous Motivation, and Adolescent Diet Habits

Guided by self-determination theory, the aim of this study was to examine whether adolescents' autonomous motivation for making healthy diet choices mediates the association between parenting practices regarding diet and adolescent food choices. We analyzed data from the NCI FLASHE study, a survey of demographically diverse parents and their adolescent children (N = 1,646 dyads). Path models supported self-determination theory's assertion that indirect, encouraging parenting practices fostered internal motivation; in contrast, regulation was both positively and negatively linked to motivation depending on the model. Models also yielded direct paths between parenting practices and healthy and unhealthy diet choices. Overall, regardless of what predicted motivation, adolescents' autonomous motivation was linked with their consumption of healthier foods and drinks. As such, cultivating a sense of internal motivation during these formative years may put young people on a path toward healthy patterns of self-regulation later in life.

Barriers to Preparing and Cooking Vegetables Are Associated with Decreased Home Availability of Vegetables in Low-Income Households

Knowing which barriers to buying and preparing/cooking vegetables at home are linked with the home availability of vegetables and how food-security status impacts this relationship will facilitate the tailoring of future public health interventions. Baseline data were used from an elementary-school-based intervention. Data on household food-security status, availability of vegetables at home, and barriers to buying and preparing/cooking vegetables were collected from 1942 parents. Differences between food-secure and food-insecure households were examined for barriers to buying and preparing/cooking vegetables. Mixed-effects linear regression was used to estimate the associations between barriers to buying and preparing/cooking vegetables and food-security status on the home availability of vegetables. Food insecurity was reported in 27% of households. Food-insecure households were significantly more likely to report barriers to buying and preparing/cooking vegetables. The barriers to purchasing/cooking vegetables score was associated with a decrease in the home availability of vegetables score (β = −0.77; 95% CI: −0.88, −0.65; p < 0.001). Compared to food-secure households, food-insecure households were 15% less likely to have home vegetable availability (β = −1.18; 95% CI: −1.45, −0.92; p < 0.001). Although home availability of vegetables does not guarantee consumption, this study identified specific barriers that were associated with availability that can be targeted in future interventions seeking to improve vegetable consumption in the homes of low-income families.

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.

APOLO-Teens, a web-based intervention for treatment-seeking adolescents with overweight or obesity: study protocol and baseline characterization of a Portuguese sample

PURPOSE

APOLO-Teens is an ongoing web-based program combining a manualized intervention delivered by Facebook^®, a self-monitoring web application and monthly chat sessions to optimize treatment as usual for adolescents with overweight and obesity. The aims of this paper are twofold: (1) to describe the study protocol of the APOLO-Teens randomized controlled effectiveness trial and (2) to present baseline descriptive information of the Portuguese sample.

METHODS

APOLO-Teens includes adolescents aged between 13 and 18 years with BMI percentile ≥ 85 (N = 210; 60.00% girls, BMI z-score 2.40 ± 0.75) undergoing hospital ambulatory treatment for overweight/obesity. Participants completed a set of self-report measures regarding eating behaviors and habits, psychological functioning (depression, anxiety, stress, and impulsivity), physical activity, and quality of life.

RESULTS

Depression, anxiety, stress, impulsivity, and percentage body fat were inversely associated with health-related quality of life (r_s = - 0.39 to - 0.62), while physical activity out-of-school was positively correlated with health-related quality of life (r_s = 0.22). When compared to boys, girls demonstrated statistically significant higher scores on psychological distress, disturbed eating behaviors, impulsivity, were less active at school and had lower scores on the health-related quality of life (p < 0.05).

CONCLUSION

The results showed that there were gender differences in key psychological constructs that are likely to determine success with the treatment and that, therefore, need to be considered in future interventions. The results of APOLO-Teens randomized controlled trial will determine the impact of these constructs on the efficacy and adherence to a web-based intervention for weight loss in the Portuguese population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Parenting Advice School-Age Kids Offer to Parents to Promote Healthier Child Weight-Related Behaviors

OBJECTIVE

To explore parenting advice children would provide to help parents encourage positive health-related behaviors by children.

DESIGN

Focus group discussions were conducted, and children shared the advice they would provide parents to help them encourage healthy weight-related behaviors (ie, diet, physical activity, and sleep) for children.

SETTING

Focus groups (n = 65) were conducted in 3 states (Florida, New Jersey, and West Virginia).

PARTICIPANTS

School-age children (n = 194) between the ages of 6 and 11 years old.

PHENOMENON OF INTEREST

What parenting practices are recommended by children, and are they in line with best-practice guidelines?

ANALYSIS

Focus group data were analyzed to identify themes and trends.

RESULTS

Children's recommendations were congruent with authoritative parenting styles (ie, high levels of warmth and control). Most of the advice shared by children aligned with recommended parent practices (ie, responsive feeding, facilitation, environmental restructuring, parent modeling, and encouragement). However, not all of the children's advice aligned with best practices guidelines (ie, use of food rewards and deception).

CONCLUSIONS AND IMPLICATIONS

Future nutrition education programs may be strengthened by helping parents adopt best practices for promoting healthy child behaviors. Furthermore, teaching children about recommended child feeding parenting practices may help protect future generations by preparing children to care for younger siblings or raise their children using best parenting practices.

Improving Calcium Knowledge and Intake in Young Adults Via Social Media and Text Messages: Randomized Controlled Trial

BACKGROUND

Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterized as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth.

OBJECTIVE

The aim of the CAlcium Nutrition-Dietary Opportunities (CAN-DO) study was to conduct a randomized controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake.

METHODS

The intervention was a 3-arm parallel trial. Young adults aged 18 to 25 years were recruited through university and social media for a 6-week trial. Participants were randomized to 1 of the 3 arms (ie, Facebook posts, Facebook posts plus text messages, and control group that received an electronic leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods, and secondary outcomes were knowledge, self-efficacy, motivation, and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention, and the differences in change between groups were compared using multivariate regression models with multiple imputations for missing data.

RESULTS

A total of 211 participants (64/211, 30.3% males) participated (mean age 21.4 years, SD 2.1) in this study. At the end of the program, no increase in milk intake (odds ratio [OR] 1.51, 95% CI 0.61-3.75 Facebook; OR 1.77, 95% CI 0.74-4.24 Facebook plus text messages; P=.41) nor calcium-rich food was detected (P=.57). There was a significant improvement in knowledge in the Facebook plus text messages group (P<.001), but habit formation improved less than that in the other 2 groups (P=.01). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants.

CONCLUSIONS

The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimize the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000097943; http://www.anzctr.org.au/ACTRN12620000097943.aspx.

Exploring the Relationship Between MyPlate Knowledge, Perceived Diet Quality, and Healthy Eating Behaviors Among Adolescents

Purpose:

MyPlate is the current dietary guidance icon meant to communicate healthy eating patterns. The purpose of this study is to evaluate knowledge of MyPlate nutrition education messages among middle school students and its association with dietary intake and perceived diet quality.

Design:

Secondary analysis of cross-sectional data.

Settings:

Survey of eighth-grade students from 16 middle schools in California.

Subjects:

A total of 3521 eighth-grade students.

Measures:

MyPlate knowledge was assessed with 3 questions asking how much of the plate in a typical meal should be (1) fruits and vegetables, (2) grains, and (3) proteins. A brief food frequency questionnaire measured intake of fruits, vegetables, sweets, salty snacks, fast-food, and sugar-sweetened beverages (SSBs) over the past 7 days. Students self-rated their diet quality as poor, fair, good, or excellent.

Analysis:

Hierarchical logistic regression models controlling for gender, ethnicity, and socioeconomic status.

Results:

Only 11% of students answered all MyPlate questions correctly. MyPlate knowledge was associated with 65% higher odds of not consuming SSBs, but 46% lower odds of not consuming sweets. MyPlate knowledge was not associated with adolescents’ perceived diet quality or intake of salty snacks, fruits, or vegetables.

Conclusion:

Knowledge of nutrition education messages communicated by the MyPlate dietary guidance icon is limited among adolescents. The association between MyPlate knowledge and lower consumption of SSBs is encouraging, given the strong association between SSBs and childhood obesity.

Youngest versus oldest child: why does mothers' snack choice differ?

Young children frequently consume energy dense snacks, which is one of the factors contributing to childhood overweight. The consumption of more healthy snacks could help in meeting the dietary intake requirements of children. Previous research suggested that mothers of first children showed more health-conscious food behavior compared to mothers of not-first children. However, what is missing from earlier research is an in-depth exploration of differences in considerations to choose a snack and the reasons connected. Therefore, this study aims to characterize differences in mothers' snack choice for their youngest child at 2-3 years and their oldest child when he/she was of the same age. Moreover, this study aims to identify reasons for these differences. A grounded theory approach was used for data collection and analysis. Semi-structured interviews were carried out with 17 Dutch mothers with two or three children. All mothers indicated differences between snacks provided to their youngest child (2-3 years) and their oldest child when it was of the same age. Most frequently mentioned differences were youngest children receive unhealthy snacks at a younger age, the structure regarding snack providing is more fixed, and that youngest children receive less age-specific snacks. Most frequently mentioned reasons for these differences were role-modelling, novelty of the first-born, availability of other types of snacks at home, and school hours of the oldest child. The study provided insights into the possible role of siblings in shaping snack consumption. Results might be relevant for the development of intervention strategies to increase mothers' awareness and to help to meet children's dietary requirements.

The Contribution of Snacking to Overall Diet Intake among an Ethnically and Racially Diverse Population of Boys and Girls

BACKGROUND

Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood.

OBJECTIVE

The current study examined associations between snacking and children's diet quality along with differences across ethnicity or race, sex, and weight status.

DESIGN

Cross-sectional data came from Phase I of the Family Matters Study, an observational study.

PARTICIPANTS/SETTING

This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis-Saint Paul, MN in 2017-2018.

MAIN OUTCOME MEASURES

Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls.

STATISTICAL ANALYSES PERFORMED

Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only.

RESULTS

Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children's consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds.

CONCLUSIONS

Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children's food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.

Nutrition Facts Panels: Who Uses Them, What Do They Use, and How Does Use Relate to Dietary Intake?

BACKGROUND

Nutrition labels are a low-cost tool with the potential to encourage healthy eating habits.

OBJECTIVE

To investigate correlates of frequent Nutrition Facts label use, describe the types of label information most often used, and measure how label use relates to dietary intake in young adults.

DESIGN

Cross-sectional population-based study of young adults participating in Project Eating and Activity in Teens and Young Adults-IV.

PARTICIPANTS/SETTING

Surveys and food frequency questionnaires were completed during 2015-2016 by young adults (N=1,817; weighted sample=49% women) aged 25 to 36 years.

MAIN OUTCOME MEASURES

Nutrition Facts label use, frequency of using specific information on labels, and dietary intake.

STATISTICAL ANALYSES PERFORMED

Relative risks and adjusted means were used to examine how demographic, behavior, and weight-related factors were associated with Nutrition Facts panel use, and how label use related to dietary outcomes. Associations with P values <0.05 were considered statistically significant.

RESULTS

Approximately one-third (31.4%) of participants used Nutrition Facts labels "frequently." Use was significantly higher for women; for participants with high education and income; among those who prepared food regularly; among those who were physically active; among those with a weight status classified as overweight; and among those who were trying to lose, gain, or maintain weight. Label components used most often included sugars (74.1%), total calories (72.9%), serving size (67.9%), and the ingredient list (65.8%). Nutrition Facts label users consumed significantly more fruits, vegetables, and whole grains and fewer sugar-sweetened beverages, compared with nonusers. Nutrition Facts label users ate significantly more frequently at sit-down restaurants but less frequently at fast-food restaurants compared with nonusers.

CONCLUSIONS

Although Nutrition Facts label use was associated with markers of better dietary quality in a population-based sample of young adults, only one-third of participants used labels frequently. Methods to improve label use should be studied, particularly through leveraging weight- or health-related goals (eg, interest in making healthier food choices), and meeting consumer preferences concerning label content.

Predictors of breakfast skipping among 14 to 16 years old adolescents in Jordan: The influential role of mothers

AIM

To assess the prevalence and identify the predictors of breakfast skipping among 14- to 16-year-old adolescents in Jordan, focusing on mother-related variables.

BACKGROUND

Breakfast is an essential meal across one's entire lifespan and especially important during the adolescent years. The practice of skipping breakfast has become so prevalent among adolescents that it is now a well-documented nutritional problem.

DESIGN

A descriptive cross-sectional correlational design.

METHODS

A proportional cluster stratified sampling protocol was used to select 1896 adolescents and their mothers (1013) during the period of March to June 2016. A self-reported questionnaire was used to collect data on breakfast-skipping rates, the perceived reasons for this behavior, the perceived importance of consuming breakfast, and maternal encouragement of breakfast consumption.

RESULTS

The prevalence of breakfast skipping was 34.3% among adolescents and 21.5% among their mothers. A significant association was found between breakfast skipping among adolescents and their mothers (χ² [1, n = 998] = 37.90, P = .001). Maternal encouragement of breakfast consumption, gender, and adolescent perception of the importance of this meal were found to be significant predictors of adolescent breakfast skipping.

CONCLUSION

The findings highlight the importance of involving mothers in developing nutritional health plans aimed at promoting regular breakfast consumption among adolescents.

Food Parenting Practices That Influence Early Adolescents' Food Choices During Independent Eating Occasions

OBJECTIVE

To identify practices that parents use to influence early adolescents' food choices during independent eating occasions (iEOs) from parent and child perspectives.

DESIGN

In-depth interviews.

PARTICIPANTS

Low-income parents (n = 49) and early adolescent children (aged 10-13 years; n = 44) from 10 US states and the District of Columbia.

PHENOMENON OF INTEREST

Parent and child perspectives on parenting practices that influence food choices during iEOs.

ANALYSIS

Audio-recorded interviews transcribed verbatim, NVivo coding, and directed content analysis.

RESULTS

Parents reported setting rules and expectations and managing availability or accessibility as the most common practices used to influence iEOs. Other practices included teaching, pressuring to eat, monitoring, and modeling. Children reported that their parents had rules about what they could or could not eat during iEOs and that they used specific strategies (eg, call or text) to monitor their iEOs.

CONCLUSIONS AND IMPLICATIONS

Additional studies are needed to confirm findings from this exploratory study. Future cross-sectional and longitudinal studies could determine whether and to what extent food parenting practices identified in the current study are associated with healthy dietary intake during iEOs, as well as potential racial and ethnic differences.

Association of food parenting practice patterns with obesogenic dietary intake in Hispanic/Latino youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Some food parenting practices (FPPs) are associated with obesogenic dietary intake in non-Hispanic youth, but studies in Hispanics/Latinos are limited. We examined how FPPs relate to obesogenic dietary intake using cross-sectional data from 1214 Hispanic/Latino 8-16-year-olds and their parents/caregivers in the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). Diet was assessed with 2 24-h dietary recalls. Obesogenic items were snack foods, sweets, and high-sugar beverages. Three FPPs (Rules and Limits, Monitoring, and Pressure to Eat) derived from the Parenting strategies for Eating and Activity Scale (PEAS) were assessed. K-means cluster analysis identified 5 groups of parents with similar FPP scores. Survey-weighted multiple logistic regression examined associations of cluster membership with diet. Parents in the controlling (high scores for all FPPs) vs. indulgent (low scores for all FPPs) cluster had a 1.75 (95% CI: 1.02, 3.03) times higher odds of having children with high obesogenic dietary intake. Among parents of 12-16-year-olds, membership in the pressuring (high Pressure to Eat, low Rules and Limits and Monitoring scores) vs. indulgent cluster was associated with a 2.96 (95% CI: 1.51, 5.80) times greater odds of high obesogenic dietary intake. All other associations were null. Future longitudinal examinations of FPPs are needed to determine temporal associations with obesogenic dietary intake in Hispanic/Latino youth.