The association between family meals, TV viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children

Unpacking family meals: state-of-the-art review critiquing the Western ideals, positioning and promotion of family meals

Family meals are a familiar concept and are practised in many Western households. While academics have been researching family meals for decades, there is much about the family meal we still do not understand. Meanwhile, the promotion of an 'ideal' of family meals across media, health and social discourse ensues. An extensive pool of research has indicated cross-sectional associations between the frequency of family meals and optimal health outcomes. However, evidence surrounding what specifically it is about the family meal that could offer health benefits is limited. Furthermore, family meals carry a level of moral value, evoking pressure for parents to 'achieve' a family meal ideal, unattainable for many. Family meals research has traditionally focussed on mothers' perceptions and roles in family mealtimes. While literature is starting to emerge on the often-overlooked cognitive contribution required to plan and execute family meals, little structural supports exist to streamline these efforts or make them more achievable for contemporary families. The published literature is only starting to include cultural and demographic diversity, making it difficult to understand and promote realistic and feasible family meals across populations. The popular depiction of family meals needs to evolve alongside changes in social norms. Our call to action to address these issues is to draw on existing family meal practices, continue to diversify our investigations, and broaden our definitions and understandings of what a family meal is or could be, and how it should be measured.

Decreased frequency of sugar-sweetened beverages intake among young children following the implementation of the health promotion levy in South Africa

OBJECTIVE

This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

DESIGN

Prospective cohort study.

SETTING

Ten schools in North West Province, South Africa.

PARTICIPANTS

950 children aged 5-9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

RESULTS

The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

CONCLUSIONS

The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.

Shaping a moral body in family dinner talk: Children's socialization to good manners concerning bodily conduct

The family meal has been extensively investigated as a site for children's acquisition of eating-related behaviors and attitudes, as well as culture-specific rules and assumptions. However, little is known about children's socialization to a constitutive dimension of commensality and even social life: good manners concerning bodily conduct. Drawing on 20th century scholarship on body governmentality and good manners, and building on recent studies on family meal as a socialization site, the article sheds light on this overlooked dimension of family commensality. Based on a corpus of more than 20 h of videorecorded family dinner interactions collected in Italy, and using discourse analysis, the article shows that family mealtime constitutes a relevant arena where parents control their children's conduct through the micro-politics of good manners. By participating in mealtime interactions, children witness and have the chance to acquire the specific cultural principles governing bodily conduct at the table, such as "sitting properly", "eating with cutlery", and "chewing with mouth closed". Yet, they are also socialized to a foundational principle of human sociality: one's own behavior must be self-monitored according to the perspective of the generalized Other. Noticing that forms and contents of contemporary family mealtime talk about good manners are surprisingly similar to those described by Elias in his seminal work on the social history of good manners, the article documents that mealtime still constitutes a privileged cultural site where children are multimodally introduced to morality concerning not only specific table manners, but also more general and overarching assumptions, namely the conception of the body as an entity that should be (self)monitored and shaped according to moral standards.

Validation of a short food group questionnaire to determine intakes from healthy and unhealthy food groups in 5-9-year-old South African children

BACKGROUND

Reliable dietary data for children are necessary to investigate associations with health outcomes. The present study aimed to develop and validate a questionnaire to determine the frequency of intakes of specific healthy and unhealthy food groups in young children.

METHODS

Participants were 5-9-year-old South African children (n = 920) from 10 urban schools. Their parents completed a demographic questionnaire and the food intake questionnaire with food pictures. Based on the literature, four healthy food groups (fruits, vegetables, milk, meat/fish/poultry/eggs) and six unhealthy food groups (hot and cold sugar-sweetened beverages, candy, salty snacks, cakes and fast foods) were included, with five different frequency responses. Six experienced nutritionists assessed the face validity and content validity. After pilot testing, construct validity and homogeneity were determined in the participants. Convergent validity was determined using urinary sodium and potassium concentrations as biological intake markers.

RESULTS

Nutritionists confirmed face and content validity. Caregivers confirmed understanding of the questionnaire. Three factors explained 50.2% of the variance, with most unhealthy food groups as factor 1, fruits and vegetables as factor 2, and animal source protein and milk groups clustered with sugar-sweetened beverages as factor 3. The frequency of milk group, fruits and vegetables intake correlated negatively, whereas the frequency of salty snacks and fast foods intakes correlated positively with the urinary sodium:potassium ratio.

CONCLUSIONS

The healthy and unhealthy food group questionnaire has advantages of low respondent burden, as well as acceptable content and convergent validity in South African children. The questionnaire may be used to investigate associations between food intakes and health outcomes.

Screen use while eating is associated with lower intuitive eating and higher disordered eating in Chinese adult men and women

OBJECTIVE

We aimed to explore the potential associations between screen use while eating and intuitive eating and disordered (thinness-oriented and muscularity-oriented) eating behaviors.

METHODS

Analyses included 600 Chinese adults (50% women; Mage  = 30.67, SD = 8.08) recruited online. The use of four major screen devices was captured, including cell phones, tablets, computers, and TVs. Three types of eating behaviors were examined, namely intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating. Pearson correlation and hierarchical regression analyses were conducted separately for men and women to examine the sex-specific associations between screen use while eating and intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating.

RESULTS

In both men and women, more screen use while eating was significantly associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating, above and beyond total screen time and social media use.

DISCUSSION

We found preliminary evidence for the significant links between screen use while eating and intuitive eating and disordered eating. Given the global increases in screen use, continued research is warranted to further explore the role of screen use while eating in the development and maintenance of intuitive eating and disordered eating.

PUBLIC SIGNIFICANCE

Much remains unknown regarding screen use while eating and eating behaviors. We found that in both Chinese men and women, more screen use while eating was significantly and uniquely associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating. Findings highlight the importance of incorporating screen use while eating in future research on intuitive eating and disordered eating.

Cross-sectional and longitudinal associations between family meals frequency and children's overweight/obesity in families at high risk of type 2 diabetes: The Feel4Diabetes-study

BACKGROUND

The frequency of family meals has been suggested as a protective factor against obesity among children.

OBJECTIVE

This study aimed to investigate the cross-sectional and longitudinal associations between family meals frequency and children's overweight/obesity in families at high risk of type 2 diabetes (T2D) across six European countries.

METHODS

989 parent-child dyads (52% girls and 72% mothers) were included. Participants completed validated measures to assess the frequency of family meals and anthropometrics. Multivariable regression models were applied to examine the longitudinal associations between family meals frequency and overweight/obesity in children. Logistic regression was performed to predict the odds of having overweight/obesity depending on changes in family meals frequency over a two-year follow-up period. Analyses were stratified for children's sex.

RESULTS

High frequency of family breakfasts and/or dinners was inversely associated with children's BMI in boys and girls at T2. Results showed decreased odds of overweight/obesity at follow-up among both boys (OR = 0.65; 95% CI 0.41, 0.96) and girls (OR = 0.53; 95% CI 0.31, 0.87) who consumed minimum of three times family breakfasts and/or family dinners a week at baseline. An increase in family breakfasts and/or dinners frequency was associated with lower odds of overweight/obesity in both boys and girls at follow-up.

CONCLUSION

A high frequency of family breakfasts and/or dinners but not lunch during childhood is associated with lower odds of overweight/obesity development in children from families at high risk of T2D. The promotion of family meals could help in preventing the development of overweight/obesity among children.

"That's the routine": A qualitative exploration of mealtime screen use in lower educated Australian families with young children

BACKGROUND

Family meals are an opportune context for initiating healthy eating habits in young children. However, using screens at family mealtimes may negate some of the associated nutritional and social benefits. In High Income countries, frequent mealtime screen use is common, particularly in families of low socioeconomic position (SEP). This study aimed to explore experiences and acceptability of mealtime screen use in families of low SEP with young children.

METHODS

Qualitative interviews with 25 mothers of low SEP were conducted via telephone or Zoom™ using Photo Interviewing and a semi-structured interview script. Transcripts were analysed thematically using a Constructivist paradigm.

RESULTS

Many parents reported an eagerness for reducing family mealtime screen use. Three major themes were identified in explaining the reasons behind levels of engagement in family mealtime screen use. These included parental self-efficacy, such as parental confidence in saying no to screens at mealtimes, physical resources such as having enough space in the home for a functioning dining table without view of a television, and temporal priorities such as prioritising screen use for managing children's difficult behaviour at mealtimes over long-term health considerations.

CONCLUSIONS

This study highlights that although family mealtime screen use is likely linked with a range of child behaviours and parenting practices that may negatively influence children's dietary intake and social engagement, parents often considered screens acceptable at mealtimes. Nonetheless, parents' desire to reduce family mealtime screen use provides an important opportunity to determine how best to support parents to achieve this.

Cultural Influences on Family Mealtime Routines in Mexico: Focus Group Study with Mexican Mothers

Mexico’s obesity rates are alarming, and experts project drastic increases in the next thirty years. There is growing interest in understanding how remote acculturation and globalization processes influence health behaviors. The present study used focus group data from a central state, San Luis Potosí, in Mexico to explore mothers’ perspectives on factors that influence family mealtime routines. Thematic analysis was used to identify barriers and facilitators to healthy mealtime routines and diet within families. Twenty-one mothers participated in the focus groups; 76% were full-time stay at home mothers, the majority were low-income (65%), and fewer than half reached a high school education. Three major themes emerged: (1) mothers do most of the visible work involving mealtime routines; (2) family meals are different today, and globalization is a contributing factor; and (3) family mealtimes are shifting to weekend events. Empowering mothers to negotiate diet with family members to build healthy routines, navigate challenges due to changing environments, and set family boundaries around technology use during mealtimes should be taken into consideration when promoting healthy behaviors with Mexican families.

Mealtime TV Use Is Associated with Higher Discretionary Food Intakes in Young Australian Children: A Two-Year Prospective Study

Background: Mealtime television use has been cross-sectionally associated with suboptimal diets in children. This study aimed to assess the two-year prospective association between baseline mealtime television use and subsequent diets in young children, and identify socioeconomic differences. Methods: Parents reported their child’s television use at meals, and fruit, vegetable, and discretionary food intakes. Multivariable linear and logistic regression analyses assessed the association between baseline mealtime television use and follow-up diet outcomes. Differences were assessed by socioeconomic position. Results: Participants were 352 Australian parents of children aged six months to six years. Daily mealtime television use (average frequency/day) was associated with higher daily frequency of discretionary food intakes (β 0.2, 95% confidence interval (CI) 0.07–0.67) at the 2-year follow-up. Individually, television use during breakfast and dinner (1–2 days/week compared to never) predicted higher daily intake frequency of discretionary food, β 0.36 (95% CI 0.12–0.60) and β 0.19 (95% CI 0.00–0.39), respectively. Similarly, 3–7 days/week of television use during breakfast and lunch predicted higher frequency of discretionary food intake, β 0.18 (95% CI 0.02–0.37) and β 0.31 (95% CI 0.07–0.55), respectively. Associations were not socioeconomically patterned. Conclusions: Investigating mealtime television use motivators across the socioeconomic spectrum could inform interventions targeting the high consumption of discretionary foods in children.

Nutritional self-care practices and skills of patients with diabetes mellitus: A study at a tertiary hospital in Ghana

Introduction

Nutritional management decreases and/or prevents the complications and deaths associated with diabetes mellitus. However, the majority of patients living with diabetes do not engage in optimal nutritional management of diabetes because they see it as the most difficult aspect of managing the condition. This study aimed to explore and describe the practices and skills on nutritional management of diabetes mellitus among patients living with diabetes attending a Ghanaian hospital.

Materials and methods

This study employed an exploratory, descriptive qualitative research design. Fifteen participants were recruited using purposive sampling, and interviewed with a semi-structured interview guide. Content analysis was performed on the data gathered, following which three main themes emerged.

Results

More than two-thirds of the participants of this study had adequate meal planning skills, ate the right quantity of foods, engaged in healthy eating habits, and consumed healthy sources of carbohydrates, fats and protein when eating. However, more than half of the participants had insufficient knowledge and skills in the reading and usage of food labels.

Conclusions

The participants of this study largely engaged in optimal nutritional management of diabetes due to their healthy dietary practices and preferences. It is recommended that health care professionals in Ghana find practical and robust ways to factor the reading and usage of food labels into the care and management of patients with diabetes.

Consumers' acceptance of the first novel insect food approved in the European Union: Predictors of yellow mealworm chips consumption

Climate and environmental-related challenges are high on the agenda of the European Union (EU). One priority is to redesign the existing food system into a more sustainable one, where the link between healthy people and a balanced environment is considered. The EU bets on the role of insect farming in supporting the transition toward healthier and future-proof diets. Following this orientation, we investigated consumers' attitude toward yellow mealworm chips (YMC) and identified the predictors of YMC consumption. The causal relationships between constructs were explored using the structural equation modeling (SEM) based on partial least squares (PLS) using SmartPLS software. The perceived lower environmental impact of YMC compared to meat was the most appreciated characteristic of YMC. The study identified five predictors of YMC consumption, among which the perceived characteristics of YMC have the strongest influence on the consumption probability. Against the expectations of the authors, disgust with the accidental encounter of insects in foods did not influence the probability of eating YMC. Age was another predictor of YMC consumption. It is known that food preferences and eating behaviors are mainly developed during childhood and tend to manifest in adult life. Consequently, it can be inferred that acceptance and preference for insect-based foods (IBF) should be stimulated from early childhood. Finally, practical implications are advanced as possible solutions to overcome the obstacles toward YMC consumption.

The reflective eater: Socializing French children to eating fruits and vegetables

Studies often suggest that the family meal is the locus for the acquisition of healthy eating habits. However, these studies rarely offer a deeper understanding of what it is about eating together as a family that increases the intake of healthy foods, such as fruits and vegetables. This ethnographic study examines dinners in French households, whose children have shown to habitually consume fruits and vegetables, analyzing talk around the dinner table. Our analysis shows that naturally occurring exchanges between parents and children socialize children to experiencing eating in culturally informed ways that promote attending to the prized characteristics, such as origin, quality, taste, and preparation of food items that intrinsically elevates their value and leads to their consumption. These communicative patterns also encourage reflection and openness to foods, which, we posit, constitute ways of 'doing being French'. Ultimately, we argue that French children's readiness to eat fruits and vegetables is not linked to them being healthy, but rather is derived from the cultural significance of experiencing sensory pleasure from food and from being able to talk about and share these experiences with others, that is being reflective eaters.

Frequency of family meals and food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study

A family meal is defined as a meal consumed together by the members of a family or by having ≥ 1 parent present during a meal. The frequency of family meals has been associated with healthier food intake patterns in both children and parents. This study aimed to investigate in families at high risk for developing type 2 diabetes across Europe the association (i) between family meals' frequency and food consumption and diet quality among parents and (ii) between family meals' frequency and children's food consumption. Moreover, the study aimed to elucidate the mediating effect of parental diet quality on the association between family meals' frequency and children's food consumption. Food consumption frequency and anthropometric were collected cross-sectionally from a representative sample of 1964 families from the European Feel4Diabetes-study. Regression and mediation analyses were applied by gender of children. Positive and significant associations were found between the frequency of family meals and parental food consumption (β = 0.84; 95% CI 0.57, 1.45) and diet quality (β = 0.30; 95% CI 0.19, 0.42). For children, more frequent family meals were significantly associated with healthier food consumption (boys, β = 0.172, p < 0.05; girls, β = 0.114, p < 0.01). A partial mediation effect of the parental diet quality was shown on the association between the frequency of family meals and the consumption of some selected food items (i.e., milk products and salty snacks) among boys and girls. The strongest mediation effect of parental diet quality was found on the association between the frequency of family breakfast and the consumption of salty snacks and milk and milk products (62.5% and 37.5%, respectively) among girls.

CONCLUSIONS

The frequency of family meals is positively associated with improved food consumption patterns (i.e., higher intake of fruits and vegetables and reduced consumption of sweets) in both parents and children. However, the association in children is partially mediated by parents' diet quality. The promotion of consuming meals together in the family could be a potentially effective strategy for interventions aiming to establish and maintain healthy food consumption patterns among children.

TRIAL REGISTRATION

The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov , March 20, 2015.

WHAT IS KNOWN

• Parents' eating habits and diet quality play an important role in shaping dietary patterns in children • Family meals frequency is associated with improved diet quality of children in healthy population What is New: • Frequency of family meals was significantly associated with healthier food consumption among parents and children in families at high risk of type 2 diabetes in six European countries. • Parental diet quality mediates the association between family meals frequency and the consumption of some selected food items among children.

Maternal feeding practices and toddlers' fruit and vegetable consumption: results from the DIT-Coombe Hospital birth cohort in Ireland

Background

Health benefits of fruit and vegetable have been well recognized. However, insufficient consumption of fruit and vegetable is prevalent among toddlers, and has become a global public health issue. Maternal feeding practices are potential factors influencing toddlers’ dietary intake, including fruit and vegetable intake. This study was conducted to explore the influence of maternal feeding practices on toddlers’ fruit and vegetable consumption in Ireland.

Methods

A follow-up to the DIT-Coombe Hospital birth cohort was conducted. Mothers in the original cohort were invited to participate in the present follow-up study by phone. A questionnaire assessing maternal feeding behavior and the child’s 3-day food diary was sent to mothers who agreed to take part in the present study by post, together with a self-addressed stamped envelope.

Results

There were 193 mother-children pairs included in the analysis, and the mean age of children was 2.4 (SD 0.7) years old. Toddlers’ mean daily intakes of vegetable and fruit were 67.57 (SD 45.95) g and 213.35 (SD 170.78) g, respectively. Logistic regression analyses showed that maternal practice of breastfeeding for more than 4 weeks was positively associated with fruit (OR = 2.93, 95% CI: 1.29–6.64) and vegetable (OR = 1.95, 95% CI: 1.00–3.81) intake or the contribution of fruit (OR = 2.62, 95% CI: 1.19–5.80) and vegetable (OR = 2.02, 95% CI: 1.02–3.99) to the total diet. Letting the child eat with other family members was associated with high vegetable intake (OR = 5.45, 95%CI: 1.69–17.61) and high contribution of vegetable to total diet (OR = 3.78, 95% CI: 1.04–13.82). Not being too worried about the child’s refusal to eat was positively associated with toddlers’ vegetable intake (OR = 2.10, 95%CI: 1.09–4.05).

Conclusions

To increase children’s fruit and vegetable intake, and develop good eating habits, parents should eat with their toddlers, be patient and not put much pressure on their children in the context of meal feeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00743-z.

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

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

What Is Commensality? A Critical Discussion of an Expanding Research Field

Commensality (the act of eating together) is studied in a range of disciplines and often considered important for social communion, order, health and well-being, while simultaneously being understood as in decline (especially the family meal). However, such claims are also contested in various ways. In this paper, we discuss the expanding field of commensality research and critically reflect on the debates surrounding its social functions, including its role in public health. We illuminate the deep social and cultural significance of commensality, through time and space, and conclude that whether or not commensality is the preferred social form of eating for any given individual, it is difficult to escape its sociocultural desirability and idealization. As a cross-cultural phenomenon in both past, present, and future, we suggest that commensality deserves further research. This includes commensality as a research topic in itself and as an entry point to unveil different dimensions of social relations between people, as well as interactions between humans and material objects.

Exploring Eating Challenges and Food Selectivity for Latinx Children with and without Autism Spectrum Disorder Using Qualitative Visual Methodology: Implications for Oral Health

Diet and food choices significantly impact teeth, including enamel quality and development of dental caries. However, studies focusing on diet and its relation to oral care in Latinx children with and without Autism Spectrum Disorders (ASD) have been minimally addressed in research. This qualitative study used an inclusive visual methodology to explore what Latinx caregivers learned about their child's diet preferences and food routines in relation to their oral health. As a secondary aim, the study sought to explore whether notable differences in diet emerged between Latinx children with and without ASD. Participants were 32 Latinx caregivers from 18 families with children with and without Autism (n = 8 with a typically developing child and n = 10 with a child with ASD) who completed a food journal activity and photo elicitation interview. Interviews were thematically coded for themes pertaining to parents' perceptions of their child's diet and oral health. Findings of this study indicate that the process of taking photos helped Latinx caregivers to better situate the barriers and behaviors influencing everyday food routines in their children within the context of relating to their overall oral health. Via their active participation in the research process, parents were empowered to note strategies they could employ that would directly impact their child's oral health outcomes, such as reducing juice intake and monitoring sugar consumption. Therefore, visual research methodologies are an important strategy for researchers to consider in order to empower participants to be part of the research process and part of the outcomes, and to offer better understanding of the lived experience of populations underrepresented in the literature, such as Latinx children with and without ASD and their families.

Momentary and personal characteristics predicting maternal fruit and vegetable preparation for children using ecological momentary assessment

A large body of literature on child-focused research regarding healthy eating within the family context has focused on behavioral management strategies, such as reinforcement, or parental modeling through personal intake or encouragement. However, food preparation behaviors among mothers have been understudied. Also unknown is how maternal food preparation behaviors vary across population subgroups and contexts. The study objective was to elucidate momentary characteristics (i.e., time of day, weekday, and family meals) and personal characteristics (i.e., ethnicity, working status, household characteristics, body mass index, income, and child's age) associated with maternal fruit and vegetable (F/V) preparation through ecological momentary assessment (EMA). 186 mothers (M_age = 40.81) of children (M_age = 9.61, 49.5% female) completed six semi-annual waves, each lasting seven days. Mothers completed up to eight EMA surveys a day, which assessed family meals and F/V preparation, and reported personal characteristics through paper questionnaires. Multilevel generalized estimating equations examined the likelihood of F/V preparation. Momentary, within-day characteristics (i.e., occurrence of family meals, weekdays, afternoons) were associated with greater likelihood of mothers' fresh F/V preparation (ps < 0.05). Additionally, personal characteristics such as non-Hispanic ethnicity, not working full-time, having a child aged six months to five years in the household, and lower child BMI-z were associated with greater fresh F/V preparation among mothers (ps < 0.05). Findings may inform family-based obesity and nutrition intervention programs by understanding which families and in what contexts mothers are more likely to prepare F/Vs.

Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity

OBJECTIVE

To investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents.

DESIGN

Cross-sectional analysis of a randomized control trial SETTING: Eighteen middle schools in Miami-Dade County, Florida.

PARTICIPANTS

Two-hundred and eighty Hispanic seventh- and eighth-grade students MAIN OUTCOME MEASURES: Physical activity, fruit and vegetable intake, and added sugar intake.

ANALYSIS

Structural equation modeling.

RESULTS

The findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (β = .30; P = .001; 95% confidence interval [CI], 0.52-2.68) and physical activity in girls (β = .26; P = .010; 95% CI, 0.16-1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [β= .18; P = .039; 95% CI, 0.02-2.60] but had a moderating effect on fruit and vegetable consumption in girls (β = .21; P = .015; 95% CI, 0.14-2.19).

CONCLUSIONS AND IMPLICATIONS

Family mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers

BACKGROUND

Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions.

OBJECTIVE

This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families.

METHODS

A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts.

RESULTS

Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children.

CONCLUSIONS

Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone's tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives.

Association of fruit and vegetable intake with meal skipping in children and adolescents: the CASPIAN-V study

BACKGROUND

There are few studies on the association of main meal consumption with fruit and vegetable intake. This study aims to assess the relation between skipping main meals and fruit and vegetable intake in children and adolescents.

METHODS

This multi-centric cross-sectional study was conducted in 30 provinces of Iran. This study was conducted in the framework of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study (CASPIAN- V). 14,440 school students aged 7-18 years were assessed. Logistic regression analyses were used to evaluate the association between frequency of fruit and vegetable intake with skipping main meals.

RESULTS

Overall, 14,274 students completed the study (99% participation rate). Their mean (SD) age was 12.3 (3.2) (53% were aged 6-12), 50.6% of them were boys, and 71.3% lived in urban area. In multivariate logistic regression model, statistically significant associations were found between skipping main meals and low fruits and vegetables intake. Skipping breakfast was associated with vegetables intake [OR = 1.19(95% CI 1.02-1.38)] and fruits intake [OR = 5.33(95% CI 4.46-6.37)]. Skipping lunch was associated with vegetables intake [OR = 1.61(95% CI 1.29-1.96)] and fruit intake [OR = 9.11(95% CI 6.55-12.67)]. Skipping dinner was associated with vegetables intake [OR = 1.52 (95% CI 1.15-2.01)] and fruits intake [OR = 2.21(95% CI 1.64-2.97)].

CONCLUSIONS

In this study, low frequency of fruit and vegetable intake was associated with skipping main meals. The results highlight the importance of promoting regular meal consumption with increase in the intake of fruit and vegetables among children and adolescents.

LEVEL OF EVIDENCE

Level V.

Family Meal Frequency, Diet, and Family Functioning: A Systematic Review With Meta-analyses

OBJECTIVE

To examine the direction and magnitude of the relation between family meal frequency and dietary and family functioning outcomes in children (aged 2-18 years).

DESIGN

Systematic literature review with meta-analysis.

METHODS

Independent electronic searches, 1 for each outcome of interest, were conducted across 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and PsycINFO. Studies were included if they were peer-reviewed and published in English in the US through December 2018.

MAIN OUTCOME MEASURES

Diet and family functioning.

RESULTS

Dietary outcomes showed some evidence of a positive association between family meal frequency and fruits, vegetables, fruits and vegetables, sugar-sweetened beverages, and the Healthy Eating Index. There was less clear evidence of this relation in snacks, fast food, and desserts. A positive association was found between family meal frequency or dinner family meal frequency and family functioning outcomes. All studies included had cross-sectional and longitudinal study designs.

CONCLUSIONS AND IMPLICATIONS

There is some evidence to show a positive relation between family meal frequency and dietary outcomes. There is stronger evidence for the relation with family functioning outcomes. Most articles included in the systematic reviews were excluded from meta-analysis owing to inadequate data and high methodological diversity across exposure and outcome variables.

An Examination of Family Variables as Mediators of the Association of Acculturation With Sugar-Sweetened Beverage Consumption Among Latinx Adolescents

The objective of this study was to examine the mediating effects of family support for dietary habits and family meal frequency on the relationship between acculturation and sugar-sweetened beverage (SSB) consumption among Latinx adolescents (N = 131). Acculturation was positively associated with SSB consumption (B = 0.07, P < .01). Results suggest that family support for dietary habits and family meal frequency did not mediate the relationship between acculturation and SSB consumption. However, acculturation was negatively associated with family support for dietary habits (B = -0.10, P < .01) and family meal frequency (B = -0.11, P < .05). Future research should examine other family influences as mediators of the relationship between acculturation and SSB consumption.

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.

Vegetable intake in Australian children and adolescents: the importance of consumption frequency, eating occasion and its association with dietary and sociodemographic factors

OBJECTIVE

We aimed to profile vegetable consumption and its association with dietary and sociodemographic factors.

DESIGN

Secondary analysis of a nationally representative nutrition survey. 'Vegetables' refers to non-discretionary 'vegetables and legumes/beans' as defined by the Australian Dietary Guidelines (ADG). Prevalence of vegetable consumption, frequency of intake, proportion meeting ADG recommendations, most popular food groups, intake at each reported eating occasion, and the profile of high and low vegetable consumers (based on the median servings) were determined.

SETTING

Australian 2011-2012 National Nutrition and Physical Activity Survey.

PARTICIPANTS

Children and adolescents aged 2 to 18 years (n 2812).

RESULTS

Vegetables were consumed by 83·0% (95% CI 81·6, 84·4%) of participants, but the median vegetable servings was less than a third of the ADG recommendations. 'Leaf and stalk vegetables' and 'potatoes' were the most popular vegetable-dense food groups at lunch and dinner, respectively. Sixty-four percent had vegetables once a day, and predominantly at dinner. Vegetable frequency was positively associated with daily vegetable servings and variety. Participants who consumed vegetables twice a day generally had vegetables at both lunch and dinner and had nearly double the servings (2·6, sd 1·9) of those who consumed them once (1·5, sd 1·5). High vegetable consumers were older, had higher total energy, but lower discretionary energy intake and were less likely to be at risk of metabolic complications.

CONCLUSION

Increasing the frequency of vegetable consumption may assist with increasing daily vegetable servings. A focus on consuming vegetables at lunch may assist with increasing both total servings and variety.

Psychometric properties of an abbreviated Childhood Family Mealtime Questionnaire among overweight and obese Hispanic adolescents

The current family mealtime literature shows that assessments of the mealtime environment are typically self-report, yet few studies discuss validation techniques or report using validated scales. As such, the current analysis was conducted to validate one of the only published measures to assess the mealtime environment from the adolescent perspective. Specifically, the Childhood Family Mealtime Questionnaire (CFMQ) was evaluated in a sample of 280 overweight and obese Hispanic adolescents to address the need for a validated measure of the family mealtime environment in a demographic that is disproportionately affected by the current obesity epidemic. Results of exploratory and confirmatory factor analyses to evaluate the optimal factor structure, reliability, and validity for a revised, abbreviated CFMQ are presented here. The concurrent validity of the CFMQ was evaluated using correlations between the factor structures and the previously used, culturally appropriate comparable measure of family functioning. Correlations were also computed between factor scores and obesogenic outcomes (fruit and vegetable intake, added sugar intake, and physical activity). Analyses produced a revised, abbreviated version that includes 22 items (reduced from a total of 69 items) and consists of the following 4 factors: family mealtime communication (5 items), family mealtime stress (7 items), appearance weight control (5 items), and mealtime structure (6 items). Cronbach's alphas are reported for reliability. When examining CFMQ concurrent validity with the family functioning latent variable, results showed the family mealtime communication subscale ranked highest. Additionally, the family mealtime communication subscale was associated with all three obesogenic outcomes. This abbreviated CFMQ may be a useful tool for those studying family mealtime environments and their influence on obesity and its associated lifestyle behaviors.

Deconstructing the Family Meal: Are Characteristics of the Mealtime Environment Associated with the Healthfulness of Meals Served?

BACKGROUND

Multiple studies and guidelines emphasize the benefits associated with family meals. However, family meals are not well defined and little research has been conducted to determine whether mealtime characteristics are associated with the healthfulness of foods served.

OBJECTIVE

The objective of this study was to define and measure specific mealtime characteristics and examine whether these characteristics are associated with the healthfulness of meals served to young children from low-income families, as measured by the Healthy Meal Index (HMI).

PARTICIPANTS/SETTING

Study participants included 272 young children from low-income families residing in southeast Michigan during 2011 to 2013.

DESIGN

For this cross-sectional study, parents videorecorded 757 mealtimes that were coded for four mealtime variables and meal healthfulness using the HMI. Mealtime characteristics included Eating at a Table (vs not), Served Family-Style (vs not), TV Off (vs not), and Parent Partakes (sits and eats or drinks with child) (vs not). A Family Meal was defined as a meal that had all four measured mealtime characteristics.

MAIN OUTCOME MEASURES

All meals were scored using the HMI, which has two components: the HMI Adequacy score (based on the presence of foods that are recommended for a healthy diet) and the HMI Moderation score (based on the absence of foods recommended to be consumed in moderation). The scores are summed to obtain the HMI Total score.

STATISTICAL ANALYSES PERFORMED

Generalized estimating equations tested the associations of mealtime characteristics with HMI scores, controlling for child sex and age, and parent education and race/ethnicity.

RESULTS

In adjusted models, Family Meals were positively associated with HMI Adequacy (P=0.02) and Total (P=0.05) scores. Eating at a Table was positively associated with HMI Moderation (P=0.01) and HMI Total (P=0.01) scores. Served Family-Style was positively associated with HMI Adequacy scores (P=0.04). TV Off was associated with higher HMI Total scores (P=0.05). Parent Partakes was not associated with HMI scores.

CONCLUSIONS

Family Meals were associated with greater healthfulness of the foods served. Characteristics of mealtime that are commonly utilized to define Family Meal were differentially associated with meal healthfulness.

Watching Television while Eating: Associations with Dietary Intake and Weight Status among a Diverse Sample of Young Children

BACKGROUND

Television (TV) watching at family meals has been associated with poorer dietary quality and weight outcomes in children. Most research has been limited to family meals, overlooking the influence of TV at any meal.

OBJECTIVE

This study assesses how often children are eating meals at home while watching TV, the association between child dietary intake while watching TV during meals eaten at home and whether the association depends on meal type (eg, breakfast) or child race/ethnicity, and whether the number of meals consumed while watching TV at home is associated with overall child dietary quality or weight status.

DESIGN

The Family Matters study utilized a cross-sectional design and was conducted between 2015 and 2016.

PARTICIPANTS/SETTING

Three 24-hour dietary recalls were conducted on children aged 5 to 7 years (n=150; 25 each from non-Hispanic white, African American, Latino, Native American, Somali, and Hmong households).

MAIN OUTCOME MEASURES

Main outcomes of this study were dietary intake at meals, overall dietary quality, and child weight status.

STATISTICAL ANALYSIS PERFORMED

Conditional fixed effects estimators were used to address correlated error terms to model within-person variation between TV and dietary intake and race/ethnicity differences in child dietary outcomes.

RESULTS

TV was watched during 30% of meals eaten at home, which differed significantly by race/ethnicity (P<0.001). Although effect sizes were small, TV watching at meals was associated with unhealthier intake of some foods groups (eg, increased sugar-sweetened beverages and chips/crackers and decreased fruits), dependent on the meal occasion (eg, snacks). However, TV watching during meals at home was not significantly associated with dietary intake for other food groups. These associations did not depend on race/ethnicity. An association between number of meals consumed while watching TV with overall dietary quality or weight status was not found.

CONCLUSIONS

Although more research is needed, results suggest TV watching while eating meals at home is relatively common, depends on race/ethnicity, and that TV watching at some meal occasions is associated with child intake of certain food groups, with a majority being unhealthy.

Home Environment Factors and Health Behaviors of Low-income, Overweight, and Obese Youth

Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management program. Multivariable logistic regression examined how home environment (parenting practices, family meal habits, and home availability of fruits/vegetables, sugar-sweetened beverages (SSBs), screen media, and physical activity resources) are related to children's intake of fruit, vegetables, and SSBs, and moderate-vigorous physical activity and sedentary time (ST) after adjusting for potential confounders. Results: Children were more likely to consume fruit if their families frequently ate meals together and infrequently watched TV during meals, and more likely to consume vegetables with high fruit/vegetable availability and low SSB availability. Children were more likely to engage in ST if parents practiced monitoring and frequently watched TV during meals. Conclusions: Overweight or obese children appear to have healthier habits if their families eat meals together without watching TV and if healthy food choices are available in the home. Encouraging parents to focus these practices may promote healthier body weight in children.

An examination of food parenting practices: structure, control and autonomy promotion

OBJECTIVE

In recent years, researchers have been working towards creating a standard conceptual framework of food parenting. To understand how parents' reports correspond with the proposed model, the current study examined parents' reports of their feeding behaviours in the context of a newly established framework of food parenting.

DESIGN

Cross-sectional, with a two-week follow-up for a subset of the sample. Participants completed a quantitative and qualitative survey to assess food parenting. The survey included items from common food parenting instruments to measure the constructs posited in the framework. Exploratory factor analyses were conducted to ascertain which items related most closely to one another and factors were mapped on to existing constructs.

SETTING

Online.

PARTICIPANTS

Parents of children aged 2·5-7 years (n 496). Of these, 122 completed a two-week follow-up.

RESULTS

Analyses revealed eleven aspects of Structure (monitoring; distraction; family presence; meal/snack schedule; unstructured practices; healthy/unhealthy food availability; food preparation; healthy/unhealthy modelling; rules), ten aspects of Coercive Control (pressure to eat; using food to control emotions; food incentives to eat; food incentives to behave; non-food incentives to eat; restriction for health/weight; covert restriction; clean plate; harsh coercion) and seven aspects of Autonomy Promotion (praise; encouragement; nutrition education; child involvement; negotiation; responsive feeding; repeated offering). Content validity, assessed via parents' open-ended explanations of their responses, was high, and test-retest reliability was moderate to high. Structure and Autonomy Promoting food parenting were highly positively correlated.

CONCLUSIONS

In general, parents' responses provided support for the model, but suggested some amendments and refinements.

Impact of a Healthy Weight Intervention Embedded Within a National Home Visiting Program on the Home Food Environment

Purpose: To determine whether a lifestyle intervention embedded within Parents as Teachers (PAT), a national child development and parenting home visiting program, helped families make food-related home environment changes.

Design: Secondary data analysis of a stratified randomized pragmatic trial. (Trial Registration: This study is registered at www.clinicaltrials.gov NCT01567033).

Setting: Participant homes in St. Louis, Missouri.

Subjects: Women (n = 179 with pre-post data, of 230 with baseline) participating in standard PAT, with overweight or obesity, and at least one preschool child with BMI percentile ≥60%.

Intervention: PAT + Healthy Eating and Active Living Taught at Home (HEALTH), embedded elements of the Diabetes Prevention Program within the standard PAT curriculum. PAT + HEALTH addressed specific behaviors that impact caloric intake (e.g., sugar-sweetened beverages), focusing on behavioral and environmental strategies. Consistent with PAT practice, the frequency, number, and focus (i.e., time spent on intervention components) of home visits were determined by the family's needs; dose structure was flexible [on average intervention: 23 (SD = 9), usual care: 13 (SD = 6) visits].

Measures: Food availability/accessibility and distractions in the home were assessed with items drawn largely from the HomeSTEAD Survey.

Analysis: Generalized estimating equations (GEEs) were used to test equality of changes between baseline and 24 months in the intervention and usual care groups.

Results: The only significant difference in the pattern of change between usual care and intervention was soda availability/accessibility (p = 0.013).

Conclusion: This embedded intervention successfully reduced availability/accessibility of sugar-sweetened beverages in the home. However, given the limited impact on other food-related home environment factors, future interventions could seek to more effectively intervene on all aspects of the home environment.

The frequency of family meals and nutritional health in children: a meta-analysis

Findings on the relationship between family meal frequency and children's nutritional health are inconsistent. The reasons for these mixed results have to date remained largely unexplored. This systematic review and meta-analysis of 57 studies (203,706 participants) examines (i) the relationship between family meal frequency and various nutritional health outcomes and (ii) two potential explanations for the inconsistent findings: sociodemographic characteristics and mealtime characteristics. Separate meta-analyses revealed significant associations between higher family meal frequency and better overall diet quality (r = 0.13), more healthy diet (r = 0.10), less unhealthy diet (r = -0.04) and lower body mass index, BMI (r = -0.05). Child's age, country, number of family members present at meals and meal type (i.e. breakfast, lunch or dinner) did not moderate the relationship of meal frequency with healthy diet, unhealthy diet or BMI. Socioeconomic status only moderated the relationship with BMI. The findings show a significant relationship between frequent family meals and better nutritional health - in younger and older children, across countries and socioeconomic groups, and for meals taken with the whole family vs. one parent. Building on these findings, research can now target the causal direction of the relationship between family meal frequency and nutritional health.

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.

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.

Listening to Immokalee moms

Purpose

The purpose of this paper is to present a case study of the research steps taken to identify message directions for a community-wide health communication campaign aimed at supporting healthier eating behaviors among Latino farmworker families in the Immokalee community in Florida. Latino mothers were targeted to understand their beliefs about children’s healthy eating needs and identify communication campaign opportunities that would reinforce choices made in the home, surrounding meal planning, food selection and preparation and portion sizes.

Design/methodology/approach

A sequential mixed-methods approach using focus group, group interview and qualitative message concept testing was used in three distinct stages of research exploration. An independent sample was recruited at each stage through convenience sampling and snowball sampling methods. The stages of change theory provided a framework for research inquiry in the context of healthy eating-at-home practices.

Findings

In general, mothers were aware and participatory in the effort to serve healthy meals for their children at home. The time and money associated with buying nutritious foods and cooking healthy meals daily was stressful, but they were receptive to communication efforts to help them maintain their commitment to give their children healthy foods. These findings provided directional opportunities for the discovery and implementation of health communication strategies. Test results found that the target was most receptive to message strategies that acknowledged the responsibility of both parents to model healthy eating practices to children.

Research limitations/implications

Recruiting resulted in small sample sizes at each stage of the investigation. The reliability of quantitative measurement was a limitation to the research conclusions.

Practical implications

Partnership with the audience from discovery to conceptualization resulted in messages that uniquely resonated with the audience for which they were aimed. Understanding about the target stage of readiness improves message effectiveness to the target group.

Social implications

Health communication campaigns planned and developed with the target audience at its center will generate message strategies that effectively address issues of greatest relevance to those communication agents that seek to change.

Originality/value

The study provides a unique exploration of the steps that health communication agents should pursue to establish a thorough profile of their target audience and the issues that resonate when considering healthy eating behavior at home. The application of the stages of the change model encouraged the discovery of issues surrounding the challenge and highlighted potential obstacles that would mitigate the behavior change efforts.

Television During Meals in the First 4 Years of Life

The development of children's mealtime television (TV) habits has not been well studied. We assessed whether mealtime TV habits established in infancy will persist into early childhood. We analyzed data collected through parent surveys at birth and at 6-month intervals from a randomized controlled trial. We used t-tests, χ² tests, and a multivariable logistic regression to determine if family characteristics were associated with mealtime TV. A McNemar test was used to assess whether mealtime TV exposure changed over time. College-educated fathers and families with an annual income >$50 000 were associated with less-frequent TV exposure during children's mealtimes. It was found that 84% of children retained their level of exposure to TV during mealtimes from the first 24 months through 48 months of life. Clinicians should counsel families about mealtime TV use within the first 2 years of life because these habits seem to develop early and persist into at least early childhood.

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.

Intakes of Energy and Discretionary Food in Mexico Are Associated with the Context of Eating: Mealtime, Activity, and Place

BACKGROUND

The prevalence of obesity and the intake of discretionary foods [high saturated fat and/or added sugar (HSFAS) products and sugar-sweetened beverages (SSBs)] are high in Mexico. It is important to understand whether the intakes of HSFAS products and SSBs are associated with the context in which they are consumed.

OBJECTIVE

Our aim was to estimate the associations between total energy and discretionary food (HSFAS products and SSBs) intakes and the context of eating (mealtime, activity, and place).

METHODS

We used data from 10,087 participants aged ≥1 y from the Mexican National Health and Nutrition Survey 2012. Dietary intake was estimated through a 24-h dietary recall that included questions on mealtime, activity, and place in which each food item was consumed. The associations between energy and discretionary food intakes and the context of eating were estimated by using multiple linear regression stratified by age group and adjusted for sociodemographic variables.

RESULTS

Compared with breakfast, the percentage of energy that HSFAS products contributed was 16-29 (range in all age groups) percentage points higher during midafternoon snacks and 16-23 percentage points lower at lunch and almuerzo (Mexican brunch); the percentage of energy from SSBs was 3.4-7.6 percentage points higher during midmorning snacks (P < 0.05). In many age groups and mealtimes, we found that compared with eating only while seated, the percentage of energy as HSFAS was 5.3-14 percentage points higher when watching television (P < 0.05). Compared with eating at home, the percentage of energy from HSFAS was 12-26 percentage points higher on the street and the percentage of energy from SSBs was 3.4-6.0 percentage points higher at school and 2.9-15 percentage points higher at work (P < 0.05).

CONCLUSIONS

These results highlight the need to promote healthier food selection among the Mexican population when snacking and watching television and healthier food environments at work, school, and on the street.

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.

Associations among Nine Family Dinner Frequency Measures and Child Weight, Dietary, and Psychosocial Outcomes

BACKGROUND

Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes, but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation might impact relationships with youth weight, dietary, and psychosocial outcomes.

OBJECTIVE

This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes.

DESIGN/PARTICIPANTS

This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8- to 12-year-old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011 to 2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys.

OUTCOME MEASURES

Outcomes included child body mass index z scores (BMIz); fruit, vegetable, and sugar-sweetened beverage intake; dietary quality (Healthy Eating Index-2010); family connectedness; and meal conversations.

STATISTICAL ANALYSES PERFORMED

Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes.

RESULTS

All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver and child reporters (r=0.17 to 0.94; P<0.01). In unadjusted analyses, 78% of family dinner frequency measures were significantly associated with BMIz and 100% were significantly associated with fruit and vegetable intake and Healthy Eating Index-2010. In adjusted models, most significant associations with dietary and psychosocial outcomes remained, but associations with child BMIz remained significant only for parent/caregiver- (β±standard error=-.07±.03; P<0.05) and child-reported (β±standard error=-.06±.02; P<0.01) family dinner frequency measures asking about "sitting and eating" dinner.

CONCLUSIONS

Despite phrasing variations in family dinner frequency measures (eg, which family members were present and how meals were occurring), few differences were found in associations with dietary and psychosocial outcomes, but differences were apparent for child BMIz, which suggests that phrasing of family dinner frequency measures can influence associations found with weight outcomes.

Fundamental constructs in food parenting practices: a content map to guide future research

Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.

The Family-Home Nutrition Environment and Dietary Intake in Rural Children

Obesity and food insecurity rates are higher among rural compared to non-rural populations. Little is known, however, about how family-home environments influence childhood obesity-related behaviors, particularly in rural settings. This study examined associations between the family-home nutrition (FN) environment, food insecurity, and dietary intake (fruits, vegetables, whole grains, dairy, protein foods, and added sugars) in rural elementary school-age children (grades K-5/6; n = 102). Parents/caregivers completed surveys on FN, food insecurity, and the Block Kids Food Screener (BKFS). Body mass index (BMI, kg/m2) was calculated from measured height and weight. Approximately 33% of children were classified as overweight/obese and 28% of families were at-risk for food insecurity. Multivariable linear regression analyses examined associations between dietary intakes with FN and food insecurity. More favorable FN scores were associated with lower added sugar intake (B = -1.38, p = 0.04) and higher vegetable (B = 0.15, p < 0.001), fruit (B = 0.71, p = 0.01), and dairy (B = 0.31, p < 0.001) intakes. No significant associations were found between food insecurity and dietary intake. Given the association between higher FN scores and more favorable dietary intake, promoting healthy FN environments among rural children is warranted.

Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework

OBJECTIVE

To systematically review the literature and map published studies on 4-8-year-olds' intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO).

DESIGN

Articles were identified through database searches (PubMed, PyscINFO®, Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences).

SETTING

Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1).

SUBJECTS

Children aged 4-8 years, or parents/other caregivers.

RESULTS

Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective.

CONCLUSIONS

The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children's excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.

Early Childhood Screen Time and Parental Attitudes Toward Child Television Viewing in a Low-Income Latino Population Attending the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Early childhood media exposure is associated with obesity and multiple adverse health conditions. The aims of this study were to assess parental attitudes toward childhood television (TV) viewing in a low-income population and examine the extent to which child BMI, child/parent demographics, and household media environment are associated with adherence to American Academy of Pediatrics (AAP) guidelines for screen time.

METHODS

This was a cross-sectional survey study of 314 parents of children ages 0-5 years surveyed in English or Spanish by self-administered questionnaire at a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinic in Oregon.

RESULTS

In this majority Latino sample (73%), half (53%) of the children met AAP guidelines on screen time limits, 56% met AAP guidelines for no TV in the child's bedroom, and 29% met both. Children were more likely to meet AAP guidelines when there were <2 TVs in the home, there was no TV during dinner, or their parents spent less time viewing electronic media. Parents who spent less time viewing electronic media were more likely to report believing that TV provides little value or usefulness.

CONCLUSIONS

In this low-income, predominantly Latino population attending WIC, parent media-viewing and household media environment are strongly associated with child screen time. Programs aimed at reducing child screen time may benefit from interventions that address parental viewing habits.

Relationship between family meal frequency and individual dietary intake among diabetic patients

Background

Notoriously, the island of Mauritius has one of the highest prevalence of diabetes in the world. Management of the disease is very important and family meals are undoubtedly beneficial to patients as they promote the development of healthy eating behaviours and food choices. This study has aimed to probe into potential relationship(s) between family meal frequency and individual dietary intake among diabetic patients and to establish whether family cohesion may be a plausible mediator of this relationship.

Methods

A cross-sectional survey was carried out with a random sample of 384 diabetic patients. The Family Adaptability and Cohesion Evaluation Scale III was used to obtain information on two general aspects of family functioning, that is, cohesiveness and adaptability. Chi-squared (χ²) tests, independent sample t-tests and one-way ANOVA were used to determine statistical significance. Pearson correlation was used to examine associations between family meal frequency, individual dietary intake and family cohesion. Hierarchical linear regression models were performed for the mediation analysis.

Results

Family meal frequency (breakfast, lunch and dinner) was observed to be positively associated with intake of fish, raw vegetables, dried and fresh fruits, low-fat milk, cheese, yogurt, nuts and light butter and negatively associated with intake of red meat, white rice, white bread, whole egg fried, chocolates, fried cakes, burgers, chips, and fried noodles/rice. Average mediation (52.6 %) was indicated by family cohesion for the association between family meal frequency and individual dietary intake among diabetic patients. Sobel’s test further confirmed the trend towards complete mediation (z = 15.4; P < 0.05).

Conclusions

A strong relationship between family meal frequency and individual dietary intake among diabetic patients was recorded. The present study is one of the few studies that have examined family cohesion as a mediator of the relationship and to our best knowledge is the first work to demonstrate a trend towards complete mediation. Results obtained can be used by health professionals to devise strategies for increasing knowledge and awareness of both diabetic patients and their respective families to curd down this public health burden.