Caregiver feeding practices and weight status among African American adolescents: The Jackson Heart KIDS Pilot Study

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

Introduction

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

Methods

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

Results

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

Discussion

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

Study design and rationale for TEENS+REACH: Evaluating ripple effects of a family-based lifestyle intervention to untreated family members

Background

Understanding the effects of family-based lifestyle intervention beyond the treated adolescent is important, given that obesity is a familial disease and there are likely bidirectional relations between an adolescent's treatment success and broader household changes. However, it is unknown if recommended household-wide changes are adopted or if untreated family members experience weight-related benefits.

Methods

TEENS + REACH leverages our ongoing randomized clinical trial of TEENS+, a family-based lifestyle intervention for adolescents with obesity, to determine: 1) if household-wide changes to the shared home environment are implemented, 2) if ripple effects to untreated family members are observed, and 3) whether these changes are predictive of adolescents' weight management success. TEENS + REACH will expand trial assessments to include comprehensive assessments of the shared home feeding, weight, and physical activity environment of the target adolescents. Specifically, we will enroll untreated children (8-17yrs) and caregivers living in the same household as the target parent/adolescent dyad (N = 60 families). At 0, 2, 4 (primary endpoint), and 8-months, the target parent/adolescent dyad and other untreated children and caregivers in the home will complete anthropometric assessments.

Discussion

Results will determine the familial reach of TEENS+ and reveal potential mediators of treatment response, which can inform future efforts to optimize family-based lifestyle interventions.

Trial registration

TEENS + REACH was retrospectively registered in Clinicaltrials.gov March 22, 2023 (NCT05780970) as an observational study ancillary to the TEENS + clinical trial, registered February 22, 2019 (NCT03851796).

The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial

BACKGROUND

There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents' inclusion in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment.

METHODS

Participants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up.

DISCUSSION

Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03851796. Registered: February 22, 2019.

Peers empowering peers-feasibility of a peer educator training program to prevent diabetes

Background

This study assessed the feasibility and acceptability of the Healthy Outcomes through Peer Educators (HOPE) training program designed to train African American (AA) grandmothers to serve as peer educators for other AA grandmothers who are at risk for diabetes. The newly trained peer educators will provide the needed encouragement and positive reinforcement essential for successful sustainable health behaviors to grandmothers enrolled in a subsequent Diabetes Prevention Program.

Methods

Thirty AA women between the ages of 49–72 were enrolled in the pre-post single group study. The participants were required to attend a 2-h Diabetes Prevention Program session every week for 16 weeks. The sessions covered the role of the peer educator and encouraged participants to increase their physical activity and consume more servings of fruits and vegetables daily. We noted the number of participants who successfully completed the training and solicited their perspective regarding the strengths of the program and suggestions to improve the program. The Wilcoxon Signed Ranks Test was performed to evaluate changes in body weight, self-reported physical activity, and fruit and vegetable intake from baseline to week 16.

Results

Ninety three percent (n = 28) of enrollees completed the training program. All (n = 28) the peer educator trainees indicated that they would recommend the program to a friend and 93% (n = 26) reported that the program met their needs. The participants (n = 28) felt that the training prepared them to offer support to other grandmothers in their community. A Wilcoxon Signed Ranks Test revealed that participants body weights were significantly lower after completion of the 16 week training program (median = 156.5 lbs., n = 28) compared to baseline (median = 163.0, n = 28), Z = − 4.43, p < 0.05. Fruit and vegetable intake increased significantly (median = 5, n = 28) at week 16 compared to week one, (median = 2, n = 28) Z = 4.46, p < 0.05. Participants were more physically active at week 16 (median = 150 min per week, n = 28) compared to week 1, (median = 30 min per week, n = 28) Z = 4.62, p < 0.05.

Conclusions

The peer educator training component of HOPE was found to be feasible and acceptable as evidenced by our successful recruitment and retention of participants. Participation in the peer educator training program also resulted in improvement in health behaviors.

The role of parents in adolescent obesity treatment: Results of the TEENS+ randomized clinical pilot trial

BACKGROUND

The optimal role for involving parents in adolescent obesity treatment is unknown.

OBJECTIVE

To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss.

METHODS

Adolescent/parent dyads (N = 82; mean adolescent age = 13.7 ± 1.2 years) participated in TEENS+, a 4-month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post-treatment), and 7-months. Within- and between-group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes).

RESULTS

PWL parents had greater 4-month weight losses (∆kg_0-4m  = -5.14 ± 4.87 kg) compared to PAC (-2.07 ± 3.89 kg; between-group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within-group adolescent ∆BMI_0-4m (PWL: -0.97 ± 1.38 kg/m² vs. PAC: -0.93 ± 1.42 kg/m² ; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI_4-7m increases (+0.41 ± 1.07 kg/m² ; p = 0.02) while PAC did not (+0.05 ± 1.31 kg/m² ; p = 0.82).

CONCLUSION

Parent treatments were distinct in implementation and both yielded significant 4-month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration.

Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.

Social and Behavioral Factors Associated with BMI and Waist Circumference among Adolescents: The Jackson Heart KIDS Pilot Study

Background

African American children and adolescents make up a disproportionately large segment of those classified as overweight and obese. The purpose of this study was to examine social and behavioral factors associated with accelerated accumulation of weight and adiposity among this group.

Methods

The data for this cross-sectional study were drawn from the Jackson Heart KIDS Pilot Study - an offspring cohort study comprising 12- to 19-year-old descendants of Jackson Heart Study participants (N=212). Body mass index (BMI) and waist circumference were the outcomes of interest. Daily hassles, fruit and vegetable consumption, physical activity, television watching, parent/grandparent weight status and participant birth weight, age and sex were the independent variables included in the analyses.

Results

Males and females were equally represented in the study and the mean BMI and waist circumference for adolescents in the study was 25.81±7.78 kg/m² and 83.91 ± 19.81 cm, respectively. Fully adjusted linear regression models for the total sample produced results indicating that age, television viewing, weight control, and parental weight status were positively associated with BMI and waist circumference, respectively. Findings from sex-stratified models for BMI and waist circumference indicated that the significance of coefficients for age, television viewing, and parent/grandparent weight status varied by sex.

Conclusions

Knowledge is limited about how sex or gender interact with social and behavioral factors to influence African Americans' health and additional studies are needed to specify how these factors interact to accelerate weight gain and adipose tissue accumulation over the life course.

The Moderating Effects of the Families Improving Together (FIT) for Weight Loss Intervention and Parenting Factors on Family Mealtime in Overweight and Obese African American Adolescents

Few studies have integrated positive parenting and motivational strategies to address dietary outcomes such as frequency of family mealtime. The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort trial (n = 241 dyads) testing the efficacy of integrating a motivational plus family weight loss (M + FWL) intervention for healthy eating and weight loss in overweight and obese African American adolescents. The current study tested the interaction of parenting styles (responsiveness, demandingness) and parental feeding practices (restriction, concern about child’s weight, pressure to eat) and the FIT intervention on frequency of family mealtime over 16 weeks. Multilevel modeling demonstrated significant interactions between the group-based treatment and responsiveness (p = 0.018) and demandingness (p = 0.010) on family mealtime. For the group-based M + FWL intervention, increased responsiveness and reduced demandingness were associated with increased frequency of family mealtime from baseline to 16 weeks. There was also a negative association between parental restriction and frequency of family mealtime, but a positive association between parental concerns about their adolescent’s weight and frequency of mealtime. These findings are the first to demonstrate that an authoritative or nurturing parenting style moderated intervention effects for improving the frequency of family mealtime in overweight and obese African American adolescents.

Effects of Parenting and Perceived Stress on BMI in African American Adolescents

OBJECTIVE

This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI.

METHODS

Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention.

RESULTS

Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI.

CONCLUSIONS

These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.

Associations of parenting factors and weight related outcomes in African American adolescents with overweight and obesity

This study evaluated the associations between parenting factors and adolescent weight related outcomes in African American adolescents with overweight and obesity. Baseline heights and weights were collected from 241 African American adolescents (11-16 years) with overweight and obesity. Self-reported adolescent perceptions of caregiver's parenting style (responsiveness, demandingness), parental feeding practices (monitoring, responsibility, weight related concerns, pressure-to-eat, and restriction), and their own dietary self-efficacy for healthy eating were assessed. Results demonstrated that greater parental responsiveness was significantly associated with lower adolescent body mass index (BMI) and higher adolescent dietary self-efficacy. In contrast, parental concern about adolescent weight was significantly associated with greater adolescent BMI, while greater parental responsibility for foods was associated with lower adolescent BMI. Although parental pressure-to-eat was significantly associated with higher dietary self-efficacy, greater parental restriction was associated with lower dietary self-efficacy. The results of this study highlight the importance of parental responsiveness and responsibility in understanding obesity related outcomes in African American adolescents with overweight and obesity.

Parental feeding practices across child's weight status: Evidence of the Italian validation of the Child Feeding Questionnaire

OBJECTIVE

The main aim of this study was to assess the psychometric proprieties of the Child Feeding Questionnaire (CFQ) in Italian mothers.

DESIGN

Mothers completed the Italian version of the CFQ, and children's anthropometric data were collected. Construct validity of the CFQ was assessed by comparing three different models: (a) a seven correlated factors model in which all items were analysed; (b) a seven correlated factors model with composite items based on the Restriction factor and (c) an eight correlated factors model with a separate Reward factor. Measurement invariance using BMI categories and gender was evaluated. Furthermore, discriminant validity with group comparison was performed between BMI categories and gender.

SETTING

Italy.

PARTICIPANTS

A total of 1253 6-year-old Italian children (53·9 % male) attending elementary school (1st grade) and their mothers (mean age = 38·22 years; sd = 4·89) participated in this study.

RESULTS

The eight-factor model with a separate reward factor provided the best fit for the data. The strict invariance of the CFQ across child BMI categories and gender was confirmed. The CFQ internal consistency was acceptable for most subscales. However, two subscales showed no adequate values. As expected, the CFQ scales showed significant differences between BMI categories, while no gender-related differences were found.

CONCLUSIONS

The study indicated the Italian version of the CFQ to be factorially valid for assessing parental feeding practices of 6-year-old children across BMI categories. Future research should address low internal consistency in some of the CFQ subscales.

Writing Accountability Groups Are a Tool for Academic Success: The Obesity Health Disparities PRIDE Program

Introduction

The current hypercompetitive extramural funding environment in the United States emphasizes the critical need for effective research training programs that focus not only on grantsmanship, but on skill development across the full range of research activities, culminating in writing research results for publication. Using Writing Accountability Groups (WAG), the National Heart, Lung, and Blood Institute (NHLBI) funded Obesity Health Disparities (OHD) PRIDE is one of the few research training and mentoring programs that places an equal focus on scientific writing and grant writing. This article reports on the utility of WAGs for OHD PRIDE mentees.

Method

Participants included 14 of 26 individuals who were fellows in the OHD PRIDE research training and mentoring program. A typical WAG has between four and eight members who meet for one hour each week over a 10-week period and commit a priori to attend at least 70% of the sessions. Summary statistics were produced to characterize number of peer-reviewed publications, grants, years in academic rank, and category of current academic rank, barriers to frequency of writing, and duration of writing. Results from pre- and post-WAG surveys were compared to determine the overall impact of the WAG. The study period discussed in this article took place between January and December 2017 and included data from three 10-week cycles beginning in February, May, and September.

Results

Fifty-three percent of OHD PRIDE participants successfully completed at least one 10-week WAG cycle. The WAGs did not have a statistically significant impact on either the frequency of writing or the duration of writing. However, the majority of the participants who successfully completed at least one WAG cycle reported that they either maintained or increased their frequency or duration of writing.

Conclusion

By providing a structured approach to developing and/or enhancing a practice of consistent writing, time management skills, and collaborative relationships, the WAG has promise for enhancing scientific writing skills for many trainees and early-career faculty. Longer term follow-up is needed to more fully assess the potential impact of WAGs.

Religiosity and Excess Weight Among African-American Adolescents: The Jackson Heart KIDS Study

Recent studies suggest that religion and spirituality can yield health benefits for young African-Americans. We examined the relationship between religious practices, spirituality, and excess weight among African-American adolescents (N = 212) residing in the Deep South. Results from modified Poisson regression analysis indicate that adolescents who prayed daily had a lower prevalence of excess weight (PR 0.77 [95% CI 0.62-0.96]) than those who did not. This relationship was only significant for 12-15 year-old participants in age-stratified analysis. These findings suggest that preventive interventions offered to children and younger adolescents can have implications for weight status across the lifespan.

Overweight and Obesity Coexist with Thinness among Lao's Urban Area Adolescents

INTRODUCTION

In recent decades, the developing countries of Southeast Asia, including the Lao People's Democratic Republic (Lao PDR), have experienced a rapid growth of their urban population. Partly as a result of that, issues of undernutrition and overnutrition became a significant public health problem.

OBJECTIVE

To examine the prevalence of overweight and obesity and their related factors, among the school-attending adolescents in the Lao capital of Vientiane.

METHODS

A cross-sectional data on 300 adolescents aged 15-19 were collected during the months of March, April, and May 2018 by means of a self-administrated questionnaire. Anthropometric measurements were used to obtain data on height and weight. Pearson's chi-squared test, Fisher exact tests, and univariable and multivariable logistic regressions were applied in the course of the statistical analysis.

RESULTS

The study found a high prevalence of overweight/obesity (23.3%) and thinness (10.3%). Poor eating habits were noted in 67.0% of adolescents, even though 78.0% of them had a good knowledge of nutrition. Factors significantly associated with the overweight/obesity were low physical activities (aOR = 18.3; 95% CI: 5.51-60.66) and adolescents living with their guardians (aOR = 0.25; 95% CI: 0.08-0.79). Results also indicated that, in 47.3% of the cases, teachers, acting as a source of health and nutrition information, can prevent the risk of adolescents' overweight/obesity (aOR = 2.05, 95% CI = 1.11-3.80) but not their thinness (aOR = 0.4, 95% CI = 0.17-0.88).

CONCLUSIONS

Laotian adolescents are facing the spectrum of malnutrition in urban areas. To improve adolescents' nutritional status, there is a need for a collaborative approach of public health agencies that would address the issues of an effective food and nutrition policy. The school curricula should also include programs on nutrition and physical education.

Development and Preliminary Evaluation of Chinese Preschoolers' Caregivers' Feeding Behavior Scale

BACKGROUND

Caregivers' feeding behavior plays a crucial role in the development of overweight and obesity in preschoolers. However, to date, there is no broadly accepted scale or questionnaire for assessing preschoolers' caregivers' feeding behavior in China.

OBJECTIVE

To develop a scale that can be used to assess preschoolers' caregivers' feeding behavior in China and to conduct a preliminary evaluation of the scale's reliability, validity, and discriminative ability.

DESIGN

The scale was created through a literature review and qualitative interviews with the target population. Items were reviewed by 50 caregivers of preschoolers and 10 experienced pediatricians, and 95 items were selected to form a draft scale. The draft scale underwent three rounds of investigation, and the results from these evaluations were used to select items that formed the final scale.

PARTICIPANTS/SETTING

Three groups of caregivers (n=175, 400, and 912) were sampled and stratified from urban and suburban kindergartens in the cities of Jinan and Xi'an between March 2016 and October 2017 to participate in evaluations of the draft scale. From these caregiver groups, 146, 362, and 768 participants completed valid questionnaires, respectively, which were used in the scale's evaluation.

PRIMARY OUTCOME MEASURES

The general demographic data of the participants and scores of each item in the scale were the primary outcome measures.

STATISTICAL ANALYSES PERFORMED

Exploratory factor analysis and variability analysis were used to evaluate the draft scale, based on data from two rounds of investigation. The structure of the scale was explored through confirmatory factor analysis, and its reliability, construct validity, and discriminative ability were evaluated based on data from a third round of investigation.

RESULTS

The Chinese Preschoolers' Caregivers' Feeding Behavior Scale (CPCFBS) consisted of 35 items and seven dimensions; the total cumulative variance contribution rate was 58.6%; the Cronbach's α coefficient was .91; the split-half reliability coefficient was 0.89; and the test-retest reliability coefficient was 0.85. The age and weight status of the children and the caregivers' age and education levels, as well as family incomes and child-caregiver relationships, were correlated with feeding behavior.

CONCLUSIONS

The CPCFBS appeared to have good reliability and construct validity in specific Chinese populations. Future studies are needed to confirm existing findings in different Chinese populations with larger sample sizes.

Associations Among Caregiver Feeding Practices and Blood Pressure in African American Adolescents: The Jackson Heart KIDS Study

Caregiver feeding practices have been linked to youth health outcomes. The present study examined associations among caregiver feeding practices and blood pressure in 212 African American adolescents via the Child Feeding Practices Questionnaire. Results revealed a positive association between caregivers' concern about their child's weight and diastolic blood pressure, which was more acute for older adolescent boys. Caregivers' perceived responsibility for the quality and quantity of food their child receives was also associated with lower diastolic blood pressure in older adolescent boys. Feeding practices are ideal targets of lifestyle intervention, and health care providers should continue to involve caregivers as adolescents approach adulthood.

Theory-Informed Research Training and Mentoring of Underrepresented Early-Career Faculty at Teaching-Intensive Institutions: The Obesity Health Disparities PRIDE Program

Mentoring has been consistently identified as an important element for career advancement in many biomedical and health professional disciplines and has been found to be critical for success and promotion in academic settings. Early-career faculty from groups underrepresented in biomedical research, however, are less likely to have mentors, and in general, receive less mentoring than their majority-group peers, particularly among those employed in teaching-intensive institutions. This article describes Obesity Health Disparities (OHD) PRIDE, a theoretically and conceptually based research training and mentoring program designed for early-career faculty who trained or are employed at Historically Black Colleges and Universities (HBCUs).