1
|
Wang J, Wu R, Wei X, Chang YS, Tang X, Zhu B, Cao Y, Wu Y, Zhu D. Bidirectional Associations between Parental Feeding Practices and Child Eating Behaviors in a Chinese Sample. Nutrients 2023; 16:44. [PMID: 38201874 PMCID: PMC10780825 DOI: 10.3390/nu16010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Child eating behaviors (CEBs) and parental feeding practices (PFPs) play critical roles in childhood obesity. However, the bidirectional relationships between CEBs and PFPs remain equivocal. This longitudinal study aimed to explore their bidirectional relationships. METHODS A convenience sample of 870 parents with preschoolers was recruited in this longitudinal study (Shanghai, China). Three non-responsive feeding practices (NFPs), three responsive feeding practices (RFPs), five CEBs, and covariates were collected using validated questionnaires at baseline and the 6-month follow-up. Cross-lagged analyses using structural equation modeling (SEM) were performed to examine their bidirectional relationships. RESULTS Eight hundred and fifty-three parents completed questionnaires, with a response rate of 98%. The mean age of their children at baseline was 4.39 years (standard deviation = 0.72 years). Eighteen out of sixty longitudinal cross-lagged paths were statistically significant. Parental encouragement of healthy eating and content-restricted feeding were found to be bidirectionally associated with child food fussiness. Four parent-driven associations and one child-driven association were identified between RFPs and CEBs. For example, monitoring was negatively associated with children's unhealthy eating habits (β = -0.066, standard error (SE) = 0.025, p < 0.01). Eight child-driven associations and one parent-driven association were observed between NFPs and CEBs. For example, higher child satiety responsiveness predicted a higher pressure to eat (β = 0.057, SE = 0.029, p < 0.01) and the use of food as a reward (β = 0.083, SE = 0.031, p < 0.01). CONCLUSIONS There were bidirectional, parent-driven, and child-driven associations. Parents should be encouraged to adopt RFPs to shape CEBs. Increasing parents' understanding of CEBs and providing them with reasonable coping strategies would help optimize PFPs.
Collapse
Affiliation(s)
- Jian Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Ruxing Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Xiaoxue Wei
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Xianqing Tang
- Department of Children’s Disease Prevention, Jinyang Community Health Service Center, Shanghai 200136, China;
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Daqiao Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| |
Collapse
|
2
|
Markides BR, Hesketh KD, Maddison R, Laws R, Denney-Wilson E, Campbell KJ. Fussy Eating Rescue, a mobile-web app for responsive feeding practises among parents of toddlers: protocol for a pilot randomised controlled feasibility trial. Pilot Feasibility Stud 2023; 9:128. [PMID: 37481664 PMCID: PMC10362701 DOI: 10.1186/s40814-023-01278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/10/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Fussy eating is most often a developmentally typical behaviour, generally presenting during toddlerhood. However, up to half of parents of young children are concerned about fussy eating, and this concern may mediate the use of nonresponsive feeding practises, such as coercive or unstructured feeding and using food to reward eating. Despite the high prevalence of parental concern for fussy eating and the negative impacts nonresponsive feeding practises have on children's health and diets, no previous digital intervention to improve the feeding practises of parents of toddlers concerned about fussy eating has been evaluated. AIM This article describes the protocol of a randomised controlled feasibility pilot aiming to evaluate Fussy Eating Rescue, a purely web app based intervention for parents of toddlers. The primary aim is to investigate feasibility and acceptability; secondary aims are to explore indications of intervention effect on parents' feeding practises or children's eating behaviours. METHODS Fussy Eating Rescue features include: (1) a Tracker, that allows parents to track repeated offers of food, (2) Topics, providing information on fussy eating, effective feeding strategies, and general nutrition, (3) Rescues, containing quick references to material supporting Topics contents, (4) Recipes, and (5) SMS notifications. Parents of toddlers (12-36 months old, n = 50) who have concerns about fussy eating will be recruited via Facebook. Parents will be randomised to an intervention group, which receives access to the app for 6 weeks, or to wait-listed control. Outcomes will be assessed at baseline and 6 weeks after app use, using online questionnaires and app usage statistics. Primary outcomes include participant retention rate, intervention engagement, app usability, perceived ease in using the app, perceived usefulness of the app, and user satisfaction. Secondary outcome measures include parents' feeding practises and children's eating behaviours. DISCUSSION Results will inform whether Fussy Eating Rescue is a feasible way to engage parents concerned for their toddler's fussy eating behaviours. If feasible and acceptable to users, a larger trial will further examine the efficacy of the Fussy Eating app in improving parents' feeding practises and children's eating behaviours. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry on 15 July, 2021 (ACTRN12621000925842).
Collapse
Affiliation(s)
- Brittany Reese Markides
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia.
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| |
Collapse
|
3
|
Feldman K, Asta K, Gearhardt AN, Sturza JM, Appugliese D, Miller AL, Rosenblum K, Kong KL, Crandall AK, Lumeng JC. Characterization of a Vigorous sucking style in early infancy and its predictive value for weight gain and eating behaviors at 12 months. Appetite 2023; 185:106525. [PMID: 36898582 PMCID: PMC10281081 DOI: 10.1016/j.appet.2023.106525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/13/2023] [Accepted: 03/04/2023] [Indexed: 03/12/2023]
Abstract
This study sought to identify sucking profiles among healthy, full-term infants and assess their predictive value for future weight gain and eating behaviors. Pressure waves of infant sucking were captured during a typical feeding at age 4 months and quantified via 14 metrics. Anthropometry was measured at 4 and 12 months, and eating behaviors were measured by parent report via the Children's Eating Behavior Questionnaire-Toddler (CEBQ-T) at 12 months. Sucking profiles were created using a clustering approach on the pressure wave metrics, and utility of these profiles was assessed for predicting which infants will have weight-for-age (WFA) percentile changes from ages 4-12 months that exceed thresholds of 5, 10, and 15 percentiles, and for estimating each CEBQ-T subscale score. Among 114 infants, three sucking profiles were identified: Vigorous (51%), Capable (28%), and Leisurely (21%). Sucking profiles were found to improve estimation of change in WFA from 4 to 12 months and 12-month maternal-reported eating behaviors above infant sex, race/ethnicity, birthweight, gestational age, and pre-pregnancy body mass index alone. Infants with a Vigorous sucking profile gained significantly more weight during the study period than infants with a Leisurely profile. Infant sucking characteristics may aid in predicting which infants may be at greater risk of obesity, and therefore sucking profiles deserve more investigation.
Collapse
Affiliation(s)
- Keith Feldman
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, USA.
| | - Katharine Asta
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA.
| | - Julie M Sturza
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA
| | | | - Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Kai Ling Kong
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, USA.
| | - Amanda K Crandall
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
4
|
Barrett KJ, Moding KJ, Flesher A, Johnson SL. "The Kale Is Green" and Other Things Caregivers Say when Feeding Infants and Toddlers Are Associated with Child Rate of Acceptance. J Nutr 2023; 153:1297-1304. [PMID: 36803576 DOI: 10.1016/j.tjnut.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Responsive feeding is important for helping children to develop healthy eating behaviors. Verbal feeding interactions between caregivers and children may reflect caregiver's responsiveness and contribute to children's developing lexical networks related to food and eating. OBJECTIVES This project aimed to: 1) characterize what caregivers say to infants and toddlers during a single feeding session and 2) test the associations between caregiver's verbal prompts and food acceptance by children. METHODS Filmed interactions of caregivers and their infants (N = 46 infants aged 6-11 mo) and toddlers (N = 60 toddlers aged 12-24 mo) were coded and analyzed to explore the following: 1) what caregivers said during a single feeding session and 2) whether caregiver's verbalizations were associated with child food acceptance. Caregiver verbal prompts were coded during each food offer and summed across the feeding session; prompts were categorized as supportive, engaging, and unsupportive. Outcomes included accepted tastes, rejected tastes, and rate of acceptance. Mann-Whitney's U tests and Spearman's correlations tested bivariate associations. Multilevel ordered logistic regression tested associations between verbal prompt categories and the rate of acceptance across offers. RESULTS Verbal prompts were largely supportive (41%) and engaging (46%), and caregivers of toddlers used significantly more verbal prompts than caregivers of infants (mean ± SD: 34.5 ± 16.9 compared with 25.2 ± 11.6; P = 0.006). Among toddlers, more engaging and unsupportive prompts were associated with a lower rate of acceptance (ρ = -0.30, P = 0.02; ρ = -0.37, P = 0.004). For all children, multilevel analyses revealed that more unsupportive verbal prompts were associated with a lower rate of acceptance (b = -1.52; SE = 0.62; P = 0.01) and individual caregiver use of more engaging and unsupportive prompts than usual was associated with a lower rate of acceptance (b = -0.33; SE = 0.08; P < 0.001: b = -0.58; SE = 0.11; P < 0.001). CONCLUSIONS These findings suggest that caregivers may strive for a supportive and engaging emotional setting during feeding, although verbalization category may change as children exhibit more rejection. Furthermore, what caregivers say may change as children develop more advanced language capabilities.
Collapse
Affiliation(s)
- Katherine J Barrett
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States.
| | - Kameron J Moding
- Purdue University, Department of Human Development and Family Studies, West Lafayette, IN, United States
| | - Abigail Flesher
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States
| | - Susan L Johnson
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States
| |
Collapse
|
5
|
Wang J, Zhu B, Wu R, Chang YS, Cao Y, Zhu D. Bidirectional Associations between Parental Non-Responsive Feeding Practices and Child Eating Behaviors: A Systematic Review and Meta-Analysis of Longitudinal Prospective Studies. Nutrients 2022; 14:nu14091896. [PMID: 35565862 PMCID: PMC9103127 DOI: 10.3390/nu14091896] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Parental non-responsive feeding practices and child eating behaviors both play significant roles in childhood obesity. However, their longitudinal relationships are less clear. This systematic review aimed to examine their bidirectional associations. Methods: A systematic search of five databases was conducted from inception to February 2022. Data synthesis was performed using a semi-quantitative and quantitative approach. Results: A total of 14 studies with 15348 respondents were included. A total of 94 longitudinal effects from 14 studies of parental non-responsive feeding practices on child eating behaviors were investigated, and 19 statistically significant effects were discovered. Seventy-seven longitudinal effects from nine studies of child eating behaviors on parental feeding practices were examined, with fifteen being statistically significant. The pooled results of meta-analysis showed five statistically significant associations: parental restrictive feeding positively predicted child enjoyment of food (β = 0.044; 95% CI: 0.004, 0.085); use of food as a reward positively predicted child emotional eating (β = 0.09; 95% CI: 0.04, 0.15); child food responsiveness positively predicted restrictive feeding (β = 0.04; 95% CI: 0.02, 0.06); use food as a reward (β = 0.06; 95% CI: 0.03, 0.10). In addition, the pooled effects showed that child satiety responsiveness negatively predicted restrictive feeding (β = −0.05; 95% CI: −0.08, −0.01). Conclusions: The bidirectional relationships between parental non-responsive feeding practices and child eating behaviors are inconsistent and a few showed statistical significance. Theory-driven longitudinal studies using validated instruments and controlling for potential confounders are needed to unveil their relationships and provide evidence for obesity prevention interventions.
Collapse
Affiliation(s)
- Jian Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (B.Z.); (R.W.)
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (B.Z.); (R.W.)
| | - Ruxing Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (B.Z.); (R.W.)
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden
- Correspondence: (Y.C.); (D.Z.); Tel.: +86-021-63846590 (D.Z.)
| | - Daqiao Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (B.Z.); (R.W.)
- Correspondence: (Y.C.); (D.Z.); Tel.: +86-021-63846590 (D.Z.)
| |
Collapse
|
6
|
Graf MD, Lutenbacher M, Wasser H, Dietrich MS, Karp SM. Choking, allergic reactions, and pickiness: A qualitative study of maternal perceived threats and risk avoidance strategies during complementary feeding. Appetite 2022; 171:105914. [PMID: 35007666 PMCID: PMC8842507 DOI: 10.1016/j.appet.2022.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Abstract
An infant's early eating experiences influence later growth and health. However, motivators for mothers' complementary feeding decisions for their infants, such as the process of introducing solid foods, remains unclear. This qualitative study identified maternal perceived threats surrounding complementary feeding and strategies mothers use to mitigate perceived threats of adverse feeding-related health outcomes for their infants. Twenty-seven mothers participated in private, semi-structured interviews. Inductive and deductive qualitative content analysis revealed three primary themes of maternal perceived threats: a) choking, b) allergic reaction, and c) pickiness. Within each primary theme were sub-themes that further delineated the perceived threats and outlined specific and focused complementary feeding practices (CFPs) mothers used for each type of perceived threat. Findings suggest mothers have difficulty with estimating the likelihood and severity of risks and rely on elevated threat perception to guide their feeding decisions. CFPs used to prevent perceived threats were disproportionate to risks, and, at times, actually introduced additional, alternative risks.
Collapse
Affiliation(s)
| | - Melanie Lutenbacher
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, United States
| | - Heather Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, United States; Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN, 37235, United States
| | - Sharon M Karp
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, United States
| |
Collapse
|
7
|
DeJesus JM, Venkatesh S. Does social modeling increase infants' willingness to accept unfamiliar foods? INFANCY 2021; 27:181-196. [PMID: 34812560 DOI: 10.1111/infa.12442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/13/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022]
Abstract
Despite a rich knowledge base about infants' social learning and studies observing social referencing in other species in food contexts, we know surprisingly little about social learning about food among human infants. This gap in the literature is particularly surprising considering that feeding unfamiliar foods to infants is a very common experience as infants begin to eat solid foods. The present study examines whether parental social modeling influences infants' willingness to accept unfamiliar foods. In two Zoom sessions, parents will be asked to feed unfamiliar foods to their 6- to 24-month-old infants (different unfamiliar foods in each session). In both sessions, infants' food acceptance and rejection will be measured. In the first session, parents will be asked to do what they would typically do; spontaneous social modeling will be recorded. In the second session, parents will be instructed to model eating the unfamiliar food. We will examine associations between infants' willingness to eat unfamiliar foods, parent social modeling, and extant parent and infant characteristics.
Collapse
Affiliation(s)
- Jasmine M DeJesus
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Shruthi Venkatesh
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| |
Collapse
|
8
|
Chilman L, Kennedy-Behr A, Frakking T, Swanepoel L, Verdonck M. Picky Eating in Children: A Scoping Review to Examine Its Intrinsic and Extrinsic Features and How They Relate to Identification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9067. [PMID: 34501656 PMCID: PMC8431657 DOI: 10.3390/ijerph18179067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
The health benefits and importance of family mealtimes have been extensively documented. Picky eating can impact this complex activity and has numerous extrinsic (or external) and intrinsic (or internal) features. Occupational therapists work with children and their families by looking at both intrinsic and extrinsic influences and are therefore well-placed to work within this context. This scoping review comprises a comprehensive search of key health industry databases using pre-determined search terms. A robust screening process took place using the authors pre-agreed inclusion and exclusion criteria. There were 80 studies that met the inclusion criteria, which were then mapped using content analysis. The most common assessments used to identify picky eating relied on parental reports and recall. Often additional assessments were included in studies to identify both the intrinsic and extrinsic features and presentation. The most common reported intrinsic features of the child who is a picky eater included increased sensitivity particularly to taste and smell and the child's personality. Extrinsic features which appear to increase the likelihood of picky eating are authoritarian parenting, rewards for eating, and pressuring the child to eat. Most commonly reported extrinsic features that decrease the likelihood of picky eating are family meals, responsive parents, and involving the child in the preparation of food. In conclusion, there is a lack of published papers addressing the role of occupational therapists in the assessment and identification of picky eating in children. There appears to be a complex interplay between intrinsic and extrinsic features which impact caregiver responses and therefore on the picky eater.
Collapse
Affiliation(s)
- Laine Chilman
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Locked Bag 4 Maroochydore, Maroochydore DC, Sunshine Coast, QLD 4558, Australia ; (A.K.-B.); (L.S.); (M.V.)
| | - Ann Kennedy-Behr
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Locked Bag 4 Maroochydore, Maroochydore DC, Sunshine Coast, QLD 4558, Australia ; (A.K.-B.); (L.S.); (M.V.)
- School of Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Thuy Frakking
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, Herston, QLD 4510, Australia;
- Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD 4029, Australia
| | - Libby Swanepoel
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Locked Bag 4 Maroochydore, Maroochydore DC, Sunshine Coast, QLD 4558, Australia ; (A.K.-B.); (L.S.); (M.V.)
| | - Michele Verdonck
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Locked Bag 4 Maroochydore, Maroochydore DC, Sunshine Coast, QLD 4558, Australia ; (A.K.-B.); (L.S.); (M.V.)
| |
Collapse
|
9
|
Iwinski S, Cole NC, Saltzman JA, Donovan SM, Lee SY, Fiese BH, Bost KK. Child attachment behavior as a moderator of the relation between feeding responsiveness and picky eating behavior. Eat Behav 2021; 40:101465. [PMID: 33310487 PMCID: PMC10796209 DOI: 10.1016/j.eatbeh.2020.101465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Picky eating (PE) behavior is common in early childhood, but persistent PE is associated with unhealthy development and caregiver-child stress during feeding. Identifying modifiable feeding and parent-child relationship factors that impact PE is important for decreasing risks associated with PE. OBJECTIVE This study examined associations between caregiver Feeding Responsiveness (FR) and child PE behaviors using caregiver reports and observations of family mealtimes. An additional aim examined whether children's attachment behavior moderates this association. METHODS The analysis sample consisted of 110 families participating in a larger longitudinal study of nutrition and child health. Home observations were conducted when children were 18-24 months (52% females) to assess caregiver-child interactions. Caregivers were, on average, 30.9 years old and mostly White (73.6%). Family mealtimes were videotaped and coded for FR and child PE behaviors. Caregivers completed surveys regarding FR and PE behaviors. RESULTS Caregiver-reported FR was significantly correlated with observed FR, r (107) = 0.26, p = 0.007; and caregiver-reported PE was associated with observed PE, r (107) = 0.21, p = 0.029. Caregiver-reported FR was inversely related to observed PE, but only when children were characterized by observers to have more positively toned and smooth interactions with caregivers. Using observational data, child attachment significantly moderated the relationship between FR and PE behaviors. CONCLUSIONS The quality of caregiver-child interactions may impact the degree to which FR is effective in reducing PE. Future longitudinal studies that include more diverse populations, multiple caregivers, and potential mechanisms accounting for these associations are needed.
Collapse
Affiliation(s)
- Samantha Iwinski
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America.
| | - Natasha Chong Cole
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States of America
| | - Jaclyn A Saltzman
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America; The MITRE Corporation, Bedford, MA, United States of America
| | - Sharon M Donovan
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States of America; Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States of America
| | - Soo-Yeun Lee
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States of America; Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States of America
| | - Barbara H Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America
| | - Kelly K Bost
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America
| |
Collapse
|
10
|
Zohar AH, Pick S, Lev-Ari L, Bachner-Melman R. A longitudinal study of maternal feeding and children's picky eating. Appetite 2020; 154:104804. [PMID: 32693002 DOI: 10.1016/j.appet.2020.104804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/22/2020] [Accepted: 07/14/2020] [Indexed: 01/07/2023]
Abstract
This study aimed to estimate the rate of persistent picky eating (PE) in children 3-8 years of age, and to characterize children with PE and their mothers. From a base sample of 1055 mothers of children 3.4 ± 1.3 years old, we selected those who described their children as picky eaters (PEs; n = 185, 17.5%) for a longitudinal study. 109 PE dyads participated, as well as a matched comparison group of dyads without PE (n = 106). At T1 mothers self-reported on trait anxiety, perfectionism, attachment style; as well as on the child's behavioral problems, their temperament, and their executive function. The participants were re-evaluated twice, at two-year intervals (T2 and T3). At T2 the mothers self-reported on their personality, on their child feeding practices, and reported their child's eating behavior. At T3 the mothers self-reported on their feeding style and the children self-reported on a pictorial frequent food questionnaire. PE persisted throughout T2 and T3 in 22.5% of T1 PE children in the longitudinal study, or in 3.94% of the base sample. The child characteristics that distinguished the PE and non-PE groups at T1 predicted 9-10% of the variance of T3 PE. Maternal feeding practices at T2 contributed 1-2% to the explained variance. It can be concluded that for the overwhelming majority of children, PE is a passing phase. Maternal feeding practices have limited long-term influence on children's PE. Unless PE is persistent and severe, parents would best be advised to relax their feeding efforts.
Collapse
Affiliation(s)
- Ada H Zohar
- Ruppin Academic Center, Emek Hefer, 40250, Israel; The Lior Tsfaty Center for Suicide and Mental Pain Studies, Israel.
| | - Shahar Pick
- Ruppin Academic Center, Emek Hefer, 40250, Israel.
| | - Lilac Lev-Ari
- Ruppin Academic Center, Emek Hefer, 40250, Israel; The Lior Tsfaty Center for Suicide and Mental Pain Studies, Israel.
| | - Rachel Bachner-Melman
- Ruppin Academic Center, Emek Hefer, 40250, Israel; Hebrew University of Jerusalem, Mount Scopus, 9190500, Israel.
| |
Collapse
|
11
|
Beckers D, Karssen LT, Vink JM, Burk WJ, Larsen JK. Food parenting practices and children's weight outcomes: A systematic review of prospective studies. Appetite 2020; 158:105010. [PMID: 33075443 DOI: 10.1016/j.appet.2020.105010] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 09/19/2020] [Accepted: 10/11/2020] [Indexed: 01/10/2023]
Abstract
This systematic review is the first to provide an overview of the prospective links between food parenting practices and children's weight outcomes. Three databases were searched. All titles, abstracts and full-texts were double screened by two independent reviewers. Peer-reviewed journal articles published after 1990 assessing the prospective association between food parenting practices and weight outcomes of children aged 2-18 years were eligible. A total of 38 eligible studies were identified, focusing on 12 separate food parenting practices. Restriction, pressure to eat, and monitoring were generally not associated with children's weight over time, but higher quality studies suggest that pressure to eat was associated with lower weight outcomes over time. Most studies on food availability and accessibility found null-findings as well. Instrumental-but not emotional-feeding was associated with higher weight over time, but higher quality studies are needed to confirm this link. Results involving the link between frequency of mealtime and child weight were mixed. Autonomy supporting and other structure-related food parenting practices were understudied. In conclusion, food parenting practices receiving the most attention within prospective studies (i.e., restriction, pressure to eat, monitoring) were generally not associated with children's weight outcomes over time. Future high quality studies should focus more on other food parenting practices, further unravel bidirectional links between food parenting and children's eating behaviors and weight outcomes, and examine the mediating role of dietary intake.
Collapse
Affiliation(s)
- Desi Beckers
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands.
| | - Levie T Karssen
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands
| | - William J Burk
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands
| |
Collapse
|
12
|
DeJesus JM, Venkatesh S. Show or tell: Children's learning about food from action vs verbal testimony. Pediatr Obes 2020; 15:e12719. [PMID: 32869955 DOI: 10.1111/ijpo.12719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood obesity continues to be a critical health concern in the United States. Nonetheless, interventions that focus on delivering verbal lessons about food and health to children in preschool classrooms have had only modest effects. OBJECTIVES The present study examines the relative effectiveness of showing vs telling children about food to promote healthy eating, with a focus on unfamiliar foods and vegetables. METHODS Three- to six-year-old children (n = 71) were tested in a laboratory study in which they watched videos of two people eating apple-broccoli puree. One person took five bites of the food; the other said they liked the food. RESULTS Children did not differentiate between the food they saw someone eat and the food they heard someone talk about. Children's food intake was negatively associated with parent reports of children's eating behavior on the Food Fussiness subscale of the Child Eating Behavior Questionnaire. We found similar patterns in an analogous toy task. In an unfamiliar object task, children selected the action demonstration as the right way to use the object. CONCLUSIONS We find no evidence that action vs verbal testimony is more persuasive in guiding children's food choices, but action testimony may be persuasive in other domains. The associations between children's food intake and pickiness provide growing evidence of alignment between parent assessments of their children's typical eating behavior and children's food choices in laboratory studies.
Collapse
Affiliation(s)
- Jasmine M DeJesus
- Department of Psychology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Shruthi Venkatesh
- Department of Psychology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| |
Collapse
|
13
|
Tan CC, Domoff SE, Pesch MH, Lumeng JC, Miller AL. Coparenting in the feeding context: perspectives of fathers and mothers of preschoolers. Eat Weight Disord 2020; 25:1061-1070. [PMID: 31190293 PMCID: PMC6906266 DOI: 10.1007/s40519-019-00730-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/06/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This study examined how fathers and mothers coparent around child feeding. METHODS Father-mother pairs (N = 30) of preschool-aged children (M child age = 4.1 years old) participated in joint or group interview sessions. RESULTS Three themes emerged from the qualitative analysis: (1) couples' division of labor regarding feeding tasks seemed to align with stereotypical gender roles; (2) couples noted that they attempted healthier family eating habits in comparison to families of origin and recognized the influence of extended family on their attempts at healthier feeding; (3) couples agreed on the importance of family mealtime, routines, and healthy meals, yet disagreed on strategies to limit unhealthy foods and achieve harmonious family meals. CONCLUSIONS This study identified processes of coparenting and child feeding areas that were particularly challenging to manage among parents, which could be important targets for childhood obesity interventions. LEVEL OF EVIDENCE V, descriptive study.
Collapse
Affiliation(s)
- Cin Cin Tan
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls Street, 10th Floor, Ann Arbor, MI, 48109-5406, USA.
- Department of Psychology, University of Toledo, Ohio, USA.
| | - Sarah E Domoff
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls Street, 10th Floor, Ann Arbor, MI, 48109-5406, USA
- Department of Psychology, Central Michigan University, Mt. Pleasant, USA
| | - Megan H Pesch
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls Street, 10th Floor, Ann Arbor, MI, 48109-5406, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, USA
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls Street, 10th Floor, Ann Arbor, MI, 48109-5406, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, USA
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls Street, 10th Floor, Ann Arbor, MI, 48109-5406, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA
| |
Collapse
|
14
|
Russell CG, Russell A. "Food" and "non-food" self-regulation in childhood: a review and reciprocal analysis. Int J Behav Nutr Phys Act 2020; 17:33. [PMID: 32151265 PMCID: PMC7063723 DOI: 10.1186/s12966-020-00928-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In developmental science, there is an extensive literature on non-food related self-regulation in childhood, where several domains relating to emotions, actions and cognitions have been identified. There is now growing attention to food related self-regulation in childhood, especially difficulties with ASR, and the consequences for weight gain and adiposity. The aim of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood (referred to as appetite self-regulation (ASR) and general self-regulation (GSR) respectively). The focus was on commonalities and differences in key concepts and underpinning processes. METHODS Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing. RESULTS AND DISCUSSION The scholarship on GSR in childhood has had a focus on the role of the cognitively-oriented Executive Function (EF), the temperamentally-based Effortful Control (EC) and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. "Hot" and "cool/cold" EF and self-regulation situations have been distinguished. There were some parallels between GSR and ASR in these areas, but uncertainty about the contribution of EF and EC to ASR in young children. Possible differences between the contribution to ASR-related outcomes of delay-of-gratification in food and non-food tasks were apparent. Unique elements of ASR were identified; associated with psychological, biological and neurological responses to food and bottom-up processes. A diverse number of situations or elements connected to ASR exist: for example, energy balance homeostasis, caloric compensation, hunger regulation, satiation, satiety, energy density of food, eating in the absence of hunger, emotional eating, etc. CONCLUSIONS: Self-regulation in food and non-food domains are amenable to a reciprocal analysis. We argue that self-regulation of appetite should be added as a domain under the umbrella of self-regulation in childhood along with the other non-food related domains. This could lead to a broader understanding of self-regulation in childhood, and generate novel lines of enquiry.
Collapse
Affiliation(s)
- Catherine G Russell
- Faculty of Health, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Alan Russell
- College of Education, Psychology and Social Work, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia
| |
Collapse
|
15
|
Abstract
OBJECTIVE To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood. DESIGN A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008-2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height. SETTING Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998-1999. PARTICIPANTS The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years). RESULTS Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults' weight status, use of weight-control strategies or report of binge eating. CONCLUSIONS While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.
Collapse
|
16
|
Wolstenholme H, Heary C, Kelly C. Fussy eating behaviours: Response patterns in families of school-aged children. Appetite 2019; 136:93-102. [PMID: 30668966 DOI: 10.1016/j.appet.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/23/2018] [Accepted: 01/09/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fussy eating is the unwillingness to eat both familiar and novel foods. Childhood fussy eating can be a barrier to a healthful diet and is associated with mealtime stress and conflict. Research has primarily focused on parenting practices in response to fussy eating in pre-schoolers. Less is known about parenting practices and family processes such as setting goals and managing emotions in relation to fussy eating in older children. This research aims to explore how families respond to fussy eating behaviours in school-aged children and based on parents' retrospective accounts, to investigate how responses change over time. METHODS 16 parents from 14 families of school-aged children (6-10 years) participated in semi-structured qualitative interviews. Interviews were analysed using inductive thematic analysis. RESULTS Three family process themes were identified which explain how families respond to fussy eating behaviours: 1) Dynamic and Evolving Feeding Goals, 2) Managing Negative Emotions and 3) Parenting Practices: Figuring out What Works. Three distinct patterns were identified regarding how parent responses change over time: 1) Resistance-to-Acceptance Response, 2) Fluctuating Response and 3) Consistent Response. DISCUSSION The family response to fussy eating behaviours is complex, dynamic and contextual. This has implications for the design and interpretation of quantitative studies, and for the development of guidelines and interventions.
Collapse
Affiliation(s)
- Hazel Wolstenholme
- School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Caroline Heary
- School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, University Road, Galway, Ireland.
| |
Collapse
|
17
|
Miller AL, Miller SE, Clark KM. Child, Caregiver, Family, and Social-Contextual Factors to Consider when Implementing Parent-Focused Child Feeding Interventions. Curr Nutr Rep 2018; 7:303-309. [PMID: 30353367 PMCID: PMC6237637 DOI: 10.1007/s13668-018-0255-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Interventions that aim to alter child eating behaviors often focus on parents as a proximal influence. Yet, parents can be difficult to engage. Therefore, intervention recommendations are often not implemented as designed. The goal of this review is to highlight factors at multiple contextual levels that are important to consider when developing interventions to address child eating, due to their implications for overcoming parent engagement challenges. RECENT FINDINGS Intervention studies suggest that parents are often the key to successfully changing child eating behaviors, and many interventions focus on feeding. Factors such as child eating phenotypes, parent stress, family system dynamics, and sociodemographic constraints have also been identified as shaping food parenting. Challenges at multiple contextual levels can affect the likelihood of parent engagement. Addressing factors at the child-, parent-, family-, and broader social-contextual levels of influence is essential in order to promote best practices for parent-focused feeding interventions.
Collapse
Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH-I, Room 3718, Ann Arbor, MI, 48109-2029, USA.
| | - Sara E Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH-I, Room 3718, Ann Arbor, MI, 48109-2029, USA
| | - Katy M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH-I, Room 3718, Ann Arbor, MI, 48109-2029, USA
| |
Collapse
|
18
|
Galloway AT, Watson P, Pitama S, Farrow CV. Socioeconomic Position and Picky Eating Behavior Predict Disparate Weight Trajectories in Infancy. Front Endocrinol (Lausanne) 2018; 9:528. [PMID: 30279678 PMCID: PMC6154220 DOI: 10.3389/fendo.2018.00528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/21/2018] [Indexed: 01/27/2023] Open
Abstract
Infant weight gain has long-term implications for the establishment of overall health. We examined whether socioeconomic position (SEP), the use of pressure as a feeding practice, and picky eating relate to changes infant in weight-for-length (WFL). A modified developmental design was used to examine whether current levels of child picky eating, parental use of pressure, and SEP were associated with changes in WFL during infancy. Health providers distributed survey packets during routine well-child visits made in the homes of families with young children in New Zealand (n = 193). Primary caregivers of young children provided their child's current level of picky eating, their use of pressure, and their SEP. They also reported their child's professionally-measured WFL from birth, 8, 15, and 21 months of age. A multi-level modeling analysis yielded an interaction between SEP and picky eating in predicting infant weight change over time. Children who had a low SEP and were not picky eaters were on the highest WFL trajectory and children who had a low SEP and were picky eaters were lowest on the WFL trajectory. A main effect revealed that higher levels of parental pressure predicted lower WFL in infants at each age, but did not interact with SEP or picky eating. Findings from this study indicate that the combination of eating behavior and SEP are associated with differential infant growth patterns. These results suggest that eating behavior and SEP should be included in the development of interventions designed to achieve healthy weight during childhood.
Collapse
Affiliation(s)
- Amy T Galloway
- Department of Psychology, Appalachian State University, Boone, NC, United States
- Ara Institute of Canterbury, Christchurch, New Zealand
| | - Paul Watson
- Ara Institute of Canterbury, Christchurch, New Zealand
- Royal New Zealand Plunket Trust, Wellington, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute, Otago University, Christchurch, New Zealand
| | - Claire V Farrow
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| |
Collapse
|