1
|
Berge JM, Hazzard VM, Trofholz A, Noser AE, Hochgraf A, Neumark-Sztainer D. 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? Appetite 2023; 191:107080. [PMID: 37832722 PMCID: PMC11006826 DOI: 10.1016/j.appet.2023.107080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/15/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Vivienne M Hazzard
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Amy E Noser
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anna Hochgraf
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| |
Collapse
|
2
|
Middleton G, Golley RK, Patterson KA, Coveney J. Barriers and enablers to the family meal across time; a grounded theory study comparing South Australian parents' perspectives. Appetite 2023; 191:107091. [PMID: 37865298 DOI: 10.1016/j.appet.2023.107091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/05/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
Family meals are positively associated with numerous beneficial health and social outcomes. Current discourse however claims that parents are faced with numerous barriers when trying to bring the family together to share a meal. Solutions for overcoming barriers to a positive shared family meal are often individualistic and do not address the systemic pressures and burdens families have faced for decades. The aim of this study was to explore the systemic and novel barriers and enablers to shared family meals as experienced by families across time. To achieve this, a qualitative study informed by grounded theory was conducted. Parents of South Australian families were recruited and interviewed in the 1990s, and a new sample of parents were recruited and interviewed in 2020. Transcripts were analysed using grounded theory and comparative analysis methods. Thirty-two parents from 16 families were interviewed in the 1990s, and 22 parents from 10 families in 2020. Ten factors were identified presenting as either enablers or barriers to the family meal, depending on the context they were experienced. Barriers and enablers were largely consistent across time. Scheduling and flexibility, children's disruptions and children's independence, privileges required to have family meals and motivation and commitment to the family meal were identified as persistent enablers and barriers across time. These findings indicate that parents are faced with similar challenges they have been facing for decades and are still not being adequately supported to execute family meals regularly. Recognising that factors present as either barriers or enablers to the family meal provides us with opportunities to transform barriers to enablers and support families to have regular, meaningful family meals.
Collapse
Affiliation(s)
- Georgia Middleton
- Caring Futures Institute, Flinders University, Tarntanya, Adelaide, South Australia, Australia; College of Nursing and Health Sciences, Flinders University, Tarntanya, Adelaide, South Australia, Australia.
| | - Rebecca K Golley
- Caring Futures Institute, Flinders University, Tarntanya, Adelaide, South Australia, Australia; College of Nursing and Health Sciences, Flinders University, Tarntanya, Adelaide, South Australia, Australia
| | - Karen A Patterson
- College of Nursing and Health Sciences, Flinders University, Tarntanya, Adelaide, South Australia, Australia
| | - John Coveney
- Caring Futures Institute, Flinders University, Tarntanya, Adelaide, South Australia, Australia; College of Nursing and Health Sciences, Flinders University, Tarntanya, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Daragan C, Tate AD, Trofholz AC, Berge JM. Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals. Appetite 2023; 184:106480. [PMID: 36736904 PMCID: PMC10033380 DOI: 10.1016/j.appet.2023.106480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine parent-reported key family meal characteristics to advance the conceptualization of how parents perceive family meals to inform public health interventions and clinical practice. DESIGN Cross-sectional study design using ecological momentary assessment (EMA) and online survey data from a racially and ethnically diverse population. PARTICIPANTS Parent/child dyads (N = 631) with children ages 5-9 years old from diverse, low-income households. ANALYSIS Multi-level logistic regression, conditional fixed effects estimators and multi-level logistic models with inverse probability weights. RESULTS Characteristics of meals that parents considered family meals (N = 3328) included: homemade, prepared by the caregivers, eaten at home (table/counter), most of the nuclear family gathered, having a conversation and an enjoyable atmosphere (p < 0.001). Characteristics of meals that parents deemed as non-family meals (N = 562) included: watching TV/tablets, non-family members joining, chaotic/rushed atmosphere (p < 0.001). CONCLUSIONS AND IMPLICATIONS Parents consider family meals to be meals that take place at home around a table/counter, with homemade food prepared by the caregivers, and most family members gathered enjoying a conversation without other distractions. Study findings indicated that parents endorse specific characteristics as key for defining what "counts" as a family meal. These findings can be used by clinicians as recommendations for improving one's family meal experience and by future research as the basis for intervening on family meal characteristics and standardization of a definition of family meals.
Collapse
Affiliation(s)
- Christina Daragan
- University of Minnesota Medical School, 515 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Allan D Tate
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 202 B.S. Miller Hall, 101 Buck Rd, Athens, GA, 30602, USA.
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Delaware Street SE Room 425, MMC 381, Minneapolis, MN, 55455, USA
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Delaware Street SE Room 425, MMC 381, Minneapolis, MN, 55455, USA.
| |
Collapse
|
4
|
Berge JM, Tate A, Trofholz A, Kunin-Batson A. Intergenerational Pathways Between Parental Experiences of Adverse Childhood Experiences (ACEs) and Child Weight: Implications for Intervention. J Am Board Fam Med 2023; 36:39-50. [PMID: 36460355 PMCID: PMC11068311 DOI: 10.3122/jabfm.2022.220134r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND/OBJECTIVE Prior research suggests an association between parental experiencing of 1 or more adverse childhood experiences (ACEs) and increased risk for overweight/obesity in children. However, the pathways through which parental experiences of ACEs lead to child weight are unclear. METHODS Participants were parent and child dyads from racially/ethnically diverse and low-income households in Minneapolis and St. Paul, Minnesota, in 2015. Parents completed an online survey regarding their own adverse experiences in childhood, their height and weight, parenting practices, and mental health. Child height and weight were obtained from electronic medical records. Structural equation modeling was used to examine the extent to which parent mental health and parenting practices mediate associations between parental ACEs and child body mass index (BMI) percentile. RESULTS The parent mental health pathway was statistically significant in explaining the intergenerational transmission of parental ACEs to child weight. Parent ACEs were positively associated with low parent mental health, parent low mental health was correlated with higher parent BMI > 25, and parent overweight was positively related to higher child BMI percentile. CONCLUSIONS Study findings suggest that intervening on parent low mental health may be a key factor in reducing the intergenerational transmission between parental ACEs and child weight.
Collapse
Affiliation(s)
- Jerica M. Berge
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Allan Tate
- University of Georgia, College of Public Health, Athens, GA
| | - Amanda Trofholz
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Alicia Kunin-Batson
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN
| |
Collapse
|
5
|
Middleton G, Golley RK, Patterson KA, Coveney J. The Family Meal Framework: A grounded theory study conceptualising the work that underpins the family meal. Appetite 2022; 175:106071. [PMID: 35490845 DOI: 10.1016/j.appet.2022.106071] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
The family meal has been recognised as an integral part of family life. With the positive health outcomes associated with the family meal, it has been proposed as a strategy for encouraging health-promoting behaviours. However, a detailed understanding of the physical and mental work required to execute the family meal is lacking. The aim of this research was to conduct a grounded theory study to understand the components required to successfully execute the family meal. Two temporal data sets (1993-4/2020) in which diverse participants were sampled were used for this study. Methods used to conduct qualitative interviews with parents in the 1990s were mirrored in the conduct of qualitative interviews with parents in 2020. The interview data was analysed drawing on grounded theory methodology and methods. The entire sample included 54 parents from 28 families. A conceptual framework, 'The Family Meal Framework', was developed from the analyses. The five main components of The Framework are the cognitions (invisible work considering the needs of the family), actions (physical tasks required for the family meal), outcomes (the event of the family meal), the beliefs and feelings (expectations and attitudes toward the family meal), and the person(s) responsible (who undertakes the work). This framework provides a novel theory describing the reactive, cyclical nature of the work required to execute the family meal. This new understanding provides discrete opportunities for intervention in family meal research, practice, policy and promotion.
Collapse
Affiliation(s)
- Georgia Middleton
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Karen A Patterson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - John Coveney
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
6
|
de Brito JN, Loth KA, Fertig A, Trofholz AC, Tate A, Berge JM. Participant characteristics and dietary correlates of SNAP and other assistance programs among families with children from racially and ethnically diverse households. Appetite 2022; 174:106015. [PMID: 35364114 PMCID: PMC9058240 DOI: 10.1016/j.appet.2022.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/02/2022]
Abstract
The objective of this study was to describe food purchasing behaviors and the home food environment across families simultaneously receiving SNAP (Supplemental Nutrition Assistance Program) and other cash and food assistance benefits, and assess how child dietary intake varied across three distinct categories of assistance (i.e., SNAP and other assistance programs, assistance programs other than SNAP, and not enrolled in any assistance program). This cross-sectional study was conducted with parents of children aged 5-9 years (N = 1033) from low-income and racially and ethnically diverse households, living in Minneapolis and Saint Paul, Minnesota, metropolitan areas. In an online survey, parents reported enrollment in seven assistance programs (SNAP, WIC [Special Supplemental Nutrition Program for Women, Infants and Children Program], free or reduced-cost school breakfast, free or reduced-cost school lunch, SSI [Supplemental Security Income Program], MFIP [Minnesota Family Investment Program], daycare assistance), food purchasing behaviors, the home food environment, and child dietary and fast-food intake. Descriptive statistics were computed to describe food purchasing behaviors and the home food environment. Multivariable linear regressions were used to evaluate the association between assistance categories and child dietary intake factors. Models were adjusted for child age, parent and child sex, race and ethnicity, household income, primary caregiver's educational attainment, employment status, and place of birth. Relative to families participating in assistance programs other than SNAP and not enrolled in any assistance program, families participating in SNAP and other assistance programs had less reliable modes of transportation to go food shopping (use 'my own car or vehicle' 57% vs. 90% and 83%, respectively), shopped less frequently during the month ('1 big trip a month and small trips in between' 35% vs. 19% and 24%, respectively], had a somewhat higher presence of energy-dense (e.g., 'French fries' 60% vs. 35% and 25%, respectively) and high-sodium food items in the home (e.g., 'canned pasta' meals 48% vs. 35% and 20%, respectively), and some aspects of children's dietary intake that were not congruent with current dietary recommendations (e.g., consumption of 'fried vegetables' 3.9 times/week [95% CI 3.4, 4.4] vs. 2.9 [2.3, 3.5] and 2.8 [2.1, 3.6], respectively). Findings could inform targeted strategies to maximize the impact of simultaneous programs' benefits on improving child dietary intake and reaching eligible households not enrolled in assistance programs.
Collapse
Affiliation(s)
- Junia N de Brito
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55455, USA.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St SE, Suite 400, Minneapolis, MN, 55414, USA
| | - Angela Fertig
- Humphrey School of Public Affairs, University of Minnesota, 130 Humphrey School, 301 19th Avenue South, Minneapolis, MN, 55455, USA
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St SE, Suite 400, Minneapolis, MN, 55414, USA
| | - Allan Tate
- Department of Epidemiology and Biostatistics, University of Georgia, 101 Buck Rd, Athens, GA, 30606, USA
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St SE, Suite 400, Minneapolis, MN, 55414, USA
| |
Collapse
|
7
|
Lee J, Friend S, Horning ML, Linde JA, Flattum C, Lindberg R, Fulkerson JA. Are patterns of family evening meal practices associated with child and parent diet quality and weight-related outcomes? Appetite 2022; 171:105937. [PMID: 35045323 PMCID: PMC8892840 DOI: 10.1016/j.appet.2022.105937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/20/2022]
Abstract
Family meal practices such as family member presence, fast food consumption and media usage have been associated with health outcomes. However, little is known about combinations of family meal practices and their effects on diet and health. This secondary data analysis aimed to identify patterns of family evening meal practices and examine their associations with family characteristics (e.g., demographics and chaos) and child and parent diet quality and weight-related outcomes. We used baseline data from a community-based randomized controlled trial with 7- to 10-year-old children and their parents in rural Minnesota (n = 114). Parent-reported structural (e.g. media usage) and interpersonal (e.g. mealtime routines) aspects of family evening meal practices were included in latent profile analyses to identify patterns. Diet quality was assessed by child Healthy Eating Index-2015 and parent fruit and vegetable intake. Weight-related outcomes were determined using measured body mass index (z-scores) and percent body fat. A 3-class model was the model of best-fit. The Unplanned Infrequent Family Evening Meals with Mixed Healthfulness class (C1) featured the least frequent family evening meals and the lowest scores for mealtime routines and planning skills. The Family Evening Meals with Fast Food class (C2) characterized having family evening meals four times a week, but fast food was often served. The Planful, Healthful and Frequent Family Evening Meals class (C3) reported the highest meal routine and planning scores as well as frequent family evening meals. Parents in C3 had higher consumption of fruits and vegetables and children in C3 had lower percent body fat, compared to those in other classes. Distinctly different patterns of family evening meal practices suggest a need for considering heterogeneity of family evening meal practices in developing tailored family-meal interventions.
Collapse
Affiliation(s)
- Jiwoo Lee
- School of Nursing, University of Minnesota, 308 Harvard St. S.E., Minneapolis, MN, 55455, USA.
| | - Sarah Friend
- School of Nursing, University of Minnesota, 308 Harvard St. S.E., Minneapolis, MN, 55455, USA.
| | - Melissa L Horning
- School of Nursing, University of Minnesota, 308 Harvard St. S.E., Minneapolis, MN, 55455, USA.
| | - Jennifer A Linde
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
| | - Colleen Flattum
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
| | - Rebecca Lindberg
- Rebecca E. Lindberg, LLC, 4629 Arden Avenue, Edina, MN, 55424, USA.
| | - Jayne A Fulkerson
- School of Nursing, University of Minnesota, 308 Harvard St. S.E., Minneapolis, MN, 55455, USA.
| |
Collapse
|
8
|
Ravikumar D, Spyreli E, Woodside J, McKinley M, Kelly C. Parental perceptions of the food environment and their influence on food decisions among low-income families: a rapid review of qualitative evidence. BMC Public Health 2022; 22:9. [PMID: 34983469 PMCID: PMC8727174 DOI: 10.1186/s12889-021-12414-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The food environment within and surrounding homes influences family dietary habits with socio-economic areas at a nutritional disadvantage. Families’ perception of the food environment and how it influences their food decisions is less clear. This rapid review aimed to synthesise qualitative evidence of parental perspectives of the food environment and their influence on food decisions among disadvantaged families. Method Qualitative and mixed-methods peer-reviewed journal articles published after 2000, that explored the perspectives of low-income parents in relation to their food environment and how this impacted food decisions for families with children aged 2-17 years, were included in this review. Embase, Scopus and PsycINFO were the databases chosen for this review. Search strategies included seven concepts related to family, food, perceptions, influences, environment, socio-economic status and study type. Two independent reviewers screened sixty-four studies. Thematic synthesis was employed. Results Two thousand one hundred and forty five results were identified through database searching and 1,650 were screened. Fourteen articles that originated from the US, Australia and the UK were included in this review. No articles were excluded following quality appraisal. Child preferences, financial and time constraints, and location and access to food outlets were barriers to accessing healthy food. Parental nutrition education and feeding approaches varied but positive outcomes from interventions to address these behaviours will be short-lived if inequities in health caused by poverty and access to affordable and healthy food are not addressed. The reliance on social support from families or government sources played an important role for families but are likely to be short-term solutions to health and nutritional inequities. Conclusions This qualitative evidence synthesis provides an insight into the perceptions of low-income parents on the factors influencing food decisions. Findings have implications for public health and the development of effective strategies to improve the dietary habits of children of disadvantaged families. Sustainable changes to dietary habits for families on low-income requires policy responses to low income, food access and to the high cost of healthy foods.
Collapse
Affiliation(s)
- Divya Ravikumar
- Health Promotion Research Centre, National University of Ireland Galway, University Rd, Galway, Republic of Ireland
| | - Eleni Spyreli
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Jayne Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Michelle McKinley
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, University Rd, Galway, Republic of Ireland
| |
Collapse
|
9
|
Horning ML, Friend S, Lee J, Flattum C, Fulkerson JA. Family Characteristics Associated with Preparing and Eating More Family Evening Meals at Home. J Acad Nutr Diet 2022; 122:121-128. [PMID: 34399976 PMCID: PMC8688213 DOI: 10.1016/j.jand.2021.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/03/2021] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Research has demonstrated dietary quality benefits of family meals and meals prepared at home. Less is known about associations between the proportion of family evening meals made at home and key personal, behavioral, and environmental characteristics. Moreover, most studies often measure these data retrospectively. OBJECTIVE The objective of this study is to describe the proportion of evening meals made at home measured in real time and to assess associations between personal, behavioral, and environmental characteristics that are associated with a higher proportion of evening meals prepared and consumed at home. DESIGN This study is a cross-sectional secondary analysis of baseline data collected during 2017 and 2018 from the New Ulm at Home study, a randomized controlled trial conducted in rural Minnesota to evaluate the effectiveness of a childhood obesity prevention program for school-aged children. PARTICIPANTS/SETTING The present study analyzes a subset of the New Ulm at Home trial data from families (N = 108) who completed at least four evening meal screeners collected in real time with ecological momentary assessment technology over a 2-week period. MAIN OUTCOME MEASURE The main outcome measure was the proportion of family evening meals made at home, calculated using two cutpoints (≤50% of evening meals prepared at home vs >50%; ≤70% vs >70%). STATISTICAL ANALYSIS Descriptive statistics were used to describe the proportion of evening meals prepared at home. Logistic regression analyses adjusted for parent education were used to assess associations between family characteristics and the two different proportions of meals made at home. RESULTS Most family evening meals were prepared and eaten at home (62%). Logistic regression models indicated meal planning skills (odds ratio=1.19, 95% CI 1.01 to 1.39) and mealtime routines (odds ratio=1.20, 95% CI 1.03 to 1.40) were significantly associated with odds of preparing more than 50% of evening meals at home. Only meal planning skills (odds ratio=1.27, 95% CI 1.06 to 1.51) was significantly associated with odds of preparing more than 70% of evening meals at home. CONCLUSIONS Study findings indicated mealtime routines and meal planning skills were associated with preparing more than 50% of evening meals at home, but only meal planning skills were associated with preparing more than 70% of evening meals at home, which may suggest the importance of adapting interventions for families. Future research should build on these findings in randomized controlled trials.
Collapse
Affiliation(s)
- Melissa L Horning
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, Minneapolis, Minnesota, 55455
| | - Sarah Friend
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, Minneapolis, Minnesota, 55455
| | - Jiwoo Lee
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, Minneapolis, Minnesota, 55455
| | - Colleen Flattum
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 300 West Bank Office Building, 1300 S 2 St, Minneapolis, Minnesota 55454
| | - Jayne A Fulkerson
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, Minneapolis, Minnesota, 55455
| |
Collapse
|
10
|
Trofholz A, Tate A, Janowiec M, Fertig A, Loth K, de Brito JN, Berge J. Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study. JMIR Res Protoc 2021; 10:e30525. [PMID: 34855612 PMCID: PMC8686482 DOI: 10.2196/30525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day). Results A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID) DERR1-10.2196/30525
Collapse
Affiliation(s)
- Amanda Trofholz
- Humphrey School of Public Affairs, University of Minnestoa, Minneapolis, MN, United States
| | - Allan Tate
- College of Public Health, University of Georgia, Athens, GA, United States
| | - Mark Janowiec
- Humphrey School of Public Affairs, University of Minnestoa, Minneapolis, MN, United States
| | - Angela Fertig
- Humphrey School of Public Affairs, University of Minnestoa, Minneapolis, MN, United States
| | - Katie Loth
- Humphrey School of Public Affairs, University of Minnestoa, Minneapolis, MN, United States
| | - Junia N de Brito
- Humphrey School of Public Affairs, University of Minnestoa, Minneapolis, MN, United States
| | - Jerica Berge
- Humphrey School of Public Affairs, University of Minnestoa, Minneapolis, MN, United States
| |
Collapse
|
11
|
Trofholz AC, Tate A, Keithahn H, de Brito JN, Loth K, Fertig A, Berge JM. Family meal characteristics in racially/ethnically diverse and immigrant/refugee households by household food security status: A mixed methods study. Appetite 2020; 157:105000. [PMID: 33053423 DOI: 10.1016/j.appet.2020.105000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 11/27/2022]
Abstract
While there is some research examining frequency of family meals by food insecurity (FI) status, there is little research examining other family meal characteristics (e.g., type of food served at meal, emotional atmosphere) or parent feeding practices by FI status. If food and money is scarce, it may be that the broader family meal environment looks different in families with continuous access to food (food secure, FS) compared to families with FI. Using ecological momentary assessment (EMA) and qualitative data, this study explores meal characteristics and parent feeding practices at nearly 4000 family meals in a low-income, racially/ethnically diverse and immigrant/refugee sample. For 8 days, participants (i.e., parents of 5-7-year-old children) completed a survey every time they shared a meal with their child. Additionally, parents completed a qualitative interview regarding family meals. There were many meal characteristics statistically correlated with a family being FI, including: who prepared the meal and how the meal was prepared, the makeup of people at the meal, the meal location and meal atmosphere, and the food served at the meal. Qualitative data illuminated many of these findings from EMA meal surveys. Quantitatively, families with FI and FS reported similar parent feeding practices during family meals. Qualitatively, families with FI and FS reported differences in (1) parent feeding practices; (2) food served at family meals; (3) challenges to having family meals; and 4) adults' role in the family meal. This study provides suggestions for interventionists working with families, including helping families identify time management strategies, including fruits and vegetables into family meals on a budget, reducing screen time at family meals while improving the meal's emotional atmosphere, and developing positive parent feeding practice strategies.
Collapse
Affiliation(s)
- Amanda C Trofholz
- Division of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Allan Tate
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | - Junia N de Brito
- Division of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Katie Loth
- Division of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Angela Fertig
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, USA
| | - Jerica M Berge
- Division of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
12
|
Chapman-Novakofski K. Congratulations and Thank You. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:671. [PMID: 32646597 DOI: 10.1016/j.jneb.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
13
|
Middleton G, Golley R, Patterson K, Le Moal F, Coveney J. What can families gain from the family meal? A mixed-papers systematic review. Appetite 2020; 153:104725. [PMID: 32422173 DOI: 10.1016/j.appet.2020.104725] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023]
Abstract
The family meal has been associated with numerous health and wellbeing benefits for both adults and children. However, the majority of the research in this area is correlational, unable to prove a causal relationship between family meals and health and wellbeing outcomes. The objectives of this systematic review were to determine the causal relationship between family meals and health and wellbeing and explore family members' perceptions of the family meal. A systematic search across five databases was undertaken to identify both intervention studies and qualitative studies investigating the family meal. Thirty-two articles were deemed eligible for inclusion in this review. Qualitative data were synthesised via the meta-aggregation approach; however, the quantitative data were too heterogeneous to perform meta-analysis. Only one intervention included in this review exclusively targeted the family meal, the remaining studies had other target strategies as part of their intervention (e.g. physical activity, snacking, sleep routines). Only two of the eight interventions reported a statistically significant difference between control and intervention groups for family meal frequency or quality, therefore we were unable to fully explore the causal relationship between family meals and health and wellbeing outcomes. The qualitative studies identified multiple barriers to the family meal, including scheduling conflicts, exhaustion and lack of time, and reported family connection and communication as the main perceived benefits of the family meal. There is a gap between the benefits and barriers to the family meal identified through qualitative research, and current intervention strategies, with few interventions exclusively targeting the family meal. Interventions that are informed by qualitative literature and exclusively target the family meal are needed to further investigate the causal relationship between family meals and potential health and wellbeing outcomes.
Collapse
Affiliation(s)
- Georgia Middleton
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Rebecca Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Karen Patterson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - John Coveney
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
14
|
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.
Collapse
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;
| |
Collapse
|
15
|
Maugeri A, Barchitta M. A Systematic Review of Ecological Momentary Assessment of Diet: Implications and Perspectives for Nutritional Epidemiology. Nutrients 2019; 11:nu11112696. [PMID: 31703374 PMCID: PMC6893429 DOI: 10.3390/nu11112696] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
Abstract
The ecological momentary assessment (EMA) of eating behaviors represents an innovative, detailed and valid approach to capture the complexity of food intake and to overcome limitations of traditional dietary assessment methods. Moreover, EMA studies might generate a large variety of data (e.g., dietary, behavioral, physical, sociopsychological, and contextual information), thereby enabling to examine concurrent exposures and events. Due to the increasing number of studies in this field of research, here we systematically reviewed EMA methods for the assessment of dietary intake in epidemiological studies, and discussed implications and perspectives for future research. Our study summarized several protocols and platforms that may be applied to assess diet in terms of eating frequency, choices, and habits. Nearly 38% of studies used an event-contingent strategy by asking participants to report foods and beverages consumed in real-time at each eating occasion. Instead, approximately 55% of studies used a signal-contingent prompting approach that notified the participants to record their dietary consumption. The remaining studies used a combination of event- and signal-contingent protocols to compare their accuracy or to improve the assessment of dietary data. Although both approaches might improve the accuracy and ecological validity of dietary assessment—also reducing the burden for participants—some limitations should nevertheless be considered. Despite these limitations, our systematic review pointed out that EMA can be applied in various fields of nutritional epidemiology, from the identification of determinants of dietary habits in healthy people to the management of patients with eating or metabolic disorders. However, more efforts should be encouraged to improve the validity and the reliability of EMA and to provide further technological innovations for public health research and interventions.
Collapse
|