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Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic. Int J Obes (Lond) 2021; 45:1086-1094. [PMID: 33603129 DOI: 10.1038/s41366-021-00778-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Child and Adult Eating Behavior Questionnaires (CEBQ, AEBQ) are established measures of eating behaviors. However, no similar measure is available for adolescents. Prior research has validated the AEBQ in adult samples, and one study has explored using the measure with adolescents. However, no studies to date have examined the validity of the AEBQ in adolescent clinical populations. Furthermore, no studies have examined associations between the AEBQ and indicators of health status in adolescents. METHODS A total of 280 adolescents (12-17 years old, 60% female) seen in a pediatric weight management clinic completed the AEBQ at intake. Confirmatory factor analysis (CFA) was conducted with AEBQ items to evaluate the model fit of one-, two-, seven-, and eight-factor structures. Intercorrelations between scale scores from AEBQ Food Approach and Food Avoidance domains were calculated. Associations of AEBQ scales with body mass index (BMI) and binge-eating behaviors were examined using Spearman Rho correlations and independent t-tests. RESULTS CFAs revealed that the best fitting model was a seven-factor structure excluding the Hunger scale, although overall model fit was only marginally acceptable (X2 = 980.94, CFI = 0.925, TLI = 0.915, RMSEA = 0.074). Intercorrelation analyses indicated that all Food Approach scales were significantly associated with one another (r = 0.243-0.654); Food Avoidance scales were inconsistently correlated (r = 0.034-0.439). No AEBQ scales were correlated with BMI (r = -0.101-0.082). Stronger links were found with binge eating; higher frequency binge-related behaviors were associated with higher Food Approach scores. CONCLUSIONS The seven-factor structure of AEBQ demonstrates a marginally acceptable fit for treatment-seeking adolescents with obesity. The Food Approach scales demonstrated more convergent validity than the Food Avoidance scales. The Food Approach scales also exhibited some clinical utility for identifying patients with increased risk for binge eating, which is a common target for behavioral intervention. Implications for maximizing the AEBQ's potential for assessing eating behaviors in adolescents with obesity are discussed.
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Lowe KD, Lott MA, Jensen CD. Associations Between Parent-Child Communication and Connectedness, Parent Feeding Behavior, and Child Body Mass in Pre-Adolescent Children. J Pediatr Psychol 2021; 46:59-68. [PMID: 33166382 DOI: 10.1093/jpepsy/jsaa087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study evaluated associations between parent-child connectedness and communication, parent feeding behaviors (restriction, pressure to eat, and monitoring), and age- and sex-standardized child body mass index (zBMI) in a sample of pre-adolescent children aged 8-12 years. METHODS A community sample of three hundred and eight child-parent dyads completed measures of communication and connectedness. Parents completed a feeding behavior measure and children were weighed and their height was measured. We examined whether parental feeding behaviors and parent-child communication and connectedness predicted child zBMI and whether parental feeding behaviors moderated the association between parent-child communication and connectedness and child zBMI. RESULTS Feeding restriction was positively associated with zBMI, while both pressure to eat and food monitoring exhibited negative associations with zBMI. Child-reported communication was inversely associated with zBMI and parental pressure to eat moderated this association such that lower pressure to eat predicted a stronger association between communication and zBMI. CONCLUSIONS These findings are consistent with previous research suggesting that parent feeding strategies and parent-child communication are important contributors to child weight status. This study also provides preliminary evidence suggesting that adaptive parent-child communication is associated with lower body mass when parents avoid pressuring their child to eat. Our study provides an important extension of this body of research into middle childhood, a relatively understudied developmental stage.
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Affiliation(s)
| | - Mark A Lott
- University of Texas Southwestern Medical Center.,Children's Health
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Conflicts between adolescents and their caregivers living in slums of Mumbai, India in relation to junk food consumption and physical activity. Public Health Nutr 2020; 24:5207-5217. [DOI: 10.1017/s1368980020001640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
To explore influences on the diet and physical activity of adolescents living in Mumbai slums, from the perspectives of adolescents and their caregivers.
Design:
Three investigators from Mumbai conducted six focus group discussions.
Setting:
The study was conducted in suburban Mumbai slums.
Participants:
Thirty-six adolescents (aged 10–12 and 15–17 years) and twenty-three caregivers were recruited through convenience sampling.
Results:
The findings highlighted the complex negotiations between adolescent and caregivers surrounding adolescent junk food consumption and physical activity opportunities. Caregivers learned recipes to prepare popular junk foods to encourage adolescents to eat more home-cooked, and less ‘outside’, food, yet adolescents still preferred to eat outside. To adolescents, the social aspect of eating junk food with friends was an important and enjoyable experience. Caregivers felt that they had no control over adolescents’ food choices, whereas adolescents felt their diets were dictated by their parents. Adolescents wanted to be physically active but were encouraged to focus on their academic studies instead. Gender was also a key driver of physical activity, with girls given less priority to use outside spaces due to cultural and religious factors, and parental fears for their safety.
Conclusions:
These findings show that adolescents and caregivers have different agendas regarding adolescent diet. Adolescent girls have less opportunity for healthy exercise, and are more sedentary, than boys. Adolescents and caregivers need to be involved in designing effective interventions such as making space available for girls to be active, and smartphone games to encourage healthy eating or physical activity.
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Banna J, Richards R, Jones B, Anderson AK, Reicks M, Cluskey M, Gunther C, Hongu NK, Lora K, Misner S, Monroe-Lord L, Topham G, Wong SS, Lim E. Describing Independent Eating Occasions among Low-Income Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030981. [PMID: 32033251 PMCID: PMC7037151 DOI: 10.3390/ijerph17030981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/26/2022]
Abstract
The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10–13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 ± 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.
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Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii-Manoa, Honolulu, HI 96822, USA
- Correspondence: ; Tel.: +1-808-956-7857
| | - Rickelle Richards
- Department of Nutrition, Dietetics & Food Science, Brigham Young University, Provo, UT 84602, USA;
| | - Blake Jones
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA;
| | - Alex Kojo Anderson
- Department of Foods and Nutrition, University of Georgia, Athens, GA 30602, USA;
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA;
| | - Mary Cluskey
- School of Biological and Population Health Sciences, Nutrition, Oregon State University, Corvallis, OR 97331, USA; (M.C.); (S.S.W.)
| | - Carolyn Gunther
- Department of Human Sciences, Ohio State University, Human Nutrition Program, Columbus, OH 43210, USA;
| | - Nobuko Kay Hongu
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85721, USA; (N.K.H.); (S.M.)
| | - Karina Lora
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC 20052, USA;
| | - Scottie Misner
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85721, USA; (N.K.H.); (S.M.)
| | - Lillie Monroe-Lord
- Center for Nutrition, Diet and Health, University of the District of Columbia, Washington, DC 20008, USA;
| | - Glade Topham
- Couple and Family Therapy Program, Kansas State University, Manhattan, KS 66506, USA;
| | - Siew Sun Wong
- School of Biological and Population Health Sciences, Nutrition, Oregon State University, Corvallis, OR 97331, USA; (M.C.); (S.S.W.)
| | - Eunjung Lim
- Department of Quantitative Health Sciences, University of Hawaii-Manoa, Honolulu, HI 96813, USA;
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Frequency of eating alone is associated with adolescent dietary intake, perceived food-related parenting practices and weight status: cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) Study results. Public Health Nutr 2019; 22:1555-1566. [PMID: 30813975 DOI: 10.1017/s1368980019000107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine relationships between frequency of adolescents eating alone (dependent variable) and diet, weight status and perceived food-related parenting practices (independent variables). DESIGN Analyses of publicly available, cross-sectional, web-based survey data from adolescents. SETTING Online consumer opinion panel. SUBJECTS A US nationwide sample of adolescents (12-17 years) completed Family Life, Activity, Sun, Health, and Eating (FLASHE) Study surveys to report demographic and family meal characteristics, weight, dietary intake, home food availability and perceptions of parenting practices. Parents provided information about demographic characteristics. Logistic regression analyses were used to test for associations between variables. RESULTS About 20 % of adolescents reported often eating alone (n 343) v. not often eating alone (n 1309). Adjusted odds of adolescents often eating alone were significantly higher for non-Hispanic Black compared with non-Hispanic White adolescents (OR=1·7) and for overweight or obese compared with normal- or underweight adolescents (OR=1·6). Adjusted odds of adolescents eating alone were significantly lower for those who reported that fruits and vegetables were often/always available in the home (OR=0·65), for those who perceived that parents had expectations about fruit and vegetable intake (OR=0·71) and for those who agreed with parental authority to make rules about intake of junk food/sugary drinks (OR=0·71). Junk food and sugary drink daily intake frequency was positively associated with often eating alone. CONCLUSIONS Often eating alone was related to being overweight/obese, having less healthy dietary intake and perceptions of less supportive food-related parenting practices.
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Ziauddeen N, Page P, Penney TL, Nicholson S, Kirk SFL, Almiron-Roig E. Eating at food outlets and leisure places and "on the go" is associated with less-healthy food choices than eating at home and in school in children: cross-sectional data from the UK National Diet and Nutrition Survey Rolling Program (2008-2014). Am J Clin Nutr 2018; 107:992-1003. [PMID: 29741556 PMCID: PMC5985724 DOI: 10.1093/ajcn/nqy057] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/06/2018] [Indexed: 12/25/2022] Open
Abstract
Background Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity. Objective The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey. Design Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5-18 y from the UK National Diet and Nutrition Survey Rolling Program (2008-2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and "on the go." Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking. Results The main eating location across all age groups was at home (69-79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and "on the go" combined increased with age, from 5% (1.5-3 y) to 7% (11-18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4-10 y who ate school-sourced foods. Conclusions Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat "on the go," may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.
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Affiliation(s)
- Nida Ziauddeen
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Polly Page
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Tarra L Penney
- UKCRC Center for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Sonja Nicholson
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Sara FL Kirk
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eva Almiron-Roig
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
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Arundell L, Fletcher E, Salmon J, Veitch J, Hinkley T. The correlates of after-school sedentary behavior among children aged 5-18 years: a systematic review. BMC Public Health 2016; 16:58. [PMID: 26795731 PMCID: PMC4722784 DOI: 10.1186/s12889-015-2659-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children and adolescents spend a large proportion of the after-school period in sedentary behaviors (SB). Identifying context-specific correlates is important for informing strategies to reduce these behaviors. This paper systematically reviews the correlates of children's and adolescents' after-school SB. METHODS A computerized literature search was performed in October 2015 for peer-reviewed original research journal articles published in English before October 2015. Eligibility criteria included: 1) sample aged 5-18 years; 2) quantified the amount of SB or component of this that the children/adolescents were performing after school; 3) a measure of SB as the dependent outcome; and 4) the association between potential correlates and after-school SB. RESULTS Data were synthesized in October 2015. Thirty-one studies met the eligibility criteria: 22 studies among children (≤ 12 years), six among adolescents (>12 years), two had a combined sample of children and adolescents and one cohort followed children from childhood to adolescence. Findings were separated by after-school location i.e. after-school programs (n = 4 studies) and unidentified locations (n = 27). There was insufficient evidence to draw conclusions on all but two of the 58 potential correlates: sex and age. Among children at unidentified locations there was a null association between sex (male) and overall after-school SB, a null association between sex (male) and after-school TV viewing, a positive association between age and overall after-school SB and an inconsistent association between age and after-school TV viewing. No correlates of after-school sedentary behaviour while at after-school programs were identified. CONCLUSIONS Only two correlates have been investigated frequently enough to determine an overall association; neither correlate is modifiable. Due to the lack of consistent investigation of potential correlates, further evidence is required to accurately identify potential intervention targets. PROSPERO REGISTRATION NUMBER CRD42014009180.
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Affiliation(s)
- Lauren Arundell
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Australia.
| | - Elly Fletcher
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Australia.
| | - Jo Salmon
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Australia.
| | - Jenny Veitch
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Australia.
| | - Trina Hinkley
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Australia.
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Reicks M, Banna J, Cluskey M, Gunther C, Hongu N, Richards R, Topham G, Wong SS. Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention. Nutrients 2015; 7:8783-801. [PMID: 26506384 PMCID: PMC4632451 DOI: 10.3390/nu7105431] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/22/2015] [Accepted: 10/12/2015] [Indexed: 12/16/2022] Open
Abstract
Among early adolescents (10-14 years), poor diet quality along with physical inactivity can contribute to an increased risk of obesity and associated biomarkers for chronic disease. Approximately one-third of United States (USA) children in this age group are overweight or obese. Therefore, attention to factors affecting dietary intake as one of the primary contributors to obesity is important. Early adolescents consume foods and beverages during eating occasions that occur with and without parental supervision. Parents may influence eating behaviors of early adolescents during eating occasions when they are present or during independent eating occasions by engaging in practices that affect availability of foods and beverages, and through perceived normative beliefs and expectations for intake. Therefore, the purpose of this article was to describe the influence of parenting practices on eating behaviors in general and when specifically applied to independent eating occasions of early adolescents. This information may be helpful to inform parenting interventions targeting obesity prevention among early adolescents focusing on independent eating occasions.
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Affiliation(s)
- Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave., St. Paul, MN 55108-6099, USA.
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, Agricultural Sciences 216, University of Hawaii at Manoa, 1955 East-West Rd, Honolulu, HI 96822, USA.
| | - Mary Cluskey
- College of Public Health and Human Sciences, Nutrition, Oregon State University, 101 Milam Hall, Corvallis, OR 97331-3303, USA.
| | - Carolyn Gunther
- Department of Human Sciences, the Ohio State University, 313 Campbell Hall, 1787 Neil Ave, Columbus, OH 43210, USA.
| | - Nobuko Hongu
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721-0038, USA.
| | - Rickelle Richards
- Department of Nutrition, Dietetics & Food Science, Brigham Young University, S233 Eyring Science Center, Provo, UT 84602, USA.
| | - Glade Topham
- Department of Human Development and Family Science, Oklahoma State University, 243 Human Sciences, Stillwater, OK 74078, USA.
| | - Siew Sun Wong
- College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Hallie E. Ford Center for Healthy Children and Families, Extension Family and Community Health Program, Nutrition, Oregon State University, Ballard Hall 105E, Corvallis, OR 97331-3303, USA.
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He L, Zhai Y, Engelgau M, Li W, Qian H, Si X, Gao X, Sereny M, Liang J, Zhu X, Shi X. Association of children's eating behaviors with parental education, and teachers' health awareness, attitudes and behaviors: a national school-based survey in China. Eur J Public Health 2013; 24:880-7. [PMID: 24287031 DOI: 10.1093/eurpub/ckt177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In China, childhood obesity is a growing health issue. Eating behaviors among children can be influenced by both the family and school environment. We examine the association between these environments and eating habits among children. METHODS A total of 11 270 fourth to sixth grade school children, 11 270 of their fathers or mothers, and 1348 teachers from 48 schools were sampled using a multistage cluster random sampling method. Questionnaires collected information on eating behaviors among children, non-communicable chronic disease (NCD)-related health knowledge and behaviors among teachers, and education levels among parents. Mixed effect logistic regression models were used to describe the key associations between eating behaviors among children and teacher and parental characteristics. RESULTS Health awareness, positive health attitudes, never-smoking and regular-exercise among teachers was positively associated with healthy eating behaviors among their students (having breakfast, vegetables and dairy products every day; P < 0.05), and negatively associated with the unhealthy behaviors (daily intake of fried foods and desserts and sugary beverages; P < 0.05). More than one parent having a high school level or above was positively related to healthy eating behaviors among their children (P < 0.05), but its associations with high-calorie eating habits were negative in urban and positive in rural areas (P < 0.05). CONCLUSIONS School-based interventions which target health-related awareness, attitude and behaviors among school teachers may help improve school-aged children's eating behaviors. Parental education levels may help guide efforts to target children at higher risk of unhealthy eating habits.
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Affiliation(s)
- Liu He
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yi Zhai
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | | | - Weirong Li
- 3 Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hanzhu Qian
- 4 Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Xiang Si
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xin Gao
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Melanie Sereny
- 5 Department of Sociology, Duke University, Durham, NC, USA
| | - Jing Liang
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaolei Zhu
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaoming Shi
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
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