Family functioning: associations with weight status, eating behaviors, and physical activity in adolescents

Understanding family functioning in mothers and daughters with obesity

PURPOSE

This study sought to understand family functioning surrounding weight in Mexican American women with obesity.

METHODS

Semi-structured in-depth interviews were conducted with mothers and adult daughters (N = 116).

RESULTS

Thematic analysis identified five themes. 1) The communication process drives perception of supportive messages. Messages perceived as non-supportive consist of directives as interventions, confirmation of faults, and critical compliments whereas supportive consist of compliments, encouragement, empathetic listening, and disclosure. 2) Acculturation differences interfere with intergenerational alliance. Differences involve dissonance in communication, behavioural expectations, and weight-related practices. 3) Maladaptive conflict responses contribute to relational strain. These responses include avoidance, withdrawal, and defensiveness. 4) Role transformations alter the generational hierarchical relationship. Daughters serve as role models, caregivers, or collaborators. 5) Low communal coping heightens psychological distress. It does so by challenging family roles, increasing social isolation, and compromising social support.

CONCLUSION

Obesity interventions for Mexican American women may benefit from targeting relational skills to improve family functioning.

Applying the Family Stress Model to responsive feeding and early obesity prevention

Rapid weight gain during infancy and obesity during early childhood may lead to adverse health outcomes during later childhood and into adulthood, especially in families experiencing economic hardship. Families experiencing economic hardship may also experience food insecurity, which can impact child development and responsive feeding, an important target for obesity prevention in early life. The Family Stress Model suggests that stress, particularly economic hardship, can negatively impact parents' mental health, parenting, and quality of family relationships. This review proposes a conceptual model that expands upon the original Family Stress Model by including parent-child dyadic interactions during feeding (i.e., responsive feeding) as well as the coparenting relationship around feeding. Our conceptual model integrates responsive feeding into the Family Stress Model and includes the impact of food insecurity on feeding and child health outcomes. Such models that consider multiple influences on child development have implications for the design of effective interventions to promote healthy growth for entire families. Future directions in this research will empirically test the model and explore early intervention strategies that aim to promote responsive feeding, nutrition security, and health within families. Continuing interdisciplinary research between the fields of nutrition and family development will be key to addressing the complex interplay of family stressors, parent responsiveness, and childhood obesity.

Psychometric properties of the Chinese Family Assessment Instrument: evidence from mainland China

Regarding the assessment of family functioning in Chinese people, there are several research gaps. First, although there are some instruments in the field, there are very few validated instruments. Second, while some translated measures have been developed, there are very few assessment tools based on indigenous Chinese concepts. Third, compared to Hong Kong, research on family assessment is relatively inactive in mainland China. Fourth, there are very few family assessment tools to assess perceived family functioning in older children and early adolescents. Fifth, few studies used large samples to validate family assessment tools. Sixth, researchers seldom utilized longitudinal data to examine the psychometric properties of family assessment tools. Finally, few studies have examined factorial validity across samples and time to demonstrate the stability of Chinese family assessment measures. In Hong Kong, based on focus group data (i.e., indigenous concepts of family functioning) and an integration with the family science literature, we have developed the Chinese Family Assessment Instrument (C-FAI) to assess perceived family functioning according to the perception of adolescents. Results showed that the C-FAI possessed good reliability and validity. Specifically, five dimensions of the measure (mutuality, communication, conflict, parental concern and parental control) were supported via exploratory factor analysis and confirmatory factor analysis. Convergent validity and reliability of the C-FAI were illustrated. To understand the psychometric properties of the C-FAI in mainland China, we collected three waves of data from students in the period of preadolescence and early adolescence in mainland China (N = 3,732). Based on the data, we examined the psychometric properties of the measure, particularly factor invariance in different samples and at different times. Confirmatory factor analysis provided support for the five dimensions in C-FAI, including factorial invariance in terms of configuration, factor loading, intercepts, and over time. There was evidence for convergent validity and discriminant validity of the measure. Finally, reliability analyses showed that the total C-FAI scale and its subscales are internally consistent. The present findings suggest that family researchers and practitioners can use the C-FAI to objectively assess perceived family functioning in preadolescence and early adolescence in different Chinese communities.

Longitudinal associations between family meal quality and quantity: Does one matter more for child, parent, and family health and well-being or are they synergistic?

It is unknown how family meal quantity (i.e., frequency) and quality (i.e., meal healthfulness and interpersonal quality) are associated with child, parent, and family health and well-being over time. This study aimed to examine longitudinal associations between family meal quantity and quality and child, parent, and family health and well-being and whether there was a synergistic effect between family meal quantity and quality. Children ages 5-9 and their parents from six racial/ethnic groups participated in this longitudinal cohort study. Regression models adjusted for socio-demographic characteristics examined family meal quantity, interpersonal quality, and nutritional quality at baseline and interactions between quantity and quality, in relation to changes in child, parent, and family health outcomes from baseline to 18-month follow-up. Higher family meal quantity predicted reduced obesity prevalence, improved diet quality and less food fussiness, food responsiveness, and conduct problems among children at follow-up. Higher family meal quality predicted improved diet quality, lower emotional problems, less food responsiveness, and fewer peer relationship problems among children, improved diet quality and reduced psychological distress for parents, and less family chaos at follow-up. One interaction between family meal quantity and quality was found for child peer relationship problems. Overall, family meal quantity and quality were independently important for child health and well-being and for some parent and family health outcomes. Clinicians working with families may want to emphasize the importance of both family meal quantity and quality, as these longitudinal findings suggest potential benefits for the entire family.

Current Family Functioning and Youth Cardiometabolic Health in the SOL Youth Study

BACKGROUND

Family functioning may impact children's cardiometabolic health; however, few studies have examined multiple cardiometabolic markers among a diverse racial/ethnic cohort. The relationship between child- and caregiver-reported family functioning and the cardiometabolic health of Hispanic/Latino youth was examined.

METHOD

Data were from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) (2012-2014), a population-based cohort study of children and adolescents whose parents participated in the HCHS/SOL (2008-2011). The relationship between youth- and caregiver-rated family functioning, and concordance of ratings is modeled, utilizing the general functioning subscale of the McMaster Family Assessment Device with youth objective cardiometabolic health markers (obesity, central adiposity, prediabetes/diabetes, prehypertension/hypertension, triglycerides, HDL cholesterol) adjusting for sociodemographic factors.

RESULTS

Among boys, child/caregiver concordant ineffective family functioning rating was associated with higher cumulative cardiometabolic risk (adjusted B (95% CI): 0.30 (0.04, 0.56)), but no association was observed among girls (adjusted B (95% CI): 0.04 (-0.13, 0.21)). Among girls, ineffective child rating/effective caregiver rating was associated with higher cumulative cardiometabolic risk (adjusted B (95% CI): 0.27 (0.06, 0.48)), but no association was observed among boys (adjusted B (95% CI): 0.02 (-0.23, 0.27).

CONCLUSION

Findings suggest that family functioning among this Hispanic/Latino population may influence cardiometabolic risk among youth. Observed differences in the associations by youth sex and concordant/discordant reports of family functioning suggest interventions at the family level, targeting both caregivers and youth, that consider differential sex effects are warranted.

Family connectedness and sexual minority Asian Americans' eating behavior regulation

To date, psychosocial and interpersonal protective factors such as family connectedness have received little attention in studies of eating behaviors among sexual minority Asian Americans. Therefore, we investigated associations of family connectedness and two types of eating behavior regulation motives and the moderating role of individualism in these associations among 134 sexual minority Asian American young adults. Linear regression models assessed the main and interaction effects of family connectedness and individualism on introjected and identified eating behavior regulation motives. We observed a significant interaction effect between family connectedness and individualism only on introjected regulation. For participants with low levels of individualism, those who reported high levels of family connectedness had lower scores for introjected regulation of eating behavior. The findings of this study highlight the importance of examining strengths related to sexual minority Asian Americans by demonstrating the important role family connectedness plays in eating behavior regulation motives, particularly for those with lower individualism.

The relationship between family function and the incidence of overweight/obesity in children and adolescents in Chengdu city, Sichuan province of China: based on latent profile analysis

BACKGROUND

Overweight/obesity in children and adolescents has become a global health problem, and family function may be associated with its occurrence. Studies exploring the association between family function and overweight/obesity in children and adolescents were performed in Western and Taiwan, China. To date, related studies haven't been conducted in Mainland China.

OBJECTIVES

To investigate the current status of overweight, obesity, and family function among children and adolescents in Chengdu, China, and to explore their associations.

METHODS

Children and adolescents in five primary and middle schools were chosen by cluster sampling. Body Mass Index was used to measure the status of overweight and obesity, and the Chinese family assessment instrument was adopted to assess family function. Latent profile analysis and stepwise logistic regression were applied to identify family classification and explore the relationships between family function and overweight/obesity.

RESULTS

A total of 7616 (84.92%) children and adolescents out of 8968 completed the study with qualified-filled questionnaires. Nine hundred and sixty-six (12.68%)participants were overweight and 656 (8.61%) were obese. The family function was categorized into three profiles: mild (63.93%), moderate (12.32%), and severe (23.75%) dysfunction. The prevalence of overweight was 12.16%, 14.71%, and 13.05% for mild, moderate, and severe family dysfunction, respectively. And the prevalence of obesity was 8.19%, 10.77%, and 8.62% respectively. Participants in moderate and severe dysfunction families were more likely to be overweight (moderate: OR = 1.27, 95% CI:1.01 ~ 1.59, P = 0.04; severe: OR = 1.38, 95% CI:1.15 ~ 1.66, P = 0.001) and obese (moderate: OR = 1.35, 95% CI:1.02 ~ 1.79, P = 0.03; severe: OR = 1.55, 95% CI:1.23 ~ 1.96, P < 0.001). Sociodemographic data such as gender, residence, grade, pocket money per week, the number of siblings, and the education level of the mother were all associated with the risk of being overweight/obese in children and adolescents.

CONCLUSIONS

The problems of being overweight or obese exist among children and adolescents in Chengdu. And the risk of being overweight or obese increases along with the decrease in family function.

The interplay between food insecurity and family factors in relation to disordered eating in adolescence

This study examined the association between food insecurity and both binge eating and unhealthy weight-control behaviors (UWCBs) and assessed whether such associations differ by factors within the family environment. Data were collected from a diverse sample of adolescents (Mage = 14.5 years; 54.1% female) and their parents/guardians (N = 2137 dyads) participating in EAT 2010 (Eating and Activity over Time). Food-insecure adolescents were more likely to report binge eating (prevalence ratio [PR] = 1.94; 95% confidence interval [CI]: 1.41-2.69) and UWCBs (PR = 1.34; 95% CI: 1.21-1.49) than food-secure adolescents. Family meal importance (p = .03) and family communication (p < .001) significantly moderated the association between food insecurity and UWCBs, such that the association was weaker at lower levels of these factors. Significant interactions with parental weight talk/concern (p < .001) and weight teasing (p = .04) indicated a weaker association between food insecurity and UWCBs in the presence of these factors. Findings indicate that the association between food insecurity and UWCBs among youth is less salient in the absence of family protective factors and in the presence of family risk factors for UWCBs, indicating the importance of targeting food insecurity itself, regardless of the presence of family risk or protective factors for UWCBs.

A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design

BACKGROUND

Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan.

METHODS/DESIGN

The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference.

DISCUSSION

This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care.

TRIAL REGISTRATION

This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

George SM. The Effects of Parent-Adolescent Acculturation Gaps on Adolescent Lifestyle Behaviors: Moderating Role of Family Communication

Objectives

This study examined 1) associations between parent-adolescent acculturation gaps in Americanism and Hispanicism and adolescents' lifestyle behaviors (fruit and vegetable intake and physical activity), and 2) the moderating roles of adolescent- and parent-reported family communication on these associations.

Methods

Hispanic adolescents who have overweight or obesity (n=280; 52% female, 13.0±0.8 years old) and their parents (88% female, 44.9±6.5 years old) completed baseline measures on acculturation, family communication, weekly physical activity, and daily fruit and vegetable intake as part of their participation in a family-based health promotion efficacy trial. Acculturation gaps were calculated by taking the product of adolescent and parent scores for each subscale (Americanism and Hispanicism). We conducted multiple linear regression analyses with three-way interaction terms (e.g., parent Americanism x adolescent Americanism x family communication) to assess for moderation.

Results

Family communication significantly moderated the association between parent-adolescent acculturation gaps in Americanism and adolescent fruit and vegetable intake. For families with low adolescent-reported family communication, parent-adolescent discrepancies in Americanism were associated with lower adolescent fruit and vegetable intake whereas there were no significant associations for families with high family communication. There were no effects on weekly minutes of physical activity. Acculturation gaps in Hispanicism were not significantly associated with either outcome.

Conclusions

Findings highlight the importance of parent-adolescent acculturation gaps and family communication on fruit and vegetable intake for Hispanic adolescents. Targeting parent-adolescent acculturation gaps for families with low levels of communication may be important to improve dietary behaviors in Hispanic adolescents, who are already disproportionately affected by obesity.

The Interactive Role of Family Functioning among BMI Status, Physical Activity, and High-Fat Food in Adolescents: Evidence from Shanghai, China

Objectives: Family functioning (FF), physical activity (PA), and high-fat food consumption (HF) are associated with adolescents being overweight and obese; however, little is known about their interactions. Therefore, this study aimed to examine how they work jointly on adolescent obesity with BMI as the outcome variable. Methods: A cross-sectional survey utilizing a cluster sampling design was conducted. Multinomial logistic regressions, multiplication interaction (MI), and marginal effects (MEs) were tested. Results: Active PA (non-overweight vs. obesity: OR = 2.260, 95% CI [1.318, 3.874]; overweight vs. obesity: OR = 2.096, 95% CI [1.167, 3.766]), healthy HF (non-overweight vs. obesity: OR = 2.048, 95% CI [1.105, 3.796]) and healthy FF (overweight vs. obesity: OR = 2.084, 95% CI [1.099, 3.952]) reduced obesity risk. Overweight students with healthy FF were less likely to become obese regardless of PA (inactive: OR = 2.181, 95% CI [1.114, 4.272]; active: OR = 3.870, 95% CI [1.719, 8.713]) or HF (unhealthy: OR = 4.615, 95% CI [1.049, 20.306]; healthy: OR = 5.116, 95% CI [1.352, 19.362]). The MEs of inactive PA and unhealthy FF were −0.071, 0.035, and 0.036 for non-overweight, overweight, and obese individuals, respectively (p < 0.05); the MEs of HF and healthy FF individuals were −0.267 and 0.198 for non-overweight and obese individuals, respectively (p < 0.05). Conclusions: Unhealthy FF regulated the influence of inactive PA or unhealthy HF on adolescent obesity, altogether leading to a higher risk of obesity.

Family Related Variables' Influences on Adolescents' Health Based on Health Behaviour in School-Aged Children Database, an AI-Assisted Scoping Review, and Narrative Synthesis

Objects

Health Behaviours in School-aged Children (HBSC) is an international survey programme aiming to investigate adolescents' health behaviours, subjective perception of health status, wellbeing, and the related contextual information. Our scoping review aimed to synthesise the evidence from HBSC about the relationship between family environmental contributors and adolescents' health-related outcomes.

Methods

We searched previous studies from six electronic databases. Two researchers identified the qualified publications independently by abstract and full-text screening with the assistance of an NLP-based AI instrument, ASReview. Publications were included if they were based on HBSC data and investigated the effects of family environment on adolescents' health outcomes. Researches addressed family-related factors as mediators or moderators were also included.

Results

A total of 241 articles were included. Family environmental contributors could be mapped into six categories: (1) Demographic backgrounds (N = 177); (2) General family's psycho-socio functions (N = 44); (3) Parenting behaviours (N = 100); (4) Parental health behaviours (N = 7); (5) Family activities (N = 24); and (6) Siblings (N = 7). Except for 75 papers that assessed family variables as moderators (N = 70) and mediators (N = 7), the others suggested family environment was an independent variable. Only five studies employed the data-driven approach.

Conclusion

Our results suggest most research studies focussed on the influences of family demographic backgrounds on adolescents' health. The researches related to parental health behaviours and siblings are most inadequate. Besides, we recommend further research studies to focus on the mediator/moderator roles of the family, for exploring the deep mechanism of the family's impacts. Also, it would be valuable to consider data-driven analysis more in the future, as HBSC has mass variables and data.

School and community drivers of child diets in two Arab cities: The SCALE protocol and innovative tools to assess children’s food environments

Background

In the context of the rapid nutrition transition experienced by middle-income countries of the Arab region, children and adolescent’s food choices and dietary behaviors are early risk factors for the development of non-communicable diseases. Assessment of factors influencing food choices among this age group is challenging and is usually based on self-reported data, which are prone to information and recall bias. As the popularity of technologies and video gaming platforms increases, opportunities arise to use these tools to collect data on variables that affect food choice, dietary intake, and associated outcomes. This protocol paper describes the SCALE study (School and community drivers of child diets in Arab cities; identifying levers for intervention) which aims to explore the environments at the level of households, schools and communities in which children’s food choices are made and consequently identify barriers and enablers to healthy food choices within these environments.

Methods

Field studies are being conducted in primary schools, among children aged 9–12 years, in Greater Beirut, Lebanon and Greater Tunis, Tunisia. A stratified random sample of 50 primary schools (public and private) are selected and 50 children are randomly selected from grades 4-5-6 in each school. The study includes surveys with children, parents/caregivers, school directors, teachers, and nutrition/health educators to assess individual diets and the contextual factors that influence children’s food choices. Innovative locally adapted tools and methods such as game-based choice experiments, wearable cameras and neighborhood mapping are used to describe the environments in which children’s food choices are made.

Discussion

The SCALE study will generate contextual knowledge on factors in school and neighborhood environments that influence child dietary behaviors and will inform multi-level interventions and policies to address childhood malnutrition (under-and over-nutrition). By integrating methods from various disciplines, including economics, data science, nutrition, and public health and by considering factors at various levels (home, school, and neighborhood), the study will identify levers for intervention with the potential to improve children’s dietary behaviors. This will help fill existing gaps in research on food systems and consequently guide positive change in Lebanon and Tunisia, with the potential for replicability in other contexts.

Insight Into the Adolescent Patient Experience With Nonalcoholic Fatty Liver Disease

OBJECTIVES

Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease in youth, yet little is known about the adolescent patient's experience with NAFLD, which is key for treatment engagement. We examined adolescents' experiences with NAFLD diagnosis, thoughts on how NAFLD affects their daily life, understanding and perceptions of diagnosis and treatment, and impressions of how to improve care.

METHODS

Utilizing a mixed-method design, adolescents with NAFLD (N = 16; Mean age = 15.8 years; Mean BMI = 37 kg/m 2 ) participated in focus groups. To supplement qualitative data, adolescents and their caregiver completed measures assessing illness perceptions, adolescent quality of life, and eating/activity behaviors.

RESULTS

Focus group themes suggested reactions to diagnosis varied from unconcerned to anxious. NAFLD diagnosis occurred within the context of other psychological/medical concerns and was not perceived to affect most adolescents' daily lives. Although adolescents understood general contributors to NAFLD, comprehension of their diagnosis varied. Adolescents were more likely to make lifestyle changes when families were supportive, and they preferred tailored recommendations for health behavior change from the healthcare team. Notably, 62.5% of adolescents were more concerned about their weight than NAFLD. Almost half (43.8%) identified as food insecure.

CONCLUSIONS

Adolescents with NAFLD may benefit from personalized treatment. Care could be enhanced by ensuring comprehension of diagnosis, problem-solving personal, and family barriers and increasing family support. Harnessing adolescents' desire for weight loss may be a more salient driver for change in disease status. Interventions should also address systemic barriers such as food insecurity to ensure equitable care.

Family Systems Cultural and Resilience Dimensions to Consider in Nutrition Interventions: Exploring Preschoolers' Eating and Physical Activity Routines During COVID-19

OBJECTIVE

To describe the weight-related family functioning of racial minority families with low income using family systems theory as an interpretive framework.

DESIGN

Primarily a qualitative study with interviews plus; descriptive demographics, anthropometrics, a family functioning measure, and food insecurity screening.

SETTING

Telephone interviews with families of preschool-aged children in an urban setting.

PARTICIPANTS

Primary caregivers of preschool-aged children.

PHENOMENON OF INTEREST

Cultural impacts on family systems.

ANALYSIS

Interviews were audio-recorded, transcribed verbatim, and loaded into NVivo 12 for thematic analysis. Descriptive statistics.

RESULTS

The 23 participants were mothers and 2 maternal grandmothers. Seventy-four percent were African American, most children were normal weight (n = 15, 65%), mean family function scores were high, and more than half the families were at risk for food insecurity (n = 13, 56%). Acculturation and intergenerational eating-related cultural dimensions were discerned as the overarching themes influencing family cohesion. Family cohesion appeared to have helped the families adapt to the impact of coronavirus disease 2019.

CONCLUSIONS AND IMPLICATIONS

Cultural dimensions such as acculturation and intergenerational influences appeared to be associated with social cohesion and family functioning around weight-related behaviors for these families. These findings add cultural and family resilience dimensions to family systems theory in nutrition interventions.

Associations between family functioning during early to mid-childhood and weight status in childhood and adolescence: findings from a Quebec birth cohort

BACKGROUND

Impaired family functioning has been associated with obesity in children and adolescents, but few longitudinal studies exist. We examined whether family functioning from early to mid-childhood is associated with overweight and obesity in later childhood and adolescence.

METHODS

We examined data from the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort (N = 2120), collected between 1998 and 2011. Parent-reported family functioning was assessed at 4 time points between ages 0.5 and 8 years using the McMaster Family Assessment Device with established cut-offs for impaired family functioning. Participants were classified as having experienced: 1) early-childhood impaired functioning, 2) mid-childhood impaired functioning, 3) both early and mid-childhood impaired functioning, or 4) always healthy family functioning. Overweight and obesity were determined at 10- and 13-years using WHO criteria. Covariate adjusted multinomial logistic regressions were fitted to the data to examine associations between longitudinal family functioning groups (using the always healthy functioning as reference category) and the likelihood of having overweight and obesity (vs normal weight) at ages 10 (n = 1251) and 13 years (n = 1226).

RESULTS

In the 10- and 13-year sub-samples, respectively 10.2% and 12.5% of participants had experienced both early and mid-childhood impaired family functioning. Participants in this group had an increased likelihood of having obesity (vs normal weight) at age 10 years [OR = 2.63 (95% CI: 1.36; 5.08)] and at age 13 years [OR = 1.94 (95% CI: 0.99; 3.80] compared to those in the always healthy functioning group. No associations were found for other family functioning categories or for overweight status.

CONCLUSION

Approximately one in ten children experienced impaired family functioning throughout early and mid-childhood. Findings suggest a link between impaired functioning across childhood and the development of obesity at 10 years of age and possibly at 13 years of age.

Psychometric Qualities of the McMaster Family Assessment Device-General Functioning Subscale for Malaysian Samples

Family functioning has been associated with psychological well-being and physical health. The 12-item McMaster Family Assessment Device–General Functioning Subscale (FAD-GF) has been widely used to assess individuals’ overall level of family functioning. However, it has shown an inconsistent factor structure across various studies. The present study investigated its psychometric qualities in two studies with two different adult samples in Malaysia. In Study 1 (N = 417, 55.3% females, 19 to 26 years old), exploratory factor analyses were conducted, and four models were found: a three-factor model with 11 items, a two-factor model with 12 items, and one-factor models with six negatively worded items and six positively worded items, respectively. Study 2 (N = 358, 65.1% females, 18 to 60 years old) compared models found in past studies and those found in Study 1 through confirmatory factor analyses on another sample of adults. Among the six competing models, the two-factor model with three positively worded and three negatively worded items (i.e., FAD-GF-SF) is preferable because it did not require modification and showed a clear-cut result of goodness of fit. The subscales demonstrated satisfactory internal consistency. In conclusion, the FAD-GF-SF is a useful instrument for measuring family functioning in the Malaysian context.

Physical Activity Levels and Screen Time among Youth with Overweight/Obesity Using Mental Health Services

Youth with mental illness have higher levels of obesity than children in the general population. Both regular physical activity and limited screen time have been recommended to reduce and prevent childhood obesity. This study examines accelerometer-based moderate-vigorous physical activity (MVPA) and screen time among youth with overweight/obesity issues who are receiving mental health care. This study looked at a 12-month weight management randomized clinical trial for overweight/obese youth aged 8-18 years who are receiving mental health services. At baseline, MVPA was assessed using accelerometers, and screen time was self-reported. Among 100 youth, 43% were female, 44% were Black, and 48% were <13 years old. In an adjusted general linear model, higher levels of MVPA were associated with the younger age group (p = 0.012), male participants (p = 0.013), and lower BMI z-scores (p = 0.014). In a separate model, higher screen time was associated with participants who were Black (p = 0.007). Achieving optimal cardiovascular health at the population level requires an understanding of the groups that are most in need of additional assistance. These data reinforce that targeted lifestyle approaches to promote increased physical activity and decreased screen time among overweight/obese youth using mental health services may need additional tailoring for sex, age, and race subgroups.

Adverse childhood experiences in relation to mood-, weight-, and eating-related outcomes in emerging adulthood: Does self-compassion play a buffering role?

BACKGROUND

Adverse childhood experiences (ACEs) are associated with a range of health problems, yet protective factors such as self-compassion may help buffer these associations.

OBJECTIVE

This study examined associations of distinct patterns of ACEs with depressive symptoms, body mass index (BMI), and disordered eating symptoms and investigated self-compassion as a potential protective factor.

PARTICIPANTS AND SETTING

Data from a diverse sample of 1440 emerging adults (M_age = 22.2 years; 53.7% female; 80.3% with race/ethnicity other than non-Hispanic white) came from the population-based EAT 2018 (Eating and Activity over Time) study.

METHODS

Seven types of ACEs were retrospectively self-reported and used as model indicators in latent class analysis to identify patterns of ACEs. Self-compassion, depressive symptoms, height and weight (to calculate BMI), and disordered eating symptoms were also assessed. Demographic-adjusted regression models were conducted.

RESULTS

Three latent classes emerged: "low ACEs" (66.5% of the sample), "household dysfunction" (24.3%), and "household dysfunction and abuse" (9.1%). Compared to participants in the "low ACEs" class, participants in either latent class involving household dysfunction demonstrated higher levels of depressive and disordered eating symptoms. Participants in the "household dysfunction and abuse" class also had higher BMI. Associations differed by self-compassion for depressive symptoms (p_interaction = 0.01), BMI (p_interaction = 0.03), and disordered eating symptoms (p_interaction = 0.005), such that associations for latent classes characterized by ACEs were weaker with higher levels of self-compassion.

CONCLUSIONS

These findings suggest self-compassion may act as a buffer against adverse mood-, weight-, and eating-related outcomes in the face of adversity and therefore may be an important intervention target.

Family Functioning Assessment and Child Psychosocial Symptoms in Family Medicine

PURPOSE

Children and young adults underutilize behavioral health services, in part due to the challenges with identifying and providing services for child behavioral health in primary care. The objective of this study was to determine if a brief assessment of family functioning captures specific child psychosocial symptoms in a Family Medicine practice.

DESIGN AND METHODS

Eighty-three parent child dyads, in which the parent or child was a patient at the Family Medicine practice, participated in a cross-sectional study, including assessments of demographics, family functioning, child behavioral health symptoms, and health related pediatric quality of life (HRQOL). Bivariate correlations, independent samples t-test, and linear and logistic regression tested associations of parent and child reported family functioning with child behavioral health symptoms and HRQOL.

RESULTS

Parent and child reports of family functioning were significantly associated. Child, but not parent reports of family functioning were significantly associated with parent and child reports of behavioral health symptoms. Parent's reports of increased family functioning impairment were only significantly associated with parent's reports of decreased HRQOL. Family functioning impairment was associated with parent and child reports of increased behavioral health symptoms and decreased HRQOL.

CONCLUSION

Future work should determine if screening for family functioning impairment, may serve as a means of identifying and treating child behavioral health symptoms in Family Medicine.

PRACTICE IMPLICATIONS

Identifying impaired family functioning may serve to engage children and their parents in services, who may otherwise not be identified as having symptoms.

CHAOS in the Home Environment and Child Weight-Related Outcomes

INTRODUCTION

Biopsychosocial approaches to health care are critical to addressing childhood obesity. This study aimed to examine how multiple indicators of the home environment related to child weight-related outcomes. We hypothesized that families with home environments of higher chaos and stress, and lower quality parent-child interactions, would have children with a higher body mass index (BMI), less healthy dietary intake, and less healthy eating behaviors.

METHODS

Data were drawn from the cross-sectional Phase I of the Family Matters study. Participants were 150 racially/ethnically diverse families with a child between 5 to 7 (mean, 6.4) years old. We used a latent profile analysis approach. A 4-class solution fit the data well, and we used predicted class posterior probabilities to assign families to classes. We then regressed the results onto the distal outcomes of child BMI, healthy dietary intake, and healthy eating behaviors.

RESULTS

Families were classified as Collaborative-Chill (n = 38), Busy Bees (n = 37), Engaged (n = 61), and Inconsistent-Distant (n = 14). Collaborative-Chill was used as the reference class. Inconsistent-Distant families had children with higher BMI (P < .001) that were more food responsive (P < .001). Busy Bees families had children who were more food responsive (P = .04) and more satiety responsive (P = .02). Engaged families had children who were marginally more food responsive (P = .06).

CONCLUSION

Household chaos, parent stress, and parent-child interactions are important components of the home environment implicated in children's weight-related outcomes. Health care providers should consider these indicators with child patients who struggle with obesity.

A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research

BACKGROUND

Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships.

METHODS

We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos.

RESULTS

Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred.

CONCLUSIONS

Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

[Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

Designing for Multilevel Behavior Change: A Father-Focused Nutrition and Physical Activity Program for Mexican-Heritage Families in South Texas Border Communities

Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.

Influence of Parenting Style on Body Mass Index, Physical Activity, and Sedentary Time

The purpose of the current study was to determine the influence of parenting style on body mass index (BMI) percentile, physical activity (PA), and sedentary time (ST) in children. Accelerometers were used to assess PA and ST in 152 fifth-grade children. Parenting style was assessed by the child participants’ responses to modified questions from the Parenting Style Inventory II and dichotomized as authoritative or non-authoritative. Multiple linear regression analyses were utilized to identify significant predictors of outcomes of interest. Parenting style did not predict ST or any intensity of PA; however, BMI percentile and gender were significant predictors of moderate-intensity PA, vigorous-intensity PA, and moderate-to-vigorous intensity PA (P < .01). BMI percentile was predicted to be lower in females with authoritative mothers (P < .01). While authoritative and non-authoritative parenting style did not predict objectively measured PA or ST in early adolescents, authoritative parenting style did predict BMI percentile in female participants.

The Family Function and Exercise Behavior of Chinese College Students: A Moderated Mediation Model of Exercise Value Cognition and Only-Child Status

The purpose of this study is to investigate the mediating role of exercise value cognition between family function (FF) and exercise behavior and the moderating role of an only-child status. A questionnaire survey was conducted on 504 Chinese college students using the FF scale, the exercise value cognition scale, and the exercise behavior scale. The analysis yielded four main findings. (1) There are significant differences between an only-child and a non-only-child for negative exercise behavior and FF. The only-child group has a higher average FF score and a lower average negative exercise score. (2) Exercise behavior and four of its dimensions-exercise autonomy, attention control, exercise planning, and situational induction-are each significantly positively correlated with FF and exercise value cognition. (3) FF is a significantly positive predictor of exercise behavior, both directly and through exercise value cognition, which plays a partial mediating role. (4) Only-child status significantly moderates the mediating effect of exercise value cognition in the link between FF and exercise behavior. The intergroup differences mainly manifest in the influence of FF on exercise behavior and the influence of exercise value cognition on exercise behavior. In the only-child subsample, exercise value cognition plays a complete mediating role. The results of the current study demonstrated the important role that FF and exercise value cognition played in promoting the exercise behavior of college students. These findings have important implications for exercise behavior in adolescents by maintaining sound communication between family members and developing a healthy lifestyle or value cognition.

A Qualitative Inquiry into the Eating Behavior and Physical Activity of Adolescent Girls and Boys in Indonesia

BACKGROUND

Despite the rising double burden of malnutrition, adolescent nutrition has received little attention in Indonesia. Eating and physical activity behaviors established in adolescence are known to track into adulthood and may contribute to chronic diseases in later life. This study aimed to explore the eating behaviors and physical activity of Indonesian adolescents, and their influencing factors.

METHODS

The study, designed as a qualitative study, was conducted in 2 selected districts in Indonesia: Klaten and Lombok Barat. Data were collected through immersion, open and informal discussions, and participant observations with 302 adolescent girls and boys.

RESULTS

The eating and physical activity behaviors of adolescent boys and girls are influenced by contextual changes in their family lifestyles and environment. The adolescents in this study only conflate physical activity with participation in sport. Even when a wider view of physical activity is cast, their level of physical activity remains low, especially for adolescent girls. Adolescents and their families generally eat 3 meals a day, with schools an important source of food for adolescents. Adolescents skip breakfast at home, and breakfast and lunch are usually purchased and eaten at school. Fewer families cook and families rarely eat together due to increasingly busy lives, increased mobility, and digital connectivity.

CONCLUSIONS

The rapid contextual shifts taking place in Indonesia influence the home, school, and peer environment to shape eating behaviors and physical activity among adolescent boys and girls. Gender-responsive multicomponent school-based interventions have the potential to serve as an important entry point for influencing adolescent nutrition.

Does Motivational Interviewing Improve the Weight Management Process in Adolescents? A Systematic Review and Meta-analysis

BACKGROUND

Due to the complex nature and high heterogeneity of motivational interviewing (MI) trials, available data on the effectiveness of these interventions on weight management in the early years of life is not yet conclusive. This study aimed to (1) evaluate the effectiveness of MI-based interventions on modifying obesity-related behaviors and consequently controlling weight in adolescents, and (2) determine characteristics of participants and interventions through sub-group analysis.

METHODS

Electronic databases, i.e., Medline, Elsevier, ISI, Cochrane Central Register of Controlled Trials (Clinical Trials), PsycINFO, and subject-related key journals were searched for randomized controlled trials that investigated the effect of MI-based interventions on weight management in overweight/obese adolescents. Primary outcomes were BMI, BMI Z-score, waist circumference, and fat percentage. Secondary outcomes were related behaviors (dietary intake and physical activity) and cognitive abilities (self-efficacy, self-regulation, self-control). Of the 3673 studies initially screened for eligibility, nineteen studies met the inclusion criteria and eighteen studies were entered in the meta-analysis. Meta-regression and sub-group analyses were conducted to control the high heterogeneity of studies. Sensitivity analysis has been conducted based on the Cochrane guidelines using the leave-one-out methods.

RESULTS

MI-based interventions did not affect on all primary outcomes, including BMI, BMI Z-score, waist circumference, and fat percentage; however, in terms of secondary outcomes, only sugary beverage intake was reduced in adolescents (SMD =  - 0.47, K = 3, I² = 26.2%). Physical activity and cognitive variables were not considered in the current analysis due to limited data and high heterogeneity in measurements and reports. In addition, findings of sensitivity results showed that MI could significantly reduce waist circumference among adolescents (SMD =  - 0.51, 95% CI - 0.91 to - 0.11). In terms of subgroup analysis, our results showed that various characteristics of participants (age, sex, weight status) and interventions (parental involvement, study duration, fidelity assessment, type of the control groups) could affect related primary and secondary outcomes among adolescents.

CONCLUSION

MI-based behavioral interventions had minor effects on reducing sugary beverage intake in all adolescents while a reduction in central obesity was noted predominantly among girls and those with complete participation. The current results indicate that the main characteristics influencing goal achievement in MI interventions are the age of participants, MI fidelity assessment, parental involvement, duration of interventions, and type of the control groups.

A Strategic Plan for Strengthening America's Families: A Brief from the Coalition of Behavioral Science Organizations

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America’s children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.

Changes in Parent and Child Skin Carotenoids, Weight, and Dietary Behaviors over Parental Weight Management

(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.

Family health climate: a qualitative exploration of everyday family life and health

Background

The family is an important social environment for children’s, adolescents’ and adults’ health. However, studies mostly focused on dyadic and unidirectional influences of parents on their children. Studies addressing influences arising from daily family life and including family-level influences are rare and the existing studies solely focus on the relevance for children’s health or health-related behaviors. We use a qualitative approach to explore how daily family life and its inherent health-related cues affect family members’ physical activity and eating behavior.

Methods

Semi-structured interviews utilizing an interview guide were conducted. Since we aimed to examine family life, we analyzed both parents’ and their children’s views on health-related interaction patterns and family environmental influences on individuals’ health-related behavior. Twenty-two members of seven families were interviewed. Transcripts of the interviews were systematically analyzed following Grounded Theory principles.

Results

The interviews revealed that various individual as well as environmental factors shape health-related aspects of daily family life. A model was developed that organizes these influencing factors on family life with regard to health-related interactions and the emergence of the Family Health Climate (FHC) – reflecting shared perceptions and cognitions regarding a healthy lifestyle within families – and its consequences. Family interactions and family time, often realized through shared family meals, are key factors for families’ health with regard to nutrition and physical activity. The FHC showed to affect various aspects related to health behavior of individual family members.

Conclusions

The model sheds light on underlying processes and mechanisms of family life that influences individuals’ health-related behavior. Based on a better understanding of the association between family life and individual health behavior the development of family-based interventions can be informed. Furthermore, the insights can help to guide further research focusing on families as a system.

The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

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.

Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems

The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ² = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.

Adolescent vegetable consumption: the role of socioemotional family characteristics

OBJECTIVE

To describe associations between adolescents' frequency of vegetable consumption, food parenting practices and socioemotional family characteristics, and to explore potential mediated relationships that may contribute to an understanding of the family processes involved.

DESIGN

Cross-sectional survey among adolescents aged 13-15 years.

SETTING

A survey questionnaire including self-report measures on adolescents' frequency of vegetable consumption, perceived food parenting practices (i.e. family dinner frequency, maternal/paternal healthy eating guidance (HEG), maternal/paternal social support for vegetable consumption) and socioemotional family characteristics (i.e. general family functioning and level of cohesion and conflict within the family) was distributed in a convenience sample of secondary school students.

PARTICIPANTS

Four hundred forty students from five secondary schools in eastern Norway completed the questionnaire.

RESULTS

Results from multiple linear regression analysis revealed positive and statistically significant associations between adolescents' frequency of vegetable consumption, maternal HEG and family cohesion. A partial indirect (mediated) association between family cohesion and adolescents' frequency of vegetable consumption, working through maternal HEG, was also found.

CONCLUSIONS

Results from the present study suggest that perceived family cohesion may influence adolescents' frequency of vegetable consumption both directly and indirectly. However, there is a need for continued investigation of family-related factors influencing adolescent eating. In particular, the role of socioemotional family characteristics should be further scrutinised in future studies.

Mothers' Diet and Family Income Predict Daughters' Healthy Eating

Introduction

Understanding the degree to which parents may influence healthy behaviors may provide opportunities to intervene among populations at increased risk of diseases, such as breast cancer. In this study, we examined the association between daughters’ healthy eating habits and family lifestyle behaviors among girls and their families by using baseline data from the LEGACY (Lessons in Epidemiology and Genetics of Adult Cancer from Youth) Girls Study. Our objective was to examine the relationship between daughters’ healthy eating and family lifestyle behaviors and to compare these associations between families with and without a history of breast cancer.

Methods

We examined demographic and lifestyle data from a cohort of 1,040 girls aged 6 to 13 years from year 1 (2011) of the LEGACY study. Half had a family history of breast cancer (BCFH). We used mixed-effects linear regression to assess the influence of the mother and father’s physical activity, family relationship scores, the mother’s diet, the family’s income, and the daughter’s sports participation, age, body mass index (BMI), and race/ethnicity on the daughter’s Healthy Eating Index (HEI) score.

Results

Daughters’ healthy eating was significantly correlated with the mother’s diet (r[668] = 0.25, P = .003) and physical activity (r[970] = 0.12, P = .002), the father’s physical activity (r[970] = 0.08, P = .01), and the family income (r[854] = 0.13, P = .006). Additionally, the mother’s diet (β coefficient = 0.71, 95% CI, 0.46–0.88, P = .005) and family income (β coefficient = 3.28, 95% CI, 0.79–5.78, P = .002) significantly predicted a daughter’s healthy eating. Analyses separated by family history status revealed differences in these associations. In families without a history of breast cancer, only the mother’s diet (β coefficient = 0.62; 95% CI, 0.29–0.95; P = .001) significantly predicted the daughter’s healthy eating. In families with a history of breast cancer, the mother’s diet (β coefficient = 0.73, 95% CI, 0.42-1.03, P = .006) and family income (β coefficient = 6.24; 95% CI, 2.68–9.80; P = .004) significantly predicted a daughter’s healthy eating.

Conclusion

A mother’s diet and family income are related to the daughter’s healthy eating habits, although differences exist among families by family history of breast cancer.

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

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

Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment

PURPOSE OF REVIEW

The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity.

RECENT FINDINGS

Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.

What factors are associated with obesity-related health behaviours among child refugees following resettlement in developed countries? A systematic review and synthesis of qualitative and quantitative evidence

Refugee children are likely to become less active and eat more unhealthily after their resettlement in developed countries. This review aims to identify and synthesize research about factors that influence unhealthy behaviours related to obesity in this population. Six electronic databases were searched systematically to identify studies that sampled refugee children or parents of refugee children aged 2 to 16 years who have resettled in a developed country. Methodological and cultural study quality was assessed and factors associated with obesity-related health behaviours investigated. Twenty studies fulfilled the inclusion criteria. Five major themes, representing factors influencing health behaviours, were identified from the data synthesis process: Acculturation, Environmental, Socioeconomic, Cognitive, and Family. The analysis revealed that refugee's health behaviours are influenced by several complex factors that are common to immigrant groups but have a greater influence among refugees. The review also revealed parental practices influence the health behaviours of children, especially those aged 2 to 10 years. Research is needed to understand further the role that parents have in influencing health behaviours and weight trajectories of children following resettlement.

Results of a Family-Based Intervention Promoting Healthy Weight Strategies in Overweight Hispanic Adolescents and Parents: An RCT

INTRODUCTION

Hispanic adolescents in the U.S. are disproportionately affected by overweight and obesity compared with their White, non-Hispanic counterparts. This study examines the efficacy of an evidence-based family intervention adapted to target obesity-related outcomes among Hispanic adolescents who were overweight/obese compared with prevention as usual.

STUDY DESIGN

This study was an RCT.

SETTING/PARTICIPANTS

Participants were Hispanic adolescents who were overweight/obese (n=280, mean age=13.01 [SD=0.82] years) in the 7th/8th grade and their primary caregivers. Primary caregivers were majority female legal guardians (88% female, mean age=41.88 [SD=6.50] years).

INTERVENTION

Participants were randomized into the family-level obesity-targeted intervention or referral to community services offered for overweight/obese adolescents and families (condition). Data collection began in 2015.

MAIN OUTCOME MEASURES

Primary outcomes included dietary intake (e.g., reduction of sweetened beverages) and past-month moderate-to-vigorous physical activity. Secondary outcomes were BMI and family functioning assessed among adolescents and primary caregivers.

RESULTS

Study analyses (2019) indicated no significant intervention effects for adolescents' primary outcomes. Intervention effects were found for parents' intake of fresh fruits and vegetables (β=0.12, 95% CI=0.02, 0.23), added sugar (β= -0.11, 95% CI= -0.22, -0.004), and sweetened beverages (β= -0.12, 95% CI=-0.23, -0.02), and parents showed decreased BMI (β= -0.05, 95% CI= -0.11, -0.01) at 6 months after baseline compared with usual prevention. Intervention effects were found for adolescent family communication (β=0.13, 95% CI=0.02, 0.24), peer monitoring (β=0.12, 95% CI=0.01, 0.23), and parental involvement (β=0.16, 95% CI=0.06, 0.26) at 6 months after baseline compared with prevention as usual.

CONCLUSIONS

This intervention was not effective in improving overweight/obesity-related outcomes in adolescents. The intervention was effective in improving parents' dietary intake and BMI; however, the effects were not sustained in the long term. Other intervention strategies (e.g., booster sessions, increased nutritional information) may be necessary to sustain beneficial effects and extend effects to adolescent participants.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT03943628.

Building a Foundation for Family Health Measurement in National Surveys: A Modified Delphi Expert Process

INTRODUCTION

Families are the most proximal and powerful context for the development, promotion, and disruption of health of individuals across the life course. Despite families' critical role in health, U.S. nationally representative health surveys lack comprehensive and standardized assessments of family health and functioning.

METHODS

To foster research on family health in population surveys, we developed a conceptualization of family health using a modified Delphi process with family health experts. Experts responded online to produce consensus definitions of 'family' and 'family health.' Guided by these definitions, they responded to a survey to create a list of concepts for measurement of family health and ranked the importance and measurability of those concepts.

RESULTS

We achieved consensus among 15 family health experts on definitions of 'family' and 'family health.' Thirty-one family health concepts were organized into six domains, then ranked by relevance and importance as follows: (1) "Family relationships" and "family social context" tied for first priority, (2) "family member health, (3) "family health-related practices," (4) "family health resources," and (5) "management of time and activities."

DISCUSSION

Social relationships and social environment were prioritized as more essential than other aspects of family environments typically assessed in population surveys, such as health practices and family members' illness and disease. This study develops the scientific groundwork needed to advance routine monitoring of family health in national health surveys and in child/family performance measures.

George SM, Kitzman H, Kipp CJ. Families Improving Together (FIT) for weight loss: a resource for translation of a positive climate-based intervention into community settings

Climate-based weight loss interventions, or those that foster a nurturing family environment, address important ecological influences typically ignored by the traditional biomedical treatments. Promoting a climate characterized by positive communication, autonomy support, and parental warmth supports adolescents in making healthy behavioral changes. In addition, encouraging these skills within the family may have additional benefits of improved family functioning and other mental and physical health outcomes. Although several programs have identified essential elements and established the evidence base for the efficacy of these interventions, few have offered resources for the translation of these constructs from theoretical concepts to tangible practice. This paper provides strategies and resources utilized in the Families Improving Together (FIT) for weight loss randomized controlled trial to create a warm, supportive climate characterized by positive communication within the parent-child relationship. Detailed descriptions of how Project FIT emphasized these constructs through facilitator training, intervention curriculum, and process evaluation are provided as a resource for clinical and community interventions. Researchers are encouraged to provide resources to promote translation of evidence-based interventions for programs aiming to utilize a positive climate-based family approach for lifestyle modification.

Family function and eating behaviours among Hispanic/Latino youth: results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

OBJECTIVE

To elucidate mechanisms across family function, home environment and eating behaviours within sociocultural context among Hispanic youth.

DESIGN

Two models tested via path analysis (youth fruit and vegetable (FV) consumption; empty energy consumption) using data from the Study of Latino Youth (2011-2013).

SETTING

Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.

PARTICIPANTS

Youth (8-16-year-olds), n 1466.

RESULTS

Youth ate 2·4 servings of FV per d and received 27 % of total energy from empty energies. Perceiving higher acculturative stress was indirectly associated with lower FV consumption via a pathway of low family function and family support for FV (β = -0·013, P < 0·001) and via lower family closeness and family support (β = -0·004, P = 0·004). Being >12-year-olds was indirectly associated with lower FV consumption via lower family closeness and family support (β = -0·006, P < 0·001). Household food security was indirectly associated with greater FV consumption via family closeness and family support (β = 0·005, P = 0·003). In contrast, perceiving higher acculturative stress was indirectly associated with higher empty energy consumption (via family closeness and family support: β = 0·003, P = 0·028 and via low family function and low family support: β = 0·008, P = 0·05). Being older was associated with higher consumption of empty energies via family closeness (related to family support: β = 0·04, P = 0·016; parenting strategies for eating: β = 0·002, P = 0·049).

CONCLUSIONS

Findings suggest pathways of influence across demographic and sociocultural context, family dynamics and home environment. The directionality of these associations needs confirmation using longitudinal data.

Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children

OBJECTIVE

To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children.

DESIGN

Cross-sectional survey.

SETTING

Two US weight management centers.

PARTICIPANTS

259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2-18 years) MAIN OUTCOME MEASURE(S): Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation.

ANALYSIS

Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates.

RESULTS

Patients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021).

CONCLUSIONS AND IMPLICATIONS

Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.

Family Meal Frequency, Diet, and Family Functioning: A Systematic Review With Meta-analyses

OBJECTIVE

To examine the direction and magnitude of the relation between family meal frequency and dietary and family functioning outcomes in children (aged 2-18 years).

DESIGN

Systematic literature review with meta-analysis.

METHODS

Independent electronic searches, 1 for each outcome of interest, were conducted across 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and PsycINFO. Studies were included if they were peer-reviewed and published in English in the US through December 2018.

MAIN OUTCOME MEASURES

Diet and family functioning.

RESULTS

Dietary outcomes showed some evidence of a positive association between family meal frequency and fruits, vegetables, fruits and vegetables, sugar-sweetened beverages, and the Healthy Eating Index. There was less clear evidence of this relation in snacks, fast food, and desserts. A positive association was found between family meal frequency or dinner family meal frequency and family functioning outcomes. All studies included had cross-sectional and longitudinal study designs.

CONCLUSIONS AND IMPLICATIONS

There is some evidence to show a positive relation between family meal frequency and dietary outcomes. There is stronger evidence for the relation with family functioning outcomes. Most articles included in the systematic reviews were excluded from meta-analysis owing to inadequate data and high methodological diversity across exposure and outcome variables.

Relationship of Parental Support on Healthy Habits, School Motivations and Academic Performance in Adolescents

The objective of the study was to analyze how parental support relates to the physical activity practice, satisfaction with sports, level of physical activity, academic performance and alcohol consumption. Descriptive cross-sectional study, with 1100 adolescents (12-16 years old), where the factors related to parental support, gender and age acted as independent variables, and satisfaction with sport, level of physical activity (PA), academic performance and alcohol consumption acted as dependent variables. A multivariate statistical analysis was conducted. Adolescents with little parental support show (p < 0.001) more boredom, less fun, worse academic performance and higher alcohol consumption. Gender shows differences (p < 0.001) experiencing girls more boredom, less fun, less PA practice and higher academic performance than boys. Age establishes (p < 0.01) that older adolescents (15-16 years old) experience more boredom, less fun, less PA practice, lower academic performance and higher alcohol consumption than young boys and girls (12-14 years old). Parental support towards PA practice improves healthy habits, benefits academic performance and school satisfaction with physical and sports activity.

Latino adolescent-father discrepancies in reporting activity parenting practices and associations with adolescents' physical activity and screen time

Background

Latino fathers may play important roles in adolescents’ physical activity and screen time. However, informant discrepancies regarding paternal activity parenting practices may challenge studies supporting evidence-based applications. This study examined Latino adolescent-father discrepancies in reporting paternal activity parenting practices, types of discrepancies by participant characteristics, and associations between discrepancy types and adolescents’ physical activity and screen time.

Methods

The sample for this cross-sectional study included Latino early adolescents and their fathers (n = 138 dyads) from baseline data collected for a family-centered, healthy lifestyle intervention in a metropolitan area. In parallel measures, Latino adolescents and fathers reported paternal activity parenting practices related to expectation or allowance, behavioral modeling, and providing opportunities for physical activity or screen time. Level of agreement and discrepancies were examined using the percentage of agreement, weighted kappa statistics, Pearson correlation coefficients, and paired-sample t-tests. Undesirable discrepancy types included adolescents reporting lower scores for paternal physical activity parenting practices or higher scores for paternal screen time parenting practices than fathers. Participants’ sociodemographic characteristics and weight status were compared by discrepancy type using between-group t-tests or Chi-square tests. Associations between discrepancy type and adolescents’ physical activity and screen time were examined using multivariate regression analyses.

Results

The study sample was low-income with a high prevalence of overweight and obesity. Adolescent and paternal reports of activity parenting practices had poor agreement (percentages of agreement: 22.2–34.3%, weighted kappa statistics: < 0.2, and correlation coefficients: 0.06–0.25). An undesirable discrepancy type for certain parenting practices was more likely to be observed among fathers without full-time employment, girls, older adolescents, and adolescents and fathers within overweight or obese BMI categories. Discrepancies in paternal expectation regarding physical activity and allowance of screen time had adverse associations with adolescents’ physical activity (β = − 0.18, p = 0.008) and screen time (β = 0.51, p <  0.001).

Conclusion and implications

Discrepancies in reporting activity parenting practices were evident between Latino adolescents and their fathers, especially among certain sociodemographic and weight status groups. Adolescents’ perceptions on paternal parenting practices tended to be better indicators of their activity levels than fathers’ reports.

Do Parents Perceive That Organized Activities Interfere with Family Meals? Associations between Parent Perceptions and Aspects of the Household Eating Environment

BACKGROUND

Research has related child participation in organized activities to health and academic benefits; however, participation may interfere with family meals.

OBJECTIVE

Examine whether parents perceive child participation in organized activities to interfere with family meals and how perceptions are related to the household eating environment.

DESIGN

A cross-sectional analysis was completed using survey data collected in 2015-2016 as part of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study.

PARTICIPANTS

Survey participants were originally recruited in Minneapolis-St Paul schools in 1998-1999. The analytic subsample of parents (one per household, n=389, 69% female, 31% nonwhite race, mean age=31) had one or more children involved in an organized activity. Approximately 33% of households included a child aged 2 to 5 and no older child; two thirds of households included school-aged children (6 to 18 years).

MAIN OUTCOME MEASURES

Parents reported family meal frequency, family meal scheduling difficulties, frequency of at-home meal preparation, and their own intake of fast food, fruit, and vegetables.

STATISTICAL ANALYSES PERFORMED

Analyses compared household environment characteristics reported by parents who perceived low interference between organized activities and family meals to characteristics reported by parents who perceived moderate to high interference from at least one form of activity. Regression models included a dichotomous indicator of interference as the independent variable and were adjusted for parental and household characteristics.

RESULTS

Among parents with children at any age, moderate to high interference was associated with lower family meal frequency, greater difficulty scheduling family meals, and more fast-food intake (all P≤0.01). The perception of moderate to high interference was more common among parents who reported involvement in both sport and nonsport activities (P<0.001) and those with a school-aged child (P<0.001) vs those with only preschool-aged children.

CONCLUSIONS

Follow-up research, including qualitative studies, is needed to identify the specific aspects of child participation in organized activities (eg, scheduled time of day) that may interfere with family meals.