Social-environmental influences on children's diets: results from focus groups with African-, Euro- and Mexican-American children and their parents

Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review

Background and Aims

One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY.

Methods/Literature Search Strategy

Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review.

Results

The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY.

Conclusion

The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.

Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study

BACKGROUND

While vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables.

METHODS

A total of 26 children (15 boys) aged 10-12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo.

RESULTS

Four major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks.

CONCLUSIONS

Children's inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children's vegetable consumption, particular focus on future research in this area is warranted.

TRIAL REGISTRATION

FEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).

Pythagorean Self-Awareness Intervention Promoted Healthy Dietary Patterns, Controlled Body Mass Index, and Reduced Self-Reported Stress Levels of Primary School Children: Α One-Arm Pilot Study

Stress is common in childhood and an important factor that affects behavior later in adulthood. The aim of this study was to assess the effects of the Pythagorean Self-Awareness Intervention (PSAI), a holistic "cognitive reconstruction" technique to assess primary school children's stress levels, adherence to the Mediterranean diet, and body mass index. Secondary outcome measures included relations with peers, sleep, and hair cortisol concentrations. This one-arm pilot study took place in a primary school, from February to June 2019. Participants were 32 pupils attending the second grade of primary school who received the 8-week PSAI to adopt healthy behaviors and lifestyle. Self-report measures were applied for the evaluation of various variables at the beginning and the end of the eight-week intervention. There were statistically significant reductions in stress levels (p = 0.00), nightmares' frequency (p = 0.00), body mass index (p = 0.03), and bully scale (p = 0.00), and improvement in Mediterranean diet quality (p = 0.00). Hair cortisol concentrations increased (p = 0.02). The social scale significantly increased. Bedtime remained the same after the intervention. This pilot trial showed that the PSAI promoted healthy dietary patterns, controlled children's body mass index, and reduced their self-reported stress levels. Further research on the implementation of this holistic program on children is suggested, in well-powered randomized controlled trials.

Examining Elementary School Children's Knowledge about Food and Nutrition in Southwestern Ontario, Canada

Purpose: Knowledge is fundamental to helping children make nutritional choices that support lifelong healthy behaviours. This study (i) investigates elementary school children's knowledge about food and nutrition and (ii) identifies sociodemographic factors influencing children's reported knowledge.Methods: In 2017-2019, a survey was administered to 2443 students (grades 5-8) at 60 schools across southwestern Ontario, Canada, and a parent survey was used to validate self-reported sociodemographics. Multiple regression was used to analyse children's knowledge scores and related sociodemographic factors. A total knowledge score was calculated by summing correct responses derived from 46 individual questions in the student survey.Results: Mean total knowledge score was 29.2 out of a possible 46 points (63.5% correct). Students demonstrated some knowledge and awareness of strategies to encourage fruit and vegetable consumption, healthy food selection, nutrition, and food preparation skills, although knowledge of food guide recommendations and locally sourced produce were limited. Female sex, family income, and rurality were associated with higher knowledge scores.Conclusions: Results provide insight regarding strengths and gaps in elementary-school children's food and nutrition knowledge. Poor performance of students on specific food guide-related questions suggests that the general guidance of the 2019 Canada's Food Guide might be better understood by children and adolescents.

How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies

Promoting healthy eating habits can prevent adolescent obesity in which family may play a significant role. This review synthesized findings from qualitative studies to identify family barriers and facilitators of adolescent healthy eating in terms of knowledge, attitudes, and practices (KAP). A literature search of four databases was completed on 31 July 2020; qualitative studies that explored family factors of adolescent (aged 10 to 19 years) eating habits were included. A total of 48 studies were identified, with the majority being from North America and sampled from a single source. Ten themes on how family influences adolescent dietary KAP were found: Knowledge—(1) parental education, (2) parenting style, and (3) family illness experience; Attitudes—(4) family health, (5) cultivation of preference, and (6) family motivation; Practices—(7) home meals and food availability, (8) time and cost, (9) parenting style, and (10) parental practical knowledge and attitudes. This review highlights five parental characteristics underlying food parenting practices which affect adolescents’ KAP on healthy eating. Adolescents with working parents and who are living in low-income families are more vulnerable to unhealthy eating. There is a need to explore cultural-specific family influences on adolescents’ KAP, especially regarding attitudes and food choices in Asian families.

Mothers' Perceptions and Attitudes towards Children's Vegetable Consumption-A Qualitative, Cross-cultural Study of Chilean, Chinese and American Mothers Living in Northern California

This exploratory research focused on the cultural variables involved in children’s vegetable consumption, through the analysis of mothers’ perceptions, attitudes, and feeding practices regarding their children’s intake, using qualitative consumer research methods. Twelve focus groups of mothers with children between 2–12 years old (Euro-Americans n = 20, Chinese n = 19, and Chilean n = 19) were conducted. All participants lived in Northern California, had higher education, and incomes that did not limit their vegetable purchase. Intercultural differences in vegetable preferences and consumption habits were found. Mothers across all groups agreed on the importance of children’s vegetable consumption, the influence that mothers have over their children’s vegetable intake, and how challenging it is to get children to eat a variety of vegetables. The ethnic groups differed regarding how they perceived the level of mothers’ responsibility over children’s vegetable intake, the way that mothers defined the amount of vegetables that children should eat, the constraints that mothers had on increasing their children’s vegetable intake and mothers’ recommendations to encourage vegetable consumption. Our study suggests that under similar socio-economic and parental education levels, culture-specific strategies should be considered to foster healthy dietary habits in children.

Associations between parental perception of- and concern about-child weight and use of specific food-related parenting practices

Little is known about the association between parental perception of their child's weight as well as parent's current and future concerns regarding their child's weight and a broad range of food-related parenting practices. This study used the first wave of cross-sectional data from the longitudinal Family Matters study to examine the relationships between parental perception of child weight status, parent concern for child's current and future weight and parent use of different types of food-related practices. Parent/child dyads (n = 150) were recruited from primary care clinics. Multiple regression models were fit to examine cross-sectional relationships between parental perception and concern for their child's weight and food-related parenting practices (food restriction, pressure-to-eat, food control, food monitoring, nutrition education, and parent modeling). Parents who perceived their child to be underweight had lower scores for food restriction than parents who perceived their child to be overweight. Parents who reported concern about their child's current weight reported higher scores for food restriction and monitoring than parents who were not currently concerned. Parents who reported concern about their child's future weight status reported higher scores for pressure-to-eat and monitoring than parents who were not at all concerned about their child's future weight status. The relationship between parental perception of child's current weight status and parent use of food restriction, pressure-to-eat, and overall food control was modified by child sex. Overall, results suggest that parent's perceptions of and concerns about their child's current and future weight status were correlated with their feeding approaches. Health care providers may want to consider providing anticipatory guidance for parents that have concerns about their child's weight by teaching them about positive, evidence-based ways they can engage in healthy food-related parenting practices.

Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: a randomised controlled trial

OBJECTIVE

Diet-related diseases are the leading cause of morbidity and mortality in the USA. While the critical aspects of a healthy diet are well known, the relationship between community-based, teaching kitchen education and dietary behaviours is unclear. We examined the effect of a novel culinary medicine education programme on Mediterranean diet adherence and food cost savings.

DESIGN

Families were randomised to a hands-on, teaching kitchen culinary education class (n = 18) or non-kitchen-based dietary counselling (n = 23) for 6 weeks. The primary outcome was adherence to the validated nine-point Mediterranean diet score, and the secondary outcome was food cost savings per family.

SETTING

The Goldring Center for Culinary Medicine, a community teaching kitchen in New Orleans.

PARTICIPANTS

Families (n = 41) of at least one child and one parent.

RESULTS

Compared with families receiving traditional dietary counselling, those participating in hands-on, kitchen-based nutrition education were nearly three times as likely to follow a Mediterranean dietary pattern (OR 2·93, 95% CI 1·73, 4·95; P  <  0·001), experiencing a 0·43-point increase in Mediterranean diet adherence after 6 weeks (B  =  0·43; P  <  0·001). Kitchen-based nutrition education projects to save families $US 21·70 per week compared with standard dietary counselling by increasing the likelihood of consuming home-prepared v. commercially-prepared meals (OR 1·56, 95% CI 1·08, 2·25; P  =  0·018).

CONCLUSIONS

Community-based culinary medicine education improves Mediterranean diet adherence and associates with food cost savings among a diverse sample of families. Hands-on culinary medicine education may be a novel evidence-based tool to teach healthful dietary habits and prevent chronic disease.

Challenges and Facilitators to Promoting a Healthy Food Environment and Communicating Effectively with Parents to Improve Food Behaviors of School Children

Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.

Latino Parents' Perceptions of Physical Activity and Healthy Eating: At the Intersection of Culture, Family, and Health

OBJECTIVE

To explore Latino parents' perspectives on healthy living and identify strategies to incorporate in a future child obesity intervention.

DESIGN

Descriptive, qualitative study.

SETTING

Participants were recruited from an emerging Latino community (area with low [ < 5%] yet growing concentrations of Latinos) in Allegheny County, PA.

PARTICIPANTS

Thirty-two parents of preschool children participated in 5 Spanish-language focus groups.

PHENOMENON OF INTEREST

Parents' perceptions of a healthy lifestyle (ie, physical activity and nutrition).

ANALYSIS

Data were analyzed using the constant comparison method to identify salient categories, themes, and patterns.

RESULTS

Three overarching themes were identified: (1) Healthy Living: Beyond One's Control; (2) Estamos Acostumbrados [We Are Used to a Certain Lifestyle]; and (3) Latin American and US Culture Conflict. In general, parents perceived maintaining a healthy lifestyle to require enormous effort and that change was difficult given a lack of knowledge and control.

CONCLUSIONS AND IMPLICATIONS

Key intervention approaches with this population may include a focus on the family environment. Increasing knowledge, building self-efficacy, and modeling behavior through family recipe preparation and physical activity breaks may be necessary, as well as an emphasis on and orientation to community resources to support behavior change and physical activity and healthy eating habits.

Modeling Parental Influence on Teenagers' Food Consumption: An Analysis Using the Family Life, Activity, Sun, Health, and Eating (FLASHE) Survey

OBJECTIVE

To investigate (1) how perceived parental control, perceived parental modeling, and parent-teen co-decision making are associated with teenagers' consumption of fruits and vegetables as well as sugary drinks and less healthful food; and (2) whether self-efficacy mediates this relationship.

DESIGN

Cross-sectional survey.

PARTICIPANTS

A total of 1,657 adolescents aged 12-17years.

MAIN OUTCOME MEASURE(S)

Perceived parental control, perceived parental modeling, parent-teen co-decision making, self-efficacy, and consumption of fruits and vegetables as well as sugary drinks and less healthful food.

ANALYSIS

Ordinary least-squares regressions and mediation analyses.

RESULTS

After controlling for teenagers' self-efficacy, perceived parental control was not significantly associated with teenagers' fruit and vegetable consumption but it was negatively related to teenagers' consumption of sugary drinks and less nutrient-dense food. Perceived parental modeling had a positive correlation to teenagers' fruit and vegetable consumption and a negative relationship to their consumption of sugary drinks and less healthful food. Parent-teen co-decision making regarding teenagers' food consumption emerged as a positive predictor for teenagers' fruit and vegetable consumption but not for that of sugary drinks and foods with little nutritional value after controlling for self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Findings from this study demonstrated that perceived parental behaviors were related to teenagers' nutrition intakes. Not exerting too much control and having teenagers participate in the decision-making process could help teenagers eat more healthily. Furthermore, providing a positive role model for teenagers can be an effective strategy to encourage teenagers to eat better.

Food commercials do not affect energy intake in a laboratory meal but do alter brain responses to visual food cues in children

Food commercials promote snack intake and alter food decision-making, yet the influence of exposure to food commercials on subsequent neural processing of food cues and intake at a meal is unclear. This study tested whether exposing children to food or toy commercials altered subsequent brain response to high- and low-energy dense food cues and influenced laboratory intake at a multi-item, ad libitum meal. Forty-one 7-9-year-old children (25 healthy weight; 16 with overweight/obesity) completed five visits as part of a within-subjects design where they consumed multi-item test-meals under three conditions: no exposure, food commercial exposure, and toy commercial exposure. On the fourth and fifth visits, functional magnetic resonance imaging (fMRI) was performed while children viewed low- and high-energy dense food images following exposure to either food or toy commercials. Linear mixed models tested for differences in meal energy intake by commercial condition. A whole-brain analysis was conducted to compare differences in response by commercial condition and child weight status. Meal intake did not differ by commercial condition (p = 0.40). Relative to toy commercials, food commercials reduced brain response to high-energy food stimuli in cognitive control regions, including bilateral superior temporal gyri, middle temporal gyrus, and inferior frontal gyrus. Commercial condition * weight status interactions were observed in orbitofrontal cortex, fusiform gyrus, and supramarginal gyrus. Children with overweight/obesity showed increased response in these regions to high-energy stimuli following food commercials. Food commercial exposure affected children's subsequent processing of food cues by reducing engagement of the prefrontal cortex, a region implicated in cognitive control. Even though food commercial exposure did not increase intake at a meal, the effect of reduced prefrontal cortical engagement on a broader range of consumption patterns warrants investigation.

Healthy Eating for Obese Children From Socioeconomically Disadvantaged Families: Its Ecological Factors and Strategies

INTRODUCTION

Researchers explored the meanings of "eating" for obese children from socioeconomically disadvantaged families and identified multilevel factors and strategies for their healthy eating based on ecological perspectives.

METHODOLOGY

Grounded on a qualitative research design, focus group interviews were conducted with each group of key stakeholders: obese children, their mothers, and social workers from public welfare systems in South Korea.

RESULTS

"Eating" and "healthy eating" were defined as "fulfilling deprivations" and "integrating balance into their lives," respectively. Eight factors and four strategies for their healthy eating were identified at intrapersonal, interpersonal, organizational, and community/political levels.

DISCUSSION

These findings may help nurses in Western culture understand the cultural context of obese children's eating embedded in socioeconomically disadvantaged families and public welfare systems in Asian culture. Furthermore, these findings provide specific guides to culturally relevant, multilevel strategies for promoting healthy eating in the field of childhood obesity prevention.

A Qualitative Exploration Into the Parent-Child Feeding Relationship: How Parents of Preschoolers Divide the Responsibilities of Feeding With Their Children

OBJECTIVE

To explore the extent to which parents divide responsibilities of feeding (what, when, where, how much, and whether) with their children and the factors that influence parents' approach to feeding.

DESIGN

Individual interviews.

PARTICIPANTS

Parents (n = 40) of preschoolers.

PHENOMENON OF INTEREST

Division of feeding responsibilities; motivation for feeding approach; challenges to feeding.

ANALYSIS

Audio-recorded interviews were transcribed verbatim and coded using deductive and inductive content analysis.

RESULTS

Parent's approaches to feeding varied widely. A few parents followed the Division of Responsibility approach closely. Instead, many parents gave their child more than the recommended amount of influence over what foods were served and offered children less than the recommended amount of autonomy over the whether and how much of eating. Meals and snacks were approached differently; parents exhibited less control over the timing of snacks as well as the types and amounts of foods eaten during snacks, compared with the control exhibited during meals.

CONCLUSIONS AND IMPLICATIONS

These data support future research to understand the impact of this framework on child health outcomes when it is adhered to on all eating occasions, including snacks. Collaboration by researchers and clinicians to explore alternative frameworks that encourage parents to provide the structure and autonomy support may enhance positive outcomes in children.

Direct and indirect effects of parent stress on child obesity risk and added sugar intake in a sample of Southern California adolescents

OBJECTIVE

Research indicates that children are at higher risk for obesity if their parents have been exposed to a larger number of stressors, yet little is known about effects of parents' subjective, perceived experience of stress on children's eating behaviours and adiposity and whether weight-related parenting practices (i.e. parent rules and positive family meal practices) mediate this relationship. The present study evaluated the direct and mediated relationship between parent perceived stress and child waist circumference and parent stress and child consumption of added sugars one year later.

DESIGN

Longitudinal panel data.

SETTING

Eleven communities in Southern California, USA.

SUBJECTS

Data were collected over two waves from parent-child dyads (n 599). Most parents were female (81 %) and Hispanic (51 %); children were 11 years old on average (sd 1·53; range 7-15 years) and 31 % received free school lunch.

RESULTS

Perceived parent stress was not significantly associated with child waist circumference or consumption of added sugars one year later, and mediating pathways through parenting practices were not significant. However, parent rules were significantly associated with lower child consumption of added sugars (β=-0·14, P<0·001).

CONCLUSIONS

Results suggest that parent rules about the types of foods children can eat, clearly explained to children, may decrease child consumption of added sugars but not necessarily lead to changes in obesity risk. Parent- and family-based interventions that support development of healthy rules about child eating have the potential to improve child dietary nutrient intake.

Children's and parents' opinions on the sport-related food environment: a systematic review

Sport is a key setting for interventions to address child obesity given its obesogenic nature. Understanding children's and parents' opinions on the sport-related food environment is critical in developing effective programmes and policies to improve children's health. This systematic review synthesizes quantitative and qualitative research examining children's and parents' opinions on the sport-related food environment. During July 2016, a range of electronic databases of academic and grey literature were searched. Thirty-two publications (11 including children, 17 parents and 4 both) were included for review. The publications were assessed using the Analysis Grid for Environments Linked to Obesity framework to categorize the sport-related food environment into the physical, sociocultural, economic and political environments. The literature available investigating children's and parents' opinions of the sport-related food environment suggests that many children and parents consider the environment neither conducive to nor supportive of children's healthy food behaviours or wider health and well-being. Both groups would likely support actions to change and improve it. This systematic review found that original research specifically investigating children's and parents' perspectives on almost all aspects of the sport-related food environment is limited. Thus, there is scope for further investigation into this important part of children's food environments.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Differences and Agreement in Perception of Child Picky Eating Among Center- and Home-Based Childcare Providers and Parents and Its Impact on Utilized Mealtime Strategies

Picky eating is a problematic eating behavior caregivers may encounter with children under their care. A picky eater (PE) is typically characterized as consuming a narrow range of food, as well as rejecting several food items. Much of the literature regarding PEs involves parents, although use of nonparental childcare arrangements in the United States has increased in the past several decades. Although data on parental mealtime strategies exist, little is known about how parent and childcare provider pickiness perceptions differ between types of childcare, such as center-based childcare (CBCC) and home-based childcare (HBCC), or how these perceptions influence the mealtime strategies utilized. The objectives of this study were to (1) compare perceptions of child pickiness between parents and childcare providers, (2) compare percent agreement in pickiness perception between the dyads of CBCC parents and providers and HBCC parents and providers, and (3) identify mealtime strategy utilization based on pickiness perception. A total of 52 child, parent, and childcare provider triads participated in the study and completed the Mealtime Assessment Survey and the Parent/Teacher Mealtime Strategy Survey regarding the same child. Results showed that parents are 1.4 times more likely than childcare providers to perceive a child as being picky, HBCC parents and providers are 1.4 times more likely to perceive a child as being picky than CBCC parents and providers, CBCC parents and providers disagree more in their perception of child pickiness than HBCC parents and providers (41% vs 26%), and finally, perception of child pickiness has a greater influence on mealtime strategies utilized by parents. These results can be used to focus intervention efforts aimed at improving child eating habits across the home and childcare location.

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.

Directive and non-directive food-related parenting practices: Associations between an expanded conceptualization of food-related parenting practices and child dietary intake and weight outcomes

This study examines associations between an expanded conceptualization of food-related parenting practices, specifically, directive and non-directive control, and child weight (BMI z-score) and dietary outcomes [Healthy Eating Index (HEI) 2010, daily servings fruits/vegetables] within a sample of parent-child dyads (8-12 years old; n = 160). Baseline data from the Healthy Home Offerings via the Mealtime Environment (HOME Plus) randomized controlled trial was used to test associations between directive and non-directive control and child dietary outcomes and weight using multiple regression analyses adjusted for parental education. Overall variance explained by directive and non-directive control constructs was also calculated. Markers of directive control included pressure-to-eat and food restriction, assessed using subscales from the Child Feeding Questionnaire; markers of non-directive control were assessed with a parental role modeling scale and a home food availability inventory in which an obesogenic home food environment score was assigned based on the types and number of unhealthful foods available within the child's home food environment.

DIRECTIVE CONTROL

Food restriction and pressure-to-eat were positively and negatively associated with BMI z-scores, respectively, but not with dietary outcomes.

NON-DIRECTIVE CONTROL

An obesogenic home food environment was inversely associated with both dietary outcomes; parental role modeling of healthful eating was positively associated with both dietary outcomes. Neither non-directive behavioral construct was significantly associated with BMI z-scores.

TOTAL VARIANCE

Greater total variance in BMI-z was explained by directive control; greater total variance in dietary outcomes was explained by non-directive control. Including a construct of food-related parenting practices with separate markers for directive and non-directive control should be considered for future research. These concepts address different forms of parental control and, in the present study, yielded unique associations with child dietary and weight outcomes.

Food availability, modeling and restriction: How are these different aspects of the family eating environment related to adolescent dietary intake?

OBJECTIVES

To examine individual associations between aspects of the family eating environment (home food availability, parental modeling, and food restriction) and adolescent dietary intake and explore the combined relationship (i.e., environment profiles) between these aspects of the family eating environment and adolescent dietary intake.

METHODS

Adolescents [14.4 years old (SD = 2.0)] and their parents (N = 2383 parent-adolescent pairs] participated in 2 coordinated, population-based studies. Adolescent surveys were completed at school and parent surveys were conducted via mail or phone.

RESULTS

Healthy home food availability was positively associated with fruit/vegetable intake and negatively associated with soda and snack food intake in adolescents. Healthy parental modeling was negatively associated with adolescent soda consumption. Food restriction was positively associated with fruit/vegetable consumption and snack food intake. Examination of family eating environment profiles revealed that it was the home food availability component of the profiles that was associated with observed differences in fruits/vegetable consumption, whereas the parental modeling and food restriction components contributed to differences in soda and snack foods consumption.

CONCLUSIONS

Findings indicate that among the three aspects of the family eating environment explored, making healthy food available at home was most consistently associated with healthy dietary intake in adolescents.

LA Sprouts: A 12-Week Gardening, Nutrition, and Cooking Randomized Control Trial Improves Determinants of Dietary Behaviors

OBJECTIVE

To evaluate the effect of an exploratory 12-week nutrition, cooking, and gardening trial (LA Sprouts) on preference for fruit and vegetables (FV); willingness to try FV; identification of FV; self-efficacy to garden, eat, and cook FV; motivation to garden, eat, and cook FV; attitudes toward FV; nutrition and gardening knowledge; and home gardening habits.

DESIGN

Randomized controlled trial.

SETTING

Four elementary schools.

PARTICIPANTS

Three hundred four predominately Hispanic/Latino third- through fifth-grade students were randomized to either the LA Sprouts group (n = 167 students) or control group (n = 137 students).

INTERVENTION

Twelve-week after-school nutrition, cooking, and gardening intervention.

MAIN OUTCOME MEASURES

Determinants of dietary behavior as measured by questionnaire at baseline and postintervention.

ANALYSIS

Analyses of covariance.

RESULTS

After the 12-week program, compared with controls, LA Sprouts participants improved scores for identification of vegetables (+11% vs +5%; P = .001) and nutrition and gardening knowledge (+14.5% vs -5.0%; P = .003), and were more likely to garden at home (+7.5% vs -4.4%; P = .003).

CONCLUSIONS

The LA Sprouts program positively affected a number of determinants of dietary behaviors that suggest possible mechanisms by which gardening and nutrition education act to improve dietary intake and health outcomes.

Predicting habits of vegetable parenting practices to facilitate the design of change programmes

OBJECTIVE

Habit has been defined as the automatic performance of a usual behaviour. The present paper reports the relationships of variables from a Model of Goal Directed Behavior to four scales in regard to parents' habits when feeding their children: habit of (i) actively involving child in selection of vegetables; (ii) maintaining a positive vegetable environment; (iii) positive communications about vegetables; and (iv) controlling vegetable practices. We tested the hypothesis that the primary predictor of each habit variable would be the measure of the corresponding parenting practice.

DESIGN

Internet survey data from a mostly female sample. Primary analyses employed regression modelling with backward deletion, controlling for demographics and parenting practices behaviour.

SETTING

Houston, Texas, USA.

SUBJECTS

Parents of 307 pre-school (3-5-year-old) children.

RESULTS

Three of the four models accounted for about 50 % of the variance in the parenting practices habit scales. Each habit scale was primarily predicted by the corresponding parenting practices scale (suggesting validity). The habit of active child involvement in vegetable selection was also most strongly predicted by two barriers and rudimentary self-efficacy; the habit of maintaining a positive vegetable environment by one barrier; the habit of maintaining positive communications about vegetables by an emotional scale; and the habit of controlling vegetable practices by a perceived behavioural control scale.

CONCLUSIONS

The predictiveness of the psychosocial variables beyond parenting practices behaviour was modest. Discontinuing the habit of ineffective controlling parenting practices may require increasing the parent's perceived control of parenting practices, perhaps through simulated parent-child interactions.

Family Factors and Body Mass Index Among Korean-American Preschoolers

PURPOSE

The purpose of this study was to examine family factors related to BMI z-scores and overweight/obesity among Korean-American (KA) preschoolers.

METHODS

A cross-sectional study was conducted with 104 KA preschoolers and their mothers in the Chicago metropolitan area. KA mothers completed questionnaires and their preschool-age children's weights and heights were measured. Hierarchical multiple linear regression and multiple logistic regression were performed.

RESULTS

Twenty-two percent of preschoolers were overweight or obese (BMI ≥85th percentile). Family factors explained 30% of the variance in the children's BMI z-scores, with parenting feeding style and family functioning contributing most. In logistic regression, children were more likely to be overweight/obese if: a family had more children, the mother perceived her child as overweight/obese, and the family had regular child routines.

CONCLUSION

Health care providers should consider the family as one unit of care and use that unit to implement culturally appropriate childhood overweight/obesity prevention for Korean-American preschool-aged children. Parental feeding style and parents' attitudes about child weight should be considered when advising Korean-Americans about reducing children's overweight/obesity.

"It Hurts a Latina When They Tell Us Anything About Our Children": Implications of Mexican-Origin Mothers' Maternal Identities, Aspirations, and Attitudes About Cultural Transmission for Childhood Obesity Prevention

BACKGROUND

This qualitative study explored values, attitudes, and beliefs held by Mexican-origin mothers of preschool-aged children to enhance understanding of cultural influences on behaviors associated with childhood obesity risk.

METHODS

During face-to-face interviews, 39 Mexican-origin mothers of preschool-aged children discussed their hopes for their children, their image of the perfect mother, Mexican and American foods, why they taught their children about these foods, and their opinions about television (TV) viewing language.

RESULTS

Participants wanted their children to become successful, "good" people, which necessitated doing well in school. Mothers also wanted their children to know them, which required understanding the mothers' Mexican backgrounds. Mothers wanted their children to maintain Mexican values and identities. Some mothers viewed American culture as harmful. Many participants prepared their child for going to Mexico by exposing them to Mexican culture and foods. Some mothers fed their children American foods to prepare them for school. Perceptions of American foods generally reflected stereotypical unhealthy foods. TV helped teach children Spanish and English. Being a good mother was core to participants' identities; thus, hearing about child overweight made some mothers feel like failures.

CONCLUSIONS

Health promotion programs may be more salient to mothers if they: underscore how a healthy weight can help children in school; teach mothers to prepare healthy American foods that their children will encounter in kindergarten; assist mothers in teaching their children about Mexico; and present information about childhood obesity in ways that reinforce what mothers are doing well, enhance mothers' self-efficacy, and allay feelings of failure.

Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test

Background

Vegetable consumption protects against chronic diseases, but many young children do not eat vegetables. One quest within the mobile application Mommio was developed to train mothers of preschoolers in effective vegetable parenting practices, or ways to approach getting their child to eat and enjoy vegetables. A much earlier version of the game, then called Kiddio, was alpha tested previously, but the game has since evolved in key ways.

Objective

The purpose of this research was to alpha test the first quest, substantiate earlier findings and obtain feedback on new game features to develop an effective, compelling parenting game.

Methods

Mothers of preschool children (n=20) played a single quest of Mommio 2 to 4 times, immediately after which a semi-structured interview about their experience was completed. Interviews were transcribed and double coded using thematic analysis methods.

Results

Mothers generally liked the game, finding it realistic and engaging. Some participants had difficulties with mechanics for moving around the 3-D environment. Tips and hints were well received, and further expansion and customization were desired.

Conclusions

Earlier findings were supported, though Mommio players reported more enjoyment than Kiddio players. Continued development will include more user-friendly mechanics, customization, opportunities for environment interaction, and food parenting scenarios.

Do stressed mothers have heavier children? A meta-analysis on the relationship between maternal stress and child body mass index

Child obesity continues to be a prevalent public health issue. This meta-analysis synthesized 17 studies investigating the association between levels of psychological stress experienced by mothers and the body mass index of their children. The overall standardized mean difference effect size was positive and significantly different from zero in cross-sectional d = 0.20 (k = 14, 95% confidence interval [CI]: 0.06, 0.34) and longitudinal studies d = 0.18 (k = 5, 95% CI: 0.00, 0.351) and had significant heterogeneity in both (cross-sectional, Q[13] = 193.00, P < 0.001; longitudinal, Q[4] = 29.46, P < 0.001). In longitudinal studies, effect sizes were larger when children also would have experienced the stressor, Q(6) = 4.68, P < 0.05, for toddlers than infants, Q(4) = 5.04, P < 0.05, and in higher quality studies, Q(4) = 14.58, P < 0.05. Results highlight the potential benefits of including a parent stress management component in childhood obesity prevention programmes.

Prose Fiction as a Narrative Companion for a Vegetable Parenting Videogame

OBJECTIVE

The purpose of this research is to explore the capacity of story to connect to a health-related videogame, as well as the qualities that may increase efficacy by making the story compelling. Parents of 3-5-year-old children often report difficulty getting their children to eat vegetables, which are protective against chronic illnesses. Videogames may be vehicles for training parenting practices for successful vegetable consumption outcomes but often rely on stories to provide context and details. Unfortunately, storytelling may interrupt immersion and player agency. Delivering stories outside of gameplay may provide an understanding of game situations while maintaining immersion.

MATERIALS AND METHODS

Two companion storylines (one a romantic adventure and the other a suspenseful fantasy) were generated for a vegetable parenting game, "Mommio," targeting mothers of preschool children. Mothers of 3-5-year-old children (n=18) read both storylines and completed semistructured interviews.

RESULTS

Mothers preferred the romantic adventure, which featured strong characters, relatable issues, and an engaging plot. Most mothers were interested in playing the "Mommio" videogame after reading the stories.

CONCLUSIONS

Results suggest that it is possible for prose literature to both motivate gameplay and be an immersive narrative companion to, but separate from, games for health. This literature should include engaging, realistic stories and relatable strong characters.

Does maternal psychopathology increase the risk of pre-schooler obesity? A systematic review

The preschool years may be a critical period for child obesity onset; however, literature examining obesity risk factors to date has largely focused on school-aged children. Several links have been made between maternal depression and childhood obesity risks; however, other types of maternal psychopathology have been widely neglected. The aim of the present review was to systematically identify articles that examined relationships between maternal psychopathology variables, including depressive and anxiety symptoms, self-esteem and body dissatisfaction, and risks for pre-schooler obesity, including weight outcomes, physical activity and sedentary behaviour levels, and nutrition/diet variables. Twenty articles meeting review criteria were identified. Results showed positive associations between maternal depressive symptoms and increased risks for pre-schooler obesity in the majority of studies. Results were inconsistent depending on the time at which depression was measured (i.e., antenatal, postnatal, in isolation or longitudinally). Anxiety and body dissatisfaction were only measured in single studies; however, both were linked to pre-schooler obesity risks; self-esteem was not measured by any studies. We concluded that maternal depressive symptoms are important to consider when assessing risks for obesity in preschool-aged children; however, more research is needed examining the impact of other facets of maternal psychopathology on obesity risk in pre-schoolers.

Parental stress increases body mass index trajectory in pre-adolescents

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Rates of childhood obesity have increased since the mid-1970s. Research into behavioural determinants has focused on physical inactivity and unhealthy diets. Cross-sectional studies indicate an association between psychological stress experienced by parents and obesity in pre-adolescents.

WHAT THIS STUDY ADDS

We provide evidence of a prospective association between parental psychological stress and increased weight gain in pre-adolescents. Family-level support for those experiencing chronic stress might help promote healthy diet and exercise behaviours in children.

OBJECTIVE

We examined the impact of parental psychological stress on body mass index (BMI) in pre-adolescent children over 4 years of follow-up.

METHODS

We included 4078 children aged 5-10 years (90% were between 5.5 and 7.5 years) at study entry (2002-2003) in the Children's Health Study, a prospective cohort study in southern California. A multi-level linear model simultaneously examined the effect of parental stress at study entry on the attained BMI at age 10 and the slope of change across annual measures of BMI during follow-up, controlled for the child's age and sex. BMI was calculated based on objective measurements of height and weight by trained technicians following a standardized procedure.

RESULTS

A two standard deviation increase in parental stress at study entry was associated with an increase in predicted BMI attained by age 10 of 0.287 kg m(-2) (95% confidence interval 0.016-0.558; a 2% increase at this age for a participant of average attained BMI). The same increase in parental stress was also associated with an increased trajectory of weight gain over follow-up, with the slope of change in BMI increased by 0.054 kg m(-2) (95% confidence interval 0.007-0.100; a 7% increase in the slope of change for a participant of average BMI trajectory).

CONCLUSIONS

We prospectively demonstrated a small effect of parental stress on BMI at age 10 and weight gain earlier in life than reported previously. Interventions to address the burden of childhood obesity should address the role of parental stress in children.

Awareness of social influence on food intake. An analysis of two experimental studies

There is consistent evidence that the amount of food we consume can be influenced by the eating behaviour of other people. Some previous experimental studies reported that consumers are unaware of this influence on their behaviour. The present research tested whether people may be more aware of social influence on their eating than previously assumed. In two studies, participants (total n = 160) were exposed to information about the amount of snack food other people had been eating shortly before being served the same snack food and eating as much as they liked. After this, participants responded to questions regarding whether they thought their food intake had been socially influenced, and reported the reasons why they believed they had or had not been influenced. Of the 160 participants, 34% reported that they had been influenced, 10% were unsure and 56% reported they had not been influenced. Crucially, participants' reports of social influence appeared to be accurate; the food intake of participants reporting social influence was significantly affected by the amount of food other people had been eating, whereas the food intake of participants denying social influence was unaffected. Individuals may be more aware of the effect that social influence has on their eating behaviour than previously assumed. Further work is needed to identify the factors which determine whether people are susceptible to social influence on eating behaviour.

Children's executive function and high-calorie, low-nutrient food intake: mediating effects of child-perceived adult fast food intake

OBJECTIVE

This study tested the relationships among child executive function (EF), child-perceived parent fast food intake, and child self-reported subsequent consumption of high-calorie, low-nutrient (HCLN) food.

DESIGN

One year and 6-month longitudinal observation from a larger randomized controlled trial.

SETTING

Southern California elementary schools.

PARTICIPANTS

Fourth- and fifth-grade children (N = 1,005) participating in the Pathways to Health obesity prevention program.

RESULTS

Child EF problems were associated with higher concurrent HCLN intake (B = 0.29, SE = 0.10, p < .001) and had a significant indirect effect through higher perceived frequency of parent fast food intake (indirect effect = 0.17, 95% confidence interval [CI] = [0.11, 0.25], p < .001). Longitudinally, child EF problems did not significantly predict higher HCLN intake a year and a half later (B = 0.01, SE = 0.10, p = .92, n = 848) but did have a significant indirect effect through higher perceived parent fast food intake (indirect effect = 0.05, 95% CI = [0.02, 0.10], p < .001).

CONCLUSIONS

Children's EF difficulties may increase their perception of parent concurrent fast food intake, contributing to their own unhealthy food intake. However, EF problems may not directly affect HCLN intake across time, except when problems are associated with child perception of more frequent parent consumption of convenience foods. Future research is needed to investigate the possibility that helping children perceive and understand role models' convenience food consumption may improve child dietary consumption patterns.

Race/ethnicity and income in relation to the home food environment in US youth aged 6 to 19 years

BACKGROUND

The home food environment is complex and has the potential to influence dietary habit development in young people. Several factors may influence the home food environment, including income and race/ethnicity.

OBJECTIVE

To examine the relationship of income and race/ethnicity with three home food environment factors (ie, food availability frequency, family meal patterns [frequency of family and home cooked meals], and family food expenditures).

DESIGN

A cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES).

PARTICIPANTS

A total of 5,096 youth aged 6 to 19 years from a nationally representative sample of US individuals participating in NHANES 2007-10.

STATISTICAL ANALYSES PERFORMED

Prevalence of food availability frequency was assessed for the entire sample, race/ethnicity, poverty income ratio (PIR), and race/ethnicity stratified by PIR. Mean values of family meal patterns and food expenditures were calculated based on race/ethnicity, PIR, and race/ethnicity stratified by PIR using analysis of variance and least squares means. Tests of main effects were used to assess differences in food availability prevalence and mean values of family meal patterns and food expenditures.

RESULTS

Non-Hispanic whites had the highest prevalence of salty snacks (51.1%±1.5%) and fat-free/low-fat milk (39.2%±1.7%) always available. High-income homes had the highest prevalence of fruits (75.4%±2.4%) and fat-free/low-fat milk (38.4%±2.1%) always available. Differences were found for prevalence of food availability when race/ethnicity was stratified by PIR. Non-Hispanic blacks had the lowest prevalence of fat-free/low-fat milk always available across PIR groups. Differences in mean levels of family meal patterns and food expenditures were found for race/ethnicity, PIR, and race/ethnicity stratified by PIR.

CONCLUSIONS

Race/ethnicity and PIR appear to influence food availability, family meal patterns, and family food expenditures in homes of youth. Knowledge of factors that influence the home food environment could assist in developing effective strategies to improve food environments for young people.

Formative research to develop a community-based intervention for chronic disease prevention in Guatemalan school-age children

Background

Noncommunicable diseases (NCD) are the most common causes of morbidity and mortality worldwide, even in low- and middle-income countries (LMIC). Recent trends in health promotion emphasize community-based interventions as an important strategy for improving health outcomes. The aim of this study was to conduct formative research regarding the perceptions of NCD risk factors, their influencing factors, and community resources available to aid the development and implementation of a community-based intervention with school-age children.

Methods

Focus group discussions (n = 18), home visits (n = 30), and individual semi-structured interviews (n = 26) were conducted in three urban communities in Guatemala with school-age children (10–12 years of age), teachers, parents, and local community members (i.e., school principals, school food kiosk vendors, religious leaders, authority representatives). All focus groups and interviews were transcribed verbatim for thematic analysis.

Results

Children, parents, and teachers have general knowledge about modifiable risk factors. Adults worried more about tobacco use, as compared to unhealthy diet and physical inactivity in children. Participants identified features at the intrapersonal (e.g., negative emotional state), interpersonal (e.g., peers as role models), and organizational and community levels (e.g., high levels of crime) that influence these risk factors in children. School committees, religious leaders, and government programs and activities were among the positive community resources identified.

Conclusions

These findings should help researchers in Guatemala and similar LMIC to develop community-based interventions for NCD prevention in school-age children that are effective, feasible, and culturally acceptable.

Relationships among parent and youth healthful eating attitudes and youth dietary intake in a cross-sectional study of youth with type 1 diabetes

Background

Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents.

Methods

Youth (n=252) ages 8–18 years with diabetes duration ≥1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling.

Results

Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling β^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) β^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes β^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling β^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality.

Conclusions

Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.

Experimental evidence on the impact of food advertising on children's knowledge about and preferences for healthful food

To understand the rising prevalence of childhood obesity in affluent societies, it is necessary to take into account the growing obesity infrastructure, which over past decades has developed into an obesogenic environment. This study examines the effects of one of the constituent factors of consumer societies and a potential contributory factor to childhood obesity: commercial food communication targeted to children. Specifically, it investigates the impact of TV advertising on children's food knowledge and food preferences and correlates these findings with their weight status. Evaluations of traditional information- and education-based interventions suggest that they may not sustainably change food patterns. Based on prior consumer research, we propose five hypotheses, which we then test using a subsample from the IDEFICS study, a large-scale pan-European intervention study on childhood obesity. The results indicate that advertising has divergent effects on children's food knowledge and preferences and that food knowledge is unrelated to food preferences. This finding has important implications for both future research and public policy.

A randomised controlled trial and mediation analysis of the 'Healthy Habits', telephone-based dietary intervention for preschool children

Background

Consumption of non-core foods in childhood is associated with excessive weight gain in childhood. Parents play a vital role in establishing healthy diet behaviours in young children. The aim of this study was to assess the effectiveness of a telephone-based intervention in reducing child consumption of non-core foods, and to examine parent and home food environment mediators of change in child consumption.

Methods

The ‘Healthy Habits’ trial utilised a clustered randomised controlled design.

Setting/participants

Parents were recruited from 30 preschools (N = 394 participants, mean age 35.2±5.6 years). Parents randomized to the intervention group received four telephone contacts and print materials. Parents allocated to the control condition receive generic print materials only. Non-core food consumption was assessed using a validated child dietary questionnaire at baseline, 2 and 6 months post recruitment in 2010.

Results

The intervention was effective in reducing child consumption of non-core foods at 2 months (intention to treat analysis: z=-2.83, p<.01), however this effect was not maintained at 6 months. Structural equation modelling using 2 month data indicated that child access to non-core foods in the home and child feeding strategies mediated the effect of the intervention.

Conclusion

The telephone-based intervention shows promise in improving short term dietary behaviour in preschool age children, however further development is needed to sustain the effect in the long-term.

Trial registration

Australian Clinical Trials Registry: ACTRN12609000820202

A review of the psychological and familial perspectives of childhood obesity

Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents' perceptions of their child's overweight highly influence the well-being of obese children and the way in which they perceive themselves. THE PRESENT REVIEW PAPER AIMS TO BROADEN THE SCOPE OF KNOWLEDGE OF CLINICIANS ABOUT SEVERAL IMPORTANT PSYCHOSOCIAL AND FAMILIAL DIMENSIONS OF CHILDHOOD OBESITY: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children's perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.

Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African American women caretakers?

The purposes of this descriptive study were to (1) describe nutrition knowledge, attitudes, beliefs (KAB), and self-efficacy among low-income African American and Hispanic women; (2) identify the associations these variables have on diet quality and weight status; (3) identify barriers to healthy eating. Data from three separate studies were combined and analyzed. The total sample included African Americans (N = 92) and Hispanics (N = 272). Descriptive statistics and bivariate analyses were used to identify associations between KAB and body mass index (BMI) and diet quality. The majority of African Americans had good knowledge in nutrition while Hispanics had fair knowledge. Attitudes toward eating a healthy diet were significantly associated with high fiber intake among African Americans and low fat consumption among Hispanics. A computed KAB score showed no significant relation to individuals' weight status or diet quality. However, attitudes and beliefs about healthy foods strongly correlated with participants' weight or diet consumption among Hispanics. The most common barrier to consuming a healthy diet reported by both groups was the cost of healthy foods. It is therefore recommended to address these variables when addressing obesity and poor dietary intake among low-income minority groups.