Associations of parent dietary role modeling with children's diet quality in a rural setting: Baseline data from the NU-HOME study

A recipe for health: A descriptive qualitative study examining paternal influence and the establishment of children's healthy eating habits in Singapore

This study aimed to explore Singaporean fathers' perceived influence over their children's eating habits. A descriptive qualitative study design was used. Convenience sampling was used to recruit fathers of children aged 3-21 years old from a general paediatric outpatient clinic in a tertiary public hospital. Data were collected from September 2023 to January 2024. Fifteen fathers were interviewed until data saturation. A semi-structured interview guide was used to conduct virtual interviews and thematic analysis was used for data analysis. Three themes and nine subthemes were identified. The three themes were: (1) laying a good foundation, (2) circumstances shaping perspectives, and (3) agents of future behavioural change. Fathers perceived themselves as influencing their children's eating habits by laying a good foundation and that their perspectives were influenced by their circumstances such as lack of time and gender roles. Fathers identified elements that could initiate their future behaviour change to better influence their children's eating habits. These findings provide nuanced insights into paternal perceptions, for the future development of father-specific interventions to enhance their influence in promoting good eating habits among their children. Healthcare professionals can encourage paternal involvement through providing health education on healthy nutrition for their children to both mothers and fathers in the clinical setting. Healthcare professionals can also organize hands-on events that teach about food exploration and nutrition for fathers to take part in with their children.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

Perceptions of Parental Support for Physical Activity and Healthy Eating among School-age Children During COVID-19 pandemic

Family routines play a key role in promoting child health behaviors. This study 1) describes changes in children's perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explores how sex, age, and pandemic-related economic stressors relate to changes. Children's perceptions of family routines were assessed using four subscales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Linear mixed models assessed changes in perceptions and associated factors (child age and sex; caregiver(s) job loss during pandemic). Children (N=277) were aged 9.3-15.5y at pandemic onset (March 2020), dichotomized by median age (12.1y) as younger and older. Children's perceptions of PA-policies (pre-pandemic mean=15.4) and Diet-policies (pre-pandemic mean=26.3) increased significantly from pre- to early (b=1.2 and 2.3, respectively) and mid-pandemic (b=1.0 and 1.2, respectively). Diet-rules (pre-pandemic mean=10.8) decreased significantly from pre- to early (b=-1.1) and mid-pandemic (b=-2.0), with no PA-Diet-role-model changes. Younger children had a greater increase in perceived PA-policies and Diet-policies across the pandemic. Females (59.9%) had a greater decrease in perceived Diet-rules across the pandemic and less increase in Diet-policies and PA-Diet-role-model from pre- to early pandemic. Children whose caregiver(s) lost employment (51.8%) perceived a greater increase in PA-policies. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules for diet during the pandemic. Future research is needed to understand how changes in family routines relate to PA and healthy eating behaviors.

Parent Weight, Diet, Active Living, and Food-Related Outcomes of the Family-Focused:NU-HOME Randomized Controlled Trial: NU-HOME Randomized Controlled Trial

BACKGROUND

Little is known about parent outcomes of rural, family-focused childhood obesity prevention trials.

OBJECTIVE

Our aim was to evaluate parent outcomes of the rural, family-focused NU-HOME (New Ulm at HOME [Healthy Offerings via the Mealtime Environment]) randomized controlled trial designed to prevent obesity in children aged 7 through 10 years.

DESIGN

Families were randomized to the intervention or wait-list control group after baseline data collection. Staff measured parent height, weight, and percent body fat. Surveys measured parent cognitive and behavioral outcomes (eg, portion-size confidence, dietary intake, total and moderate-to-vigorous physical activity, and screen time). Post-intervention data were collected 8 to 10 months after baseline.

PARTICIPANTS/SETTING

The randomized controlled trial took place in rural, south central Minnesota, and enrolled parent and child dyads (N = 114; 2017-2018); 98 parents provided data at post intervention (2018-2019) and comprise the analytic sample. Parent inclusion criteria were being the primary meal preparer, living with the child most of the time, and being willing to attend intervention sessions. Exclusion criteria were planning to move or having a medical condition that would contraindicate participation.

INTERVENTION

The theory-guided intervention (7 sessions and 4 goal-setting calls) focused on family eating and active living behaviors.

MAIN OUTCOME MEASURES

Height, weight, and percent body fat were measured and the survey assessed diet, active living, and food-related outcomes.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models tested change in parent outcomes from baseline to post intervention by treatment group adjusted for demographic characteristics and baseline values.

RESULTS

In the intervention group vs control group, parent total weekly hours of physical activity was 1.73 hours higher (95% CI 0.11 to 3.35 hours) and portion-size confidence was 1.49 points higher (95% CI 0.78 to 2.19). No other statistically significant changes were observed by treatment group.

CONCLUSIONS

Findings indicate that parent cognitive and behavioral outcomes are amenable to change in family-focused childhood obesity prevention programs. Parent increases in portion-size confidence and total physical activity hours may support long-term parent health and provide positive context for child health.