Parents' barriers and strategies to promote healthy eating among school-age children

Marital Conflict and Healthy Dietary Habits Among Preschoolers: A Study of the Experience of Coupled Women in Urban Mexico

In Mexico social dynamics are changing toward less traditional arrangements. With a qualitative interview study, we explore the link between marital conflict and mothers' ability to foster healthy dietary habits. Sample consisted of 21 middle-class cohabitating mothers of preschoolers. Results suggests that marital conflict leads women to experiences of tension, ambivalence, or inaction on fostering healthy eating habits. Parents' mismatch in gender beliefs, food preferences, time orientation, and risk aversion play a role in creating disagreements. When men participate, women feel "helped" and grateful, but the forms and extent of desired participation may vary among traditional, ambivalent and non-traditional women.

I'll Never Give Up: A Qualitative Study of Caregivers' Perceptions and Decisional Processes When Feeding Infants and Toddlers Novel and Disliked Foods

OBJECTIVE

To better understand caregivers' decisional processes related to offering novel and disliked foods to their infants and toddlers.

DESIGN

As part of a parent study on young children's food acceptance that took place in Denver, CO, this secondary analysis used a basic qualitative approach to explore caregivers' decisional processes related to repeated exposure and children's food rejection.

PARTICIPANTS

English-speaking caregivers of infants and toddlers (aged 6-24 months; n = 106) were recruited via flyers and social media and interviewed (from July, 2017 to January, 2018) during a laboratory visit focused on introducing a novel food.

PHENOMENON OF INTEREST

Factors influencing caregiver decisions to (dis)continue offering novel or disliked foods.

ANALYSIS

Using a combined deductive and inductive coding approach, trained researchers coded transcripts and codes, which were reviewed and discussed by all investigators to identify themes.

RESULTS

Three major themes (and 2 subthemes) were generated regarding caregivers' decisions about re-offering rejected foods: 1) Caregivers understand that multiple experiences with new foods are needed because children's reactions can be unpredictable and depend upon time, developmental stage, and child traits; 2) Caregivers vary in their persistence and decisions to keep offering foods depending on responsiveness to child cues (sub-theme) and adult-centered beliefs, needs, and decisions (sub-theme); 3) Child food acceptance will change with time, circumstances, and development if you keep trying.

CONCLUSIONS AND IMPLICATIONS

Although caregivers are aware of repeated exposure, additional implementation research focused on translating theory into effective home practices could assist caregivers to persist in offering novel or disliked foods.

Identifying barriers and facilitators to increase fibre intakes in UK primary school children and exploring the acceptability of intervention components: a UK qualitative study

OBJECTIVE

Within the UK, dietary fibre intakes are well below recommended intakes and associated with increased risk of obesity. This study aimed to explore the views of parents and children on barriers and facilitators to increasing fibre intakes and improving diets, alongside investigating the appropriateness of intervention components to overcome modifiable barriers.

DESIGN

Qualitative study including semi-structured interviews and focus groups informed by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model.

PARTICIPANTS

Year 5 children (aged 9-10-years) and parents, recruited through London primary schools.

RESULTS

A total of twenty-four participants (eleven parents and thirteen children) took part. Five key themes were identified as barriers and facilitators, namely lack of (and improving) knowledge, social factors (including parent-child conflicts, limited time for food preparation, influence of peer and family members), current eating habits, influence of the school, community and home environment in shaping eating behaviours, and the importance of choice and variety in finding foods that are healthy and tasty. Parents strongly supported school-based dietary interventions to enable consistent messaging at home and school and help support dietary behaviour change. Practical sessions (such as workshops to strengthen knowledge, taste tests and food swap ideas) were supported by parents and children.

CONCLUSIONS

By using a theory-driven approach to explore the barriers and facilitators to increasing fibre intake, this research identified important themes and modifiable barriers to behaviour change and identifies acceptable intervention components to overcome barriers and bring about sustained dietary behaviour change in primary school children.

Parents' food choice for their preschool-aged children: A means-end investigation

BACKGROUND

Despite the growing literature on the importance of parental feeding practices, the factors that influence how parents make decisions regarding the foods they offer to their young children are not fully understood. Means-end theory and its associated methodology known as laddering provide a useful framework for characterizing the relationships between the attributes of a choice option (e.g., a food item), the consequences (i.e., the benefits or costs/risks) associated with those attributes and the personal values (i.e., enduring beliefs) those consequences help reinforce. The present research uses this means-end perspective to enrich our understanding of how parents make food choices for their preschool-aged children.

METHODS

Interviews were conducted with parents (N = 33) of 3- to 5-year-old children to explore the factors underlying parents' decisions regarding the foods they recently offered, prefer to offer and avoid offering to their preschooler. The resulting data were transcribed, content analysed and summarized in a series of summary diagrams known as hierarchical value maps (HVMs).

RESULTS

Study results indicate that although most parents reported trying to make food decisions because they want their child to be healthy, factors such as avoiding fights/battles and low perceived likelihood their child would eat a food may be barriers to offering certain foods.

CONCLUSIONS

Taken together, these study findings enhance our understanding of the range of meanings underlying parents' food choice decisions and suggest opportunities for interventions to improve the quality of foods that parents offer to their children at home.

How Can We Increase the Nutrition-Related Knowledge in Children Aged 7-12 Years: Results of Focus Groups Interviews with Parents-Junior-Edu-Żywienie (JEŻ) Project

Nutrition education is a long-term process that should cover various population groups. A special focus should be placed on children, adolescents and their parents. The aim of this research was to find out the opinions of parents of primary school pupils aged 7-12 on their expectations towards school education in the areas of food and nutrition, addressed to both pupils and their parents. The research was conducted among 101 parents of primary school pupils with the use of the Focus Group Interview (FGI) method. It demonstrated that what is most needed are hands-on activities relating to basic theoretical issues. While parents see the need for nutrition education for their children, educating pupils in this area is of interest to only some of the respondents for whom nutrition aspects are quite important. All parents would like formal nutrition education at school, but at the same time, they do not want classes to take up too much of their children's time, due to the already excessive number of school subjects. It seems appropriate to include everyone in regard to nutrition education, regardless of their declared interest in this issue. The need for consistent presentation of educational content addressed to teachers and parents is very important, so that they can, in a uniform way, shape the attitudes towards food and nutrition of children and adolescents.

Exploring the feasibility of using evidence-based feeding practices to promote children's healthy eating in holiday clubs

OBJECTIVE

Encouraging healthy eating is a public health priority in the United Kingdom (UK), given the high prevalence of poor diet and overweight/obesity among school-aged children. Holiday clubs are organisations providing childcare and activities during the school holidays and frequently provide food to children at risk of food insecurity, primarily through government-funded programmes like the Holiday Activities and Food programme. However, the research suggests that holiday clubs could do more to maximise opportunities to promote children's healthy eating by using evidence-based feeding practices.

DESIGN

During August-September 2020, video-based interviews were conducted exploring staff perceptions of the feasibility of using four evidence-based feeding practices to promote children's healthy eating: modelling; involvement in food choice; involvement in food preparation and cooking and involvement in meal planning. Feasibility was assessed using four dimensions of a feasibility framework (acceptability, demand, practicality and implementation).

SETTING

UK holiday clubs.

PARTICIPANTS

Twenty-five staff actively involved in delivering UK holiday clubs (project leaders, coordinators, cooks and coaches/youth workers).

RESULTS

Staff generally reported good acceptability (dimension 1) and demand (dimension 2) for the feeding practices. However, the practicality (dimension 3) of using the practices was dependent on various factors (logistics, resources, staff readiness, children, peers and parents). Promisingly, in the fourth feasibility dimension (implementation), staff provided numerous practical solutions to overcome these barriers.

CONCLUSIONS

Evidence-based feeding practices can be implemented in numerous ways and are therefore generally feasible in holiday clubs. Holiday clubs should be empowered to use evidence-based feeding practices through training resources, sharing networks and provision of sustainable funding.

Healthy helpers: using culinary lessons to improve children's culinary literacy and self-efficacy to cook

Background

Children do not eat the recommended amounts of vegetables, and school-based nutrition education has not been found to impact this behavior. Cooking education is associated with improved children's culinary literacy (CL) and eating behaviors. This study investigated the impact of a culinary literacy (CL) curriculum on children's acceptance of vegetable-added (mushrooms) recipes, CL, self-efficacy to cook (SE), and willingness to try vegetables (WV).

Methods

A convenience sample of 39 fourth and fifth graders were exposed to a six-lesson virtual CL curriculum that taught basic cooking skills and how to prepare six recipes, including three traditional recipes and the same recipes with added vegetables.

Results

Children who participated in the CL curriculum accepted vegetables added to pizza pockets, but vegetables added to macaroni and cheese and fajitas negatively affected the acceptance of recipes. Children improved their CL and SE but did not show a significant change in their WV.

Conclusion

Findings suggest that CL programs focusing on vegetables may drive factors associated with dietary behavior change, SE, and acceptance of vegetables. Future studies should consider CL as a potential method to improve vegetable intake in children in tandem with nutrition education or as a sole intervention. The study was limited by its small sample size, the virtual setting, and the use of mushrooms as the primary vegetable source. Future studies should be conducted with a larger sample size, in a traditional classroom setting, use a variety of vegetables, and collect qualitative data on the sensory characteristics affecting children's WV.

Development of a New Questionnaire to Assess Parental Perceived Barriers When Promoting Healthy Eating Habits in Young Children: First Findings

Social cognitive models suggest a crucial role played by perceived barriers in promoting healthy behaviors, including healthy eating. We aimed to develop a new questionnaire to assess parental perceived barriers to healthy feeding in young children and perform the instrument's preliminary psychometric evaluation. The initial pool of items was developed based on reviews and qualitative studies. First, we conducted an online, descriptive, cross-sectional study with 278 parents of 2-6-year-old children to examine its factorial structure and internal consistency. Then, a second study with 168 parents from a similar population assessed convergent/discriminant and known-groups validity. The exploratory factorial analysis confirmed the scale's theoretical structure. Five scales were found: Child-Related Barriers, Parent-Related Barriers-Vegetables and Fruit, Parent-Related Barriers-Added Sugars, Social Context-Related Barriers, and Cost-Related Barriers. All scales presented adequate reliability. We found weak to moderate, negative, and significant correlations between child- and parent-related barriers regarding vegetables and fruits, feeding practices to promote children's eating self-regulation, and food parenting self-efficacy. Additionally, parents who perceived their children as easy and well-regulated reported significantly fewer child-related barriers than parents with poorly self-regulated and inhibited children. The results support the instrument's preliminary psychometric adequacy regarding its validity and reliability and corroborate earlier empirical studies about the main parental barriers when promoting young children's healthy eating habits.

Development and validation of a parental competence questionnaire in the paediatric hospital emergency setting (ECP-U)

OBJECTIVE

To develop and validate a parental competence questionnaire for parents of children seeking care in hospital emergency departments.

METHODS

An instrumental study of the development of an assessment questionnaire was carried out in three phases: 1) review of relevant measures and item generation, 2) content validity evaluation, 3) psychometric evaluation. Exploratory factor analysis was performed to examine the factorial structure. Internal consistency was evaluated using ordinal alpha. Hypothesis testing was determined between the resulting factors, the Parental Stress Scale and the State-Trait Anxiety Inventory.

RESULTS

The participants were 270 parents of children aged 0-14 years old from a referral hospital in Valencia (Spain). An 18-item questionnaire was developed, comprising five factors that explain 53.0% of the variance: 1) "emotional management and expression", 2) "passive social support", 3) "parental agency", 4) "basic needs and care" and 5) "active social support". The internal consistency for the different factors was modest (>0.70). A negative correlation between the Parental Stress Scale and the parental competence questionnaire was found for most of the factors.

CONCLUSIONS

This questionnaire on parental competence in the hospital emergency department (ECP-U) is a useful and simple self-report instrument for assessing the parental competence of parents with children in the emergency department.

PRACTICAL IMPLICATIONS

The resulting questionnaire is of practical value to both healthcare professionals and researchers in this field. It can be administered quickly in clinical practice and used to identify parents' levels of parental competence and refer those with difficulties to appropriate support services.

The Activities of the Slovenian Strategic Council for Nutrition 2023/24 to Improve the Health of the Slovenian Population and the Sustainability of Food: A Narrative Review

The health status of individuals in Slovenia across age groups is a matter of concern, as current unsustainable lifestyle choices are already leading to various chronic noncommunicable diseases (NCDs). Outdated national dietary guidelines, their inconsistent implementation, and a lack of structural changes represent obstacles to promoting healthy and sustainable nutrition. Limited access to and rising prices of healthy, sustainable foods, in addition to the high availability of low-priced, highly processed foods, increase the risk of NCDs. The lack of systematic health monitoring and early disease detection poses a challenge. Global and local environmental issues, resistance, and/or the inability to adopt healthier diets hinder individuals from changing their nutritional behaviours. In this narrative review, we provide an overview of the current situation in Slovenia as well as planned activities initiated by the Slovenian government and the Prime Minister's Strategic Council for Nutrition, aiming to make progress in supporting healthy and sustainable nutrition, limiting food waste, and increasing the availability of healthier foods for all. Improving the sustainability of the Slovenian food system can contribute to several Sustainable Development Goals (SDGs), ensuring Slovenia's commitment to internationally agreed-upon targets. This could lead Slovenia to take a role as a pilot country in testing and implementing the necessary systemic changes, which could be further applied in other countries.

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families' use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: 'Child factors', 'Eating beliefs', 'Effectiveness beliefs', 'Past experience', 'Current family behaviours', 'Harms', 'Knowledge', 'Need for change', 'Parent effort', 'Parent values' and 'Practical issues'. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a "protective mindset" that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake.

Barriers to Healthy Family Dinners and Preventing Child Obesity: Focus Group Discussions with Parents of 5-to-8-Year-Old Children

BACKGROUND

Although numerous physical and mental health benefits for children have been linked to family dinners, many families still do not have regular family meals together. This study sought to identify the barriers that keep families from having dinners together.

METHODS

We interviewed 42 parents of 5-to-8-year-old children in small focus groups to identify barriers and challenges that keep families from having healthy and consistent dinners together.

RESULTS

Parents reported the main barriers were time (e.g., time strain and overscheduling, mismatched schedules, long work hours, etc.), lack of meal planning or failure to follow plans, lack of skills (e.g., cooking skills or nutritional awareness), external factors (e.g., daycare, schools, or extended family, and competing with advertising), and food-related challenges (e.g., picky eating, food allergies). Parents also suggested potential solutions to overcome these barriers.

CONCLUSIONS

Overall, parents had a desire to have family dinners with their children, but they felt that there are many barriers keeping them from establishing or maintaining consistent family mealtimes. Future research, as well as child obesity prevention and intervention efforts, should consider these barriers and suggested solutions in efforts to promote healthy and consistent family meals as a means of lowering the prevalence of childhood obesity.

Beyond enjoyment: Young children consider the normative goodness of activity engagement when attributing happiness

Individuals are typically happy when engaging in enjoyable activities. But many enjoyable activities could be harmful when engaged in to excess. Do children consider the normative goodness of activity engagement levels when attributing happiness? To examine this question, we presented children with enjoyable activities that are often harmless in moderation but harmful in excess. When told that engaging in their favorite activities at their preferred amount was either normatively good (i.e., harmless and permitted) or normatively bad (i.e., harmful and forbidden), 10- and 11-year-old and 7- and 8-year-old children (Study 1) and even 5-year-old children (Studies 2 and 3 with simplified methods) attributed less happiness when the engagement level was normatively bad than when it was normatively good both to themselves and to another child. Young children also perceived normatively bad engagement as less interesting and pleasurable (Study 3). The findings suggest that children consider the normative goodness of activity engagement (rather than enjoyment alone) when attributing happiness, illuminating how children understand happiness.

Preliminary Support for the Use of Motivational Interviewing to Improve Parent/Adult Caregiver Behavior for Obesity and Cancer Prevention

Motivational interviewing (MI) is a promising behavioral intervention for improving parent and adult caregiver (PAC) health behavior for obesity and cancer prevention. This study explored the preliminary effects of MI from a registered dietitian (RDMI) within an obesity prevention intervention to promote PAC behavior change and positive proxy effects on children and the home environment. N = 36 PAC/child dyads from low-resource communities were enrolled in a randomized trial testing a 10-week obesity prevention intervention. Intervention dyads were offered RDMI sessions. Data were collected at baseline and post-intervention (PAC diet quality (Healthy Eating Index (HEI)), child skin carotenoids, home environment, and PAC ambivalence regarding improving diet). Results show that for every RDMI dose, PAC HEI scores increased (0.571 points, p = 0.530), child skin carotenoid scores improved (1.315%, p = 0.592), and the home food environment improved (3.559%, p = 0.026). There was a significant positive relationship between RDMI dose and change in ambivalence (ρ = 0.533, p = 0.007). Higher baseline ambivalence was associated with greater dose (ρ = -0.287, p = 0.173). Thus, RDMI for PACs may improve diets among PACs who are otherwise ambivalent, with potential effects on the diets of their children and the home food environment. Such intervention strategies have the potential for greater effect, strengthening behavioral interventions targeting obesity and cancer.

Perceived challenges and strategies to achieve Canada's Food Guide recommendation to "Cook more often": Findings from parents of young children

Unhealthy diets are detrimental to health, but home meal preparation is associated with better diet quality. Among a sample of parents of children aged 2-12, this study aimed to 1) explore perceived challenges and strategies to meeting the 2019 Canada's Food Guide recommendation of "Cook more often". From October 2019 to January 2020, 8 focus groups were conducted with 40 parents (73% mothers; 78% white) from Southwestern Ontario, Canada. Sessions were audio-recorded and transcribed verbatim. A hybrid thematic approach with inductive and deductive data analysis was used. Reported challenges included time constraints, picky eating, lacking cooking skills, high price of some fresh ingredients, school restrictions on meals at school, and the influence of children's peers on food choices, mainly unhealthy snacks. Reported strategies to mitigate some challenges included planning and preparing meals ahead of time, using technology or services to make meal planning and grocery shopping more convenient, using devices and kitchen instruments, such as Crockpot®, to make cooking faster, receiving help from spouse or child(ren), and acknowledging that foods perceived as less healthful in moderation can be included in meal preparation. These findings can help inform interventions and educational campaigns to support cooking among families with young children.

Promoting Health Equity: Identifying Parent and Child Reactions to a Culturally-Grounded Obesity Prevention Program Specifically Designed for Black Girls Using Community-Engaged Research

The Butterfly Girls (BFG) Study is a culturally and developmentally appropriate online obesity prevention program for 8–10-year-old Black girls designed with key stakeholders in the Black community. This multi-methods investigation, conducted with parent–child dyads who participated in an outcome evaluation of the intervention, aimed to understand parent and child reactions to the program. We were particularly interested in understanding perceptions regarding its cultural and developmental appropriateness, relevance and acceptability. Program participation and survey data (demographics, parent and child write-in comments on process evaluation surveys) were analyzed. Participation data demonstrated high adherence in treatment and comparison groups. Descriptive statistics were calculated for survey data and highlighted the socioeconomic diversity of the sample. Post intervention surveys included two fill-in-the-blank questions for parents (n = 184 for question 1, n = 65 for question 2) and one for children (n = 32). Comments were analyzed using structured thematic analysis. The majority of the feedback from child participants was complimentary and many found the program relatable. Among the parent responses, the majority found the program to be beneficial in its educational nature and in promoting behavior change. This multi-methods analysis suggests that the BFG program was perceived as beneficial by parents while being culturally and developmentally appropriate and engaging for young Black girls, highlighting the importance of co-collaboration in program development.

Parental intentions to implement vegetable feeding strategies at home: A cross sectional study

In order to increase vegetable intake by children, parents are encouraged to implement strategies that promote trying and eating vegetables at mealtimes. Qualitative studies have previously highlighted barriers parents face in implementing healthy eating practices, such as time, monetary costs and child factors (e.g. fussy eaters). This study aimed to specify the relationships between child and parent factors and their effects on parental intentions to implement vegetable feeding strategies at mealtimes. Parental intentions to implement meal service (serving larger portions, offering variety, serving vegetables first) and experiential learning (repeated exposure, games, sensory play) strategies were examined. Parents (N = 302, 73 male, Mage = 33.5) also explained reasons why certain strategies may or may not work for their child (4-7y). For both types of strategy, higher food fussiness of the child predicted higher parental intentions to implement strategies at home. However, this was competitively mediated by low beliefs that the strategy would work for their child, resulting in weaker overall positive effects on intentions. In the meal service model, parental beliefs that healthy eating is important for their child had a positive, indirect effect on higher intentions, through involved parental feeding practices. However, this was not significant in the experiential learning strategies model. Written parental responses suggest that this may be due to meal service approaches being viewed as easier to implement, with little additional effort required. Increasing parental confidence to implement strategies successfully and managing expectations around successful outcomes of strategies (e.g. tasting, eating) may be important focuses of future interventions to support parents implementing vegetable feeding strategies at mealtimes.

A cross-sectional exploratory study of food literacy among Saudi parents of adolescent children aged 10 to 19 years

Introduction

Parental food literacy is fundamental in laying a solid foundation for healthy eating among their children. This study aimed to (1) evaluate the current state of food literacy among Saudi parents of 10-19 years old adolescent children, and (2) determine the correlates associated with parental food literacy.

Methods

This cross-sectional study was conducted between April and June 2022, with a convenience sample of 1845 Saudi parents (mean age = 45.1 ± 11; mothers: 56%). A Short Food Literacy Questionnaire (SFLQ) was used to meet the study aims.

Results

Findings showed that around 46% of parents had poor food literacy. Fathers were 2.4 times more likely than mothers to be food illiterate (OR = 2.4, CI = 1.9-3.0, p < 0.001). Parents residing in Riyadh, Northern borders, Jawf, or Ha'il had a three times higher risk of being food illiterate than those residing in other provinces (OR = 3.2, CI = 2.6-3.9, p < 0.001). Parental overweight or obesity increased their risk of being food illiterate by 60% (OR = 1.6, CI = 1.3-2.1, p < 0.001). Healthy parents, in contrast to those having a chronic disease (s), had a 60% higher probability of food illiteracy (OR = 0.4, CI = 0.3-0.6, p < 0.001). Educated parents had a three times higher risk of being food illiterate (vs. uneducated parents, OR = 3.0, CI = 1.6-5.8, p = 0.001). Parents making less than 3000 Saudi Riyal (SR) per month (<798 USD/779 EUR) were 40% more likely to be food illiterate than those who reported 3000-25000 SR (798-6652 USD/779-6499 EUR) (OR = 0.6, CI = 0.4-0.9, p = 0.02), and 70% more likely to be food illiterate than those making more than 25000 SR (>6652 USD/6497 EUR) (OR = 0.3, CI = 0.2-0.6, p < 0.001). Parents who lived in crowded households were twice as likely to be food illiterate as those who did not (OR = 1.9, CI = 1.5-2.4, p < 0.001).

Conclusion

The current study findings should be employed in future programming and policy-making approaches to reach Saudi parents for necessary food literacy interventions. These interventions could include bolstering their confidence while cooking, buying groceries, reading nutrition labels, and integrating them into nutrition education lessons with their children in school settings.

The diverging patterns of life satisfaction between families: A latent profile analysis in dual-earner parents with adolescents

This study identifies family profiles based on the level of life satisfaction (LS) in mothers, fathers and adolescents, and variables related to their family, food, and work life. The sample was composed of 303 families of dual-earner parents (mothers’ mean age = 40.9 years, SD = 7.4, fathers’ mean age = 43.2 years, SD = 7.2) and one of their children aged between 10 and 17 years (mean age 13.3, SD = 2.4, 51.5% female). A Latent Profile Analysis (LPA) was used to identify five family profiles. Profiles differed in LS, satisfaction with family life (SWFaL), satisfaction with food-related life (SWFoL), family functioning, both parents’ work-life balance and their perception of the financial situation of the household. Balanced and imbalanced families in terms of LS differed in the three family members’ LS and SWFaL, mothers’ and children’ SWFoL and family functioning, and both parents’ perception of financial situation. These results contribute to understanding the heterogeneity of life satisfaction dynamics between and within dual-earner families.

Evaluating environmental and inhibitory control strategies to improve outcomes in a widely available weight loss program

BACKGROUND

Although many people try to lose weight, a large proportion of individuals do not achieve clinically significant weight loss. Nonresponse and relapse rates in lifestyle interventions are largely explained by challenges in avoiding or resisting temptation in the context of omnipresent food access. Innovative enhancement strategies are needed to help individuals manage temptation in evidence-based lifestyle interventions.

METHODS

This prospective, four-parallel-arm, randomized controlled trial tests the efficacy of two weight management enhancement strategies on weight and dietary outcomes among individuals with overweight or obesity: (1) an environmental control strategy combining modification of the home food environment and grocery delivery (AVOID) and (2) an impulse control strategy involving daily, gamified inhibitory control training (RESIST). Women and men (n = 500) with overweight or obesity (Body Mass Index between 25 and 40.0 kg/m2) will be enrolled in a 12-month commercial weight-loss program (WW, formerly Weight Watchers©) and randomly assigned to one of four conditions: (1) WW alone, (2) WW + AVOID, (3) WW + RESIST, or (4) WW + AVOID + RESIST. Anthropometric, dietary, cognitive, and household food environment assessments will be conducted in English or Spanish at enrollment and at 6- and 12-month follow-up.

DISCUSSION

This research addresses the pragmatic question of how to best optimize behavior change: Should we modify the choice environment, strengthen individuals' self-regulation, or both, to maximize behavior change? This work can inform the development of enhancement strategies to promote adherence to lifestyle recommendations and other impulse control challenges.

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

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

Food and beverage offerings by parents of preschoolers: A daily survey study of dinner offerings during COVID-19

The COVID-19 pandemic is likely to have altered parents' daily feeding practices, including what and how much they feed their children, which may have negative implications for children's weight. The primary aim of this study was to examine patterns of and variation in parents' daily food and beverage offerings at dinner across 10 days during the COVID-19 pandemic using descriptive analysis and non-parametric tests. Ninety-nine parents (M_age = 32.90, SD_age = 5.60) of children ages 2–4 years (M = 2.82, SD = 0.78) completed an online baseline survey and 10 daily surveys (929 completed surveys) assessing their daily food and beverage offerings at dinner. On average, parents did not offer recommended foods and beverages on a daily basis; parents offered vegetables and protein most often across the 10 days, however, less than 50% of parents offered the recommended serving size for each group. The intraclass correlations and random sampling plots revealed considerable within-parent variation in food and beverage offerings. Eating dinner as a family, planning dinner in advance, and preparing a homemade dinner were associated with more vegetable and protein offerings, while processed, fast, or fried foods were offered less often when dinner was planned or homemade. Dairy, water, and refined grains were offered more often when dinner was homemade, while whole grains, processed, fast, or fried foods, and sugar-sweetened beverages were offered less often when dinner was homemade. The results provide documentation of parents' daily food and beverage offerings at dinner within the context of COVID-19 and point towards the importance of examining predictors and consequences of parents' daily feeding practices.

Effectiveness of national multicentric school-based health lifestyles intervention among chinese children and adolescents on knowledge, belief, and practice toward obesity at individual, family and schools' levels

BACKGROUND

This study aims to evaluate the effectiveness of the trial of national multicentric school-based health lifestyles intervention toward childhood obesity on the KBP at individual, family and schools' levels.

METHODS

The national trial was a multi-centered, cluster-controlled trial, which was conducted in seven provinces from September 2013 to February 2014, aiming at preventing childhood overweight and obesity. Integrated intervention strategies focused on changing specific practice related to energy intake and expenditure, such as decreasing the consumption of sweetened fizzy drinks, increasing the consumption of vegetables, ensuring proper protein intake, reducing sedentary practice including screen time, and maintaining at least 1 h of moderate to vigorous physical activity. A total of 27,477 children and adolescents in the control group and 30,997 in the intervention group were recruited with a mean follow-up period of 6.7 months. The binomial response mixed-effects model was used for assessing the effects of the national school-based health lifestyles intervention on obesity-related KBP at students individual, parents' and schools' levels.

RESULTS

Children and adolescents in the intervention group mastered better obesity-related knowledge, and they had higher correct response rates to all questions about obesity-related knowledge compared to the control group (P < 0.05). In terms of obesity-related belief, individuals in the intervention group was more motivated than the control group, participants in the intervention group had higher correctness of 71.18, 52.94, and 56.60% than the control group of 68.61, 49.86, and 54.43%, (P < 0.05). In addition, healthier habits of eating breakfast and drinking milk every day were observed in the intervention group. For the beliefs toward obesity, parents of the intervention group had higher correctness than the control group. At the same time except for the fruit consumption, other obesity-related practice in the intervention group were healthier than the control group (P < 0.05). Except for some beliefs and practice, the intervention effect at the parent level was not significant in other aspects.

CONCLUSION

The obesity-related knowledge and beliefs of children and adolescents got improved significantly. However, the effects on the knowledge, beliefs and certain practices of their parents and school administrators failed to reach significance.

Prevalence of lactose intolerance and malabsorption among children of two ethnic groups from the urban areas of Malaysia and its relation to calcium intake and bone health status

Lactase insufficiency could develop into lactose intolerance (LI) and disrupt the intake of calcium, which is a core nutrient for bone development in children. However, data regarding the prevalence of LI and bone health status (BHS) among Malaysian children are scarcely reported.

PURPOSE

This study aimed to determine the prevalence of LI and lactose malabsorption (LM) in Malay and Chinese children and examine its relationship with calcium intake (CI) and BHS.

METHODS

A total of 400 children participated in this study. The prevalence of lactose tolerance (LT) was assessed using hydrogen breath test, LT test, and visual analogue scales. Assessment of CI was performed using a 24-h dietary recall interview (24-h DR) and food frequency questionnaire (FFQ). Calcaneal broadband ultrasound attenuation (BUA) was measured using a quantitative ultrasonometer.

RESULTS

The prevalence of LI among Chinese children (37%) was significantly higher (p = 0.002) than among Malay children (22.5%). However, 61.5% of Malay and 54.5% of Chinese children were found to have LM. CI of the children fulfilled 30.5% and 33.9% of the Malaysian recommended CI (1300 mg/day) for 24-h DR and FFQ, respectively. The BUA score of Malay children was significantly higher (p < 0.001) than that of Chinese children. However, LT and CI were not correlated with BHS (p > 0.05, respectively).

CONCLUSIONS

LI was diagnosed among Malay and Chinese children. However, the higher prevalence of LM is rather worrying as it could develop to LI. The prevalence possibly has been worsened by insufficient CI. Thus, effective approaches to increase CI are highly needed as bone development occurs rapidly at this age and is important for the attainment of the optimum peak bone mass during late adolescence.

How beliefs about weight malleability and risk perceptions for obesity influence parents' information seeking and feeding

This study surveyed 185 parents to determine whether their perceived risk of their child developing obesity and their implicit theories about the malleability of weight independently and/or interactively predict their child-feeding and pursuit of child-related obesity risk information. Higher risk perceptions were associated with healthier feeding intentions and more information seeking. More incremental (malleable) beliefs predicted healthier feeding intentions and greater pursuit of environmental, but not genetic, information. Contrary to hypotheses, the influence of implicit theories and risk perceptions were primarily independent; however, more incremental beliefs predicted less "junk food" feeding among only parents with lower perceived risk.

"Mummy, Can I Join a Sports Club?" A Qualitative Study on the Impact of Health-Promoting Schools on Health Behaviours in the Home Setting

Information regarding school-based health-promoting interventions' potential effects in the home environment is scarce. Gaining more insight into this is vital to optimise interventions' potential. The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children's health and well-being by providing daily physical activity sessions and healthy school lunches. This qualitative study examines if and how HPSF influenced children's and parents' physical activity and dietary behaviours at home. In 2018-2019, 27 semi-structured interviews were conducted with parents from two HPSFs. Interviews were recorded and transcribed, and data were coded and interpreted through thematic analysis. HPSF resulted in various behavioural changes at home, initiated by both children and parents. Parents reported improvements in healthy behaviours, as well as compensatory, unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints. Both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home and are therefore key mechanisms to maximise school-based health-promoting interventions' impact.

Changing the Home Food Environment: Parents' Perspectives Four Years after Starting Obesity Treatment for Their Preschool Aged Child

Changing the home food environment is key to childhood obesity treatment. However, new challenges arise as the child grows older. This study investigates parents' views on the longer-term management of the home food environment, 4 years after starting obesity treatment for their preschool-aged child. Semi-structured interviews were conducted with 33 parents (85% mothers, 48% with a university degree) of 33 children (mean age 9.3 (SD 0.7), 46% girls) from Sweden. The interviews were analyzed using thematic analysis. Two main themes were developed. Making changes in the home food environment illustrates the types of changes families make over time in relation to child development. It consists of three subthemes: covert changes, overt changes and child-directed changes. The second theme, an ongoing negotiation, captures parents' experiences of managing the home food environment as a continuous process of balancing and recalibrating in relation to present challenges and concerns about the future. It includes three subthemes: concern and care, two steps forward one back and maintaining everyday balance. Managing the home food environment is a constant process affected by everyday life, parents' strategies and the child's development. Our findings can strengthen childhood obesity treatment and help prepare parents for challenges that lie ahead.

Healthy Snacks in School: How Do Regulations Work? A Mixed-Design Study

BACKGROUND

School is an important setting to promote healthy eating habits for children. We compared the effects of 4 conditions on the nutritional quality of snacks brought to school. We also investigated teachers' opinions regarding the process, barriers, and facilitators in regulation implementation.

METHODS

We compared the nutritional quality of morning snacks based on 1958 photographs from schools divided into 4 conditions: regulation based on a list of permitted foods and beverages; regulation banning sweets, chips, and sugary drinks; information without regulation; or no intervention. Based on 5 focus groups (N = 18 participants), we investigated factors influencing regulation implementation.

RESULTS

In schools with a list of permitted foods and beverages, 76% of the children had a healthy snack, compared to 52% to 54% in the 3 other conditions (p < .01). They also brought less sweet foods compared to those in the other conditions (41% vs. 68% to 71%, p < .01). In focus groups, most teachers supported regulation but also expressed ambivalence about their legitimacy.

CONCLUSIONS

In this study, a regulation based on a list of permitted foods and beverages showed the best results. All actors should be involved in a progressive implementation process to increase acceptance of such regulation.

The Families Improving Health Together (FIT) Program: Initial evaluation of retention and research in a multispecialty clinic for children with obesity

BACKGROUND

Obesity affects ∼17% of US children, with parallel increases in multiple comorbidities, especially among African-, Asian-, Hispanic-, and Native-Americans. Barriers to patient retention in pediatric obesity programs include lack of centralized care, and frequent subspecialty MD visits which conflict with patient school attendance and parental work attendance as well as with support service utilization. Lack of integration of multispecialty clinical care with interdisciplinary research is a major barrier to fuller exploration of the treatment, prevention, and understanding of obesity in childhood.

OBJECTIVE

To test the hypothesis, a novel multispecialty/interdisciplinary clinical and research infrastructure with strong emphasis on a primary obesity care physician for children with early-onset (<9 years) obesity (Families Improving health Together [FIT]) could promote lower patient attrition (primary goal) and foster productive research in pediatric obesity (secondary goal).

RESULTS

Data support the hypotheses. Over 15 months, FIT reported a >90% participant retention (p < 0.001 vs. expected rate based on other studies of similar programs). Though 90% of children had at least one adiposity-related comorbidity and 70% had at least two, there was no need for additional subspecialist visits with cardiologists, endocrinologists, gastroenterologists, or molecular geneticists. Three abstracts were presented at national meetings, and two manuscripts were published all with junior faculty as primary authors.

CONCLUSION

This pilot study suggests that an integrated multispecialty/interdisciplinary approach to children with obesity improves patient retention and can be integrated successfully with research.

Parental perceptions and practices regarding sugar intake by school-aged children: A qualitative study with Portuguese parents

Excessive sugar intake is one of the factors contributing to the alarming rates of childhood obesity and overweight in Portugal. Children's preferences and food consumption patterns are largely determined by the foods that are more familiar to them. Parents and caregivers are responsible for shaping children's eating habits since they are the ones who choose the food available in the household. The present study explores parental perceptions about sugar and sugar intake and its consequences on children's health. Moreover, we also examined the practices that parents use to regulate their children's diet, namely, to promote the consumption of desired foods (e.g., vegetables) and limit the intake of undesired food (e.g., sweets), and the perceived barriers and facilitators of sugar intake regulation. To this end, 42 interviews were conducted with parents of school-aged children (ages 6-10 years). A thematic analysis revealed that parents perceive sugar as highly negative (e.g., "evil", "poison", "addiction") and its consumption as harmful (e.g., hyperactivity; overweight). Nonetheless, the view that sugary food consumption is not necessarily problematic was also common. Indeed, most parents considered that sugar intake should be regulated but not forbidden. To control the intake of sugary foods (e.g., sodas, cookies), they reported using strategies such as restriction, explanation, or negotiation. Several barriers to sugar intake regulation were identified (e.g., birthday parties, parents' lack of knowledge), but also a few facilitators (e.g., bringing food from home to school). Our findings may inform the development of interventions or policies to promote healthier eating habits in school-age children.

Teacher Evaluation of an Experiential Vegetable Education Program for Australian Primary Schools: Does Face-to-Face Training Add Value above Digital Training?

The teacher-led implementation of healthy eating programs in schools is cost-effective and potentially impactful. Teacher acceptability is important for uptake; however, process evaluations are scarce. This study evaluated the effect of two intensities of teacher training on the evaluation of a vegetable education program for Australian primary schools by teachers. The teachers (n = 65) who implemented the program as part of a cluster RCT (25 schools in two states, New South Wales and South Australia) received either low- (provision with materials and online training) or high (additional face-to-face (F2F) training)-intensity training prior to implementing a 5-week vegetable education program. They evaluated the acceptability of a digital training module and program by indicating the level of agreement with 15 and 18 statements, respectively, using 5-point Likert scales. The average item scores ranged from 3.0 to 4.2. All but one item, including student engagement, alignment to the curriculum and intent for reuse of the program, had a rounded average or median score of 4. The level of training intensity did not impact the teacher acceptability ratings. In conclusion, the teacher acceptability was good, and additional F2F training does not add value above the solely digital training of the teachers.

Barriers to Behavior Change in Parents With Overweight or Obese Children: A Qualitative Interview Study

Overweight and obesity among children and adolescents are global problems of our time. Due to their authority and role modeling, parents play an essential part in the efficacy of prevention and intervention programs. This study assessed the barriers that parents of overweight/obese children face in preventive and interventional health care utilization. Sixteen parents were qualitatively interviewed. A content analysis was performed, and barriers to change were allocated to their stage of change according to the transtheoretical model. Among the main barriers is the underestimation of health risks caused by overweight/obesity in association with diminished problem awareness. Parents seem not necessarily in need of theoretical knowledge for prevention and interventions. They do however need support in evaluating the weight status of their child and the knowledge of whom to turn to for help as well as specific and hands-on possibilities for change. The results extend past studies by adding specific barriers to change that parents commonly experience. Possibilities to address these barriers, e.g., through trainings at the pediatric practice or adoption of conversation techniques, are discussed. Future studies might identify subgroups experiencing specific barriers and thus be able to address these in an individualized way.

Visual attention towards food during unplanned purchases - A pilot study using mobile eye tracking technology

This pilot study aims to investigate the relationships between consumers' weight status, energy density of food and visual attention towards food during unplanned purchase behavior in a real-world environment. After more than a decade of intensive experimental eye tracking research on food perception, this pilot study attempts to link experimental and field research in this area. Shopping trips of participants with different weight status were recorded with mobile eye tracking devices and their unplanned purchase behavior was identified and analyzed. Different eye movement measurements for initial orientation and maintained attention were analyzed. Differences in visual attention caused by energy density of food were found. There was a tendency across all participants to look at low energy density food longer and more often.

Intergenerational Comparison of Food Parenting of Home Eating Behaviors of Schoolchildren

OBJECTIVE

To explore intergenerational differences on key factors of food parenting practices (FPPs) related to home eating behavior of schoolchildren.

DESIGN

In-depth interviews with social recognition theory-based semistructured interviews conducted from December 2016 to January 2017.

PARTICIPANTS

Primary caregivers of elementary schoolchildren from 23 households (16 parents, 14 grandparents) in 4 remote areas of Hualien, Taiwan.

PHENOMENON OF INTEREST

Factors related to FPPs hindering micronutrient-dense food group consumption by schoolchildren in a remote area.

SETTING

In-depth interviews were conducted at participants' houses.

ANALYSIS

Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was performed to elicit studied phenomenon.

RESULTS

Routine family meals provided adequate staple, protein, and vegetables but inadequate whole grains, dairy, fruits, and nuts. More parents provided breakfast composed of pan-fried and semiprocessed products made of refined flour and sugary beverages. Both parents and grandparents had ambiguous nutrition concepts and inconsistent FPPs but in different aspects. They both reflected expectations for assistance from local schools for nutrition and FPPs education to shape up healthy eating behavior of children.

CONCLUSIONS AND IMPLICATIONS

Study findings pinpoint the strength and barriers of FPPs for primary caregivers. Implementing integrated nutrition education programs tailored for empowering nutrition literacy and FPPs is suggested to enhance the healthy eating behavior of schoolchildren in a remote area.

The Effectiveness of a Blended In-Person and Online Family-Based Childhood Obesity Management Program

Background: The purpose of this study was to evaluate the effectiveness of a 10-week blended family-based childhood obesity management program, relative to a wait-list control, in improving child body mass index (BMI) z-scores, child lifestyle behaviors, parental support for healthy eating and physical activity, and self-regulation for healthy eating and physical activity support. Methods: This study was registered as a randomized wait-listed controlled trial; however, due to low recruitment and program delivery logistics, this study transitioned into a quasi-experimental design. Families with children 8-12 years of age with a BMI ≥85th percentile for age and sex were recruited (October 2018 to March 2019) in British Columbia, Canada. The intervention provided families 10 weeks of in-person and online support on improving lifestyle behaviors. Results: Children's BMI z-scores were not significantly changed. Intervention group significantly improved their days of moderate-to-vigorous physical activity relative to control (0.75 ± 1.5; p < 0.01; ηp² = 0.15); however, child dietary behaviors were not significantly changed. Relative to control, intervention group showed significant improvements in parental support for healthy eating (0.13 ± 0.36; p < 0.05; ηp² = 0.06) and physical activity (1.0 ± 1.6; p < 0.05; ηp² = 0.09) and self-regulation for healthy eating (2.0 ± 3.5; p < 0.01; ηp² = 0.11) and physical activity support (2.0 ± 3.2; p < 0.05; ηp² = 0.28). Conclusions: Preliminary evidence showed that the intervention was not effective in improving child BMI z-scores, but it was effective in promoting children's physical activity and parents' support behaviors. A longer study period may be required to change BMI z-scores. Clinical Trial Registration number: NCT03643341.

How Minority Parents Could Help Children Develop Healthy Eating Behaviors: Parent and Child Perspectives

Minority children and children living in under-resourced households are at the greatest risk for obesity and diet-related disparities. Identifying effective strategies to reduce these risks is an important step in child obesity prevention. Parents influence the home environment and play a critical role in child obesity prevention. Eighteen parent-child dyads living in under-resourced Houston area communities participated in a mixed methods study (online surveys, telephone interviews). The purpose of the research reported here was to conduct a secondary analysis of the qualitative data to explore Black/African American and Hispanic parent and child perspectives of the ways in which parents could help their children make healthy food choices. Descriptive statistics were calculated for parent and child demographic characteristics; hybrid thematic analysis was used to code and analyze the interview transcripts. Frequencies were calculated for children's interview responses to rating scales and the grade they gave their eating habits. Mothers' responses were grouped into two broad categories: facilitators (modeling, availability, and teaching) as ways parents could help their child eat healthy, and barriers (lack of time, cost of healthy foods, and lack of knowledge) to helping their child eat healthy. Alternatively, child responses focused on ways in which parents could provide support: environmental support (home availability, home cooking, and introducing new foods) and personal support (providing child choice, teaching, and encouragement). Most children reported that eating healthy was easy, and most rated their personal eating habits as an A or B. These findings suggest that understanding the perspectives of Black/African American and Hispanic parent-child dyads can provide insight into the development of culturally and economically relevant healthy eating strategies and interventions for families living in under-resourced communities.

Understanding the influence of physical resources and social supports on primary food providers' snack food provision: a discrete choice experiment

BACKGROUND

Snack eating occasions contribute approximately a third of children's energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers' snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position.

METHODS

Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute.

RESULTS

Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (- 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight - 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds.

CONCLUSIONS

Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers' snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280.

Mealtime resistance: Hispanic mothers' perspectives on making healthy eating changes within the family

Several perceived barriers to healthy eating within the family (e.g., cost, lack of time, energy, accessibility) are documented. However, few studies have assessed Hispanic mothers' perceived barriers and strategies in implementing healthy eating changes in the family's meals. The primary goal of this qualitative study was to investigate Mexican and Puerto Rican mothers' barriers and strategies to creating healthy eating changes within the family at home. A sample of 46 Mexican-American and Puerto Rican mothers in California, Illinois, and Texas participated in this study. An average of 5 mothers participated in a focus group session in Spanish and completed a demographic survey. Focus group thematic analysis revealed that major barriers to implementing healthy eating changes within the family include child and spouse resistance as well as meal preparation time. The resistance mothers reported encountering magnify their meal preparation workload. Mothers shared that they sometimes prepared multiple meals in a single mealtime to please family members. Several strategies to promote healthy eating at home, including serving as role models, providing easy access to healthy food items at home, and not purchasing, or hiding, unhealthy food at home, were also discussed. The current study expands the existing literature by emphasizing the need to empower parents to make healthy changes within their family and the importance of taking fathers and children into account in programming so that the whole family is involved in making healthy changes.

Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial

BACKGROUND

Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children.

METHODS

A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap.

RESULTS

No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents.

CONCLUSIONS AND RECOMMENDATIONS

A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.

Dissatisfaction with Body Weight among Polish Adolescents Is Related to Unhealthy Dietary Behaviors

The aims of the study were to determine the socio-demographic factors that may affect body weight dissatisfaction and to analyze the relationship between eating habits and dissatisfaction with body weight among a national random sample of Polish adolescents aged 13–19 years. Data on gender, age, level of education, body weight status, screen time, body weight satisfaction and selected nutritional behaviors were collected using a questionnaire. Body mass status was assessed based on weight and height measurements. A total of 14,044 students from 207 schools participated in the study. A significant effect of gender, age, level of education, body weight status and screen time status on the participants’ dissatisfaction with the body weight was observed. The greater prevalence of body weight satisfaction was observed among boys, younger subjects, secondary school students, adolescents with normal body weight status and those with screen time up to 2 h. Whereas girls, older study participants (17–19 years old), overweight/obese adolescents and subjects with screen time over 4 h were more often dissatisfied with body weight. Furthermore, it has been shown that participants dissatisfied with their body weight less often met dietary recommendations. These findings can help dietitians, nutritionists and healthcare professionals to provide age-specific and gender-specific nutrition strategies to promote healthy lifestyle among school-going adolescents.

A Mobile-Based Tailored Recommendation System for Parents of Children with Overweight or Obesity: A New Tool for Health Care Centers

Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children's age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children's eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents' perceptions of the child's weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann-Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child's excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child's weight with additional strategies.

A qualitative study exploring the dietary gatekeeper's food literacy and barriers to healthy eating in the home environment

ISSUE ADDRESSED

Food literacy has been recognised as a collection of interrelated food skills and knowledge to support healthy dietary outcomes. In the home environment, the dietary gatekeeper is the individual most responsible for food preparation, and therefore, has a significant influence on the family diet. This study explored how the dietary gatekeeper's food literacy skills are used to manage dietary barriers to facilitate healthy eating in the home environment.

METHODS

Qualitative data were collected from a sample of household dietary gatekeepers with children (n = 17). Participants were also instructed to take photographs of family meals prior to the interview and these were used as interview prompts to gain deeper insights into gatekeeper behaviour.

RESULTS

Participants reported the two most significant barriers to healthy eating in households were time pressure and fussy eating. Four strategies were identified that used gatekeepers' food literacy to manage these barriers: breaking up meal tasks; customising meals for family tastes; camouflaging healthy ingredients; and facilitating food choice autonomy. These strategies incorporated interrelated food literacy skills related to the planning, preparation, selection and eating domains.

CONCLUSION

The current findings highlight the dietary gatekeeper's food literacy as an interrelated concept and show how it is operationalised to successfully manage barriers to healthy eating experienced in the home environment. SO WHAT?: Future health promotion campaigns must offer tailored communications and interventions that provide resources and support to dietary gatekeepers to foster food literacy and counteract the influence of barriers to healthy eating.

Effect of Experiential Vegetable Education Program on Mediating Factors of Vegetable Consumption in Australian Primary School Students: A Cluster-Randomized Controlled Trial

Schools provide a relevant and equitable environment to influence students towards increased vegetable consumption. This study aimed to evaluate the effectiveness of a Vegetable Education Resource To Increase Children’s Acceptance and Liking (VERTICAL) for Australian primary schools (curriculum aligned and based on a framework of food preference development and sensory experiential learning) on positively influencing factors predisposing children towards increased vegetable consumption. The secondary aim was to evaluate two levels of teacher training intensity on intervention effectiveness. A cluster-RCT amongst schools with three conditions was conducted: 1 = teaching VERTICAL preceded by online teacher training; 2 = as per 1 with additional face-to-face teacher training; 3 = Control. Pre-test, post-test and 3-month follow-up measures (knowledge, verbalization ability, vegetable acceptance, behavioural intentions, willing to taste, new vegetables consumed) were collected from students (n = 1639 from 25 schools in Sydney/Adelaide, Australia). Data were analyzed using mixed model analysis. No difference in intervention effectiveness was found between the two training methods. Compared to the Control, VERTICAL positively affected all outcome measures after intervention (p < 0.01) with knowledge sustained at 3-month follow-up (p < 0.001). In conclusion, VERTICAL was effective in achieving change amongst students in mediating factors known to be positively associated with vegetable consumption.

Do Australian children carry out recommended preventive child health behaviours? Insights from an online parent survey

AIM

To investigate (i) the proportion of Australian children who do not adhere to preventive child health behaviours, (ii) clustering of child health behaviours, (iii) the proportion of parents who are concerned about not meeting recommendations and (iv) parents' access to and interest in information on ways to establish healthy habits in their child.

METHODS

A cross-sectional online survey of 477 Australian parents of 0-4-year-old children assessed the degree to which children meet key child health recommendations (diet, physical activity, oral health, sleep, pedestrian/vehicle safety, screen use, sun safety, personal hygiene, medical care), examined clustering of health behaviours and identified parents' greatest concerns.

RESULTS

A significant proportion of children do not meet recommendations for many preventive child health behaviours. More than half of the parents report infrequent toothbrushing and dentist check-ups, less than the recommended vegetable consumption, excessive consumption of treats, not wearing safety equipment, excessive screen time and screen time during meals, child inactivity, insufficient sleep, not covering coughs and sneezes, insufficient hand and nail hygiene and inadequate sun protection. No clustering of life-style risk behaviours was found. Areas of greatest concern to parents are vegetable consumption, toothbrushing, covering coughs and sneezes, screen time and wearing sunglasses.

CONCLUSIONS

While the majority of Australian parents have accessed child health recommendations, relatively few consistently implement health-protective practices with their children. Parents are concerned about this and interested in receiving information. Future research should investigate barriers to following guidelines and how parents can best be supported in establishing healthy habits.