Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents

Associations between restrictive feeding practices and children's dietary intake: Systematic review and meta-analyses

BACKGROUND

Parents' attempt to limit or restrict children's intake of 'unhealthy' or discretionary foods has been widely considered as a counterproductive feeding practice associated with poorer dietary outcomes, but empirical evidence is varied.

AIM

The present systematic literature review aimed to investigate the association between parental restriction and children's dietary intake.

METHOD

Studies were identified through PsycInfo, MEDLINE, CINAHL, Web of Science, and Scopus databases on April 29th, 2022. Included were peer-reviewed, English-language articles published between 2001 and 2022, with an effect size between restriction and children's intake of foods that are 'healthy' (i.e., fruit, vegetables, other general healthy foods) or 'discretionary' (i.e., sweet or savoury energy-dense/nutrient poor foods, high-sugar foods, high-salt/fat foods, and high-energy/sugar-sweetened beverages), or overall diet quality. Risk of bias was assessed using a quality assessment checklist designed to evaluate survey studies.

RESULTS

Included studies (n = 44) were most often conducted in the USA, cross-sectional, and participants were mothers. Effect sizes (k = 59) from 21 studies were used in nine meta-analyses investigating various healthy and discretionary dietary intake variables. No meta-analytic effects were statistically significant. Qualitative synthesis of effect sizes ineligible for meta-analysis (k = 91) identified patterns of associations between restriction and increased intake of healthy foods, and decreased intake of discretionary foods.

CONCLUSIONS

Studies used a diverse selection of measures of restriction and dietary intake, limiting the ability of this review to make accurate cross-study comparisons. However, results suggest that instead of restriction being detrimental for children's dietary outcomes, it may be unrelated, or associated with more beneficial dietary outcomes. Research that utilises validated measures of restriction and dietary outcomes and a longitudinal design is needed to clarify this association.

Enhancing dietary adherence among African-American adolescents: the role of parenting styles and food-related practices

Introduction

Parenting styles (PSs) and food-related parenting practices (FPPs) play a crucial role in shaping adolescent eating behavior. This study aimed to investigate the relationship between the different PSs and FPPs of African-American families and the frequency of consumption of MyPlate food items by adolescents based on recommendations from the Dietary Guidelines for Americans (DGA).

Methods

This study used a cross-sectional design. Data collection was conducted using Qualtrics through an online survey of 211 African-American parents and their adolescents aged 10-17-year-old. Adolescents completed the Youth and Adolescent Food Frequency Questionnaire to assess their dietary behavior, while parents filled out the survey to identify the degree of PSs (i.e., authoritative, authoritarian, setting rules, and neglecting) and FPPs (i.e., monitoring, reasoning, copying, and modeling). Spearman's rank correlation coefficient, Wilcoxon rank-sum test, and stepwise logistic regression were performed to determine the answers to the research questions.

Results

For fruit consumption, authoritative parenting significantly reduced the likelihood of adherence to DGA, while authoritarian, monitoring, and reasoning practices increased it. Female adolescents were more likely to meet fruit intake recommendations, with a similar positive impact observed for those whose parents had above high school education. In vegetable intake, authoritarian and monitoring practices positively impact on adherence to DGA, whereas setting rules had a detrimental impact. Being in a married household also increased vegetable intake DGA adherence. For grain consumption, reasoning was a significant positive predictor, while setting rules negatively impacted adherence. Dairy DGA adherence was positively impacted by monitoring and copying practices, but negatively impacted by female gender. Protein intake showed a positive association with reasoning and parental education.

Discussion

Our findings confirm the importance of parenting in developing desired eating behaviors among African-American adolescents. The results of this study can be used to develop culture-based nutritional education programs for parents and youth.

Socio-cognitive determinants of sugar-sweetened beverage consumption among young people: A systematic review and meta-analysis

The overconsumption of sugar sweetened beverages is an increasing public health concern. Understanding the socio-cognitive determinants that drive such consumption could inform the development of interventions to reduce sugar sweetened beverage consumption. The aim of the present review and meta-analysis was to determine the strength of associations between socio-cognitive determinants and the amount and frequency of sugar sweetened beverage consumption among young people. A systematic review was conducted in accordance with PRISMA guidelines. A search was performed using the following databases: PsycINFO, MEDLINE, Scopus, ProQuest, and PubMed. The key search terms were: (1) children, adolescents, young adults; (2) sugar sweetened beverage consumption, choice or purchasing behaviour; and (3) socio-cognitive determinants related to sugar sweetened beverage consumption. The search identified 4325 papers, with 22 papers remaining after screening. Two separate meta-analyses were performed, one for amount (n = 14) and one for frequency (n = 8) of consumption. The most strongly associated determinants with amount of sugar sweetened beverage consumed were habit, intention to consume, and attitudes, whereas the most strongly associated determinants with frequency of consumption were intentions, injunctive norms, and descriptive norms. Comparisons between the meta-analyses revealed two distinct differences: injunctive norms were more strongly correlated with frequency of consumption, and self-efficacy with amount consumed. It was suggested that interventions that focus on multiple determinants, including components of the Theory of Planned Behaviour may result in the largest reductions in consumption. Specifically, focussing on changing attitudes, norms and habits, and increasing perceived behavioural control related to sugar sweetened beverages may be maximally effective in reducing consumption behaviour.

The Relationships between Parenting Practices and Child Health-Related Behaviors in Children with Intellectual Disability: The Moderating Role of Child Body Weight Status

This study aimed to examine the associations between parenting practices and child health-related behaviors, and the moderating role of child body weight status in children with intellectual disability (ID). A cross-sectional study was conducted among a sample of children with ID in Hong Kong; 440 participants were included in this study. All the variables investigated were collected from questionnaires, except body weight status, which was objectively measured. Logistic regression analysis was used to examine the associations between parenting practices and children's unhealthy behaviors. Interaction items were added to investigate the moderation effect of child body weight status, adjusting for significant background characteristics. Results showed that the parenting practices of "restricting access to unhealthy food and sedentary behaviors (RA)" (OR range: 0.63-0.64) and "using food or sedentary behaviors as rewards (UR)" (OR range: 1.28-1.60) were significantly associated with some eating behaviors, but not with sedentary behaviors. Body weight status significantly moderated these associations. Only RA showed favorable effects on some eating behaviors in children with overweight and obesity (OR range: 0.17-0.28), whereas the effects of UR differed by body weight status. Future research should focus on developing educational interventions which encourage parents to use practices that are tailored towards children's individual characteristics.

Content of lunchboxes of Dutch primary school children and their perceptions of alternative healthy school lunch concepts

OBJECTIVE

To investigate the content of lunchboxes of primary school children and to examine children's support and preferences for alternative healthy school lunch concepts.

DESIGN

A cross-sectional study among Dutch children from seven primary schools. The content of the lunchboxes was assessed by photographs. Support and preferences for alternative lunch concepts were examined via a self-reported questionnaire. Linear regression analyses were used to investigate the associations between children's support and preferences and sex, educational group and migration background.

SETTING

The Netherlands.

PARTICIPANTS

Primary school children.

RESULTS

A total of 660 children were included (average 9·9 years old). Most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts 'Sandwiches prepared by the children themselves' and a 'hot lunch buffet' had the highest mean support, while the concept 'a healthy lunch brought from home' was the most preferred concept. Small significant differences were observed depending on sex, educational group and migration background.

CONCLUSION

Lunchboxes of Dutch children contained sandwiches and a drink but rarely fruit and vegetables. Among different alternatives, children reported the highest support for the preparation of their own sandwiches in class or a hot lunch buffet. Future studies should investigate if these alternative lunch concepts improve the dietary intake of children.

Psychometric properties of the item-reduced version of the comprehensive general parenting questionnaire for caregivers of preschoolers in a Finnish context

Introduction

Many instruments for assessing general parenting have been reported as burdensome and are thus seldom used in studies exploring children’s energy balance-related behaviors or weight. This study evaluates the factorial structure of the item-reduced version of the Comprehensive General Parenting Questionnaire (CGPQ), which assesses five constructs of general parenting.

Methods

The study uses data from two cross-sectional studies: Study 1 in 2014 (n = 173) and Study 2 in 2015–16 (n = 805). Parents of children aged three to six answered the CGPQ; in Study 1 the 69-item version, and in Study 2 the 29-item version. The reduction was based on the results of the confirmatory factor analyses (CFA) in Study 1. In both datasets, internal consistency, as Cronbach’s alphas and intraclass correlations between the items of each construct, was tested. A combined assessment of the CFA and items response theory evaluated the construct validity and the item importance for the 29-item version, and a further the reduced 22-item version.

Results

In Study 1, the highest Cronbach’s alphas were shown for the five constructs in the 69-item version. A higher intraclass correlation was found between the constructs in the 69- and 29-item versions, than between the 69- and the 22-item version. However, a high concordance was found between the constructs in the 29- and 22-item versions in both Study 1 and in Study 2 (0.76–1.00). Testing the goodness-of-fit of the CFA models revealed that the 22-item model fulfilled all the criteria, showing that it had a better factorial structure than the 29-item model. Standard estimations ranged from 0.20 to 0.76 in the 22-item version.

Conclusion

The reduced 22- and 29-item versions of the 69-item CGPQ showed good model fit, the 22-item version the better of the two. These short versions can be used to assess general parenting without overburdening the respondents.

Parenting Practices and Adolescents' Eating Behaviors in African American Families

Parents play an important role in developing the eating behaviors of their children by adopting specific parenting practices. As the prevalence of obesity is high amongst African American adolescents, investigations into associations of specific parenting practices and adolescents’ eating behaviors are essential. In this exploratory study, 14 African American parent–adolescent dyads were interviewed to characterize the influence of eight different parenting practices on the consumption of three main food categories (dairy, fruits and vegetables, and unhealthy snacks). The results revealed that authoritarian parenting practices were correlated with a higher BMI percentile in adolescents, whereas modeling and monitoring are correlated with a higher parent BMI. In addition, reasoning, monitoring, modeling, and authoritative parenting practices were associated with less unhealthy snack consumption among adolescents. Reasoning and monitoring were the only parenting practices associated with higher fruit and vegetable consumption. Finally, a significant correlation was found between eating fruits and vegetables and unhealthy snacks and the location of eating. In conclusion, different parenting practices and environmental factors may impact BMI and food consumption of African American dyads. The results of this study can be used to guide improvement in, and/or development of, nutritional education interventions considering the cultural differences of racial minorities.

Emotional eating: Really hungry or just angry?

The aim of this study was to investigate the effect of parenting styles and academic self-efficacy on emotional eating behaviours within a sample of adolescents. The sample of this cross-sectionally designed study consisted of 584 adolescents between the ages of 12-17 years. In order to collect necessary data, the Emotional Eating Scale for Child and Adolescent, the Parenting Style Scale and Academic Self-efficacy Scale were utilized. In this sample, Emotional Eating Scale's total score of girls was higher than boys, and emotional eating was not related to body mass index. Parenting styles and academic self-efficacy predicted 34% of the variants seen in emotional eating behaviours of adolescents. While a positive relation existed between emotional eating and negligent parenting style, a negative significant relation occurred between permissive and democratic type of parenting styles and emotional eating. In addition, emotional eating behaviours decreased, whereas academic self-efficacy perception increased accordingly. The results showed that emotional eating behaviours of adolescents were in relation with parenting styles and academic self-efficacy. A good understanding of the multifactorial structure of emotional eating in adolescents will help to develop essential programmes in order to design effective coping mechanisms.

Examining the Moderating Effect of Parenting Style and Parental Guidance on Children's Beliefs about Food: A Test of the Parenting Style-as-Context Model

Research examining the effect of parenting practices on child food consumption has often neglected the role in which global aspects of parenting - such as parenting style - play in shaping children's dietary behaviors. To address this gap, the parenting style-as-context model was used to examine the moderating effects of parenting style - defined as the perceived emotional climate communicated to children by their parents - on the association between parental guidance of food consumption and children's beliefs surrounding food. A cross-sectional survey of 1,113 child/adolescent participants between the ages of 9 and 18 was conducted to test the theoretical propositions derived from the parenting style-as-context model. Results suggest desirable relationships between different dimensions of parental guidance of food consumption on children's beliefs surrounding foods were stronger among children who were under an authoritative parenting style compared to other parenting styles. The results offer some support for the parenting style-as-context model and has theoretical and practical implications for research targeted at understanding the role parents play in inculcating healthy dietary habits among children.

"The Way you Interpret Health": Adolescent Definitions and Perceptions of Health Literacy

BACKGROUND

Adolescents are required to take increased responsibility for their health. Although health literacy is implicated in adults' health decision-making and health behaviors, little is known about adolescents' health literacy and its relationship to their health behaviors. Furthermore, adolescent health literacy research overlooks adolescent development-specific needs and skills. Therefore, we qualitatively explored adolescents' (1) definitions of health literacy, preventive health behaviors, and health risk behaviors; and (2) perception of the health literacy/health behavior relationship.

METHODS

Six semi-structured focus groups were conducted with adolescents (N = 37) who answered questions about their perceptions of health literacy, preventive health behaviors, and health risk behaviors. Focus groups were coded using thematic analysis. Themes representing adolescents' definitions of health literacy were secondarily coded for alignment with definitions in the literature.

RESULTS

Some of adolescents' health literacy definitions aligned with the adult health literacy literature. They considered health literacy a tool for informed decision-making, but acknowledged not always using these skills.

CONCLUSIONS

Adolescents' definitions of health literacy were multidimensional, going beyond numeracy and literacy skills. Developmental characteristics and adolescents' definition of health risk behaviors were related to use of health literacy skills. Opportunities for adolescents to develop and practice health literacy skills are discussed.

Intersectionality between parenting styles, area of residence and gender on food group consumption among Costa Rican adolescents

Little is known about how parenting styles can influence the adolescent's consumption of sugar-sweetened beverages (SSB), fruits and vegetables (FV) and beans in Latin America. This study uses hierarchical moderated regression models to examine such association by area of residence, sex of the parent and of the adolescent in Costa Rica. Results showed that fathers' authoritarian style was significantly associated with lower intake of sugar-sweetened beverages (SSB) among boys (b = -0.163, p = 0.050), but not girls (b = 0.097, p = 0.114) while mother's authoritarian style was associated with lower SSB intake among girls (b = -0.138, p = 0.031), but not boys (b = 0.159, p = 0.059). Fathers' authoritative style was associated with higher consumption of fruits and vegetables (FV) among boys in rural areas (b=0.440, p= 0.017), but this association was not significant for girls (b=-0.033, p= 0.800) in rural areas or for either gender in urban areas. Parenting styles of the mothers' and fathers' were not significantly associated with Costa Rican adolescent bean consumption, in general or for any of the subgroups. Findings suggest an intersectionality in the effects of parentchild interactions by child and parent sex, cultural and geographic context, and the eating behaviors examined.

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.

Sex- and weight-specific changes in the frequency of sweet treat consumption during early adolescence: a longitudinal study

The transition from childhood to adolescence is a sensitive period, triggering changes in health- and weight-related behaviours including eating habits which likely vary between girls and boys. We aimed to characterise the changes in the frequency of consumption of select sugary foods and drinks ('sweet treats') among 4237 Finnish girls and boys during a 2-year follow-up period. Additionally, we examined four subgroups: children whose weight or waist normalised as well as children whose weight or waist circumference increased during follow-up. An FFQ was completed at 11·1 (sd 0·9) and again at 13·4 (sd 1·1) years of age. A sum variable sweet treat index (STI, range 0-84) captured the weekly consumption frequencies of sweet treats. From baseline to follow-up, the mean STI decreased among girls from 7·1 (95 % CI 6·9, 7·3) to 6·0 (95 % CI 5·9, 6·2) (P < 0·001) and boys from 8·5 (95 % CI 8·3, 8·8) to 7·8 (95 % CI 7·6, 7·8) (P < 0·001), although both sexes increased their chocolate/sweets consumption: girls from 1·3 (95 % CI 1·3, 1·4) to 1·6 (95 % CI 1·5, 1·6) (P < 0·001) and boys from 1·4 (95 % CI 1·3, 1·4) to 1·6 (95 % CI 1·6, 1·7) (P < 0·001), and boys increased their soft drink consumption from 1·4 (95 % CI 1·3, 1·4) to 1·5 (95 % CI 1·4, 1·5) (P = 0·020). We found similar decreases in both the weight and waist subgroups. To conclude, the total frequency of consumption of sweet treats decreased during early adolescence. A similar trend across subgroups suggests that the frequency of consumption of sweet treats is unrelated to becoming overweight.

"OMG, I Get Like 100 Teaspoons of Sugar a Day!" Rural Teens' Grasp of Their Beverage Consumption Habits

As part of a campaign to encourage healthier beverage consumption in a rural New Mexico high school, we wanted to understand students' perceptions of their habits, and the associated health risks and benefits surrounding water and sugar-sweetened beverage consumption to influence future messaging to change behavior. We conducted a posthoc qualitative analysis of 27 student interviews from the program evaluation with both students who participated in the campaign and those who did not. Pre-campaign, students appeared largely unaware of the health risks posed by their beverage consumption habits, lacking any knowledge of nutritional recommendations, water recommendations, or of the sugar levels in products. When informed of the risks, students expressed concern for themselves, their family members, and friends, indicated a desire to make significant changes, and reported making changes for themselves, and educating others regarding the risks. Given the large amounts of money spent and concentrated efforts focused on marketing SSBs to teens, it is critically important to be educating teens and engaging them in behavior change strategies. These data can inform future strategies to improve teen health behaviors and encourage teens to become family health messengers for obesity and diabetes prevention.

Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents

Objective:

The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents’ sugar-sweetened beverage (SSB) intake.

Design:

This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake – step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver’s SSB behaviours, caregiver’s SSB rules) and step 4: environmental (i.e., home SSB availability) level variables.

Setting:

Eight middle schools across four rural southwest Virginia counties in Appalachia.

Participants:

Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years).

Results:

Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent’s SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001).

Conclusions:

SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.

Knowledge, Attitude and Practices of Sugar-Sweetened Beverages: A Cross-Sectional Study among Adolescents in Selangor, Malaysia

This study aims to examine the level of knowledge, attitude and practices (KAP) of adolescents towards sugar-sweetened beverages (SSB), together with the associated factors that determine their KAP. Data were collected using self-administered questionnaires that consisted of sociodemographic, the KAP for the SSB questionnaire, and the Beverage Intake Questionnaire (BEVQ). The respondents’ heights, weights, waist circumferences and body fat percentages were measured. This study involved 439 adolescents aged between 13 and 17 years old, in public secondary schools in Selangor, Malaysia. The results reveal that 35% of the adolescents were overweight, 26% had a high waist circumference, and 45% had a high body fat percentage. Caffeinated drinks and full cream milk were the most frequently consumed SSBs. The KAP score revealed a good attitude (88.4%), a moderate knowledge (51.8%) and a poor practice (40.5%). Those with a higher body fat percentage showed significantly good attitude scores (p < 0.05). Low household income groups, females, adolescents aged 16–17 years old and being from an urban area demonstrated a significant (p < 0.05) positive determinant towards the KAP score. In conclusion, high awareness of negative health outcomes associated with SSBs among adolescents was not in accordance with the level of their lifestyle choices.

Frequent use of selected sugary products associates with thinness, but not overweight during preadolescence: a cross-sectional study

Convincing evidence suggests that diets laden with added sugar, specifically sugar-sweetened beverages, associate with excess weight in children. The relationships between sugar consumption frequency and BMI remain less well studied. We, therefore, evaluated children's consumption frequency of selected sugary products (n 8461; mean age 11·1 (sd 0·9) years) selected from the Finnish Health in Teens cohort study. Using a sixteen-item FFQ including six sugary products (chocolate/sweets, biscuits/cookies, ice cream, sweet pastry, sugary juice drinks and sugary soft drinks), we calculated a Sweet Treat Index (STI) for the frequency of weekly sugary product consumption and categorised children based on quartiles (Q) into low (Q1, cut-off < 4·0), medium (Q2 + Q3, range 4·0-10·5) and high STI (Q4, cut-off > 10·5), and as thin, normal and overweight/obese based on the measured BMI. Through multinomial logistic regression analyses, we found that subjects with a high STI exhibited a higher risk of being thin (OR 1·20, 95 % CI 1·02, 1·41) and lower risk of being overweight (OR 0·79, 95 % CI 0·67, 0·92), while subjects with a low STI were at higher risk of being overweight (OR 1·32, 95 % CI 1·14, 1·53). High consumption frequencies of salty snacks, pizza and hamburgers most closely were associated with a high STI. Our findings suggest that consuming sugary products at a high frequency does not associate with being overweight. The relationship between a low consumption frequency and being overweight suggests that overweight children's consumption frequency of sugary products may be controlled, restricted or underreported.

Patterns of food parenting practices regarding junk food and sugary drinks among parent-child dyads

Background

Children’s food preference and intake patterns are affected by parental child feeding practices. The objective was to determine patterns of food parenting practices regarding junk food and sugary drinks (JS) and investigate their associations with demographic characteristics and dietary intake in a large cohort of parents and their children (12–17 years).

Methods

Dyadic survey data from the cross-sectional, internet-based Family Life, Activity, Sun, Health, and Eating Study, conducted in 2014, were analyzed using latent class analysis to identify patterns of use for six JS parenting practices – negative emotions, restriction, monitoring, availability, modeling, and child involvement – based on parent and child report. Model covariates included self-reported parent and child sex, age (child only), body mass index category (based on height and weight), added sugars intake, and legitimacy of parental authority.

Results

Based on 1657 parent-child dyads, five parenting practice patterns were identified representing different levels of practice use – Complete Influencers (28%; reference class), Indifferent Influencers (21%), Negative Influencers (20%), Minimal Influencers (18%), and Disagreeing Influencers (13%). Compared to older child dyads, younger child dyads were less likely to belong to Indifferent and Minimal Influencers (79 and 63% lower odds, respectively). Greater parent added sugars intake increased the odds of belonging to Indifferent and Negative Influencers (4 and 5% higher for every teaspoon increase, respectively) while greater child added sugars intake decreased the odds of belonging to Minimal Influencers (6% lower for every teaspoon increase). Compared to dyads with high scores, dyads with low child scores for legitimacy of parental authority regarding JS were 18 times as likely to belong to Disagreeing Influencers.

Conclusions

The study findings suggest that parents utilize distinct patterns of feeding practices regarding JS ranging from use of many practices, use of some practices, to low use of any practice, with differential associations with parent and child intakes of added sugars. Counseling or intervening with parents to use a mix of structure practices, such as availability and modeling, to positively influence their child’s and possibly their own intake of sugary snacks and drinks may prove more efficacious than use of coercive control practices, such as negative emotions.

The association of parenting practices with toddlers' dietary intake and BMI, and the moderating role of general parenting and child temperament

Objective:

The objective was to examine the association between parenting practices, toddler’s dietary intake and BMI. In addition, potential moderation of these associations by general parenting and child temperament was examined.

Design:

The current cross-sectional study assessed parenting practices using the Comprehensive Feeding Practices Questionnaire, general parenting using the Comprehensive General Parenting Questionnaire, child temperament using the Child Behavior Check List, and children’s dietary intake through parental questionnaires. Children’s weight and length were objectively measured to determine BMI z-scores. Associations were examined using multiple linear regression analyses. Moderation was examined using interaction terms.

Setting:

Home setting.

Participants:

393 Dutch toddlers (age 1–3 years) and their parents recruited through fifty childcare centres and preschools in the Netherlands.

Results:

Various practices were related to children’s diet and BMI. For instance, the availability of healthy foods is the most important predictor of healthy dietary intake (e.g. β = –0·35 for sweets; β = 0·18 for fruit). The association of availability with a healthier diet was strongest when parents scored low on the positive parenting style dimensions, including nurturance, structure and/or behavioural control. In addition, it seemed that a high availability of healthy foods and low availability of unhealthy foods is especially beneficial for children showing withdrawal/depressive, anxious or overactive behaviour, while encouraging balance and variety is not beneficial for these children. All other practices were related to children’s diet and/or BMI as well.

Conclusions:

The findings underline the importance of viewing the impact of parenting practices in the context of general parenting and child temperament.

Using a Socioecological Approach to Identify Factors Associated with Adolescent Sugar-Sweetened Beverage Intake

BACKGROUND

Adolescents are among the highest consumers of sugar-sweetened beverages (SSBs) in the United States. More research is needed to understand the relationship of multiple levels of influence on adolescent SSB intake across the socioecological model in a nationally representative sample.

OBJECTIVE

This secondary analysis of cross-sectional data aims to explain variance in adolescent SSB intake by exploring the associations of adolescent demographic (ie, age, race/ethnicity, and parent socioeconomic status), intrapersonal (ie, behavioral intention, self-efficacy, and media perception), interpersonal (ie, social norms and perceived parenting practices), and home availability variables.

DESIGN

This study included 1,560 adolescents who participated in the 2014 National Cancer Institute-sponsored cross-sectional Family, Life, Activity, Sun, Health, and Eating study. Descriptive statistics, analyses of variance, and stepwise multiple linear regression models were used to explore factors associated with SSB intake. In the stepwise regression, a 4-step model was analyzed with each subsequent step adding variables from different socioecological model levels.

RESULTS

The final step that included 14 variables individually associated with SSB intake significantly predicted 16.5% of the variance in SSB intake. Four variables were associated with higher SSB intake in the final step when controlling for all other variables: male sex (β=.066), non-Hispanic black vs non-Hispanic white (β=.123), adolescent's report of having parents allow them to have SSBs on a bad day (β=.150), and home SSB availability (β=.263). Race/ethnicity other than Hispanic and/or non-Hispanic black vs non-Hispanic white was associated with lower intake (β= -.092).

CONCLUSIONS

When considering potential targets for multilevel behavioral interventions aimed at reducing adolescent SSB intake, emphasis on reducing SSB availability at home may be especially important. Furthermore, although adolescence is a period of increasing independence, parent influence on adolescent's health behaviors may also be a key intervention target. Home and parental SSB factors may be more important than targeting intrapersonal factors and social norms among adolescents.

Adolescents' Food Purchasing Patterns in The School Food Environment: Examining the Role of Perceived Relationship Support and Maternal Monitoring

The school food environment plays a role in adolescents’ dietary behaviors. In this study, adolescents’ food purchasing patterns in and around school and its potential relationship with perceived maternal relationship support and maternal monitoring were examined. Data were collected in The Netherlands in 2017. A total of 726 adolescents (45.8% boys; M_age = 13.78 ± 0.49) and 713 mothers (M_age = 45.05 ± 4.45) participated. Adolescents’ frequency of bringing and purchasing foods was assessed via a Food Frequency Questionnaire (FFQ). Relationship support and monitoring were measured via self-report questionnaires. Structural Equation Modelling (SEM) was conducted to examine associations between adolescents’ food purchasing patterns, relationship support, and monitoring. Results indicated that adolescents brought food and drinks mostly from home, and infrequently purchased these products in and around school. Yet, differences exist between subgroups of adolescents. Relationship support was positively associated with bringing fruit, vegetables and salad and negatively associated with purchasing sweet snacks. No associations were found for monitoring. These findings indicate that family-home determinants of healthy and unhealthy eating are important factors to consider when examining the impact of the school food environment on adolescents’ food purchasing patterns. This has implications for policy makers who aim to develop and implement measures to improve adolescents’ eating in and around school.

Describing Independent Eating Occasions among Low-Income Adolescents

The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10–13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 ± 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.

Testing a Social Network Intervention Using Vlogs to Promote Physical Activity Among Adolescents: A Randomized Controlled Trial

There is a need to stimulate physical activity among adolescents, but unfortunately, they are hard to reach with traditional mass media interventions. A promising alternative is to carry out social network interventions. In social network interventions, a small group of individuals (influence agents) is selected to promote health-related behaviors within their social network. This study investigates whether a social network intervention is more effective to promote physical activity, compared to a mass media intervention and no intervention. Adolescents (N = 446; M_age = 11.35, SD_age = 1.34; 47% male) were randomly allocated by classroom (N = 26, in 11 schools) to one of three conditions: social network intervention, mass media intervention, or control condition. In the social network intervention, 15% of the participants (based on peer nominations) was approached to become an influence agent, who created vlogs about physical activity that were shown during the intervention. In the mass media intervention, participants were exposed to vlogs made by unfamiliar peers (i.e., vlogs of the social network intervention). The control condition did not receive vlogs about physical activity. All participants received a research smartphone to complete questionnaires and a wrist-worn accelerometer to measure physical activity. The trial was registered a priori in the Dutch Trial Registry (NTR6903). There were no differences in objectively measured physical activity between this social network intervention and the control condition in the short-term, but there was an unexpected increase in the control condition compared to the social network intervention in the long-term. No differences between the social network intervention and mass media intervention were observed. The current study does not provide evidence that this social network intervention is effective in increasing physical activity in adolescents. Exploratory analyses suggest that this social network intervention increased the perceived social norm toward physical activity and responses to the vlogs were more positive in the social network intervention than in the mass media intervention. These initial results warrant further research to investigate the role of the social norms and the added benefit of using influence agents for social network interventions.

Clinical Trial Registration:https://www.trialregister.nl/, identifier NTR6903.

Relationship between perception of emotional home atmosphere and fruit and vegetable consumption in European adolescents: results from the I.Family survey

OBJECTIVE

Consumption of fruits and vegetables (F&V) among adolescents falls below recommendations in many Western countries. The impact of social and emotional aspects of family life on adolescent dietary behaviour may contribute to this, yet remains under-investigated. The present study examines the association between adolescents' perceptions of emotional home atmosphere (EHA) and their F&V consumption frequency.

DESIGN

An FFQ was used to assess F&V consumption frequency. EHA was assessed by an eight-item measure with three subscales: perceived home warmth, strictness and relational tension. EHA subscales were used as binary variables: a score equal to or above the median value was considered as a higher perception, while a score below the median was considered as a lower perception of the EHA in question. Country differences in meeting the European 5-a-day recommendations were described. Further, the association between EHA and F&V consumption frequency was investigated using multiple linear regression.

SETTING

Regional examination centres in eight European countries.

PARTICIPANTS

Adolescents (n 3196) aged 12-18 years.

RESULTS

The mean F&V consumption frequency was 3·27 (sd 2·84) times/d. Only 16·1 % of boys and 18 % of girls in our study sample met the recommendation of five F&V daily. After controlling for age, sex, education level of the parents and country of origin, perceived home warmth was associated with a 16 (95 % CI 9, 22) % higher F&V consumption frequency (P < 0·001).

CONCLUSIONS

F&V consumption frequency was suboptimal in the survey areas. Interventions targeting perceived warmth as a component of EHA could potentially have a positive effect on adolescents' dietary behaviour.

Sugar-Sweetened Beverages and Child Health: Implications for Policy

PURPOSE OF REVIEW

Various policies to reduce sugar-sweetened beverages (SSBs) consumption in children have been implemented. Here, we review the evidence on whether these policies are effective in reducing SSB intake and whether a reduction in SSB intake results in a concomitant reduction in child obesity. We also highlight ethical concerns with such efforts.

RECENT FINDINGS

The evidence supporting relationship between SSB consumption and child body mass index (BMI) is consistently small and lacks causality. The effects of policies are unclear; taxation has no clear relationship to SSB purchasing, innovative marketing outlets make it difficult to examine the effects of restricting marketing on SSB consumption, and there is no evidence that reducing SSB availability in schools decreases consumption. Research studies with rigorous and reproducible study designs are needed to examine whether reducing SSB consumption reduces child obesity, and to identify implementable policies that not only reduce SSB consumption but also child weight.

Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation

OBJECTIVE

A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption.

DESIGN

We conducted six focus group discussions using a semi-structured guide.

SETTING

The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented.

PARTICIPANTS

Adults aged 18 years or above living in Soweto (n 57).

RESULTS

Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons.

CONCLUSIONS

While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.

Association of food parenting practice patterns with obesogenic dietary intake in Hispanic/Latino youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Some food parenting practices (FPPs) are associated with obesogenic dietary intake in non-Hispanic youth, but studies in Hispanics/Latinos are limited. We examined how FPPs relate to obesogenic dietary intake using cross-sectional data from 1214 Hispanic/Latino 8-16-year-olds and their parents/caregivers in the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). Diet was assessed with 2 24-h dietary recalls. Obesogenic items were snack foods, sweets, and high-sugar beverages. Three FPPs (Rules and Limits, Monitoring, and Pressure to Eat) derived from the Parenting strategies for Eating and Activity Scale (PEAS) were assessed. K-means cluster analysis identified 5 groups of parents with similar FPP scores. Survey-weighted multiple logistic regression examined associations of cluster membership with diet. Parents in the controlling (high scores for all FPPs) vs. indulgent (low scores for all FPPs) cluster had a 1.75 (95% CI: 1.02, 3.03) times higher odds of having children with high obesogenic dietary intake. Among parents of 12-16-year-olds, membership in the pressuring (high Pressure to Eat, low Rules and Limits and Monitoring scores) vs. indulgent cluster was associated with a 2.96 (95% CI: 1.51, 5.80) times greater odds of high obesogenic dietary intake. All other associations were null. Future longitudinal examinations of FPPs are needed to determine temporal associations with obesogenic dietary intake in Hispanic/Latino youth.

Conceptualizing Family Influences on Children's Energy Balance-Related Behaviors: Levels of Interacting Family Environmental Subsystems (The LIFES Framework)

Healthy or unhealthy behavioral patterns develop and are maintained in a family context. The importance of the family environment for children’s and adolescents’ energy balance-related behaviors (EBRBs) has been shown previously. However, the way different family environmental factors are interrelated and interact with personal factors (e.g., motivation) are not well understood. Furthermore, the majority of studies have focused on the parent-child subsystem. However, there are family-level socialization dynamics that affect the development of a healthy lifestyle beyond the impact of parenting behaviors. The current paper aims to synthesize theoretical and empirical literature on different types of family influences. The Levels of Interacting Family Environmental Subsystems (LIFES) framework incorporates family influences on three levels (immediate, proximal, distal) and of three subsystems (individual, parent-child, family), relates them to each other and postulates potential paths of influence on children’s EBRBs. Several studies examining specific sections of the framework provide empirical support for LIFES’ propositions. Future studies should place their research in the context of the interrelationship of different family environmental influences. A better understanding of the interrelated influences would enhance the understanding of the development and maintenance of overweight and obesity among children and is crucial for the development of effective interventions.

Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home

OBJECTIVES

To examine the association between sugar-sweetened beverage availability at home and sugar-sweetened beverage consumption, and to evaluate whether this association was consistent across school and school neighborhood sugar-sweetened beverage availability.

STUDY DESIGN

Secondary data analyses were performed from the 2014 cross-sectional, Internet-based Family Life, Activity, Sun, Health, and Eating (FLASHE) study of 1494 adolescents (age 12-17 years). Ordinal logistic regression analyses were conducted to examine the association between sugar-sweetened beverage availability in the home and adolescents' frequency of sugar-sweetened beverage consumption (nondaily, <1; daily, 1-<2; daily, ≥2), adjusting for adolescent age, sex, race, and body mass index and parent marital status and housing insecurity. Stratified ordinal logistic regression analyses were used to examine the associations by school and school neighborhood sugar-sweetened beverage availability.

RESULTS

One-third (32.6%) of adolescents were nondaily consumers of sugar-sweetened beverages, 33.9% consumed 1-<2 sugar-sweetened beverages daily, and 33.5% consumed ≥2 sugar-sweetened beverages daily. Almost one-half (44.4%) reported that sugar-sweetened beverages were often or always available in the home. Frequency of sugar-sweetened beverage availability at home was associated with greater sugar-sweetened beverage consumption (OR, 2.88; 95% CI, 2.86-2.89 for rarely/sometimes available at home; OR. 5.62; 95% CI, 5.60-5.64 for often/always available at home). Similar associations were found regardless of the availability of sugar-sweetened beverages in the adolescent's school or school neighborhood.

CONCLUSIONS

Sugar-sweetened beverage availability in the home was associated with adolescent sugar-sweetened beverage consumption, regardless of sugar-sweetened beverage availability in other settings, and may be a key target for obesity prevention efforts.

Friends and Family: How African-American Adolescents' Perceptions of Dietary Beliefs and Behaviors of Others Relate to Diet Quality

BACKGROUND

Adolescents' dietary intake often fails to meet national dietary guidelines, especially among low-income African-American youth. The dietary habits established in adolescence are likely to continue into adulthood, and a poor-quality diet increases the risk of developing obesity and chronic disease. Based on principles from ecological and social-cognitive behavior change health theories, perceptions of parental beliefs about healthy eating, perceptions of peer eating behaviors, and parental monitoring of what adolescents eat may positively influence adolescent diet quality.

OBJECTIVE

The purposes of this study were to determine whether perceived parental beliefs about nutrition, perceived peer eating behaviors, and reported parental monitoring of the adolescent diet were related to African-American adolescent diet quality and whether these relationships were moderated by adolescent age or sex.

DESIGN

This secondary cross-sectional study used baseline data (2002 to 2004) from an urban community sample of low-income adolescents participating in a health promotion trial.

PARTICIPANTS/SETTING

Participants were 216 African-American adolescent-caregiver dyads in Baltimore, MD.

MAIN OUTCOME MEASURES

The 2010 Healthy Eating Index was used to estimate adolescent diet quality.

STATISTICAL ANALYSES PERFORMED

Analyses included correlations, t tests, age- and sex-by-perception regression interactions, and multivariate regressions adjusted for body mass index-for-age percentile, caregiver weight status, and caregiver depressive symptoms.

RESULTS

Higher diet quality scores were related to higher levels of perceived parental and peer support for healthy eating behaviors among adolescents (β=.21; P<0.05; β=.15; P<0.05, respectively) and to caregiver reports of parental monitoring of adolescent dietary behavior (β=1.38, P<0.01). Findings were not moderated by age or sex.

CONCLUSIONS

Consistent with ecological and social-cognitive theories, adolescents look to their friends and family in making healthy food choices. The relationships uncovered by this study describe some of the contextual, interpersonal influences associated with diet quality among low-income, urban African-American adolescents and warrant further exploration in future intervention studies.

Robotic Services Acceptance in Smart Environments With Older Adults: User Satisfaction and Acceptability Study

BACKGROUND

In Europe, the population of older people is increasing rapidly. Many older people prefer to remain in their homes but living alone could be a risk for their safety. In this context, robotics and other emerging technologies are increasingly proposed as potential solutions to this societal concern. However, one-third of all assistive technologies are abandoned within one year of use because the end users do not accept them.

OBJECTIVE

The aim of this study is to investigate the acceptance of the Robot-Era system, which provides robotic services to permit older people to remain in their homes.

METHODS

Six robotic services were tested by 35 older users. The experiments were conducted in three different environments: private home, condominium, and outdoor sites. The appearance questionnaire was developed to collect the users' first impressions about the Robot-Era system, whereas the acceptance was evaluated through a questionnaire developed ad hoc for Robot-Era.

RESULTS

A total of 45 older users were recruited. The people were grouped in two samples of 35 participants, according to their availability. Participants had a positive impression of Robot-Era robots, as reflected by the mean score of 73.04 (SD 11.80) for DORO's (domestic robot) appearance, 76.85 (SD 12.01) for CORO (condominium robot), and 75.93 (SD 11.67) for ORO (outdoor robot). Men gave ORO's appearance an overall score higher than women (P=.02). Moreover, participants younger than 75 years understood more readily the functionalities of Robot-Era robots compared to older people (P=.007 for DORO, P=.001 for CORO, and P=.046 for ORO). For the ad hoc questionnaire, the mean overall score was higher than 80 out of 100 points for all Robot-Era services. Older persons with a high educational level gave Robot-Era services a higher score than those with a low level of education (shopping: P=.04; garbage: P=.047; reminding: P=.04; indoor walking support: P=.006; outdoor walking support: P=.03). A higher score was given by male older adults for shopping (P=.02), indoor walking support (P=.02), and outdoor walking support (P=.03).

CONCLUSIONS

Based on the feedback given by the end users, the Robot-Era system has the potential to be developed as a socially acceptable and believable provider of robotic services to facilitate older people to live independently in their homes.

"Your Body Feels Better When You Drink Water": Parent and School-Age Children's Sugar-Sweetened Beverage Cognitions

Sugar-sweetened beverages (SSBs) are a leading source of added sugar in the American diet. Further, ingestion of added sugars from SSBs exceeds recommendations. Thus, interventions that effectively reduce SSB consumption are needed. Focus group discussions with parents (n = 37) and school-aged children between the ages of 6 and 11 years (n = 41) from Florida, New Jersey, and West Virginia were led by trained moderators using Social Cognitive Theory as a guide. Trends and themes that emerged from the content analysis of the focus group data indicated that both parents and children felt that limiting SSBs was important to health and weight control. However, parents and children reported consuming an average of 1.85 ± 2.38 SD and 2.13 ± 2.52 SD SSB servings/week, respectively. Parents and children were aware that parent behaviors influenced kids, but parents reported modeling healthy SSB behaviors was difficult. Busy schedules, including more frequent parties and events as children get older, were another barrier to limiting SSBs. Parents were most successful at limiting SSBs when they were not in the house. This qualitative research provides novel insights into parents' and children's cognitions (e.g., beliefs, attitudes), barriers, and facilitators related to SSB ingestion. Consideration of these insights during nutrition intervention development has the potential to improve intervention effectiveness in reducing SSB intake.

How Food Rules at Home Influence Independent Adolescent Food Choices

PURPOSE

The prevalence of unhealthy dietary behaviors among adolescents is high. We examined the effect of having health-oriented food rules at home on the healthiness of adolescents' independent food choices, and the necessity of parental oversight for such rules to be effective.

METHODS

We surveyed a socioeconomically and racially diverse San Francisco Bay Area public high school in May 2017 (N = 1,246). We used ordinal logistic regressions to assess the relationships between adolescent-reported presence of health-oriented food rules at home and the healthiness of snacks selected by adolescents in a raffle, which included a randomized controlled experiment to manipulate the level of parental approval students needed to pick up their snacks.

RESULTS

Adolescents reporting at least one health-oriented food rule at home were significantly more likely to choose healthier snacks in the raffle (adjusted odds ratio, 1.85; 95% confidence interval [CI] 1.41-2.45). Telling adolescents that a parent needed to approve the snacks did not have a significant effect on snack choice healthiness relative to a no-approval baseline condition (adjusted odds ratio, 1.01; 95% CI .55-1.86). Post hoc analyses suggest that rules may affect adolescent food-related attitudes and perceptions of parental reactions; for example, adolescents with rules reported that their parents would be more disappointed (adjusted mean difference on five-point scale, .5; 95% CI .36-.64) if they made an unhealthy food choice.

CONCLUSIONS

Having health-oriented food rules at home is associated with healthier snack choices. Findings suggest that adolescents with rules also hold beliefs that may correspond to healthier independent dietary choices.

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

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

Physical Activity Intensity Among Adolescents and Association With Parent-Adolescent Relationship and Well-Being

Participation in physical activity (PA) provides young people significant health benefits, including improved well-being. However, large percentages of children and adolescents do not meet the recommendations for PA. Given that PA patterns are established during childhood and adolescence, and evolve within the context of the family, the current study explores the relationship between perceived parent–adolescent relationships and adolescents’ PA levels, body mass index (BMI), and subjective well-being. The study was conducted in Israel, and the sample included 233 participants (126 girls, 107 boys) aged 13 to 18 years.

Participants self-reported the following measures: demographic information, BMI, the Godin-Shephard Leisure-Time Physical Activity Questionnaire, the Personal Well-Being Index, and parent–adolescent relationship. The data were analyzed using Pearson analyses, t tests, and regressions. A clear difference emerged in strenuous PA activity by sex [t(₂₂₃) = 2.1, p < .01]; the average strenuous PA was greater for boys (M = 3.9, SD = 2.4) than for girls (M = 1.8, SD = .2.4). Furthermore, different predictors of strenuous PA by sex were found: for boys, parent–adolescent relationship was a significant predictor; for girls, subjective well-being was a predictor. The findings can shed light on the need for different intervention programs for adolescent boys and girls to increase their involvement in PA.

Promoting Water Consumption on a Caribbean Island: An Intervention Using Children's Social Networks at Schools

Sugar-sweetened beverage (SSB) consumption and the associated childhood obesity are major concerns in the Caribbean, creating a need for interventions promoting water consumption as a healthy alternative. A social network-based intervention (SNI) was tested among Aruban children to increase their water consumption and behavioral intention to do so and, consequently, to decrease SSB consumption and the associated behavioral intention. In this study, the moderating effects of descriptive and injunctive norms were tested. A cluster randomized controlled trial was completed in schools (mean age = 11 years ± SD = 0.98; 54% girls). Children were assigned to the intervention group (IG; n = 192) or control group (CG; n = 185). IG children were exposed to peer influencers promoting water consumption and CG children were not. Regression analyses showed that water consumption increased for IG children with a high injunctive norm score (p = 0.05); however, their intention to consume more water remained unchanged (p = 0.42). Moreover, IG children showed a decrease in SSB consumption (p = 0.04) and an increase in their intention to consume less SSB (p = 0.00). These findings indicate that SNIs are a promising instrument for health behavioral changes for Aruba and other islands in the Caribbean region.

Adolescent Sugar-Sweetened Beverage Intake is Associated With Parent Intake, Not Knowledge of Health Risks

PURPOSE

To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent knowledge of SSB-related health risks.

DESIGN

Quantitative, cross-sectional.

SETTING

2014 SummerStyles survey.

SUBJECTS

Nine hundred and ninety parent and adolescent (12-17 years) pairs.

MEASURES

The outcome was self-reported adolescent intake (0, >0 to <1, or ≥1 time/day) of SSBs (soda, fruit drinks, sports/energy drinks, other SSBs). The exposures were self-reported parent SSB intake (0, >0 to <1, ≥1 to <2, or ≥2 times/day) and parent and adolescent knowledge of SSB-related health risks (weight gain, diabetes, and dental caries).

ANALYSIS

Separate multinomial logistic regression models were used to estimate adjusted odds ratios (aORs) for adolescent SSB intake ≥1 time/day (ref: 0 times/day), according to (1) parent SSB intake and (2) parent and (3) adolescent knowledge.

RESULTS

About 31% of adolescents consumed SSBs ≥1 time/day, and 43.2% of parents consumed SSBs ≥2 times/day. Adolescent and parent knowledge that SSB intake is related to health conditions ranged from 60.7% to 80.4%: weight gain (75.0% and 80.4%, respectively), diabetes (60.7% and 71.4%, respectively), and dental caries (77.5% and 72.9%, respectively). In adjusted models, adolescent SSB intake ≥1 time/day was associated with parent intake ≥2 times/day (aOR = 3.30; 95% confidence interval = 1.62-6.74) but not with parent or adolescent knowledge of health risks.

CONCLUSION

Parental SSB intake may be an important factor in understanding adolescent behavior; knowledge of SSB-related health conditions alone may not influence adolescent SSB behavior.

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.

Acceptance and Attitudes Toward a Human-like Socially Assistive Robot by Older Adults

Recent studies have shown that cognitive and social interventions are crucial to the overall health of older adults including their psychological, cognitive, and physical well-being. However, due to the rapidly growing elderly population of the world, the resources and people to provide these interventions is lacking. Our work focuses on the use of social robotic technologies to provide person-centered cognitive interventions. In this article, we investigate the acceptance and attitudes of older adults toward the human-like expressive socially assistive robot Brian 2.1 in order to determine if the robot's human-like assistive and social characteristics would promote the use of the robot as a cognitive and social interaction tool to aid with activities of daily living. The results of a robot acceptance questionnaire administered during a robot demonstration session with a group of 46 elderly adults showed that the majority of the individuals had positive attitudes toward the socially assistive robot and its intended applications.

Structure, coercive control, and autonomy promotion: A comparison of fathers’ and mothers’ food parenting strategies

This study explored differences in mothers’ and fathers’ food parenting strategies, specifically coercive control, structure, and autonomy promotion, and whether parenting style and parental responsibility for food parenting related to the use of these strategies. Parents of children aged 2.5–7.5 years ( N = 497) reported about their parenting practices and food parenting strategies. Parenting style accounted for the majority of the variance in food parenting. Fathers were more authoritarian than mothers. Authoritarian and permissive parenting practices were related to more coercive strategies. Mothers reported more food parenting responsibility. Responsibility was related to less coercive practices and more autonomy promotion and structure.