Structural and interpersonal characteristics of family meals: associations with adolescent body mass index and dietary patterns

Longitudinal associations between family meal quality and quantity: Does one matter more for child, parent, and family health and well-being or are they synergistic?

It is unknown how family meal quantity (i.e., frequency) and quality (i.e., meal healthfulness and interpersonal quality) are associated with child, parent, and family health and well-being over time. This study aimed to examine longitudinal associations between family meal quantity and quality and child, parent, and family health and well-being and whether there was a synergistic effect between family meal quantity and quality. Children ages 5-9 and their parents from six racial/ethnic groups participated in this longitudinal cohort study. Regression models adjusted for socio-demographic characteristics examined family meal quantity, interpersonal quality, and nutritional quality at baseline and interactions between quantity and quality, in relation to changes in child, parent, and family health outcomes from baseline to 18-month follow-up. Higher family meal quantity predicted reduced obesity prevalence, improved diet quality and less food fussiness, food responsiveness, and conduct problems among children at follow-up. Higher family meal quality predicted improved diet quality, lower emotional problems, less food responsiveness, and fewer peer relationship problems among children, improved diet quality and reduced psychological distress for parents, and less family chaos at follow-up. One interaction between family meal quantity and quality was found for child peer relationship problems. Overall, family meal quantity and quality were independently important for child health and well-being and for some parent and family health outcomes. Clinicians working with families may want to emphasize the importance of both family meal quantity and quality, as these longitudinal findings suggest potential benefits for the entire family.

Unhealthy Dietary Patterns and Their Associations with Sociodemographic Factors as Predictors among Underweight and Overweight Adolescents in Southern Thailand

(1) Background: Adolescence is a critical developmental phase; dietary intake and nutritional status significantly impact health outcomes. (2) Objective: This cross-sectional study investigated dietary patterns (DPs) and the association between sociodemographic factors and unhealthy DPs among adolescents in Thailand. (3) Methods: A multi-stage sampling selected 1480 participants from three public high schools in Nakhon Si Thammarat province. A food frequency questionnaire assessed dietary habits, and principal component analysis was used to identify DPs. Multinomial logistic regression examined the association between sociodemographic factors and DPs. (4) Results: The findings show that 25.9% of adolescents were underweight, 14.7% were overweight, and 5.8% were obese. Three DPs were identified: a healthy 'protein and vegetables' pattern and two unhealthy patterns: 'snacks' and 'processed foods', which explained 12.49%, 10.37%, and 7.07% of the dietary variance, respectively. Among underweight adolescents, higher snack consumption was associated with being younger (odds ratio (OR) = 3.24) and receiving a higher daily allowance (OR = 3.43). Additionally, female adolescents who engaged in frequent exercise had a 2.15 times higher intake of processed foods. Among overweight adolescents, higher snack intake was linked to being younger (OR = 8.65) and having larger families (OR = 6.37). Moreover, an increased daily allowance was associated with higher consumption of processed foods (OR = 11.47). (5) Conclusion: This study underscores the socio-demographic influence on unhealthy DPs. Insights can guide targeted interventions to foster healthier dietary habits during adolescence.

Family Meals and Cardiometabolic Risk Factors in Young Children

PURPOSE OF THE REVIEW

Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary patterns, and weight status in youth.

REVIEW FINDINGS

According to the American Heart Association's Life's Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality. Family meals may be an effective strategy for improved dietary patterns and weight status in youth.

The roles of child temperament, parent stress, and parenting style in family mealtimes

Family mealtimes are associated with benefits for children, including healthy eating, fewer behavior problems, and healthy psychological well-being. However, the interactions during family mealtimes, and the parent and child characteristics, which may affect both the family mealtime environment and the associated benefits in children are not fully understood. The goal of this study was to examine the role of child and parent characteristics on the family mealtime environment. We tested several mediation models to explain how child temperament (negative affectivity), parent stress, and the dimensions of parent feeding style (responsiveness and demandingness) interact and influence each other to impact the structure and quality of the mealtime environment. Parents (68 mothers; 82 fathers) of children between 2 and 6 years completed an online survey. Measures included the Children's Behavior Questionnaire, Perceived Stress Scale, Caregiver's Feeding Styles Questionnaire, and The Meals in Our Household Questionnaire. Child negative affectivity was associated with poorer mealtime quality and structure. These associations were mediated through parent responsiveness, but not demandingness. The role of demandingness in family mealtimes may depend on parent responsiveness. When examined together in a serial mediation model, child negative affectivity increased parent stress, which reduced responsiveness, and led to poorer mealtime quality and structure. These results emphasize the complex relationships between child temperament, parent stress, and the dimensions of parenting styles that occur within the mealtime context. This line of research is essential for understanding family mealtime dynamics and informing future studies aimed at creating positive interactions between parents and children during mealtimes.

Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals

OBJECTIVE

To examine parent-reported key family meal characteristics to advance the conceptualization of how parents perceive family meals to inform public health interventions and clinical practice.

DESIGN

Cross-sectional study design using ecological momentary assessment (EMA) and online survey data from a racially and ethnically diverse population.

PARTICIPANTS

Parent/child dyads (N = 631) with children ages 5-9 years old from diverse, low-income households.

ANALYSIS

Multi-level logistic regression, conditional fixed effects estimators and multi-level logistic models with inverse probability weights.

RESULTS

Characteristics of meals that parents considered family meals (N = 3328) included: homemade, prepared by the caregivers, eaten at home (table/counter), most of the nuclear family gathered, having a conversation and an enjoyable atmosphere (p < 0.001). Characteristics of meals that parents deemed as non-family meals (N = 562) included: watching TV/tablets, non-family members joining, chaotic/rushed atmosphere (p < 0.001).

CONCLUSIONS AND IMPLICATIONS

Parents consider family meals to be meals that take place at home around a table/counter, with homemade food prepared by the caregivers, and most family members gathered enjoying a conversation without other distractions. Study findings indicated that parents endorse specific characteristics as key for defining what "counts" as a family meal. These findings can be used by clinicians as recommendations for improving one's family meal experience and by future research as the basis for intervening on family meal characteristics and standardization of a definition of family meals.

A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design

BACKGROUND

Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan.

METHODS/DESIGN

The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference.

DISCUSSION

This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care.

TRIAL REGISTRATION

This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

Household Mealtimes During the 2020 COVID-19 Lockdown in Aotearoa New Zealand: The Influence of Household Type and Psychological Distress

COVID-19 lockdown meant disruptions to daily routines for households in Aotearoa New Zealand. The research presented here investigates how mealtimes changed for people living in New Zealand during the first COVID-19 lockdown in mid-2020 and sought to determine if household composition type and psychological distress impacted the frequency of engaging in several mealtime behaviors. The COVID Kai Survey collected data using an anonymous, online survey and asked questions on sociodemographic characteristics including household composition, frequency of engaging in different mealtime behaviors before and during lockdown, and psychological distress, which was measured using the Kessler 6 screening tool. The findings of this study shows an increase in the perceived importance of mealtimes (n = 807, 26.9% before lockdown, n = 1,154, 38.5% during lockdown) and an increase in the proportion of the survey respondents who stated that they frequently ate meals at the dinner table (n = 1,343, 44.8% before lockdown, n = 1,481, 49.4% during lockdown). There was a decrease, across all household composition types, in the proportion of respondents who ate out frequently at a restaurant or café (n = 878, 29.3% before lockdown, n = 5, 0.2% during lockdown, P < 0.001). The use of meal kits, e-dining, and eating meals in front of screens is also presented and discussed. All results are discussed with reference to Aotearoa New Zealand’s stringent lockdown restrictions. Respondents who experienced psychological distress during lockdown were 1.47 times more likely to consider mealtimes an important part of their day and respondents living in households with one adult and at least one child who also experienced psychological distress were 5.95 times more likely to eat dinner at the dinner table than those who did not report psychological distress. Findings of this study further the understanding of the wider societal impact of COVID-19 lockdown on everyday life.

Family Health Development: A Theoretical Framework

In recognition of the family as central to health, the concept of family, rather than individual, health has been an important area of research and, increasingly, clinical practice. There is a need to leverage existing theories of family health to align with our evolving understanding of Life Course Health Development, including the opportunities and constraints of the family context for promoting lifelong individual and population health. The purpose of this article is to propose an integrative model of family health development within a Life Course Health Development lens to facilitate conceptualization, research, and clinical practice. This model provides an organizing heuristic model for understanding the dynamic interactions between family structures, processes, cognitions, and behaviors across development. Potential applications of this model are discussed.

Mealtime emotional climate and child health: A systematic review

BACKGROUND

Positive mealtime emotional climate (MEC) has been linked to better nutrition, psychosocial, literacy and academic outcomes, and fewer behavior problems. However, MEC has been defined in a variety of ways across studies, limiting the ability to synthesize findings and plan future research.

OBJECTIVE

To identify which child characteristics are associated with MEC and to determine how previous studies have measured MEC.

METHODS

We searched three databases (1980-2020) for peer-reviewed articles measuring MEC. Inclusion criteria required at least one child-level outcome related to physical, nutritional, or developmental health; children aged 0-18 years old; and quantitative data using cohort, case-control, intervention, or experimental designs. We used a previously published taxonomy to categorize child/adolescent characteristics as correlates, non-correlates, unclear, or as having insufficient evidence, according to the amount of evidence linking them to MEC. Additionally, we extracted data about the measures and definitions of MEC from each included article.

RESULTS

Out of 668 unique studies identified in the initial search after duplicates removed, 14 met inclusion criteria, and only three used the same measure of MEC. Healthful dietary intake, disordered eating behaviors, and weight/BMI were categorized as correlates of MEC, but links to unhealthy dietary intake are unclear. Several characteristics (e.g. temperament, academic success) were examined in one study only.

CONCLUSIONS

Future research should examine the relationship between MEC and child psychosocial child outcomes and utilize a preschool age group. These findings aid in conceptualizing how MEC has been defined and measured and illuminate the importance of MEC on children's health.

Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study

Background

Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors.

Objective

To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample.

Methods

Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day).

Results

A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study.

Conclusions

The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment.

International Registered Report Identifier (IRRID)

DERR1-10.2196/30525

CHAOS in the Home Environment and Child Weight-Related Outcomes

INTRODUCTION

Biopsychosocial approaches to health care are critical to addressing childhood obesity. This study aimed to examine how multiple indicators of the home environment related to child weight-related outcomes. We hypothesized that families with home environments of higher chaos and stress, and lower quality parent-child interactions, would have children with a higher body mass index (BMI), less healthy dietary intake, and less healthy eating behaviors.

METHODS

Data were drawn from the cross-sectional Phase I of the Family Matters study. Participants were 150 racially/ethnically diverse families with a child between 5 to 7 (mean, 6.4) years old. We used a latent profile analysis approach. A 4-class solution fit the data well, and we used predicted class posterior probabilities to assign families to classes. We then regressed the results onto the distal outcomes of child BMI, healthy dietary intake, and healthy eating behaviors.

RESULTS

Families were classified as Collaborative-Chill (n = 38), Busy Bees (n = 37), Engaged (n = 61), and Inconsistent-Distant (n = 14). Collaborative-Chill was used as the reference class. Inconsistent-Distant families had children with higher BMI (P < .001) that were more food responsive (P < .001). Busy Bees families had children who were more food responsive (P = .04) and more satiety responsive (P = .02). Engaged families had children who were marginally more food responsive (P = .06).

CONCLUSION

Household chaos, parent stress, and parent-child interactions are important components of the home environment implicated in children's weight-related outcomes. Health care providers should consider these indicators with child patients who struggle with obesity.

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.

[Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

Interaction and influence of child and family characteristics upon success of weight management treatment

PURPOSE

Interventions to address childhood obesity demonstrate moderate effects at best. Previous research has focused on factors of the intervention that influence success. Yet, effective overweight and obesity interventions require an interaction between family and individual factors. It is vital to characterize those who are successful vs. those who are not within treatment based on these factors.

METHODS

This study utilized data from an existing multidisciplinary (i.e., nutrition, physical therapy, psychology, and medicine) group treatment for children with overweight and obesity. Children (N = 113) were given the Behavior Assessment System for Children, the Pediatric Quality of Life Inventory, and completed an interview at baseline, then height and weight were measured at 6 months and 12 months post-intervention. Latent class analysis was used to determine how family and individual characteristics and behavior interact and group together to characterize individuals who lose weight vs. do not lose weight during treatment.

RESULTS

The four-cluster model was the best fit for the data. The four identified groups delineated one for whom treatment was successful, and three for whom treatment was not successful. Those three were differentiated by families who appeared to have inconsistent engagement with treatment, families who appeared to not be engaged with treatment, and families who had baseline risk factors that likely require a significantly higher level of treatment.

CONCLUSION

Characterizing the differences between those who successfully respond to this treatment from those who were unsuccessful can help identify those most likely to benefit from treatment. Future research and treatment considerations should include treatment modifications for nonresponders.

LEVEL OF EVIDENCE

Level III, longitudinal cohort study.

The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

A dialectic of control and acceptance: Mealtimes with children on the autism spectrum

Shared family meals have important implications for child health and wellbeing, however, mealtimes with children on the autism spectrum are often characterized by stress and problematic behavior. A better understanding of the underlying processes can elucidate the mealtimes challenges that families with children on the spectrum face as well as how families overcome those challenges in order to promote family health and wellbeing. Through a grounded theory analysis of mealtime observations, parent interviews, and child interviews with 16 families in the United States, we identified a theory of A Dialectic of Control and Acceptance. Integral to the role of mealtimes is for parents to express love through control and acceptance, however, these parallel processes are in tension with one another. How parents negotiate this tension dictates the degree to which their expectations are well aligned with their children's strengths and challenges and are able to provide effective support.

Family Food Environment during the COVID-19 Pandemic: A Qualitative Study

Background: The COVID-19 pandemic, with its cyclical lockdown restrictions and school closures, has influenced family life. The home, work, and school environments have collided and merged to form a new normal for many families. This merging extends into the family food environment, and little is known about how families are currently navigating this landscape. The objective of the present study was to describe families’ adaptations in the family food environment during the COVID-19 pandemic. Methods: Parents participated in one of 14 virtual focus groups (conducted in English and Spanish between December 2020 and February 2021). Reflexive thematic analysis was used to analyze the transcripts. Results: Forty-eight parents (81% Hispanic and SES diverse) participated. Five themes and one subtheme were identified around changes in eating habits and mealtime frequency, increases in snacking, family connectedness at mealtimes, and use of screens at meals. Conclusions: The COVID-19 pandemic has influenced the family food environment. Families shared how their eating habits have changed and that device usage increased at mealtimes. Some changes (e.g., weight gain) may have lasting health implications for both children and parents. Public health officials, pediatricians, and schools should work with families to resume healthy habits post pandemic.

[Cooccurrence of obesogenic risk factors in Brazilian adolescents: the role of sociodemographic characteristics and parental presence]

The study aimed to estimate the prevalence of cooccurrence of obesogenic risk factors in Brazilian adolescents and associated sociodemographic and family characteristics. This is a cross-sectional study of data from the Brazilian National School Health Survey, 2009 (n = 53,274). The outcome variable (cooccurrence of obesogenic risk factors) varied from zero to five and was obtained as the sum of the risk behaviors: daily consumption of soft drinks; daily consumption of candy; insufficient consumption of fruits; insufficient consumption of vegetables; and insufficient physical activity. The explanatory variables were sex, age, skin color, region of Brazil, household goods and services score, maternal schooling, type of school, family composition, parental monitoring, and main meals shared with parents or guardians. A Venn diagram was used for exploratory analysis, plus ordinal logistic regression with partial proportional odds model for multivariate analysis. The results showed higher odds of simultaneous occurrence of the factors in adolescent girls, in teens with less parental supervision, and teens who shared fewer meals with their parents or guardians. Meanwhile, adolescents living in more developed regions of the country and those whose mothers had more schooling showed lower odds of cooccurrence of obesogenic risk factors. Actions that encourage greater family involvement and supervision in dietary behavior can have a positive impact on the prevention of obesity in Brazilian adolescents, especially in less developed regions and in homes where the mothers have less schooling.

Poverty and Food Insecurity Predict Mealtime Structure: Mediating Pathways of Parent Disciplinary Practices and Depressive Symptoms

OBJECTIVE

Structured, well-organized mealtime routines can provide many physical and mental health benefits for children. Poverty and food insecurity (FI) are socioeconomic risk factors for less effective mealtime routines. However, the specific mechanisms by which these social factors may negatively impact mealtime structure are not well-understood. We test whether poverty and FI are associated with parenting factors (mental health and parent disciplinary practices), and whether these parenting factors in turn associate with less mealtime structure.

METHODS

Low-income families (N = 270), recruited when children were approximately 6-years-old (wave 1), were followed for 2 years (wave 2). Socioeconomic and parenting factors were assessed at W1 via parent-report. Associations of poverty and FI with two measures of mealtime structure (parent-reported and observed mealtime structure at wave 1 and wave 2), mediated by parent factors (depressive symptoms, lax and overreactive parent disciplinary practices) were assessed in separate path analyses.

RESULTS

The association between higher depth of poverty and less mealtime structure in early childhood was mediated by greater parent depressive symptoms. FI was associated with less mealtime structure in early childhood, mediated by overreactive parenting, and with less mealtime structure in early and mid-childhood, mediated by lax parenting.

CONCLUSION

Poverty and food insecurity may contribute to suboptimal parent disciplinary practices and poor parent mental health, which may reduce mealtime structure for children. Addressing parent mental health and parent disciplinary practices in the context of socioeconomic adversity may be one way in which interventions can improve mealtime structure for low-income families.

Family meal characteristics in racially/ethnically diverse and immigrant/refugee households by household food security status: A mixed methods study

While there is some research examining frequency of family meals by food insecurity (FI) status, there is little research examining other family meal characteristics (e.g., type of food served at meal, emotional atmosphere) or parent feeding practices by FI status. If food and money is scarce, it may be that the broader family meal environment looks different in families with continuous access to food (food secure, FS) compared to families with FI. Using ecological momentary assessment (EMA) and qualitative data, this study explores meal characteristics and parent feeding practices at nearly 4000 family meals in a low-income, racially/ethnically diverse and immigrant/refugee sample. For 8 days, participants (i.e., parents of 5-7-year-old children) completed a survey every time they shared a meal with their child. Additionally, parents completed a qualitative interview regarding family meals. There were many meal characteristics statistically correlated with a family being FI, including: who prepared the meal and how the meal was prepared, the makeup of people at the meal, the meal location and meal atmosphere, and the food served at the meal. Qualitative data illuminated many of these findings from EMA meal surveys. Quantitatively, families with FI and FS reported similar parent feeding practices during family meals. Qualitatively, families with FI and FS reported differences in (1) parent feeding practices; (2) food served at family meals; (3) challenges to having family meals; and 4) adults' role in the family meal. This study provides suggestions for interventionists working with families, including helping families identify time management strategies, including fruits and vegetables into family meals on a budget, reducing screen time at family meals while improving the meal's emotional atmosphere, and developing positive parent feeding practice strategies.

Feeding in the Digital Age: An Observational Analysis of Mobile Device Use during Family Meals at Fast Food Restaurants in Italy

Caregiver mobile phone use while monitoring children is a behavior of increasing prevalence. Family mealtimes have long been considered a time in which parents and children connect emotionally and model eating behaviors, but prior studies have documented less parent-child conversation and more negative parent reactions to child behavioral bids at the table during parent phone use. Research on this topic to date is sparse and focuses only on US populations. The current study used non-participant naturalistic observation to record data on parental mealtime device use and family interactions while dining with children in a fast food restaurant in Italy. Thirty seven families (individuals observed = 129) were observed at a restaurant for the duration of their meal. Qualitative analysis of field notes indicated that mobile phones are frequently used by caregivers during feeding interactions. A novel observation in the current study was different patterns of use by parent gender and age. Mothers appeared to divide their attention between phone and child, whereas fathers evidenced more continuous mobile phone use during which there was lower responsiveness towards children during the meal. Younger parents more frequently used mobile phones, compared to older parents. Parents who missed child bids for attention were all phone users during the mealtime.

[Association between sharing meals with parents or guardians and obesity in Brazilian adolescents]

The study aimed to analyze the association between sharing lunch or supper with parents/guardians and obesity in Brazilian adolescents participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA in Portuguese). This was a cross-sectional, school-based study with adolescents 12 to 17 years of age. Obesity was classified by body mass index based on World Health Organization criteria, according to age and sex. The association between obesity and sharing lunch and supper with parents/guardians (never, sometimes, almost every day, and every day) was analyzed according to crude and sex- and age-adjusted prevalence ratios. A total of 71,740 adolescents were assessed. Of these, 48% and 60% of girls and 56% and 65% of boys, respectively, shared lunch and supper every day or nearly every day. Boys who shared lunch and supper with their parents/guardians nearly every day and every day showed lower prevalence of obesity. Stratified by age bracket, only younger boys that ate lunch with their parents/guardians sometimes (PR = 0.64; 95%CI: 0.46-0.89), nearly every day (PR = 0.50; 95%CI: 0.37-0.69), and every day (PR = 0.65; 95%CI: 0.49-0.85) and supper with their parents/guardians every day (PR = 0.61; 95%CI: 0.43-0.87) showed lower prevalence of obesity. The findings highlight the importance of promoting healthy eating behaviors in the family setting as part of strategies to prevent obesity in adolescents.

Do Parents Perceive That Organized Activities Interfere with Family Meals? Associations between Parent Perceptions and Aspects of the Household Eating Environment

BACKGROUND

Research has related child participation in organized activities to health and academic benefits; however, participation may interfere with family meals.

OBJECTIVE

Examine whether parents perceive child participation in organized activities to interfere with family meals and how perceptions are related to the household eating environment.

DESIGN

A cross-sectional analysis was completed using survey data collected in 2015-2016 as part of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study.

PARTICIPANTS

Survey participants were originally recruited in Minneapolis-St Paul schools in 1998-1999. The analytic subsample of parents (one per household, n=389, 69% female, 31% nonwhite race, mean age=31) had one or more children involved in an organized activity. Approximately 33% of households included a child aged 2 to 5 and no older child; two thirds of households included school-aged children (6 to 18 years).

MAIN OUTCOME MEASURES

Parents reported family meal frequency, family meal scheduling difficulties, frequency of at-home meal preparation, and their own intake of fast food, fruit, and vegetables.

STATISTICAL ANALYSES PERFORMED

Analyses compared household environment characteristics reported by parents who perceived low interference between organized activities and family meals to characteristics reported by parents who perceived moderate to high interference from at least one form of activity. Regression models included a dichotomous indicator of interference as the independent variable and were adjusted for parental and household characteristics.

RESULTS

Among parents with children at any age, moderate to high interference was associated with lower family meal frequency, greater difficulty scheduling family meals, and more fast-food intake (all P≤0.01). The perception of moderate to high interference was more common among parents who reported involvement in both sport and nonsport activities (P<0.001) and those with a school-aged child (P<0.001) vs those with only preschool-aged children.

CONCLUSIONS

Follow-up research, including qualitative studies, is needed to identify the specific aspects of child participation in organized activities (eg, scheduled time of day) that may interfere with family meals.

Do bedroom screens and the mealtime environment shape different trajectories of child overweight and obesity? Research using the Growing Up in Scotland study

OBJECTIVE

To investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample.

METHODS

Growth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children's diet patterns, overall screen use, physical activity and sleep.

RESULTS

Five trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30-5.00]; 1.62 [1.01-2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99-6.77]; 1.75 [1.17-2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13-2.36]).

CONCLUSION

Bedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity.

Examining Predictors of Watching Television During Family Meals in a Diverse Sample

OBJECTIVE

To identify predictors associated with television (TV) watching during family meals.

METHODS

Parents of racially and ethnically diverse 5- to 7-year-old children (n = 150) completed 8 days of ecological momentary assessment surveys. After each meal they shared with their child, parents answered meal-related questions (eg, who was present). Adjusted generalized estimating equations were used to estimate probabilities of watching TV during family meals for individual predictors.

RESULTS

Number of adults present, location, outside influences (eg, planned meal, stress), and time to prepare the meal were independently predictive of TV watching during the meal (P < .001).

CONCLUSION AND IMPLICATIONS

Results of the current study suggest that families may need assistance in addressing predictors (eg, stress) associated with watching TV during family meals, given prior research has shown watching TV during family meals is associated with negative dietary outcomes. Future research might investigate other factors that may also influence watching TV at family meals.

Ecological Momentary Assessment of the Breakfast, Lunch, and Dinner Family Meal Environment in Racially/Ethnically Diverse and Immigrant Households

OBJECTIVE

To describe meal characteristics across breakfast, lunch, and dinner family meals in racially/ethnically diverse and immigrant/refugee households via ecological momentary assessment; identify real-time meal characteristics associated with family meal frequency; and identify qualitative themes regarding parents' perspectives about meal characteristics and meal types that influence family meal frequency.

DESIGN

Cross-sectional study.

SETTING

In-home visits.

PARTICIPANTS

Children aged 5-7 years (n = 150) and their families from diverse and low-income households.

MAIN OUTCOME MEASURE(S)

Mixed methods.

ANALYSIS

Multiple linear regression and hybrid deductive and inductive content analysis.

RESULTS

Quantitative results indicated several similar meal characteristics occurring across weekdays and weekend days and by meal type (eg, parent prepared the meal, food mostly homemade, meal eaten at table) and some significant negative associations (P < .05) between meal characteristics and family meal frequency (eg, fast food for family meals). Eight main qualitative themes with several subthemes supported and expanded the quantitative findings and added depth to interpretation of the findings.

CONCLUSIONS AND IMPLICATIONS

Results identified specific meal characteristics both quantitatively and qualitatively that may inform the development of interventions to increase the frequency of family meals so that more families can benefit from the protective nature of family meals.

Utilizing a Board Game to Measure Family/Parenting Factors and Childhood Obesity Risk

OBJECTIVE

To describe a direct observational approach (ie, interactive family board game) to measure familyfunctioning and parenting behaviors of relevance to child weight and weight-related behaviors and to examine family functioning and parenting factors from multiple family dyads (eg, siblings, parent-child) and their associations with child weight and weight-related behaviors.

DESIGN

Cross-sectional, mixed-methods study.

SETTING

Two home visits were conducted with families 10days apart with a 7-day observational period between home visits.

PARTICIPANTS

Children (n = 150) aged 5-7years and their families from 1 of 6 racial and ethnic or immigrant and refugee groups, including African American, Hispanic, Hmong, Native American, Somali, and white, participated in the Family Matters study between 2014 and 2016.

MAIN OUTCOME MEASURE

Child weight status and weight-related behaviors (ie, diet quality, physical activity).

ANALYSIS

Adjusted logistic and linear regression models with robust SEs were used in analysis.

RESULTS

Higher family functioning scores across the majority of family dyads were significantly associated with lower child weight status (P < .05). In addition, some family functioning scores were associated with child diet and physical activity, but not consistently. Parenting behavior scores were inconsistently associated with child weight and weight-related outcomes.

CONCLUSIONS AND IMPLICATIONS

Results suggest that the interactive family board game task is a direct observational approach that researchers can use with family members to measure family functioning and parenting behaviors related to childhood obesity. Future interventions may want to consider including multiple family members in both measurement and intervention development to target childhood obesity.

The Relationship between Structure-Related Food Parenting Practices and Children's Heightened Levels of Self-Regulation in Eating

BACKGROUND

Food parenting practices influence children's eating behaviors and weight status. Food parenting practices also influence children's self-regulatory abilities around eating, which has important implications for children's eating behaviors. The purpose of the following study is to examine use of structure-related food parenting practices and the potential impact on children's ability to self-regulate energy intake.

METHODS

Parents (n = 379) of preschool age children (M = 4.10 years, SD = 0.92) were mostly mothers (68.6%), Non-White (54.5%), and overweight/obese (50.1%). Hierarchical Multiple Regression was conducted to predict child self-regulation in eating from structure-related food parenting practices (structured meal setting, structured meal timing, family meal setting), while accounting for child weight status, parent age, gender, BMI, race, and yearly income.

RESULTS

Hierarchical Multiple Regression results indicated that structure-related feeding practices (structured meal setting and family meal setting, but not structured meal timing) are associated with children's heightened levels of self-regulation in eating. Models examining the relationship within children who were normal weight and overweight/obese indicated the following: a relationship between structured meal setting and heightened self-regulation in eating for normal-weight children and a relationship between family meal setting and heightened self-regulation in eating for overweight/obese children.

CONCLUSIONS

Researchers should further investigate these potentially modifiable parent feeding behaviors as a protective parenting technique, which possibly contributes to a healthy weight development by enhancing self-regulation in eating.

Frequency of eating alone is associated with adolescent dietary intake, perceived food-related parenting practices and weight status: cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) Study results

OBJECTIVE

To examine relationships between frequency of adolescents eating alone (dependent variable) and diet, weight status and perceived food-related parenting practices (independent variables).

DESIGN

Analyses of publicly available, cross-sectional, web-based survey data from adolescents.

SETTING

Online consumer opinion panel.

SUBJECTS

A US nationwide sample of adolescents (12-17 years) completed Family Life, Activity, Sun, Health, and Eating (FLASHE) Study surveys to report demographic and family meal characteristics, weight, dietary intake, home food availability and perceptions of parenting practices. Parents provided information about demographic characteristics. Logistic regression analyses were used to test for associations between variables.

RESULTS

About 20 % of adolescents reported often eating alone (n 343) v. not often eating alone (n 1309). Adjusted odds of adolescents often eating alone were significantly higher for non-Hispanic Black compared with non-Hispanic White adolescents (OR=1·7) and for overweight or obese compared with normal- or underweight adolescents (OR=1·6). Adjusted odds of adolescents eating alone were significantly lower for those who reported that fruits and vegetables were often/always available in the home (OR=0·65), for those who perceived that parents had expectations about fruit and vegetable intake (OR=0·71) and for those who agreed with parental authority to make rules about intake of junk food/sugary drinks (OR=0·71). Junk food and sugary drink daily intake frequency was positively associated with often eating alone.

CONCLUSIONS

Often eating alone was related to being overweight/obese, having less healthy dietary intake and perceptions of less supportive food-related parenting practices.

Compared to Pre-prepared Meals, Fully and Partly Home-Cooked Meals in Diverse Families with Young Children Are More Likely to Include Nutritious Ingredients

BACKGROUND

Interest in initiatives that promote home cooking has been increasing, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families.

OBJECTIVE

The present study examined data on multiple meals per family in diverse households to determine whether home-cooked meals are more likely to contain nutritious ingredients than pre-prepared meals.

DESIGN

Data for the study came from the National Institutes of Health-funded Family Matters Study. As part of this study, between 2015 and 2016, 150 families provided ecological momentary assessment data on 3,935 meals over an 8-day observation window.

PARTICIPANTS/SETTING

In this study, investigators followed 150 families with children aged 5 to 7 years old from six racial/ethnic groups (n=25 each non-Hispanic white, non-Hispanic black, Hispanic, Native American, Hmong, and Somali families). Recruitment occurred through primary care clinics serving low-income populations in Minnesota.

MAIN OUTCOME MEASURES

The main outcomes were participants' self-reports of whether they served fruits, vegetables, and whole grains at a meal, and reports were made within hours of the meal.

STATISTICAL ANALYSES PERFORMED

Within-group estimator methods were used to estimate the associations between meal preparation and types of food served. These models held constant time-invariant characteristics of families and adjusted for whether the meal was breakfast, lunch, dinner, or a snack and whether it was a weekend meal.

RESULTS

For all racial/ethnic and poverty status groups, meals that were fully or partly home-cooked were more likely to contain fruits and vegetables than pre-prepared meals (P<0.001). Meals that were partly home-cooked were the most likely to contain whole grains (P<0.001). Restaurant meals were more likely to contain vegetables than pre-prepared meals (P<0.001) but were equally likely to contain fruits and/or whole grains as pre-prepared meals.

CONCLUSIONS

Interventions or initiatives that encourage fully or partly home-cooked meals may help families incorporate nutritious foods into their diets. In addition, evaluations of potential strategies to increase the likelihood of supplementing pre-prepared and restaurant meals with nutritious meal ingredients warrants further investigation.

Parenting styles, food-related parenting practices, and children's healthy eating: A mediation analysis to examine relationships between parenting and child diet

Parents exert a strong influence on their children's diet. While authoritative parenting style is linked to healthier weight and dietary outcomes in children, and authoritarian and permissive parenting styles with unhealthy eating, little is known about the mechanisms that mediate these relationships. Feeding styles are often examined in relation to child diet, but they do not consider the social and physical environmental contexts in which dietary behaviors occur. Therefore, this study examined whether parenting styles (authoritative, authoritarian, and permissive) were associated with three specific food-related parenting practices - mealtime structural practices (e.g., eating meals as a family), parent modeling of healthy food, and household food rules and whether these parenting practices mediated the association between parenting styles and children's diet. Participants were 174 mother-child dyads. Mothers (68% married, 58% college graduates, M_age = 41 years [SD = 6.2]) reported on their parenting practices using validated scales and parenting style using the Parenting Styles and Dimensions Questionnaire. Children (52% female, M_age = 10 years [SD = 0.9]) completed two telephone-based 24-hour dietary recalls. Dietary outcomes included the Healthy Eating Index (HEI)-2010 score, and fruit and vegetables and added sugar intake. Using PROCESS, multiple mediation cross-sectional analyses with parallel mediators using 10,000 bootstraps were performed. Significant indirect effects were observed with mealtime structure and the relationships between authoritative parenting and HEI-2010 score (b = 0.045, p < .05, CI = [0.006, 0.126]), authoritarian parenting and HEI-2010 score (b = -0.055, p < .05, CI = [-0.167, -0.001]), and permissive parenting and HEI-2010 score (b = -0.093, p < .05, CI = [-0.265, -0.008]). Child diet quality is affected by mealtime structural practices. Further examination of the features by which mealtime structural practices serve as a mechanism for parents to support healthy eating among their children may improve children's diet quality.

Similarities and differences between families who have frequent and infrequent family meals: A qualitative investigation of low-income and minority households

INTRODUCTION

Numerous quantitative studies have examined the association between family meal frequency and child/adolescent weight and weight-related behaviors. However, limited qualitative research has been conducted to identify mealtime characteristics (e.g., child behavior during meals, rules/expectations, family dynamics) that occur during family meals that may explain why some families engage in frequent family meals and others do not. This is particularly important within racially/ethnically diverse households, as these demographic groups are at higher risk for weight-related problems. The current study aimed to identify similarities and differences in mealtime characteristics between households that have frequent and infrequent family meals within a low-income and minority population.

METHODS

This qualitative study included 118 parents who participated in Family Meals, LIVE!, a mixed-methods, cross-sectional study. Parents (90% female; mean age = 35) were racially/ethnically diverse (62% African American, 19% White, 4% Native American, 4% Asian, 11% Mixed/Other) and from low-income (73% < $35,000/yr.) households. Data were analyzed using inductive content analysis.

RESULTS

Results indicated some similar mealtime characteristics (i.e., picky eating, involving family members in meal preparation) between households having frequent and infrequent family meals. Additionally, several differences in mealtime characteristics were identified between households having frequent (i.e., importance of family meals, flexibility in the definition of family meals, family meal rules, no pressure-to-eat feeding practices) versus infrequent family meals (i.e., pressure-to-eat parent feeding practices, family meals are dinner meals only, and difficult meal time behaviors).

DISCUSSION

Study findings may be useful for developing intervention targets for low-income and racially/ethnically diverse households so more families can benefit from the protective nature of family meals.

A qualitative investigation of how mothers from low income households perceive their role during family meals

BACKGROUND

Having regular family meals has been shown to be protective for child dietary intake (e.g., higher intake of fruit and vegetables). Mothers appear to be most responsible for preparing family meals. Therefore, understanding how mothers perceive their roles around family meals may help identify ways in which to help more families have regular family meals.

METHODS

United States mothers (n = 83) from the Twin Cities, Minnesota were interviewed during an in-home visit. Researchers trained in qualitative interviewing used a semi-structured approach and asked questions regarding the mothers' overall perception of their role during family meals. Interviews were coded using a mixed deductive and inductive content analysis approach. The majority of mothers were from minority and low-income households.

RESULTS

Mothers described their roles during family meals as the follows: 1) Helping children make healthy choices at family meals; 2) Making the meal happen; 3) Monitoring children's food intake; 4) Managing behavior at the family meal; 5) Making the family meal atmosphere enjoyable; and 6) Facilitating conversation/communication. Two secondary research questions also emerged about the specifics of the mothers' perception of her role at family meals (i.e., How do mothers deal with fighting or arguing if it occurs at family meals? and What do mothers talk about with children at family meals?) CONCLUSIONS: Results show that mothers have a large and varied role during family meals. Additionally, they are willing to put effort into family meals and want them to be enjoyable. Findings also suggest that mothers can be supported by encouraging fuller family participation in family meals and by offering mothers quality nutrition and parent feeding practice information.

Methodological considerations for observational coding of eating and feeding behaviors in children and their families

Background

Behavioral coding of videotaped eating and feeding interactions can provide researchers with rich observational data and unique insights into eating behaviors, food intake, food selection as well as interpersonal and mealtime dynamics of children and their families. Unlike self-report measures of eating and feeding practices, the coding of videotaped eating and feeding behaviors can allow for the quantitative and qualitative examinations of behaviors and practices that participants may not self-report. While this methodology is increasingly more common, behavioral coding protocols and methodology are not widely shared in the literature. This has important implications for validity and reliability of coding schemes across settings. Additional guidance on how to design, implement, code and analyze videotaped eating and feeding behaviors could contribute to advancing the science of behavioral nutrition. The objectives of this narrative review are to review methodology for the design, operationalization, and coding of videotaped behavioral eating and feeding data in children and their families, and to highlight best practices.

Methods

When capturing eating and feeding behaviors through analysis of videotapes, it is important for the study and coding to be hypothesis driven. Study design considerations include how to best capture the target behaviors through selection of a controlled experimental laboratory environment versus home mealtime, duration of video recording, number of observations to achieve reliability across eating episodes, as well as technical issues in video recording and sound quality. Study design must also take into account plans for coding the target behaviors, which may include behavior frequency, duration, categorization or qualitative descriptors. Coding scheme creation and refinement occur through an iterative process. Reliability between coders can be challenging to achieve but is paramount to the scientific rigor of the methodology. Analysis approach is dependent on the how data were coded and collapsed.

Conclusions

Behavioral coding of videotaped eating and feeding behaviors can capture rich data “in-vivo” that is otherwise unobtainable from self-report measures. While data collection and coding are time-intensive the data yielded can be extremely valuable. Additional sharing of methodology and coding schemes around eating and feeding behaviors could advance the science and field.

Photo-elicitation with adolescents in qualitative research: an example of its use in exploring family interactions in adolescent psychiatry

BACKGROUND

Photo-elicitation is a method used increasingly often in qualitative health research, and its positive effect on the research process is well established today. Photo-elicitation appears to facilitate verbalization and insight and to improve relationships between the researcher and participants, thereby enriching the quality of the data collected. Nonetheless, it is barely used at all in the field of adolescent psychiatry. With the aim of exploring the potential of these methods for research with adolescents receiving psychiatric care, we conducted a qualitative photo-elicitation data collection study with this population, asking them about family interactions around food.

METHODS

The data were collected from 15 adolescents and 17 parents during semi-structured interviews in which a photo taken by the adolescent served as the focus of discussion. Data were explored through inductive thematic analysis.

RESULTS

Photo-elicitation played a threefold role in this study: (1) it induced the teens' interest, thought, and pleasure, (2) it played a mediating function during the interviews, and (3) it enabled family interactions to be viewed from the adolescent's perspective. Three themes concerning family interactions were found: (1) parent-child relationship patterns, (2) the functioning of the family group, and (3) the adolescent's individual relation with food, that is, the issue of the adolescent's autonomy.

CONCLUSIONS

Photo-elicitation proved to be an innovative technique in qualitative research in the area of adolescent psychiatry, one that enriched the data and enabled the emergence of new themes in this field, related in particular to the process by which adolescents develop autonomy.

Family dinner frequency interacts with dinnertime context in associations with child and parent BMI outcomes

For youth and parents, frequent family meals have been consistently associated with positive dietary outcomes but less consistently associated with lower body mass index (BMI). Researchers have speculated dinnertime context (dinnertime routines, parent dinnertime media use) may interact with family meal frequency to impact associations with BMI. The present study evaluates the associations and interactions between dinnertime context measures and family dinner frequency with parent and child BMI. This cross-sectional study uses baseline data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus randomized control trial that aimed to prevent childhood obesity. Participants (160 parent-child dyads) completed psychosocial surveys and were measured for height and weight. General linear models tested associations and interactions between dinnertime context measures and family dinner frequency with parent and child BMI, adjusted for race and economic assistance. Lower parent dinnertime media use and higher dinnertime routines were significantly associated with lower child BMI z scores but not parent BMI scores. Interaction-moderation findings suggest higher family dinner frequency amplifies the healthful impact of the dinnertime context on child BMI z scores. Additionally, findings emphasize that promoting frequent family meals along with consistent routines and reduction in parent dinnertime media use may be important for the prevention of childhood obesity. (PsycINFO Database Record

Beyond the dinner table: who's having breakfast, lunch and dinner family meals and which meals are associated with better diet quality and BMI in pre-school children?

OBJECTIVE

Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children's overall diet quality (HEI-2010) and BMI percentile.

DESIGN

Cross-sectional baseline data (2012-2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.

SETTING

Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.

SUBJECTS

Parent-child (ages 2-5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.

RESULTS

Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children.

CONCLUSIONS

Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile.

Associations between TV viewing at family meals and the emotional atmosphere of the meal, meal healthfulness, child dietary intake, and child weight status

BACKGROUND

Research on family meals has demonstrated that family meals are protective for many aspects of child and adolescent health. It is unclear whether distractions at family meals, such as watching TV, are associated with child weight and weight-related behaviors, the emotional atmosphere at the meal, or family meal healthfulness.

METHODS

Direct observational and objective data were collected on primarily low-income and minority families (n = 120) with 6-12 year old children. Data were collected during home visits and included 24-hr dietary recalls, anthropometry, and video-recorded family meals. Video-recorded family meals were coded to assess the presence of TV, whether the family was paying attention to the TV, family group enjoyment and the dietary healthfulness of the foods served at family meals.

RESULTS

The presence of TV was negatively associated with the dietary healthfulness and emotional atmosphere of the meal and the child's overall dietary quality. It was positively associated with serving fast food for family meals. Those families who were paying attention to the TV had significantly worse meal dietary healthfulness and were more likely to have fast food at family meals compared to those who were not paying attention. No significant findings were found between the presence of TV at family meals and child overweight status.

CONCLUSIONS

Study results show that TV is frequently present at family meals. Even if families are not paying attention to the TV, it appears that simply having the TV on as background noise is associated with deleterious outcomes. In addition to increasing family meals, families should be given guidance on turning off the TV and making the family meal a time to connect with one another.

Perspectives About Family Meals from Racially/Ethnically and Socioeconomically Diverse Households With and Without an Overweight/Obese Child

BACKGROUND

Several quantitative studies have found a protective association between family meal frequency and child and adolescent weight and weight-related behaviors (e.g., healthy dietary intake, less disordered eating behaviors). However, limited qualitative research has been conducted to understand more in depth about family meal-level characteristics (e.g., rules, responsibilities, and interpersonal dynamics) that may be risk or protective factors for child weight and weight-related behaviors. The current study aimed to identify family meal-level characteristics within racially/ethnically and socioeconomically diverse households that were similar and/or different between households with and without an overweight/obese child.

METHODS

The current study is a qualitative study including 118 parents of children ages 6-12 who participated in the Family Meals, LIVE!

STUDY

Parents (92% female) were from racially/ethnically (87% minority) and socioeconomically (73% <$35,000 per year) diverse households. Parents were individually interviewed during a home visit. Data were stratified by child weight status (i.e., normal weight vs. overweight/obese) and analyzed using deductive and inductive content analysis.

RESULTS

Qualitative results showed some similarities and some differences in family meal-level characteristics by child weight status that may provide insight into past research showing significant associations between family meal frequency and child weight and weight-related behaviors. Similar themes between families with and without an overweight/obese child included: family meals provide more healthful food; rules about manners; meal planning; and involving children in meal preparation. Themes that were different between families with and without an overweight/obese child included: connection and communication; "clean your plate rule"; electronic devices; and child behavior problems.

CONCLUSIONS

Findings from the current study may be useful for developing interventions for racially/ethnically and socioeconomically diverse households with and without an overweight/obese child to be delivered through family meals.

What's Being Served for Dinner? An Exploratory Investigation of the Associations between the Healthfulness of Family Meals and Child Dietary Intake

BACKGROUND

Little is known about the healthfulness of foods offered at family meals or the relationship between the food's healthfulness and child overall dietary intake.

OBJECTIVE

This exploratory study uses a newly developed Healthfulness of Meal Index to examine the association between the healthfulness of foods served at family dinners and child dietary intake.

DESIGN

Direct observational, cross-sectional study.

PARTICIPANTS/SETTING

Primarily low-income, minority families (n=120) video recorded 8 days of family dinners and completed a corresponding meal screener. Dietary recalls were completed on the target child (6 to 12 years old). The Healthfulness of Meal Index was used to measure meal healthfulness and included component scores for whole fruit, 100% juice, vegetables, dark green vegetables, dairy, protein, added sugars, and high-sodium foods.

MAIN OUTCOME MEASURES

Child dietary intake measured by three 24-hour dietary recalls.

STATISTICAL ANALYSES PERFORMED

Linear regression models estimated the association between the healthfulness of foods served at dinner meals and overall child HEI.

RESULTS

The majority of coded meals included foods from protein and high-sodium components; more than half included foods from dairy and vegetable components. Nearly half of the meals had an added-sugar component food (eg, soda or dessert). Few meals served foods from fruit, 100% juice, or dark green vegetable components. Many components served at family dinner meals were significantly associated with child daily intake of those same foods (ie, dark green vegetable, non-dark green vegetables, dairy, and added sugars). The Healthfulness of Meal Index total score was significantly associated with child HEI score.

CONCLUSIONS

This study represents the first report of a new methodology to collect data of foods served at family dinners. Results indicated a significant association between the majority of components served at family dinner meals and child overall dietary intake. Validation of the Healthfulness of Meal Index and video-recorded family meal methodology is needed to strengthen these research methods for use in future studies.

A Review of the Structural Characteristics of Family Meals with Children in the United States

Family meals are associated with a range of positive outcomes among children and adolescents. There is inconsistency, however, in the way in which studies have defined and measured family meals. Therefore, a systematic review of the literature was conducted to determine how studies describe family meals with the use of structural characteristics. The current review focused on studies in the United States that included children ages 2-18 y. A total of 33 studies were identified that characterized family meals with the use of ≥1 of the following structural features: frequency or mean number of family meals per week, length of family meal, people present at meal, and where meals occurred. No study characterized family meals by using all 4 family meal features, whereas most studies (81%) characterized family meals by using frequency or mean number of meals per week. Findings not only provide an initial understanding of the structural features used to define family meals but also point to the importance of developing a more comprehensive, sensitive assessment that can accurately capture the complex and multidimensional nature of family meals.

Do family meals affect childhood overweight or obesity?: nationwide survey 2008-2012

BACKGROUND

The prevalence of childhood obesity is increasing worldwide and this trend is no exception for South Korea. A multidisciplinary approach is needed for the prevention and management of childhood obesity. To do so, among many other strategies, managing the family unit can be a very effective strategy.

OBJECTIVES

The purpose of this study was to identify the relationship between frequency of family meals and overweight/obesity in elementary students and to suggest the management and prevention strategies of childhood obesity.

METHODS

Data from a total of 2904 elementary students were analyzed from the 2008-2012 Korea National Health and Nutrition Examination Survey. Multiple logistic regression analysis was used to examine the association between overweight/obesity and family meals.

RESULTS

Of the total 2904 elementary students, 573 (19.4%) were overweight or obese. The odds ratio of overweight or obese students who had family dinner only was 1.21 (95% CI: 0.89-1.64), that of those who had family breakfast only was 3.20 (95% CI: 1.70-6.02), and that of those who had neither family breakfast nor family dinner was 4.17 (95% CI: 1.98-8.78) compared with those who had both family breakfast and family dinner.

CONCLUSIONS

The frequency of family meals was strongly an inverse association with childhood overweight or obesity. Therefore, we suggest that the intervention of childhood obesity should include family meals.

Eating breakfast together as a family: mealtime experiences and associations with dietary intake among adolescents in rural Minnesota, USA

OBJECTIVE

Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one's family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality.

DESIGN

Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security.

SETTING

Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012-2014.

SUBJECTS

The sample included 827 adolescents (55·1 % girls) in grades 9-10 who reported eating breakfast on at most three days per school week.

RESULTS

On average, adolescents reported eating breakfast with their family 1·3 (sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white (P=0·002) or Hispanic ethnicity (P=0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals (P<0·001) and positive attitudes (P≤0·01) about mealtime importance, interactions and structure. Family breakfast frequency was unrelated to most diet quality markers.

CONCLUSIONS

Family meals may be one important context of opportunity for promoting healthy food patterns at breakfast. Additional research is needed to better inform and evaluate strategies.

ERICA: prevalence of healthy eating habits among Brazilian adolescents

OBJECTIVE To describe the prevalence of eating habits considered healthy in adolescents according to sex, age, education level of the mother, school type, session of study, and geographic region. METHODS The assessed data come from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, national and school-based study. Adolescents of 1,247 schools of 124 Brazilian municipalities were evaluated using a self-administered questionnaire with a section on aspects related to eating behaviors. The following eating behaviors were considered healthy: consuming breakfast, drinking water, and having meals accompanied by parents or legal guardians. All prevalence estimates were presented proportionally, with their respective 95% confidence intervals. The Chi-square test was used to evaluate the differences in healthy eating habits prevalences according to other variables. The module survey of the Stata program version 13.0 was used to analyze complex data. RESULTS We evaluated 74,589 adolescents (72.9% of the eligible students). Of these, 55.2% were female, average age being 14.6 years (SD = 1.6). Among Brazilian adolescents, approximately half of them showed healthy eating habits when consuming breakfast, drinking five or more glasses of water a day, and having meals with parents or legal guardians. All analyzed healthy eating habits showed statistically significant differences by sex, age, type of school, session of study, or geographic region . CONCLUSIONS We suggest that specific actions of intersectoral approach are implemented for the dissemination of the benefits of healthy eating habits. Older female adolescents (15 to 17 years old) who studied in public schools, resided in the Southeast region, and whose mothers had lower education levels, should be the focus of these actions since they present lower frequencies concerning the evaluated healthy habits.

Home food environment factors associated with the presence of fruit and vegetables at dinner: A direct observational study

BACKGROUND

Little research exists about the factors influencing the foods available at family meals. This study examines the home food environment factors contributing to the presence of fruit and vegetables at family meals.

METHODS

Home food inventory (HFI) and survey data were collected from low-income, minority families (n = 120) with children 6-12 years old. Observations from video-recorded family dinner meals, totaling 800 videos, were used to measure the frequency at which fruit and vegetables were served. Multiple regression was used to investigate how the fruit and vegetables in the HFI and other home food environment factors were related to the number of days fruit and vegetables were served at dinner during the observation period.

RESULTS

Availability and accessibility of fruit and vegetables in the home were each found to be significantly associated with the presence of fruits and vegetables at family dinners. Of the fruit and vegetable categories (i.e., fresh, canned, or frozen), having fresh fruit and vegetables available in the home was found to be most strongly associated with serving fruit and vegetables at dinner, respectively. Higher parent intake of vegetables was associated with the presence of vegetables at dinners, and parent meal planning was associated with the presence of fruit at dinners.

CONCLUSIONS

Increasing the availability and accessibility of fresh fruit and vegetables in the home may be an effective approach to increasing the presence of fruits and vegetables at family dinners, especially among low-income, minority households. It is also essential to understand why families are not using all fruits and vegetables (e.g., canned and frozen) available in the home for family meals. Family meals are a place to promote the increased presence of both fruit and vegetables.

He Said, She Said: Examining Parental Concordance on Home Environment Factors and Adolescent Health Behaviors and Weight Status

BACKGROUND

Few studies have examined concordance/discordance between caregivers to identify whether caregivers see familial and parental factors in the home environment similarly or differently and whether the agreement or disagreement is related to adolescent obesity risk. Answers to these questions are important and may inform whether family-based childhood obesity interventions need to target both parents.

OBJECTIVE

The main objective of the study was to examine whether and how parental concordance/discordance on factors in the home environment (eg, importance of family meals, parent feeding practices, encouraging child physical activity, and limit setting on child screen time) are associated with adolescent health behaviors and weight status.

DESIGN

Data from two linked population-based studies were used in cross-sectional analyses. Linear regression models examined associations between parental concordance/discordance on home environment factors and adolescents' health behaviors and weight status.

PARTICIPANT/SETTINGS

Racially/ethnically and socioeconomically diverse adolescents (n=1,052; 54% girls; mean age=14.3 years) and their parents (n=2,104; 52% women; mean age=41.0 years) from Minneapolis and St Paul, MN, participated in the study. Anthropometric assessments and surveys were completed at school by adolescents and surveys were completed at home by parents.

RESULTS

Parental concordance on home environment factors was high for some factors (eg, 68% concordance on not pressuring adolescent to eat) and low for other factors (eg, 2% concordance on parent engaging in physically activity with child 4+ hours per week). Parental concordance on positive home environment factors (eg, frequency of family meals) was associated with more adolescent healthful eating patterns and hours of physical activity (P<0.05), but not consistently. When parents were discordant, adolescents had higher consumption of fast food and more unhealthy weight control behaviors (P<0.05), but not consistently.

CONCLUSIONS

Results suggest there is some degree of parental concordance on home environment factors; however, the results were inconsistent and approximately one-third of parents were discordant on these factors. Future research is needed to further examine the role of parental concordance/discordance on adolescent health behaviors and weight status.

Development of the General Parenting Observational Scale to assess parenting during family meals

Background

There is growing interest in the relationship between general parenting and childhood obesity. However, assessing general parenting via surveys can be difficult due to issues with self-report and differences in the underlying constructs being measured. As a result, different aspects of parenting have been associated with obesity risk. We developed a more objective tool to assess general parenting by using observational methods during a mealtime interaction.

Methods

The General Parenting Observational Scale (GPOS) was based on prior work of Baumrind, Maccoby and Martin, Barber, and Slater and Power. Ten dimensions of parenting were included; 4 were classified in the emotional dimension of parenting (warmth and affection, support and sensitivity, negative affect, detachment), and 6 were classified in the behavioral dimension of parenting (firm discipline and structure, demands for maturity, psychological control, physical control, permissiveness, neglect). Overweight children age 8–12 years old and their parent (n = 44 dyads) entering a weight control program were videotaped eating a family meal. Parents were coded for their general parenting behaviors. The Mealtime Family Interaction Coding System (MICS) and several self-report measures of general parenting were also used to assess the parent–child interaction. Spearman’s correlations were used to assess correlation between measures.

Results

The emotional dimensions of warmth/affection and support/sensitivity, and the behavioral dimension of firm discipline/structure were robustly captured during the family meals. Warmth/affection and support/sensitivity were significantly correlated with affect management, interpersonal involvement, and communication from the MICS. Firm discipline/structure was inversely correlated with affect management, behavior control, and task accomplishment. Parents who were older, with higher educational status, and lower BMIs were more likely to display warmth/affection and support/sensitivity.

Conclusion

Several general parenting dimensions from the GPOS were highly correlated with similar family functioning constructs from the MICS. This new observational tool appears to be a valid means of assessing general parenting behaviors during mealtimes and adds to our ability to measure parent-level factors affecting child weight-related outcomes. Future evaluation of this tool in a broader range of the population and other family settings should be conducted.