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Gomes AI, Pereira AI, Nogueira PC, Barros L. Development of a New Questionnaire to Assess Parental Perceived Barriers When Promoting Healthy Eating Habits in Young Children: First Findings. Nutrients 2023; 15:4672. [PMID: 37960325 PMCID: PMC10648735 DOI: 10.3390/nu15214672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
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.
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Affiliation(s)
- Ana Isabel Gomes
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal;
| | - Ana Isabel Pereira
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal; (A.I.P.); (L.B.)
| | | | - Luísa Barros
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal; (A.I.P.); (L.B.)
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Gomes AI, Roberto MS, Pereira AI, Alves C, João P, Dias AR, Veríssimo J, Barros L. Development and Psychometric Characteristics of an Instrument to Assess Parental Feeding Practices to Promote Young Children's Eating Self-Regulation: Results with a Portuguese Sample. Nutrients 2022; 14:nu14234953. [PMID: 36500987 PMCID: PMC9736991 DOI: 10.3390/nu14234953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
A parental child-centered feeding approach is likely to keep children’s biological mechanisms activated while eating, protecting them in an obesogenic context. However, few feeding practice measures assess parents’ behaviors to guide and prompt children to identify and respond appropriately to their signs of hunger and satiety. We aimed to develop and study the reliability, validity, and measurement invariance of a new scale to assess parental feeding practices to promote children’s self-regulation of food intake. To pursue this aim, we conducted two descriptive, cross-sectional, online studies in Portugal in an online format; a total of 536 parents of 2- to 6-year-old children completed the evaluation protocol. Factorial analysis findings support the theoretical organization proposed for the scale. The confirmatory factorial analysis supported a first-order factor structure with two subscales, Prompting for eating self-regulation and Teaching about eating consequences, with eight items in total. Both scales presented good internal consistency and adequate temporal stability, with a significant, positive, and moderate relationship. The results showed metric invariance for the child’s sex. Both types of practices were positively correlated with the child’s enjoyment of food. Prompting for eating self-regulation showed negative associations with parents’ emotional lack of control, children’s satiety responsiveness, slowness in eating, and fussiness. Preliminary studies confirmed both the validity and reliability of the instrument and the adequacy of adopting a self-regulatory approach when assessing child-centered feeding practices. Combining this instrument with others that assess coercive practices can be beneficial to capture ineffective parents’ behaviors on children’s eating self-regulation.
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Affiliation(s)
- Ana Isabel Gomes
- Research Center for Psychological Science (CICPSI), Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
- Correspondence:
| | - Magda Sofia Roberto
- Research Center for Psychological Science (CICPSI), Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Ana Isabel Pereira
- Research Center for Psychological Science (CICPSI), Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Cátia Alves
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Patrícia João
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Ana Rita Dias
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - João Veríssimo
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Luísa Barros
- Research Center for Psychological Science (CICPSI), Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
- Faculty of Psychology, University of Lisbon, Alameda da Universidade, 1649-013 Lisboa, Portugal
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3
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Gadaire CB, Armstrong LM, Levens SM. Development and validation of the Child Weight Risk Questionnaire. Eat Weight Disord 2022; 27:525-534. [PMID: 33860465 DOI: 10.1007/s40519-021-01181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study objective was to develop and validate a measure of parent perception of child weight-related risk, the Child Weight Risk Questionnaire (CWRQ), among a sample of US parents. METHODS A cross-sectional survey was conducted in a sample of 216 parents of 6- to 12-year-old children who were overweight. The CWRQ was used to assess parent beliefs about their child's susceptibility to physical, social-emotional, and behavioral health problems due to weight. RESULTS Confirmatory factor analysis supported the three-factor structure of the CWRQ and acceptable fit was achieved. The internal consistency of the measure was excellent. Convergent, discriminant, and incremental validity analyses provided initial evidence for CWRQ validity. CONCLUSION The CWRQ is a reliable and valid instrument for assessing parent perception of child weight-related risk. This measure could be utilized in research and applied settings to capture the multifaceted nature of parent risk perception and support efforts to tailor family weight interventions in ways that align with parent beliefs. LEVEL OF EVIDENCE Level V, cross-sectional, descriptive study.
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Affiliation(s)
- Cecily B Gadaire
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA. .,Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Laura Marie Armstrong
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA. .,Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Sara M Levens
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA.,Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
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Parents’ perceptions of their child’s weight among children in their first year of primary school: a mixed-methods analysis of an Australian cross-sectional (complete enumeration) study. Int J Obes (Lond) 2022; 46:992-1001. [PMID: 35075256 PMCID: PMC9050591 DOI: 10.1038/s41366-022-01068-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 01/13/2023]
Abstract
Abstract
Background/Objectives
To describe trends in overweight/obesity in early childhood for all children and those whose parents are concerned about their weight. To describe parents’ perceptions of their child’s weight and differences by their child’s anthropometric and sociodemographic factors.
Subjects/Methods
Analysis of the Kindergarten Health Check, a survey of all children enrolled in their first year of primary education in the Australian Capital Territory. Analysis of detailed data for 2014–2017, including qualitative analysis of parents’ comments on weight, and trends for 2001–2017.
Results
71,963 children participated in the survey between 2001 and 2017 (20,427 between 2014 and 2017). The average age of children (2001–2017) was 5 years and 9.6 months at the time of their physical health check. 2377 children (3.5%) were classified as obese based on measured body mass index (BMI) between 2001 and 2017, and a further 7766 (11.6%) overweight. Similar proportions were seen for 2014–2017. Among children with overweight/obesity in 2014–2017, 86.4% of parents (2479/2868) described their children’s weight as healthy and 13.3% (382/2868) as overweight/obese. Just 11.5% (339/2946) of parents whose children were later measured with overweight/obesity identified having a concern about their child’s weight.
Parental comments varied widely and were often incongruent with the known health risks associated with their child’s measured BMI. Comments from parents whose children were measured as obese often were normalising e.g., “born big, always big. Definitely NOT overweight, just bigger all over”, whilst parents of children in the healthy range expressed concerns about underweight.
Conclusion
Parents do not accurately perceive their child’s weight and few document concerns, even among children measuring in the obese BMI category. This lack of concern makes early interventions challenging as parents are in the “pre-contemplative” stage of behaviour change and may see public health campaigns or clinicians’ attempts to address their child’s weight as irrelevant or unhelpful.
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Gomes AI, Pereira AI, Guerreiro T, Branco D, Roberto MS, Pires A, Sousa J, Baranowski T, Barros L. SmartFeeding4Kids, an online self-guided parenting intervention to promote positive feeding practices and healthy diet in young children: study protocol for a randomized controlled trial. Trials 2021; 22:930. [PMID: 34922616 PMCID: PMC8683823 DOI: 10.1186/s13063-021-05897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Caregivers’ influence on young children’s eating behaviors is widely recognized. Nutritional interventions that focus on the promotion of children’s healthy diet should actively involve parents, focusing on their feeding behaviors and practices. Methods This work aims to describe the development and study protocol of the SmartFeeding4Kids (SF4K) program, an online self-guided 7-session intervention for parents of young (2–6 years old) children. The program is informed by social cognitive, self-regulation, and habit formation theoretical models and uses self-regulatory techniques as self-monitoring, goal setting, and feedback to promote behavior change. We propose to examine the intervention efficacy on children’s intake of fruit, vegetables, and added sugars, and parental feeding practices with a two-arm randomized controlled with four times repeated measures design (baseline, immediately, 3 and 6 months after intervention). Parental perceived barriers about food and feeding, food parenting self-efficacy, and motivation to change will be analyzed as secondary outcomes. The study of the predictors of parents’ dropout rates and the trajectories of parents’ and children’s outcomes are also objectives of this work. Discussion The SmartFeeding4Kids program relies on technological resources to deliver parents’ self-regulation techniques that proved effective in promoting health behaviors. The study design can enhance the knowledge about the most effective methodologies to change parental feeding practices and children’s food intake. As a self-guided online program, SmartFeeding4Kids might overcome parents’ attrition more effectively, besides being easy to disseminate and cost-effective. Trial registration The study was registered in ClinicalTrials.gov (NCT04591496) on October 19, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05897-z.
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Affiliation(s)
- Ana Isabel Gomes
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal.
| | - Ana Isabel Pereira
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
| | - Tiago Guerreiro
- LASIGE, Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Diogo Branco
- LASIGE, Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Magda Sofia Roberto
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
| | - Ana Pires
- LASIGE, Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Joana Sousa
- Lisbon School of Medicine, Nutrition Laboratory, University of Lisbon, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Room 2038, Houston, TX, 77030-2600, USA
| | - Luísa Barros
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
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Xiang C, Zhang Y, Yong C, Xi Y, Huo J, Zou H, Liang J, Jiang Z, Lin Q. Association between Parents' Perceptions of Preschool Children's Weight, Feeding Practices and Children's Dietary Patterns: A Cross-Sectional Study in China. Nutrients 2021; 13:nu13113767. [PMID: 34836023 PMCID: PMC8624819 DOI: 10.3390/nu13113767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 12/20/2022] Open
Abstract
Parental perception of children’s weight may influence parents’ feeding practices, and in turn, child dietary intake and weight status; however, there is limited evidence generated for preschoolers. The aim of this cross-sectional study was to investigate associations between Chinese parents’ perceptions of child weight, feeding practices and preschoolers’ dietary patterns. Participants (1616 parent-child pairs) were recruited from six kindergartens in Hunan, China. Parents’ misperception, concern, and dissatisfaction on child weight were collected through a self-administered caregiver questionnaire. Parental feeding practices and children’s dietary intake were, respectively, assessed using the Child Feeding Questionnaire and a Food Frequency Questionnaire. Linear regression models were applied to analyze associations between parental weight perceptions, feeding practices, and preschooler’s dietary patterns. Associations between parents’ weight perceptions and dietary patterns were significant only among underweight children. Regardless of child weight status, parental weight underestimation and preference for a heavier child were positively associated with pressure-to-eat. Parental weight concern was positively associated with restriction in normal weight child, but this was not found in other weight groups. In conclusion, Parents’ misperception, concern, and dissatisfaction about child weight are associated with parents’ feeding practices and may influence preschoolers’ dietary quality, but the relationships vary by children’s actual weight status.
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Affiliation(s)
- Caihong Xiang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Youjie Zhang
- Department of Child and Adolescent Health and Social Medicine, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou 215123, China;
| | - Cuiting Yong
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Yue Xi
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Jiaqi Huo
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Hanshuang Zou
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Jiajing Liang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Zhiqian Jiang
- Faculty of Agriculture, Life and Environment Science, Nutrition and Food Science Program, University of Alberta, 116st 85 Avenue, Edmonton, AB T6G 2R3, Canada;
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
- Correspondence:
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Kenney MK, Lebrun-Harris LA, Vladutiu CJ, Kogan MD. Parental Concerns About Child Weight Among 10-17-Year Olds With Overweight/Obesity: A Family Ecological Model. Acad Pediatr 2021; 21:1055-1066. [PMID: 33387678 DOI: 10.1016/j.acap.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study was to identify child, family/household, organization (provider), and neighborhood/community factors associated with parental concern about weight among children with overweight/obesity in order to inform effective interventions for improving health in this pediatric population. METHODS Prevalence of parental concern about child weight was estimated and factors identified within an adapted family ecological framework. Using cross-sectional data from the 2018 National Survey of Children's Health, we conducted bivariate and multivariable analyses of 10 to 17-year olds (N = 15,427) for whom height and weight information was reported by parents or primary caregivers. RESULTS There were 4287 children, aged 10 to 17 years, with overweight/obesity (31%). Approximately 34% of parents of children with overweight/obesity reported being concerned about their child's weight, with the remainder being not concerned. In adjusted analyses, 23% of children with overweight and 45% of children with obesity had parents who reported being concerned. Factors associated with parental concern among children with overweight/obesity included child weight status, female gender, peer social difficulties, the extent of the child's daily activities affected by health conditions, poorer parental coping, and having been told the child was overweight by a provider. CONCLUSIONS Only one in three parents of children with overweight/obesity reported being concerned about their child's weight, although parental concern was more common among children affected by obesity more so than overweight. A combination of child, family, and organization (provider) factors were associated with parental concern. Provider feedback about child overweight may improve parental awareness of a weight-related health issue.
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Affiliation(s)
- Mary Kay Kenney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md.
| | - Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md
| | - Catherine J Vladutiu
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md
| | - Michael D Kogan
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md
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Butler ÉM, Derraik JGB, Glover M, Morton SMB, Tautolo ES, Taylor RW, Cutfield WS. Acceptability of early childhood obesity prediction models to New Zealand families. PLoS One 2019; 14:e0225212. [PMID: 31790443 PMCID: PMC6886750 DOI: 10.1371/journal.pone.0225212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE While prediction models can estimate an infant's risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. We aimed to assess the acceptability of these models to New Zealand caregivers. METHODS An anonymous questionnaire was distributed online. The questionnaire consisted of multiple choice and Likert scale questions. Respondents were parents, caregivers, and grandparents of children aged ≤5 years. RESULTS 1,934 questionnaires were analysed. Responses were received from caregivers of various ethnicities and levels of education. Nearly two-thirds (62.1%) of respondents would "definitely" or "probably" want to hear if their infant was at risk of early childhood obesity, although "worried" (77.0%) and "upset" (53.0%) were the most frequently anticipated responses to such information. With lower mean scores reflecting higher levels of acceptance, grandparents (mean score = 1.67) were more receptive than parents (2.10; p = 0.0002) and other caregivers (2.13; p = 0.021); males (1.83) were more receptive than females (2.11; p = 0.005); and Asian respondents (1.68) were more receptive than those of European (2.05; p = 0.003), Māori (2.11; p = 0.002), or Pacific (2.03; p = 0.042) ethnicities. There were no differences in acceptance according to socioeconomic status, levels of education, or other ethnicities. CONCLUSIONS Almost two-thirds of respondents were receptive to communication regarding their infant's risk of childhood obesity. While our results must be interpreted with some caution due to their hypothetical nature, findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand.
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Affiliation(s)
- Éadaoin M. Butler
- A Better Start–National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G. B. Derraik
- A Better Start–National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marewa Glover
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
- Centre of Research Excellence Indigenous Sovereignty & Smoking, Auckland, New Zealand
| | - Susan M. B. Morton
- A Better Start–National Science Challenge, Auckland, New Zealand
- Centre for Longitudinal Research–He Ara ki Mua, The University of Auckland, Auckland, New Zealand
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - El-Shadan Tautolo
- A Better Start–National Science Challenge, Auckland, New Zealand
- Centre for Pacific Health & Development Research, Auckland University of Technology, Auckland, New Zealand
| | - Rachael W. Taylor
- A Better Start–National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S. Cutfield
- A Better Start–National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Butler ÉM, Suhag A, Hong Y, Liang L, Gong C, Xiong F, Luo F, Liu G, Chen S, Taylor RW, Cutfield WS, Fu J, Derraik JGB. Parental Perceptions of Obesity in School Children and Subsequent Action. Child Obes 2019; 15:459-467. [PMID: 31408357 DOI: 10.1089/chi.2018.0338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Despite perceiving their child as being above a healthy weight, many parents do not intervene. Little is known about the factors influencing parental action. We assessed parental perception of child's weight status, the prevalence of mitigating parental action, and the underlying factors. Methods: We studied 20,242 children and adolescents from 6 centers across China. Anthropometry was measured by research nurses. Parents answered questionnaires, including their perception of their child's weight status, and any subsequent weight treatment. Results: A total of 3254 children had obesity (16.1%), with 63.0% correctly perceived as overweight by their parents. These children were more likely to be older (≥8 years; p < 0.0001), have severe obesity [adjusted relative risk (aRR) 1.41; p < 0.0001], and have mothers with overweight/obesity (aRR 1.15; p < 0.0001). In particular, parents of children aged <8 years were over five times more likely to perceive their child with overweight/obesity as "thin" than parents of teenagers. Conversely, girls, older children/adolescents, and urban youth were more likely to be wrongly perceived by parents as having an overweight issue. Only one in four children (27.8%) with available information received treatment for their perceived weight problem. Children with severe obesity were more likely to be treated (aRR 1.34; p < 0.0001), as were children of mothers with overweight/obesity (aRR 1.18; p = 0.002). Conclusions: Only one in four Chinese children perceived as overweight by their parents received treatment for their weight problem. Given that overweight/obesity in childhood tracks into adulthood and many parents did not intervene despite perceiving an overweight problem in their child, interventions for childhood obesity need to extend beyond parental perception of children's weight status.
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Affiliation(s)
- Éadaoin M Butler
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand
| | - Alisha Suhag
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Ye Hong
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Liang
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunxiu Gong
- Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - Feng Xiong
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feihong Luo
- Department of Endocrinology, Children's Hospital of Shanghai Fudan University, Shanghai, China
| | - Geli Liu
- General Hospital of Tianjin Medical University, Tianjin, China
| | - Shaoke Chen
- Maternal and Children Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Rachael W Taylor
- A Better Start-National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand
| | - JunFen Fu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - José G B Derraik
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Glover M, Wong SF, Taylor RW, Derraik JGB, Fa'alili-Fidow J, Morton SM, Cutfield WS. The Complexity of Food Provisioning Decisions by Māori Caregivers to Ensure the Happiness and Health of Their Children. Nutrients 2019; 11:nu11050994. [PMID: 31052332 PMCID: PMC6566933 DOI: 10.3390/nu11050994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/08/2023] Open
Abstract
Obesity in children is a global health concern. In New Zealand, one in three school entrant children are overweight or obese. Māori, the indigenous people, are disproportionately represented among the lowest economic group and have a disproportionately high incidence of obesity. This study explored Māori parents' and caregivers' views of the relative importance of weight to health, and the facilitators and barriers to a healthy weight in children aged 6 months to 5 years. Using a grounded qualitative method, in-depth information was collected in focus groups with mostly urban parents and other caregivers. A general inductive thematic analysis (content driven) was used. Insufficient money was an overriding food provisioning factor, but cost interacted with the lack of time, the number of people to feed, their appetites, and allergies. Other factors included ideologies about healthy food, cultural values relating to food selection, serving, and eating, nutrition literacy, availability of food, cooking skills, and lack of help. Childhood obesity was not a priority concern for participants, though they supported interventions providing education on how to grow vegetables, how to plan and cook cheaper meals. Holistic interventions to reduce the negative effects of the economic and social determinants on child health more broadly were recommended.
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Affiliation(s)
- Marewa Glover
- School of Health Sciences, College of Health, Massey University, Auckland 0632, New Zealand.
| | - Sally F Wong
- School of Health Sciences, College of Health, Massey University, Auckland 0632, New Zealand.
| | - Rachael W Taylor
- Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden.
| | | | - Susan M Morton
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
- Centre for Longitudinal Research⁻He Ara ki Mua, University of Auckland, Auckland 1142, New Zealand.
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
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11
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Beckerman JP, Aftosmes-Tobio A, Kitos N, Jurkowski JM, Lansburg K, Kazik C, Gavarkovs A, Vigilante A, Kalyoncu B, Figueroa R, Klabunde R, Barouch R, Haneuse S, Taveras E, Davison KK. Communities for healthy living (CHL) - A family-centered childhood obesity prevention program integrated into Head Start services: Study protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2019; 78:34-45. [PMID: 30630109 PMCID: PMC6487308 DOI: 10.1016/j.cct.2019.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/15/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is highly prevalent and carries substantial health consequences. Childhood obesity interventions have had mixed results, which may be partially explained by the absence of theory that incorporates broader family context and methods that address implementation challenges in low-resource settings. Communities for Healthy Living (CHL) is an obesity prevention program for Head Start preschools designed with careful focus on theory and implementation. This protocol paper outlines the design, content, implementation, and evaluation of CHL. METHODS/DESIGN CHL integrates a parenting program co-led by Head Start staff and parents, enhanced nutrition support, and a media campaign. CHL content and implementation are informed by the Family Ecological Model, Psychological Empowerment Theory, and Organizational Empowerment Theory. The intervention is directed by community-based participatory research and implementation science principles, such as co‑leadership with parents and staff, and implementation in a real world context. CHL is evaluated in a three-year pragmatic cluster-randomized trial with a stepped wedge design. The primary outcome is change in child Body Mass Index z-score. Secondary outcomes include children's weight-related behaviors (i.e., diet, physical activity, screen use, and sleep), parenting practices targeted at these behaviors (e.g., food parenting), and parent empowerment. The evaluation capitalizes on routine health data collected by Head Start (e.g., child height and weight, diet) coupled with parent surveys completed by subsamples of families. DISCUSSION CHL is an innovative childhood obesity prevention program grounded in theory and implementation science principles. If successful, CHL is positioned for sustained implementation and nationwide Head Start scale-up.
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Affiliation(s)
- Jacob P Beckerman
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Alyssa Aftosmes-Tobio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Janine M Jurkowski
- Department of Health Policy, Management & Behavior, University at Albany School of Public Health, 1 University Place, Rensselaer, NY 12144, United States.
| | - Kindra Lansburg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Action for Boston Community Development, 178 Tremont Street, Boston, MA 02111, United States.
| | - Crystal Kazik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Community Action Agency of Somerville, 66 Union Square, Somerville, MA 02143, United States
| | - Adam Gavarkovs
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Adrienne Vigilante
- Community Action Agency of Somerville, 66 Union Square, Somerville, MA 02143, United States.
| | - Begum Kalyoncu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Roger Figueroa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Rachel Klabunde
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Rachel Barouch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Elsie Taveras
- Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States.
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
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12
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Boswell N, Byrne R, Davies PSW. Prospects for early childhood feeding interventions: An exploration of parent's concerns and acceptability towards social media intervention opportunities. Nutr Diet 2018; 76:444-454. [PMID: 30548377 DOI: 10.1111/1747-0080.12502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/12/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023]
Abstract
AIM The present study aims to (i) consult with parents regarding child feeding concerns, as relevant to child feeding interventions, (ii) determine parents' willingness to participate in online and social media-based interventions and (iii) determine differences in intervention acceptability based on geographic diversity and demographic characteristics. METHODS Three hundred thirty Australian parents of children (2.0-5.0 years) with child feeding concerns participated in an online, cross-sectional survey. Kruskal-Wallis with Dunn's multiple-comparison test, using Bonferroni adjustment, was used to compare differences between variables and participants characteristics (region of residence, parent age, parent education and income). RESULTS About 53.9% of respondents were concerned about child fussy eating, with lack of time and child tantrums common barriers to addressing concerns. Respondents indicated that a combination of online platforms (websites, email, Facebook) was their preferred method of intervention participation, although, a combination of online and face-to-face methods also had modest preference, particularly among lower educated parents. Participants indicated that they would participate in an online intervention (participating once a week) for more than 12 weeks (42.7%), compared with only 4 weeks (participating once a week) for traditionally delivered interventions. About 32.4% of respondents said they would be concerned about their privacy in an online intervention. CONCLUSIONS Fussy eating is likely to be an appealing focus for future child feeding interventions, with strategies to address common barriers an important curriculum area. Online interventions are likely to offer an acceptable and plausible alternative to traditional interventions that are able to reach geographically diverse populations, although face-to-face intervention components still hold appeal.
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Affiliation(s)
- Nikki Boswell
- University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Rebecca Byrne
- Queensland University of Technology, Faculty of Health, Brisbane, Queensland, Australia
| | - Peter S W Davies
- University of Queensland, School of Medicine, Brisbane, Queensland, Australia
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13
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Gonçalves S, Vieira AI, Machado BC, Costa R, Pinheiro J, Conceiçao E. Avoidant/restrictive food intake disorder symptoms in children: Associations with child and family variables. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1532796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | - Renata Costa
- School of Psychology, University of Minho, Braga, Portugal
| | - Joana Pinheiro
- School of Psychology, University of Minho, Braga, Portugal
| | - Eva Conceiçao
- School of Psychology, University of Minho, Braga, Portugal
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14
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Butler ÉM, Derraik JGB, Taylor RW, Cutfield WS. Childhood obesity: how long should we wait to predict weight? J Pediatr Endocrinol Metab 2018; 31:497-501. [PMID: 29668465 DOI: 10.1515/jpem-2018-0110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/21/2018] [Indexed: 12/17/2022]
Abstract
Obesity is highly prevalent in children under the age of 5 years, although its identification in infants under 2 years remains difficult. Several clinical prediction models have been developed for obesity risk in early childhood, using a number of different predictors. The predictive capacity (sensitivity and specificity) of these models varies greatly, and there is no agreed risk threshold for the prediction of early childhood obesity. Of the existing models, only two have been practically utilized, but neither have been particularly successful. This commentary suggests how future research may successfully utilize existing early childhood obesity prediction models for intervention. We also consider the need for such models, and how targeted obesity intervention may be more effective than population-based intervention.
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Affiliation(s)
- Éadaoin M Butler
- A Better Start - National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- A Better Start - National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rachael W Taylor
- A Better Start - National Science Challenge, Dunedin, New Zealand.,Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- A Better Start - National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
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15
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Effectiveness of a parental school-based intervention to improve young children’s eating patterns: a pilot study. Public Health Nutr 2018; 21:2485-2496. [DOI: 10.1017/s1368980018000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractObjectiveTo evaluate the effectiveness of a pilot study of a parental school-based intervention to promote healthy eating behaviours in young children.DesignA quasi-experimental longitudinal design with three conditions (complete intervention (CIG), minimal intervention (MIG), control (CG)), with repeated measures at baseline, immediately after the intervention, 6 months and 1 year after intervention.SettingFourteen public and state-funded kindergartens near Lisbon, Portugal.SubjectsParents (n349) of 3- to 6-year-old children assigned to the three conditions completed the baseline protocol. The ‘Red Apple’ intervention included four parental group sessions about young children’s growth, nutritional guidelines and positive parental feeding strategies, which was combined with adult–child activities at home and in the classroom, and newsletters (CIG). MIG included only a single nutritional counselling session, whereas the CG had no intervention. At the end, thirty-eight, twenty-six and fifty-four parents in the CIG, MIG and CG, respectively, had completed all evaluation components. Data regarding parental perception of children’s weight, self-efficacy, nutritional knowledge, feeding strategies, eating behaviours and BMI were collected at the four assessment moments.ResultsThe CIG showed improvements in children’s healthy food intake, compared with the MIG and CG. Parental self-efficacy regarding the regulation of children’s eating behaviours decreased in the CG but not in both intervention groups.ConclusionsConsidering the low dosage of the intervention, the results obtained were positive. Future studies should offer additional solutions to overcome barriers to parents’ participation.
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16
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Assessing children’s willingness to try new foods: Validation of a Portuguese version of the child’s food neophobia scale for parents of young children. Food Qual Prefer 2018. [DOI: 10.1016/j.foodqual.2017.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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