Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods

Neighbourhood, school and home food environment associations with dietary behaviours in Hong Kong adolescents: the iHealth study

This study is the first to examine whether neighbourhood, school and home food environments were associated with dietary behaviours in Hong Kong adolescents; and whether off-campus lunch school policy, bringing lunch from home and parental rules for eating behaviours moderated the associations. We used data from the international Healthy environments and active living in teenagers - (Hong Kong) [iHealt(H)] study. Participants were healthy adolescents aged 11-18 years (N = 1299; Mage = 14.7 years; 57 % girls) and their parent/primary caregivers. Participants completed surveys with validated scales to assess dietary behaviours and perceived food environments. The Microscale Audit of Pedestrian Streetscapes and Geographic Information Systems data and software were used to objectively assess food environments. A higher number of bakeries, coffee shops, cafes and convenience stores in the neighbourhood was associated with higher consumption of vegetables and lower consumption of sugar-sweetened drinks in adolescents. Adolescents who frequently brought lunch from home to school consumed fatty foods and sugar-sweetened drinks less frequently and were more likely to eat fruits and vegetables. Greater availability of unhealthy food outlets at the school was associated with higher consumption of sugar-sweetened drinks, whereas more restaurants around the school was associated with higher consumption of fruits and vegetables. Home-made lunches and restrictive parental eating rules moderated the effects of food environments on adolescents' dietary behaviours. All food environmental contexts were associated with Hong Kong adolescents' dietary behaviours; however, the home and school environment appeared to be the most influential and should be targeted in public health interventions.

Equalizing the Playing Field and Improving School Food Literacy Programs Through the Eyes of Teens: A Grounded Theory Analysis Using a Gender and Sport Participation Lens

Background: School food literacy programs (e.g., home economics) are an opportunity to improve the dietary habits of teens. However, the literature suggests that girls and athletes have better food literacy, and it is not clear how school programs contribute to this inequality. To address this, we explored how gender and sport influenced teens' perspectives of their school food literacy experiences and how they can be improved. Methods: Using semi-structured interviews and a Grounded Theory analysis, we generated a theoretical understanding of how to improve school food literacy programs for athletes and non-athletes of diverse genders. Thirty-three teens were recruited to balance sport participation (n = 18 athletes) and gender (n = 15 boys; n = 14 girls; n = 4 non-binary) based on data saturation. Results: Teens expressed four categories to improve school programs that aligned with principles of the Capability, Opportunity, Motivation and Behaviours (COM-B) Model of behaviour change. Programs should Provide a challenge (e.g., more advanced recipes), Make it fun (e.g., explore new cuisines in interactive ways) and Establish importance (e.g., health impacts). Practice is key for teens' self-confidence and development of food skills (e.g., meal planning) as well. Boys emphasized Make it fun whereas girls and non-binary teens emphasized Establishing importance. Athletes valued Practice is key more than non-athletes. Conclusions: School programs should relay the importance of food literacy in fun and tailored ways to teens (e.g., meal planning among athletes). It may be especially salient for programs to tailor their activities and messaging, where possible, to appeal to diverse teens who play sports and those who do not.

Promoting healthful and diverse eating behaviours through an extracurricular culinary skills intervention in Philadelphia

In the current study we evaluated an afterschool nutrition education programme, called Vetri Cooking Lab (VCL), for promoting healthy and diverse eating habits among at-risk children in the Greater Philadelphia area. To understand potential programme impacts, we conducted a longitudinal analysis of survey data collected before and after participation in VCL. Main study included cooking confidence, cooking knowledge, changes in dietary consumption behaviours, and changes in vegetable preferences. Participants included students in grades 3-11 enrolled in VCL during the 2018-19 school year at VCL sites (n = 60) throughout Philadelphia, PA, and Camden, NJ. Eligible participants completed surveys both before and after participating in the programme. We found that students' confidence and knowledge increased (P < 0.001) after the cooking intervention. Knowledge and confidence were positively associated (r = 0.55; P < 0.001). Confidence was correlated with consumption behaviour changes (r = 0.18; P = 0.022). Confidence was positively associated with consumption changes in both our adjusted (OR = 1.81; P < 0.001) and unadjusted models (aOR = 1.88; P = 0.013). Compared to Black students, White students were more likely to report consumption changes (aOR = 5.83; P = 0.013). Hispanic/Latino participants and participants who spoke Spanish had nearly three times higher odds of consumption behaviour changes (Hispanic/Latino OR = 2.55; P = 0.007; Spanish OR = 3.04; P = 0.005). Student age and gender were not associated with behaviour changes. Our research demonstrates that programmes integrating practical cooking skills education along with nutrition, food, and cooking education can improve confidence and knowledge about healthy food choices amongst children driving an overall improvement in children's eating habits.

The Influence of the Home Food Environment on the Eating Behaviors, Family Meals, and Academic Achievement of Adolescents in Schools in the UAE

The eating behavior (EB) and habits developed during adolescence tend to persist into adulthood, with parents and caregivers playing a significant role in shaping their children's food choices. The home environment is a crucial setting for developing eating behavior during adolescence. This study aimed to explore the influence of the home food environment (HFE) and its correlates on EB, family meals (FMs), and academic achievement among adolescents in schools in the United Arab Emirates (UAE). A cross-sectional study was conducted with 304 school-aged adolescents from the UAE. The questionnaire included sociodemographic data, dietary habits, information related to the HFE (food availability and accessibility), physical activity, sleep patterns, and academic achievement. Several questionnaire items were combined to create an HFE score. These questions included the frequency of weekly family meals, meal preparation practices, and accessibility to healthy and unhealthy food products and snacks at home. The HFE score was dichotomized into favorable and unfavorable HFE scores. Similarly, EB and FM scores were generated by combining responses to various related questions. The participants' weights and heights were measured. The findings reported that more than half (55%) of the adolescents were either overweight or obese. The majority of the participants had favorable HFE (57.2%), EB (69.1%), and FM scores (58.2%). The significant correlates to the HFE were as follows: male participants whose parents attended college (OR: 0.31; 95% CI: 0.15-0.62; p < 0.001), high academic achievers (OR: 1.98; 95% CI: 1.02-3.82; p = 0.043), and those who were physically active (OR: 1.80; 95% CI: 1.14-2.85; p = 0.012), were more likely to have favorable HFE. Moreover, the HFE score showed a highly significant positive correlation with the EB score (r = 0.573, p < 0.001) and the FM score (r = 0.384, p < 0.001). These results underscore the critical role of a healthy HFE in shaping healthy positive eating behaviors and food choices among adolescents. They provide a foundation for developing effective, evidence-based policies that can impact the health and academic success of adolescents in the UAE.

Promoting healthful food purchases through in-store interventions: Empirical evidence from rural food deserts

Effective ways to promote healthful food intake in rural areas are understudied. The paper evaluated whether a two-component, in-store intervention designed to encourage healthy food purchases was associated with improved healthfulness scores of food items purchased by shoppers in rural food deserts. One component introduced a point-of-sales label that assigned a single numerical score to each food item facilitating direct comparisons of the product's nutrition with those of other products shelved around it. The other component was a one-day nutrition education workshop promoted within the store. Interventions took place in 2015 at two stores in rural counties in the U.S. Midwest. Four stores in similar communities were selected as the control group. We applied a difference-in-difference model to estimate changes in the healthfulness of food items purchased attributable to the intervention among shoppers at the treatment stores (n = 486) and control stores (n = 10,759) using store transaction data. Healthfulness of food items was measured in terms of food scores published by the Environmental Working Group on a 1-10 scale. Both components had minimal impacts on the scores, although 0.2 and 0.1 points increases in the score per item and score per dollar were statistically significant at the 1% level respectively. A year after the intervention, these small effects of the intervention further diminished compared to the immediately after implementation. Results suggest the average effects of intervention across the study communities had limited practical significance but benefited some rural residents who were exposed to the intervention.

School-based intervention impacts availability of vegetables and beverages in participants' homes

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.

Snacking practices from infancy to adolescence: parental perspectives from longitudinal lived experience research in England

Consumption of snacks and ultra-processed foods (UPF) high in fat, salt and sugar (HFSS) is associated with rising rates of obesity and growing socioeconomic disparities in nutrition. While infancy, childhood and adolescence are critical periods for development of dietary preferences, there remains a dearth of research exploring factors that underpin snacking behaviour over this time. This review aims to address this gap by drawing from qualitative lived experience research, with 122 families of different socioeconomic position (SEP), to explore how the (i) home food environment, (ii) food environment and (iii) social value and meanings of food shape parental provision of snacks. This review shows that snacking holds important meanings in everyday family life, with infants integrated into existing snacking practices from an early age. Price promotions, low-cost and long shelf-lives all make UPF and HFSS snacks an appealing option for many low-SEP parents; while children's requests and preferences for HFSS snacks present a challenge across SEP. However, higher-SEP parents can ensure fresh fruits are always available as an alternative snack, while fruit is described as a financially risky expenditure for low-SEP families. The present findings also indicate that retailers and producers are increasingly promoting 'healthier' snacks through product packaging and marketing, such as 'meets one of your five a day', despite these products displaying similar nutritional profiles to traditional UPF and HFSS snacks. We outline a series of policy recommendations, including extending Healthy Start Vouchers and the Fruit and Vegetable Scheme in schools and action to address misleading product marketing and packaging.

Evidence of familial resemblance and family-based heritability of food intakes derived from a longitudinal cohort study

We sought to investigate the familial aggregation and family-based heritability of dietary intakes among adults in a population-based longitudinal study of the Tehran Lipid and Glucose Study (TLSG). Total of 4359 males and 5439 females entered our study. We categorized foods into main groups based on the literature on main food groups and their subgroups among the Iranian dietary habits and food culture as follows: grains, fruits, vegetables, dairy, meats, legume, nuts, beverages, snacks, and fats. The intraclass correlation coefficients (ICC) are estimated to verify familial resemblance of dietary habits for all relative pairs and spouses. Family-based heritability is obtained using a mixed effect framework with likelihood-based approach. For almost all food groups, the correlation between parents and offsprings tended to be larger than those of siblings. Family-based heritability of food groups varies from the lowest 6.36% for snacks to the highest 25.67% for fruits, and 25.66% for legume. Our findings indicated weak-to-moderate similarities between parents' and offspring's food intakes; however, the similarity in parent-child food intakes was different, and the correlation in mother-daughter food intakes was stronger than other parent-child correlations, and almost all of dietary components showed strong family-based heritability.

Is Adolescents' Free Sugar Intake Associated with the Free Sugar Intake of Their Parents?

High free sugar intake can lead to increased dental caries, obesity, and other health risks among adolescents. Studies have shown that family factors, especially parents, are one of the primary factors influencing adolescents' sugar intake. This study aims to investigate the influence of adolescent parents' free sugar intake, knowledge, attitude, and practice (KAP) on adolescents' free sugar intake. A total of 1090 pairs of adolescents and their parents from 10 secondary schools in Changsha were enrolled in a cross-sectional study. Free sugar intakes of parents and adolescents were measured using the food frequency questionnaire (FFQ). The current status of parents' knowledge, attitude, and practice in consuming free sugar was investigated using online and offline questionnaires. Parental free sugar intake was 11.55 (5.08, 21.95) g/d, and that of adolescents was 41.13 (19.06, 80.58) g/d. Parental free sugar intake, free sugar knowledge level, intake behavior, and guidance behavior were associated with adolescent free sugar intake. A superior level of parental free sugar knowledge (adjusted OR = 0.726, 95% CI: 0.557~0.946) was a protective factor for adolescent free sugar intake. Moderate and high levels of parental free sugar intake (adjusted OR = 1.706, 95% CI: 1.212~2.401; adjusted OR = 2.372, 95% CI: 1.492~3.773, respectively) were risk factors for free sugar intake in adolescents. Given the importance of parental influence on the adolescent free sugar intake, further limiting parental intake and increasing awareness of free sugars could play an active role in future interventions for adolescents' free sugar intake.

More-To-Less Home Healthful Foods Ratio is Associated With Diet Quality in Preadolescents With Elevated Body Mass Index

OBJECTIVE

To examine home food availability (HFA) and the association with diet quality in preadolescents with elevated body mass index.

METHODS

A cross-sectional analysis examined HFA and diet quality (using the 2015-Health Eating Index [HEI] derived from 1 or 2 24-hour dietary recalls) among preadolescents (n = 111; aged 8-12 years; body mass index ≥ 75th percentile). A novel ratio of more-to-less healthful items was created to represent HFA. Multivariate linear regression models examined the HFA ratio and individual food and beverage groups as correlates of HEI.

RESULTS

The HFA ratio was associated with higher HEI (β = 5.3 [1.3]; P &lt; 0.001). Home food availability of sweets (β = -2.6 [0.9]; P = 0.003) and sugar-sweetened beverages (β = -2.3 [1.0]; P = 0.02) were associated with lower HEI. Home food availability of fruits was associated with higher HEI (β = 1.3 [0.7]; P = 0.05).

CONCLUSIONS AND IMPLICATIONS

Structuring the HFA so that more healthful choices are available relative to less healthful foods could be an effective approach for improving diet quality in preadolescents at risk for obesity.

Impact of COVID-19 on food waste behaviour of families: Results from household waste composition audits

OBJECTIVE

The COVID-19 pandemic changed consumers' purchasing and cooking behaviours, which may have resulted in changes in food waste. This study aimed to assess the impact of COVID-19 on household food waste, as well as on purchasing, cooking, and food waste-related perceptions and behaviours among 19 households in Guelph, ON, Canada.

METHODS

Four-week food waste audits and online surveys were conducted in February-March 2020 (pre-COVID-19) and in July-August 2020 (post-COVID-19). Qualitative interviews were also conducted post-COVID-19 to explore participants' perceptions of household food changes due to COVID-19. Food waste results were analyzed using paired t-test, while survey results pre- and post-COVID-19 were analyzed using the Wilcoxon signed-rank test.

RESULTS

While per capita food waste did not significantly change (mean^pre = 1.076 kg per week, mean^post = 1.080 kg per week), total per capita unavoidable food waste (mean^pre = 0.388 kg per week, mean^post = 0.614 kg per week) and pre capita unavoidable fruit and vegetable (mean^pre = 0.289 kg per week, mean^post = 0.427 kg per week) waste significantly increased (p < 0.01) at post-COVID-19. Total per capita avoidable other waste decreased (mean^pre = 0.385 kg per week, mean^post = 0.179 kg per week, p < 0.05). The increase in unavoidable food waste may relate to households cooking more often at home, as reported in interviews, or shopping less frequently and buying more per trip, as identified in the surveys. The decrease in avoidable food waste could be related to the increase in serving of leftovers (p < 0.01), as identified in the surveys, or an increase in meal planning and inventory management, as reported in interviews.

CONCLUSION

Future studies should investigate whether food waste-related changes in behaviour remain after the pandemic as well as any factors associated with maintaining of these behaviours. Interventions may be an opportunity to help households maintain these changes.

Inadequate intake of vitamins and minerals among high-school pupils in the Moroccan Rif region

BACKGROUND: Inadequate nutrient intakes in adolescents may negatively affect their future health. The identification of inadequate micronutrient intakes by dietary study provides essential information to guide educational strategies for promoting healthy eating habits. OBJECTIVE: To assess the daily micronutrient intake and the prevalence of inadequacy in a sample of middle and high-school pupils in the Rif region of Morocco. METHODS: A cross-sectional study collected dietary information from food records over three non-consecutive days in a sample (n = 302) of Moroccan Riffian adolescents (12–18 years). The DIAL software, adapted for commonly eaten Moroccan foods, was used to estimate micronutrient intakes. The proportion of individuals with intakes below the Estimated Average Requirement (EAR) or the Adequate Intake (AI) level and the probability approach were used to estimate the prevalence of inadequacy. RESULTS: Regardless of gender and age group, our subjects were found to be particularly at risk of inadequate intakes of vitamins E and D, calcium and potassium. Older adolescents (14–18 years) also showed a risk of inadequate intake of folate, biotin, magnesium, iodine and zinc (among boys). CONCLUSION: For many nutrients, the daily diets of our Riffian adolescents do not meet the recommended intake levels. We emphasize the need for monitoring the dietary habits of adolescents and the development of nutrition education programs. Further studies which include the clinical and biological assessment of nutritional status, as well as the regular collection of quality and nationally representative micronutrient data, are recommended.

Changes to the home food environment and parent feeding practices during the COVID-19 pandemic: A qualitative exploration

The COVID-19 pandemic brought about many changes that potentially altered the home food environment, which has been associated with child eating patterns and dietary intake. There is also some evidence that changes due to the COVID-19 pandemic are associated with health behaviors in children, such as an increased intake of high-calorie snack food. The current study aimed to more deeply understand how the COVID-19 pandemic affected the home food environment of meal and snack time routines and parent feeding practices within families of young children. Data for this study are taken from the Kids EAT! Study, a racially/ethnically diverse cohort of families with 2-5 year old children. Qualitative interviews were conducted by phone and video conference with mothers (n = 25) during August/September 2020 and were coded using a hybrid deductive/inductive analysis approach. This allowed coders to identify themes using the interview questions as an organizational template (deductive) while also allowing unique themes to emerge from the qualitative data (inductive). Three overarching themes emerged with multiple sub-themes: 1) Mothers were more directive in the types of food and amounts of food eaten by children; 2) Mothers had less rules around mealtimes; 3) Mothers had increased meal responsibilities. When faced with a change in a structured schedule and increased stress-such as occurred with the COVID-19 pandemic, parents may benefit from advice on how to manage parent feeding practices, including tips on appropriate limit setting, establishing a schedule and routines, and improving accessibility of healthful snacks. Lessons learned during the COVID-19 pandemic may have relevance to other time periods when families face disruptions to routine and during other times of transition.

The Home Environment Interview and associations with energy balance behaviours and body weight in school-aged children - a feasibility, reliability, and validity study

BACKGROUND

The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight.

METHODS

Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7-14 days after the initial interview, to establish test-retest reliability.

RESULTS

Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26-0.61, p < 0.001), and vegetables (0.30; 0.18-0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08-2.69, p = 0.022), convenience foods (2.58; 1.64-4.05, p < 0.001), and fast foods (3.09; 1.90-5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40-0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS.

CONCLUSION

Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies.

Application of social cognitive theory in weight management: Time for a biological component?

Despite the utility of social cognitive theory for facilitating individual behavior changes needed for initial weight loss, this model has been less effective in facilitating adherence to recommended lifestyle changes required for sustainable weight-loss maintenance. One potential reason for the limited long-term effectiveness of lifestyle interventions guided by this model is that the model does not consider the important influence that biology can have on weight-relevant behaviors, during both weight loss and weight-loss maintenance, via sensations of hunger and satiety and changes in energy metabolism (expenditure and fat oxidation). We describe here a proposed revision to social cognitive theory that allows for biological factors to exist in reciprocal determinism with behavioral, environmental, and personal factors, with the goal of creating a theoretical basis for lifestyle interventions with greater personalization in order to facilitate better long-term adherence and improve weight-loss maintenance.

Differences in reporting food insecurity and factors associated with differences among Latino fathers and mothers

BACKGROUND

Food security status has been assessed as a representative score for households; however, different members in the same household may perceive and report food insecurity differently. A high prevalence of food insecurity has been reported among Latino households, therefore understanding differences in reporting food insecurity by Latino father-mother dyads may improve accuracy of assessment and plans to address food insecurity. This study aimed to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food security status among Latino father-mother dyads, and 2) identify factors associated with discordance in perceptions of food insecurity between dyads.

METHODS

Baseline data were used from a community-based, youth obesity prevention program among Latino families (n = 106 father-mother dyads). Food security was assessed with a 2-item food insecurity screen. Logistic regression models were used to evaluate associations between reporting food security status and predictor variables for fathers, mothers, and dyad-discordant responses.

RESULTS

Food insecurity was reported by 39% of fathers and 55% of mothers. Adjusted odds of reporting food insecurity were significantly higher for fathers perceiving their neighborhood was unsafe vs. safe (OR: 3.7, p < 0.05) and reporting lower vs. higher household income (OR: 3.2, p < 0.05). Adjusted odds of reporting food insecurity were significantly higher for mothers perceiving their neighborhood was unsafe vs. safe (OR: 4.1, p < 0.01) and reporting lower vs. higher home availability of fruit and vegetable (OR: 5.5, p < 0.01). Dyad discordance in reporting food security status occurred in 24% of the dyads. Adjusted odds of dyad discordant reports of food insecurity status were significantly higher for dyads reporting discordant responses regarding previous nutrition education (OR: 3.4, p < 0.05) and higher home fruit and vegetable accessibility (OR: 3.1, p < 0.05) compared to dyads reporting concordant responses. Among the 28 dyads who reported discordant nutrition education participation, 21 reported that fathers had never participated but mothers had participated more than once.

CONCLUSIONS

Differential factors were associated with reporting food security among Latino father-mother dyads. Nutrition education for fathers that improves awareness of home food supplies and a better understanding of how food accessibility influences maternal perceptions may improve dyad discordance in reporting household food security.

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

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

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.

Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices

There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSIONS

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

The Mediator and/or Moderator Role of Complexity of Knowledge about Healthy Eating and Self-Regulated Behavior on the Relation between Family's Income and Children's Obesity

Childhood obesity rates have been increasing over the years and is considered one of the most serious public health problems of the century. Low socioeconomic status has been associated with a higher body mass index. However, the pathways underlying this complex relationship are poorly understood. This study aimed to evaluate the possible mediation and/or moderation effects of complexity of knowledge about healthy eating, and self-regulation processes towards healthy eating, in the association between family's income and weight of elementary school age children. The results showed that complexity of knowledge does not mediate the relationship between socioeconomic status and weight. Still, whenever the levels of complexity of knowledge and self-regulation are high, there is a moderation effect of complexity of knowledge on the relationship between family's income and weight, conditioned by self-regulation scores. These promising findings support the idea that knowledge about healthy eating in isolation could be insufficient for practicing a healthy diet and underline the relevance of combining transmission of knowledge with training in specific competences (e.g., self-regulation strategies). Considering that complexity of knowledge about healthy eating and self-regulation strategies are interrelated and can be both improved, future preventive interventions could consider incorporating both in their design to mitigate childhood obesity.

Increased Prevalence of Psychosocial, Behavioral, and Socio-Environmental Risk Factors among Overweight and Obese Youths in Mexico and the United States

The aim of this study was to examine various psychosocial, behavioral, and socio-environmental factors in a multiethnic sample of healthy-weight, overweight, and obese youths in the United States (US) and Mexico and determine differences by sex. We conducted a cross-sectional analysis of 633 youths aged 11-18 years who completed a self-reported questionnaire. Height and weight were measured to determine body mass index (BMI). Overweight and obese youth in both countries were significantly more likely to report a higher body image dissatisfaction (Odds Ratio (OR) = 1.67 and OR= 2.95, respectively), depressive symptoms (OR = 1.08 and OR = 1.12, respectively), perceive themselves as overweight (OR = 2.57) or obese (OR = 5.30), and a lower weight-specific quality of life (OR = 0.97 and OR = 0.95, respectively) than healthy-weight youth. Obese youth have lower healthy lifestyle priorities (OR = 0.75) and are less likely to be physically active (OR = 0.79) and eat breakfast (OR = 0.47) than healthy-weight youth. Additionally, overweight and obese youth are more likely to engage in weight control behaviors (OR = 5.19 and OR = 8.88, respectively) and restrained eating than healthy-weight youth. All the aforementioned results had a p-value of <0.05, which was considered statistically significant. The association between these factors and overweight or obesity remained significant after controlling for age, sex, race/ethnicity, and country. In conclusion, obesity was associated with a range of psychosocial, behavioral, and socio-environmental risk factors in both countries. Our findings support the need for multifactorial approaches when developing interventions to address the growing problem of obesity among youth in the US and Mexico.

Interventions Aimed at Increasing Dairy and/or Calcium Consumption of Preschool-Aged Children: A Systematic Literature Review

Dairy product consumption is important during childhood, as dairy products provide nutrients to support growth and development. However, a high proportion of children globally are not meeting recommended daily intakes, which may have long-term health implications. Accumulating evidence suggests that interventions aimed at instilling healthy lifestyle habits are most effective when initiated during the preschool years. Therefore, the purpose of the review was to identify the characteristics of effective dairy and/or calcium interventions targeting preschool-aged children. A systematic literature review identified 14 intervention studies published between 1998⁻2018 addressing dairy/calcium intakes in the preschool population (1.5 to 5 years). Intervention reporting was assessed using intervention intensity, behavior change techniques and Workgroup for Intervention Development and Evaluation Research (WIDER), with the quality of studies evaluated using risk of bias and Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Five of the 14 studies included in the review reported significant improvements in children's dairy (4/5) or calcium (1/5) intake. Characteristics that may enable intervention effectiveness include the delivery of interventions in one setting (preschool facility), using specific behavior change techniques (environmental restructuring and teach to use prompts/cues), and targeting both parent and child. Overall, the interventions assessed demonstrated variable success and highlighted the need for developing effective interventions designed to increase dairy and/or calcium intakes in preschool-aged children.

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.

Parent and household influences on calcium intake among early adolescents

BACKGROUND

Calcium intake during early adolescence falls short of requirements for maximum bone accretion. Parents and the home food environment potentially influence children's calcium intakes. This study aimed to quantify parental psychosocial factors (PSF) predicting calcium intakes of Asian, Hispanic, and non-Hispanic white (NHW) early adolescent children from a parental perspective.

METHODS

This was a cross-sectional study involving the administration of a validated calcium-specific food frequency questionnaire to a convenience sample of children aged 10-13 years and the primary individual responsible for food acquisition in the child's household. Based on Social Cognitive Theory, parental factors potentially associated with children's calcium intake were also assessed via parent questionnaires. The total study sample consisted of 633 parent-child pairs (Asian = 110, Hispanic = 239, NHW = 284). Questionnaires were completed at community-based centers/sites. Outcome measures were the association between parent-child calcium (mg), milk (cups/day), and soda (cans/day) intakes and the predictive value of significant parental PSF towards calcium intakes of their children. Sex-adjusted linear regression and multivariate analyses were performed.

RESULTS

Calcium intakes of parent-child pairs were positively associated among all ethnic groups (r = 0.296; P < 0.001). Soda intakes were positively associated among Hispanic parent-child pairs only (r = 0.343; P < 0.001). Home availability of calcium-rich foods (CRF), parental rules and expectations for their child's intake of beverages, and parents' calcium intake/role modeling were positively associated with children's calcium intake and overwhelmed all other PSF in multivariate analyses. Significant cultural differences were observed. Parental role modeling was a significant factor among Hispanic dyads only. Multivariate models explained 19-21% of the variance in children's calcium intakes.

CONCLUSIONS

Nutrition interventions to improve children's calcium intakes should focus on parents and provide guidance on improving home availability of CRF and increasing rules and expectations for the consumption of CRF. Among Hispanic families, interventions promoting parental modeling of desired dietary behaviors may be most successful.

Diet Quality through Adolescence and Early Adulthood: Cross-Sectional Associations of the Dietary Approaches to Stop Hypertension Diet Index and Component Food Groups with Age

Late adolescence to early adulthood is the period of life when prevalence of overweight and obesity rises the fastest, and an important time to understand changes in dietary risk factors. In this study we assess the variation in diet quality through analysis of cross-sectional data from 2957 individuals aged 13 to 30 from the National Diet and Nutrition Study (2008–2016). Diet data were self-reported using four-day food diaries and coded to give diet quality using the dietary approaches to stop hypertension (DASH) index (range 0–80) and DASH component food groups (grams/day). The mean DASH index score was low at 34.8 (95% confidence interval (CI) = 34.3–35.4). The regression of diet quality score and food groups on age categories revealed no significant change in diet quality score with age category in males, but an improved diet quality score among females aged 19–21 (β = 2.04, 95% CI = 0.05–4.02), 25–27 (β = 3.77, 95% CI = 1.36–6.18) and 28–30 (β = 2.39, 95% CI = 0.53–4.26), compared to age 13–15. Both sexes showed increased vegetable intake with age. Dairy intake was lower in early adult ages among males, while in females there was an increase in the proportion of low-fat dairy consumed with age. Further research should address the determinants of changes in diet in early adulthood to provide evidence for the targeting of public health policy.

Changes in diet through adolescence and early adulthood: longitudinal trajectories and association with key life transitions

BACKGROUND

Early adulthood is a period associated with poor diet and rapid weight gain. This is also an age of transition, including environmental, social and lifestyle changes which may be associated with changes in diet. We assess longitudinal associations between four early adulthood life transitions (leaving home, leaving education, entering employment, and cohabitation) and changes in consumption of fruit, vegetables, confectionery and sugar-sweetened beverages (SSBs).

METHODS

Participants (n = 1100) from the Norwegian Longitudinal Health Behaviour Study, reported data on diet and life transitions on up to eight occasions from age 14 to age 30. Diet data were self-reported in response to questions on intake of fruit, vegetables, confectionery and sugar-sweetened beverages. Growth models were developed to describe changing intake of each of the four diet indicators with age. Fixed-effects regression models assessed associations between the four life transitions and within-individual changes in diet indicators, with adjustment for the remaining transitions and parenthood.

RESULTS

Diet indicators showed quadratic trajectories with age: fruit and vegetable intakes declined from age 14 to ages 23 and 21 respectively, before increasing to age 30. SSB and confectionery intakes increased to age 18, before subsequently decreasing. Leaving the parental home was associated with a decrease in fruit intake of - 0.54 times/week (95% confidence interval (95%CI): -0.87;-0.22) and vegetable intake of - 0.43 times/week (95%CI: -0.70;-0.15). Leaving education was associated with increases in confectionery (0.33 times/week (95%CI: 0.04;0.62)) and SSB intakes (0.49 times/week (95%CI: 0.10;0.87).

CONCLUSIONS

Leaving home and leaving education are associated with negative changes in diet and may present opportunities for effective diet and obesity intervention. Further study of these transitions is needed to understand the mechanisms mediating associations between life transitions and changes in diet.

Project SWEAT (Summer Weight and Environmental Assessment Trial): study protocol of an observational study using a multistate, prospective design that examines the weight gain trajectory among a racially and ethnically diverse convenience sample of economically disadvantaged school-age children

INTRODUCTION

Racial/ethnic minority school-age children are at risk for unhealthy weight gain during the summer, and there is a dearth of information regarding the underlying behavioural and environmental factors. The study objective is to provide an in-depth examination of dietary and physical activity behaviours and food, physical activity, and social environments of African American and Hispanic school-age children during the summer.

METHODS AND ANALYSIS

An observational study will be conducted using a multistate (Ohio and Indiana, USA) prospective design examining the weight gain trajectory among a racially/ethnically diverse convenience sample of economically disadvantaged school-age children. In addition, a subset of these children will be evaluated to learn their daily health behaviours and food, physical activity, and social environments during the summer. Comparisons will be made between children who routinely attend programming and those who do not, both in the larger sample and subset. Determinants of programme participation and factors that may enhance the beneficial effects of programme participation will also be identified. Data collection at the Indiana site is planned for summer 2018.

ETHICS AND DISSEMINATION

This study is approved by The Ohio State University Behavioral and Social Sciences Institutional Review Board. Results from this study will be disseminated in publications for practitioners, scientists and stakeholders.

TRIAL REGISTRATION NUMBER

NCT03010644; Pre-results.

Adherence to Canada's Food Guide recommendations among Alberta's multi-ethnic youths is a major concern: findings from the WHY ACT NOW project

BACKGROUND

Dietary habits formed during youth may result in the development of obesity and chronic diseases in adulthood. We aimed to determine the frequency of the consumption of foods and beverages and the degree of adherence to Canada's Food Guide recommendations among multi-ethnic youths.

METHODS

Participants were recruited from 12 schools in the Edmonton, Alberta area by use of posters, school newsletters and advertisements. A 30-item food frequency questionnaire was administered by a trained interviewer to assess dietary intake in a convenience sample of 557 (328 females and 229 males) youths aged 11-23 years; for the purpose of the present study, only the 14-18 years age group was considered in the analysis. Participants were divided by sex and self-identified ethnicity into four groups [Indigenous, African & Middle Eastern (AME), Asian, and European]. Statistical analysis of the data was undertaken using t-tests, Welch's analysis of variance and Games-Howell tests. P < 0.05 was considered statistically significant.

RESULTS

Vegetables and Fruit recommendations were the least likely to be followed, with 90.7-96.8% of participants in all groups not consuming the recommended number of servings day^-1 . The mean frequency of fruit consumption was lower among Indigenous youths compared to Asian youths (0.90 versus 1.37 times day^-1 ). A greater proportion of males than females (55.9% versus 44.3%) did not meet the minimum recommendations for Meat and Alternatives (P = 0.016). The percentage of youths not adhering to recommendations for Milk and Alternatives was 81.7% for Indigenous, 73.3% for AME, 78.6% for Asian and 63.5% for European youths. Indigenous youths more frequently consumed potato chips and soft drinks compared to other ethnic youths. The most frequently consumed beverage was milk (1.25 times day^-1 ).

CONCLUSIONS

The majority of youths did not consume minimum daily recommended servings of Vegetables and Fruit, Milk and Alternatives, and/or Meat and Alternatives food groups. Evidence-based dietary interventions and public health strategies are needed.

Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality

PURPOSE

To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents.

METHODS

In 2081 adolescents (12.5-17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country.

RESULTS

The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23-64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17-44% of the total effect).

CONCLUSION

Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.

Access to Street Markets and Consumption of Fruits and Vegetables by Adolescents Living in São Paulo, Brazil

Food environment and income act as determinants of diet, and consequently, of the consumption of fruits and vegetables. The objective of this study is to investigate the association between fruit and vegetable consumption, income, and street market density in adolescents living in São Paulo, Brazil. Data from 521 adolescents (12 to 19 years) participating in the 2015 Health Survey of São Paulo were used. Buffers (500, 1000, and 1500 m) were drawn around the households and the street markets were counted in each zone. Multilevel logistic regression models were used to evaluate the association between fruit and vegetable consumption, income, and street market density. The main results showed that the presence of a street market in the zone closest to the households (500 m) was associated with higher consumption of fruits and vegetables (OR: 1.73; CI 95% 1.01-3.00). Higher family income was associated with a higher consumption of fruits and vegetables for models of 500 m buffer (OR: 2.56; CI 95% 1.47-4.45), 1000 m (OR: 2.30; CI 95% 1.33-3.96), and 1500 m (OR: 2.32; CI 95% 1.35-4.00). These results support the implementation of public policies that jointly consider income and the availability of street markets or healthy food environments.

How family socioeconomic status, peer behaviors, and school-based intervention on healthy habits influence adolescent eating behaviors

Psychologists in schools can play an important role in developing policies and programs to promote healthy eating habits. This study analyses the contributions of family socioeconomic status, peer influence (schoolmates’ food consumption), and school-based nutrition interventions to explain adolescent eating behaviors. Data were obtained from the 2014 Health behaviour in school-aged children survey in Spain, with a sample of 6,851 adolescents (11- to 16-years-old). The results suggest that school-based healthy-eating programs could improve by considering parental education level and by implementing interventions focused on the peer social network. Policies that limit access to unhealthy products in schools – rather than simply offering healthy foods alongside unhealthy products – could be more effective.

Indian adolescents' perceptions of the home food environment

Background

The home food environment has the potential to influence the eating behaviour of adolescents. This investigation aimed to understand Indian adolescents’ perspectives of their home food environments.

Methods

Adolescents aged 14–16 years (n = 1026, 65.3% girls) attending private secondary schools in Kolkata completed a paper-based questionnaire during school time which included questions about family food rules, availability and accessibility of foods at home, and domestic cooking responsibility. Boys’ and girls’ opinions and experiences were compared through cross-tabulation analyses.

Results

Almost all the adolescents reported that fruits (91.6%) and vegetables (95.7%) were always available in their homes. Approximately two-fifths reported that sugar-sweetened beverages (36.2%) and salty snack foods (38.0%) were readily available. In 56.1% households, adolescents were expected to follow certain food rules during mealtimes (e.g. not talking with my mouth full). The majority of the respondents (80.4%) identified mothers as the primary meal providers, only a minority reported that fathers (5.1%) were responsible for preparation of family meals.

Conclusion

This understanding of the family-environmental determinants of adolescent dietary habits provides useful directions for nutrition promotion interventions. Health and educational professionals associated with adolescents could communicate about the development of healthy home food environments to provide positive health benefits for adolescents and their families.

Understanding Family-Level Effects of Adult Chronic Disease Management Programs: Perceived Influences of Behavior Change on Adolescent Family Members' Health Behaviors Among Low-Income African Americans With Uncontrolled Hypertensions

Background: Despite improvements in cardiovascular disease (CVD) prevention and treatment, low-income African Americans experience disparities in CVD-related morbidity and mortality. Childhood obesity disparities and poor diet and physical activity behaviors contribute to CVD disparities throughout the life course. Given the potential for intergenerational transmission of CVD risk, it is important to determine whether adult disease management interventions could be modified to achieve family-level benefits and improve primary prevention among high-risk youth. Objective: To explore mechanisms by which African-American adults' (referred to as index patients) participation in a hypertension disease management trial influences adolescent family members' (referred to as adolescents) lifestyle behaviors. Design/Methods: The study recruited index patients from the Achieving blood pressure Control Together (ACT) study who reported living with an adolescent ages 12-17 years old. Index patients and adolescents were recruited for in-depth interviews and were asked about any family-level changes to diet and physical activity behaviors during or after participation in the ACT study. If family-level changes were described, index patients and adolescents were asked whether role modeling, changes in the home food environment, meal preparation, and family functioning contributed to these changes. These mechanisms were hypothesize to be important based on existing research suggesting that parental involvement in childhood obesity interventions influences child and adolescent weight status. Thematic content analysis of transcribed interviews identified both a priori and emergent themes. Results: Eleven index patients and their adolescents participated in in-depth interviews. Index patients and adolescents both described changes to the home food environment and meal preparation. Role modeling was salient to index patients, particularly regarding healthy eating behaviors. Changes in family functioning due to study participation were not endorsed by index patients or adolescents. Emergent themes included adolescent care-taking of index patients and varying perceptions by index patients of their influence on adolescents' health behaviors. Conclusions: Our findings suggest that disease management interventions directed at high-risk adult populations may influence adolescent family members' health behaviors. We find support for the hypotheses that role modeling and changes to the home food environment are mechanisms by which family-level health behavior change occurs. Adolescents' roles as caretakers for index patients emerged as another potential mechanism. Future research should explore these mechanisms and ways to leverage disease management to support both adult and adolescent health behavior change.

Do mothers affect daughter's behaviors? Diet, physical activity, and sedentary behaviors in Kuwaiti mother-daughter dyads

The objective of the study was to evaluate 169 Kuwaiti mother-daughter dyads and their associations with health behaviors for eating healthy, engaging in physical activity, daughters perceived body weight, time spent with computer/video, and time viewing television. Female students aged 10-14 years were selected from private and public schools in the State of Kuwait. Results demonstrated that daughters exhibited similar behaviors to their mothers in their perceived eating behavior, physical activity, computer/video game use, and TV screen time. Future research is essential to determine the role of mothers in effective health behavior intervention strategies for female Kuwaiti adolescents.

Food parenting and child snacking: a systematic review

Background

While the role of parenting in children’s eating behaviors has been studied extensively, less attention has been given to its potential association with children’s snacking habits. To address this gap, we conducted a systematic review to describe associations between food parenting and child snacking, or consuming energy dense foods/foods in between meals.

Methods

Six electronic databases were searched using standardized language to identify quantitative studies describing associations of general and feeding-specific parenting styles as well as food parenting practices with snacking behaviors of children aged 2–18 years. Eligible peer-reviewed journal articles published between 1980 and 2017 were included. Data were extracted using a standard protocol by three coders; all items were double coded to ensure consistency.

Results

Forty-seven studies met inclusion criteria. Few studies focused on general feeding (n = 3) or parenting styles (n = 10). Most studies focused on controlling food parenting practices (n = 39) that were not specific to snacking. Parental restriction of food was positively associated with child snack intake in 13/23 studies, while pressure to eat and monitoring yielded inconsistent results. Home availability of unhealthy foods was positively associated with snack intake in 10/11 studies. Findings related to positive parent behaviors (e.g. role modeling) were limited and yielded mixed results (n = 9). Snacking was often assessed using food frequency items and defined post-hoc based on nutritional characteristics (e.g. energy-dense, sugary foods, unhealthy, etc.). Timing was rarely included in the definition of a snack (i.e. chips eaten between meals vs. with lunch).

Conclusions

Restrictive feeding and home access to unhealthy foods were most consistently associated with snacking among young children. Research is needed to identify positive parenting behaviors around child snacking that may be used as targets for health promotion. Detailed definitions of snacking that address food type, context, and purpose are needed to advance findings within the field. We provide suggested standardized terminology for future research.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0593-9) contains supplementary material, which is available to authorized users.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.

Neighborhood and Individual Sociodemographic Characteristics Associated with Disparities in Adult Obesity and Perceptions of the Home Food Environment

Purpose: Multiple studies have demonstrated significant disparities in the relationship between individual sociodemographic characteristics and risk of overweight or obesity. However, little information is available for assessing the complex associations among being overweight or obese with neighborhood and individual sociodemographic factors and the measured and perceived community food environment. Methods: Using 2014 national evaluation data from 20 communities (analyzed 2015-2016) that participated in the U.S. Centers for Disease Control and Prevention Community Transformation Grants Program, we used multilevel multivariable models to assess associations among factors at the individual, census tract, and county levels with being overweight or obese and with the perceived home food environment. Results: Individual level factors (age, sex, race/ethnicity, household income, and education) were significantly associated with the likelihood of being overweight or obese in every model tested. Census tract level poverty and education were significantly associated with the likelihood of being overweight or obese in univariate but not multivariable analyses. Perceived community food environment was a significant predictor of the perceived home food environment; the objective measure of county-level grocery store access was not. Neither perceived nor objective community food environment measures were significantly associated with overweight/obesity in multivariable analyses. Conclusion: Individual-level sociodemographic characteristics are more strongly associated with obesity-related outcomes than are area-level measures. Future interventions designed to address health equity issues in obesity among underserved populations may benefit from focusing on nutrition education tailored to individuals, to encourage purchase and consumption of healthy food. Improving healthy food availability in underserved communities may also be critical for nutrition education to have a meaningful impact.

Beverage Intake among Children: Associations with Parent and Home-Related Factors

Beverage intake can influence child diet quality in a positive or negative manner depending on the beverage type and amounts consumed. Parenting practices such as role modeling and control of home beverage availability have been associated with child beverage intake, whereas examination of the influence of parental beverage nutrition knowledge has been more limited. The purpose of this study was to examine the relationships between sugar-sweetened and dairy beverage intake among children (9–12 years) and home and parental factors. A questionnaire was administered among a convenience sample of parents (n = 194) to assess beverage nutrition knowledge, beverage intake and home availability of beverages. Children completed a questionnaire to estimate usual beverage intake. Daily sugar-sweetened beverage intake by children ranged from 0.4 to 48 oz. Logistic regression analysis was used to examine relationships. Parents were mostly female, white, well educated, and employed. Home availability of sugar-sweetened and dairy beverages was positively associated with child sugar-sweetened (OR = 1.48, p = 0.03) and dairy beverage intake (OR = 1.34, p = 0.03), respectively. Parent dairy beverage intake was associated with child dairy beverage intake (OR = 1.06, p = 0.01). Parent knowledge about sugar in beverages was related to child dairy beverage intake (OR = 1.46, p = 0.02), whereas calcium/dairy knowledge and general beverage nutrition knowledge were not related to child beverage intake. Parenting practices and knowledge may play a role in determining child beverage intake.

Familial Resemblance in Dietary Intakes of Children, Adolescents, and Parents: Does Dietary Quality Play a Role?

Information on familial resemblance is important for the design of effective family-based interventions. We aimed to quantify familial correlations and estimate the proportion of variation attributable to genetic and shared environmental effects (i.e., familiality) for dietary intake variables and determine whether they vary by generation, sex, dietary quality, or by the age of the children. The study sample consisted of 1435 families (1007 mothers, 438 fathers, 1035 daughters, and 1080 sons) from the multi-center I.Family study. Dietary intake was assessed in parents and their 2–19 years old children using repeated 24-h dietary recalls, from which the usual energy and food intakes were estimated with the U.S. National Cancer Institute Method. Food items were categorized as healthy or unhealthy based on their sugar, fat, and fiber content. Interclass and intraclass correlations were calculated for relative pairs. Familiality was estimated using variance component methods. Parent–offspring (r = 0.11–0.33), sibling (r = 0.21–0.43), and spouse (r = 0.15–0.33) correlations were modest. Parent–offspring correlations were stronger for the intake of healthy (r = 0.33) than unhealthy (r = 0.10) foods. Familiality estimates were 61% (95% CI: 54–68%) for the intake of fruit and vegetables and the sum of healthy foods and only 30% (95% CI: 23–38%) for the sum of unhealthy foods. Familial factors explained a larger proportion of the variance in healthy food intake (71%; 95% CI: 62–81%) in younger children below the age of 11 than in older children equal or above the age of 11 (48%; 95% CI: 38–58%). Factors shared by family members such as genetics and/or the shared home environment play a stronger role in shaping children’s intake of healthy foods than unhealthy foods. This suggests that family-based interventions are likely to have greater effects when targeting healthy food choices and families with younger children, and that other sorts of intervention are needed to address the intake of unhealthy foods by children.

Barriers and Facilitators to Intake of Dairy Products in Adolescent Males and Females With Different Levels of Habitual Intake

Background: Dairy products and alternatives can contribute to overall good health including positive body composition and decreased adiposity; however, these foods are grossly underconsumed by youth, and worldwide, almost 25% of children are overweight or obese. Objective: The study investigated the barriers and facilitators toward dairy consumption by Grade 7 youth. Methods: Thirty 50-minute, audio-recorded focus groups were conducted with 134 students in eight Grade 7 classes across 5 elementary schools. Focus groups were led by trained facilitators in the elementary schools and participants were separated based on dairy consumption and gender. Recorded data were transcribed and thematically analyzed using qualitative analysis software to identify themes related to barriers and facilitators to dairy product intake by each gender. Results: Factors considered important by males and females across different levels of habitual intake include personal knowledge about dairy products and misconceptions regarding dairy foods and their associated health benefits; food characteristics, including taste; personal behaviors such as habits or routines including dairy products; social environments including parental and peer influence; physical environments factors such as availability and skipping meals; and the convenience of dairy products. Interestingly, only males noted sports as a positive influence for dairy product intake. Also, there were differences in the way males and females perceived dining out as affecting their dairy intake. Conclusion: Results suggest several potential factors that nutrition education interventions aiming to increase dairy consumption could target.

Hispanic Mothers' Views of the Fathers' Role in Promoting Healthy Behaviors at Home: Focus Group Findings

BACKGROUND

Overweight and obesity prevention interventions rarely take into account the unique role of fathers in promoting healthy home environments.

OBJECTIVE

To use qualitative methodology to examine the views of Hispanic mothers of children aged 2 to 5 years regarding fathers' roles in promoting healthy behaviors at home.

DESIGN

Nine focus groups were conducted in Spanish with Hispanic mothers of preschool-aged children (N=55) from October to December 2015.

PARTICIPANTS/SETTINGS

Hispanic mothers were recruited from churches, community agencies, and preschools located in five Zip codes in the southwest part of Oklahoma City, OK.

ANALYSIS

Questions examined the views of Hispanic mothers regarding fathers' roles in promoting healthy behaviors at home. Focus groups were audiorecorded, transcribed in Spanish, translated into English, and coded and analyzed for themes by two coders using NVivo version 10 software.

RESULTS

Four themes were identified: fathers' disagreement with mothers about food preferences and preparation, fathers' support for child's healthy eating, fathers' support for child's physical activity, and fathers' lack of support for a healthy home food environment. Fathers' traditional expectations about the type of foods and portion sizes adults should eat conflicted with mothers' meal preparations. Mothers reported that, although they favored eating low-calorie meals, the meals fathers preferred eating were high-calorie meals (eg, quesadillas). In general, fathers supported healthy eating and physical activity behaviors for their children. Supportive behaviors for children included preparing healthy meals, using healthier cooking methods, grocery shopping with their children for healthy foods, and asking the child to participate in household chores and/or play sports. Fathers' unsupportive behaviors included bringing high-calorie foods, such as pizza, and sugary drinks into the home, using sweets and savory foods for emotion regulation, and displaying an indulgent parental feeding style.

CONCLUSIONS

Mothers' views of fathers' perceived roles in child eating and physical activity, and maintaining a healthy eating environment, have important implications for the success of promoting healthy behaviors in the homes of Hispanic families.

Dietary Patterns of European Children and Their Parents in Association with Family Food Environment: Results from the I.Family Study

The aim of this study was to determine whether an association exists between children's  and  parental  dietary  patterns  (DP),  and  whether  the  number  of  shared  meals  or  soft  drink  availability  during  meals  strengthens  this  association.  In  2013/2014  the  I.Family  study  cross-sectionally assessed the dietary intakes of families from eight European countries using 24-h  dietary recalls. Usual energy and food intakes from six- to 16-year-old children and their parents  were estimated based on the NCI Method. A total of 1662 child-mother and 789 child-father dyads  were included; DP were derived using cluster analysis. We investigated the association between  children's and parental DP and whether the number of shared meals or soft drink availability  moderated this association using mixed effects logistic regression models. Three DP comparable in  children and parents were obtained: Sweet &amp; Fat, Refined Cereals, and Animal Products. Children  were more likely to be allocated to the Sweet &amp; Fat DP when their fathers were allocated to the  Sweet &amp; Fat DP and when they shared at least one meal per day (OR 3.18; 95% CI 1.84; 5.47). Being  allocated to the Sweet &amp; Fat DP increased when the mother or the father was allocated to the Sweet  &amp; Fat DP and when soft drinks were available (OR 2.78; 95% CI 1.80; 4.28 or OR 4.26; 95% CI 2.16;  8.41, respectively). Availability of soft drinks and negative parental role modeling are important  predictors of children's dietary patterns.

The Role of SNAP in Home Food Availability and Dietary Intake among WIC Participants Facing Unstable Housing

OBJECTIVE

Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e., Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing.

DESIGN AND SAMPLE

Cross-sectional study among vulnerable families. Low-income, multiethnic families with children participating in WIC (n = 54).

MEASURES

Dietary intake was assessed with 24-hr recalls. Home food availability was assessed with an adapted home food inventory for low-income, multiethnic families. Validation results from adapted home food inventory for these families are also reported.

RESULTS

SNAP households had more foods than non-SNAP households; few significant associations were observed between food availability and child dietary intake.

CONCLUSIONS

With few exceptions, the home food environment was not related to children's dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing.