Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review

Looking to the past: Investigating 10-year place histories as a determinant of home food environments in the Healthy Communities Study

Emerging research suggests there is a need to consider the importance of place histories in studying neighborhood effects. Guided by a life course of place framework, the objective of this study is to investigate the relationship between two place history exposures and three contemporary home food environment outcomes. Exposures included 10-year neighborhood socioeconomic status (SES) histories and multi-year nutrition community programming and policy (CPP) histories. Outcomes included the availability of healthy foods in the home, the availability of unhealthy foods in the home, and household food insecurity. Associations are investigated using cross-sectional and retrospective data on 4210 US families in the national, observational Healthy Communities Study (2013-2015). Multilevel regression models, adjusted for household income and other factors, were fit for each exposure and outcome. Households residing in neighborhoods with intermittently low, consistently moderate, intermittently high, and consistently high SES histories had greater availability of healthy foods in the home than households in neighborhoods with consistently low SES histories (adjusted βs: 0.11 [95% CI: 0.02, 0.20], 0.13 [95% CI: 0.06, 0.21], 0.23 [95% CI: 0.13, 0.34], and 0.24 [95% CI: 0.15, 0.33], respectively). Households in consistently high SES neighborhoods also had a lower likelihood of household food insecurity than those in consistently low SES neighborhoods (adjusted OR: 0.54 [95% CI: 0.42, 0.71]). Neighborhood SES histories were not significantly associated with the availability of unhealthy foods in the home. Nutrition CPP histories were not significantly associated with food insecurity or the availability of unhealthy foods in the home. However, more intense nutrition CPP histories were significantly associated with greater availability of healthy foods in the home. Moreover, effect estimates increased with more long-term historical accounts of CPPs (adjusted βs: 1-year CPP histories, 0.21 [95% CI: 0.03, 0.39]; 3-year CPP histories, 0.22 [95% CI: 0.03, 0.41]; 6-year CPP histories, 0.25 [95% CI: 0.04, 0.46]; 10-year CPP histories, 0.28 [95% CI: 0.05, 0.50]). To curb food insecurity and promote the availability of healthy foods, the findings suggest considering how neighborhoods develop and evolve over time with respect to SES and nutrition CPP implementation.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden.

OBJECTIVES

To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster-randomised controlled trials (C-RCTs) and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no-intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child-feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Seventeen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children only in increasing child fruit and vegetable intake and one each examined a child-focused mindfulness intervention or providing families with fruit and vegetable interventions. We judged nine of the 53 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is moderate-certainty evidence that child-feeding practice interventions versus no-intervention control probably have a small positive effect on child vegetable consumption, equivalent to an increase of 15.5 grams as-desired consumption of vegetables (SMD 0.44, 95% confidence interval (CI) 0.24 to 0.65; 15 trials, 1976 participants; mean post-intervention follow-up = 12.3 weeks). No trials in this comparison reported information about intervention costs. One trial reported no harms or serious unintended adverse consequences (low-certainty evidence). Multicomponent interventions versus no-intervention control probably have a small effect on child consumption of fruit and vegetables (SMD 0.27, 95% CI 0.11 to 0.43; 14 trials, 4318 participants; moderate-certainty evidence; mean post-intervention follow-up = 4.0 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. One trial, which tested a multicomponent garden-based intervention, reported the installation of the garden as part of the intervention to be USD 1500 per childcare centre (low-certainty evidence). No trials in this comparison reported information about unintended adverse consequences of interventions. Parent nutrition education interventions may have little to no short-term impact on child consumption of fruit and vegetables versus no-intervention control (SMD 0.10, 95% CI -0.02 to 0.22; 14 trials, 4122 participants; low-certainty evidence; mean post-intervention follow-up = 6.4 weeks). One trial reported the total estimated cost of delivering a parent nutrition education intervention for infant feeding, physical activity and sedentary behaviours delivered by a dietitian as approximately AUD 500 per family (low-certainty evidence). One trial reported no unintended adverse consequences on family food expenditure following implementation of an intervention delivered over the telephone to improve parental knowledge and skills about the home food environment (low-certainty evidence). Trials reported receiving governmental or charitable funds, except for one trial reporting industry funding.

AUTHORS' CONCLUSIONS

There was moderate-certainty evidence that child-feeding practice interventions and multicomponent interventions probably lead to only small increases in fruit and vegetable consumption in children aged five years and under. Parent nutrition education interventions may have little or no effect on increasing fruit and vegetable consumption in children aged five years and under. Future research should be prioritised on assessment and reporting of both intervention cost and adverse effects, and development and evaluation of interventions in research gaps, including in a broader range of settings and in low- and middle-income countries. This review continues to be maintained as a living systematic review with monthly searches for new evidence and incorporation of relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

The Physical Home Food Environment in Relation to Children's Diet Quality and Cardiometabolic Health

BACKGROUND

Home food availability has been identified as an important influence on dietary intake. Less is known about the relationship between the physical home food environment (HFE) and factors of cardiometabolic health in children.

OBJECTIVE

The purpose of this study was to explore the relationship between the physical HFE and diet quality and factors of cardiometabolic health (eg, weight and blood biomarkers).

DESIGN

This was a cross-sectional secondary analysis with 1 or more children per household.

PARTICIPANTS/SETTING

This study included 44 children aged 6 to 12 years from 29 households in the Newark, DE area between August 2020 and August 2021.

MAIN OUTCOME MEASURES

The Home Food Inventory provides an obesogenic score (ie, score indicative of the presence of energy-dense foods) for the overall HFE and HFE subcategories scores; body mass index z-scores were calculated using measured height and weight; diet quality was measured using the Healthy Eating Index 2020 (HEI-2020) total scores; and cardiometabolic biomarkers were obtained from serum blood samples.

STATISTICAL ANALYSES PERFORMED

Unadjusted and adjusted linear mixed model regressions were used to test the association between the physical HFE and each of the outcome variables: body mass index z scores, HEI-2020 total scores, and cardiometabolic biomarkers. HFE subcategories (eg, fruits and vegetables) were also examined with each outcome using linear mixed model regression.

RESULTS

Mean ± SD age of the children was 9.5 ± 1.9 years, 61.4% were female, 59.1% identified as White, and 90.9% were non-Hispanic. Obesogenic score was significantly associated with body mass index z scores (β = .03, P = .029), but not HEI-2020 total scores or cardiometabolic biomarkers. As HFE fruits and vegetables subcategory increased, HEI-2020 total scores significantly increased (β = .73, P = .005) and total cholesterol (β = -1.54, P = .014) and low-density lipoprotein cholesterol levels (β = -1.31, P = .010) significantly decreased. Increased availability of sweet and salty snack food and availability of sugar-sweetened beverages was associated with increased fasting blood glucose (β = 0.65, P = .033) and insulin levels (β = 5.60, P = .035) respectively.

CONCLUSIONS

There is evidence of a relationship between the subcategories of the physical HFE and cardiometabolic factors. Future interventions are needed to understand whether altering the overall HFE or specific subcategories within the HFE can improve cardiometabolic health.

Interpersonal determinants of diet quality and eating behaviors in people aged 13-30 years: A systematic scoping review

Adolescence is an important period of increasing independence, when adolescents experience changing influences of family and friends on their diets as they transition into adulthood. We conducted a scoping review to map the literature on interpersonal determinants of diet quality and eating behaviors among individuals aged 13-30 years. We searched seven literature databases, and following screening, 329 papers were included. Determinants were grouped according to sub-categories of the Determinants of Nutrition and Eating framework: family structure (n = 122), social influences (n = 121), parental behaviors (n = 90), family food culture (n = 83), social support (n = 69), parental feeding styles (n = 24), parental attitudes/beliefs (n = 8), and parental resources/risk factors (n = 6), and we added two new sub-categories: parenting style (n = 74) and partner behaviors (n = 6). Fruit/vegetable (n = 143) and sugar-sweetened beverage (n = 102) intake were the most commonly measured diet outcomes, and breakfast consumption (n = 41) and fast food/takeaway intake (n = 39) the most commonly examined eating behaviors. This review highlights the gaps in the literature, both across the determinant sub-categories and also the relative paucity of longitudinal evidence and lack of evidence in emerging adults, particularly outside of university settings. Future research should focus on these areas to provide stronger evidence to support better design of interventions for this age group.

A report card assessment of the prevalence of healthy eating among preschool-aged children: a cross-cultural study across Australia, Hong Kong, Singapore, and the US

Objective

This study aimed to initially adopt an International Healthy Eating Report Card for Preschool-Aged Children to assess the prevalence of healthy eating behaviours and favourable family home food environments (FHFEs) among preschool-aged children in Australia, Hong Kong, Singapore, and the US. We also examined which cultural contexts would exhibit significant differences in the report card scores among the four cultural contexts.

Methods

In this cross-cultural study, 2059 parent-child dyads, with approximately 500 dyads in each cultural context, were recruited. The parents were asked to complete the validated International Healthy Eating Report Card Scale to assess the dimensions of the Report Card [i.e., Indicator of Children's Eating Behaviours: (1) Children's Dietary Patterns and (2) Children's Mealtime Behaviours, and Indicator of FHFEs: (3) Parental Food Choices and Preparation, (4) Home Healthier Food Availability and Accessibility and (5) Family Mealtime Environments]. Each indicator received a letter grade [i.e., A (≥80%) = excellent, B (60-79%) = good, C (40-59%) = fair, D (20-39%) = poor, F (<20%) = very poor and including the plus (+) and minus (-) signs] to represent the proportion of participants who could meet the predefined benchmarks. We also employed ANCOVA and Bonferroni's post-hoc test to examine the differences in the report card scores between the four cultural contexts. A significance level was set at p < 0.05.

Results

The average overall report card grade across the four cultural contexts was "B-" (Good), ranging from "C+" (Singapore and the US) to "B-" (Australia and Hong Kong). The average grade for Children's Eating Behaviours was classified as Fair ("C-"), while the average grade for FHFEs was classified as Good ("B+") for all cultural contexts. A comparison of the overall report card scores revealed that Australia exhibited a significantly higher report card score than Singapore and the US, while Hong Kong achieved a significantly higher score than Singapore.

Conclusion

The International Healthy Eating Report Card provided an overview of the prevalence of healthy eating in different cultural contexts. We believe that the International Healthy Eating Report Card may offer new perspectives on interventions for fostering healthy eating in young children.

School Health Promotion, the Body Mass Index z-Score, and Psychosocial Health in Primary Schools of the Netherlands

Childhood overweight and psychosocial issues remain significant public health concerns. Schools worldwide implement health promotion programs to address these issues and to support the physical and psychosocial health of children. However, more insight is needed into the relation between these health-promoting programs and the Body Mass Index (BMI) z-score and psychosocial health of children, while taking into account how school factors might influence this relation. Therefore, we examined whether the variation between primary schools regarding the BMI z-score and psychosocial health of students could be explained by school health promotion, operationalized as Healthy School (HS) certification, general school characteristics, and the school population; we also examined to what extent the characteristics interact. The current study had a repeated cross-sectional design. Multilevel analyses were performed to calculate the variation between schools, and to examine the association between HS certification and our outcomes. Existing data of multiple school years on 1698 schools were used for the BMI z-score and on 841 schools for psychosocial health. The school level explained 2.41% of the variation in the BMI z-score and 2.45% of the variation in psychosocial health, and differences were mostly explained by parental socioeconomic status. Additionally, HS certification was associated with slightly lower BMI z-scores, but not with psychosocial health. Therefore, obtaining HS certification might contribute to the better physical health of primary school students in general. This might indicate that HS certification also relates to healthier lifestyles in primary schools, but further research should examine this.

Sex-Moderated Divergence between Adult Child and Parental Dietary Behavior Patterns in Relation to Body Mass Condition-Evaluating the Mediating Role of Physical Activity: A Cross-Sectional Study

The main objective of this study was to explore the dietary behaviors of parents and their adult children, focusing on patterns, potential intrinsic and extrinsic predictors of body mass, and determinants of becoming overweight. Non-probability, cross-sectional sampling was used to select participants from a university student population. Young adults (19-21 years of age, n = 144) and their parents were examined. The data of those family pairs with complete sets of results were used. Dietary patterns and physical activity were assessed with questionnaires (QEB and IPAQ), and body height, weight measurements, and body mass indexes were calculated. A cophylogenetic approach with tanglegrams and heatmaps was used to study patterns, while predictors of body mass index were identified using multiple linear regression, stepwise logistic regression, and mediation analysis procedures. Cophenetic statistics confirmed significant incongruence between fathers and sons, confirmed by Baker's Gamma correlation (rBG = 0.23, p = 0.021), and mothers and daughters (rBG = 0.26, p = 0.030). The relationships between the dietary patterns of the fathers and daughters, as well as mothers and sons, were of medium strength (rBG = 0.33, p = 0.032, rBG = 0.43, p = 0.031; respectively). Most of the patterns were mixed. Fast food, fried meals, alcoholic drinks, energy drinks, and sweetened beverages were associated significantly with being overweight. Significant intrinsic predictors of excessive weight in young adults were sex (b = 2.31, p < 0.001), PA (b = -0.02, p < 0.001), and eating fermented milk and curd cheese (b = -0.55, p = 0.024), while extrinsic (parental) predictors included eating fast food and fried meals (b = -0.44, p = 0.049). Both physical activity and dietary behaviors independently determined the sons' overweight status (b = -1.25, p = 0.008; b = -0.04, p < 0.001; respectively); while only PA did in daughters (b = -0.04, p < 0.001). No mediating effects of physical activity were observed. Adult children and parental dietary patterns were divergent, reflecting the influence of multiple factors on a child's dietary habits. However, this divergence is moderated by sex. Reciprocal interactions between dietary intake-particularly positive dyads such as fruits and vegetables, fermented milk, and curd cheese-and physical activity significantly impacted children's body mass index (BMI). The study of dietary patterns in conjunction with physical activity (both as independent determinants), particularly in relation to the link between overweight/obese children and overweight/obese parents, presents a separate challenge.

FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers

OBJECTIVE

To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers.

METHODS

A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme.

RESULTS

A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity.

CONCLUSIONS

Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

Executive functioning and treatment outcome among adolescents undergoing cognitive-behavioral therapy for binge-eating disorder

BACKGROUND

Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real-world contexts.

METHODS

We assessed 73 adolescents [82.2% female; Mage = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m2] with BED at baseline, posttreatment, 6-, 12-, and 24-month follow-up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition.

RESULTS

More impulsive decision-making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (β = .07; p = .019) and more frequent LOC eating following treatment (β = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T-scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (β = -.03; p = .003). Inhibition, concentration, attention, and parent-reported EF behavior symptoms were not associated with outcome, attendance, or attrition.

CONCLUSIONS

More impulsive decision-making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre-treatment EF.

Exploring the changing association between parental and adolescent fruit and vegetable intakes, from age 10 to 30 years

BACKGROUND

Adolescence is a pivotal developmental stage, where escalating rates of overweight and obesity have raised concerns about diet quality and its association with adverse health outcomes. Parents are known to have considerable influence on childhood diet, but how this influence changes as adolescents mature is unknown. This study investigates the association between parental fruit and vegetable (FV) intake and adolescent FV consumption, exploring how this changes across adolescence and when adolescents leave home.

METHODS

Adolescents aged 10-30 years (n = 12,805) from the UK Household Longitudinal Study (UKHLS), and their parents, reported FV intakes every 2 years. Multilevel linear regression models were fitted to assess associations between parental and adolescent FV intakes, investigating interactions with age and living arrangement, and adjusting for sociodemographic covariates.

RESULTS

Parental FV intake was positively associated with adolescent FV intake (β = 0.20 [95%CI:0.19,0.22] portions/day), with the strength of this association lowest during early adolescence (10-14 years) and peaking at 17-18 years (β = 0.30 [95%CI: 0.27,0.33] portions/day). When adolescents no longer lived in the parental home, the association of parental FV intake with adolescent FV consumption decreased, but a positive association was maintained up to age 30 years.

CONCLUSIONS

Our findings emphasise the enduring effect of parental FV consumption on adolescent FV consumption, highlighting the potential for interventions to promote increased FV intake, acknowledging the lasting influence of parental diet, even beyond the confines of the parental home.

Individual and family factors correlated with children's fruit consumption

Background

Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors.

Methods

A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively.

Results

Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667).

Conclusion

The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

School health promotion and fruit and vegetable consumption in secondary schools: a repeated cross-sectional multilevel study

BACKGROUND

Worldwide, recommendations for fruit and vegetable consumption are not met, which can cause chronic diseases. Especially adolescence is an important phase for the development of health behaviours. Therefore, in the Netherlands, the Healthy School program was established to aid schools in promoting healthy lifestyles among their students. We examined to what extent the variation between secondary schools regarding students' fruit and vegetable consumption could be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Additionally, we examined whether Healthy School certification was related to the outcomes, and whether the association differed for subgroups.

METHODS

We performed a repeated cross-sectional multilevel study. We used data from multiple school years from the national Youth Health Monitor on secondary schools (grades 2 and 4, age ranged from approximately 12 to 18 years) of seven Public Health Services, and added data with regard to Healthy School certification, general school characteristics and school population characteristics. We included two outcomes: the number of days a student consumed fruit and vegetables per week. In total, we analysed data on 168,127 students from 256 secondary schools in the Netherlands.

RESULTS

Results indicated that 2.87% of the variation in fruit consumption and 5.57% of the variation in vegetable consumption could be attributed to differences at the school-level. Characteristics related to high parental educational attainment, household income, and educational track of the students explained most of the variance between schools. Additionally, we found a small favourable association between Healthy School certification and the number of days secondary school students consumed fruit and vegetables.

CONCLUSIONS

School population characteristics explained more variation between schools than Healthy School certification and general school characteristics, especially indicators of parental socioeconomic status. Nevertheless, Healthy School certification seemed to be slightly related to fruit and vegetable consumption, and might contribute to healthier dietary intake. We found small differences for some subgroups, but future research should focus on the impact in different school contexts, since we were restricted in the characteristics that could be included in this study.

An assessment tool for the international healthy eating report card for preschool-aged children: a cross-cultural validation across Australia, Hong Kong, Singapore, and the United States

Objective

This study aimed to develop and validate a globally applicable assessment tool of the 43-item International Healthy Eating Report Card Scale (IHERCS) which was designed to assess preschool-aged children's eating behaviours and family home food environments (FHFEs) across different cultural settings. In particular, we examined the factor structure, internal consistency and measurement invariance of the IHERCS across four cultural samples, including Australia, Hong Kong, Singapore, and the US. Convergent and discriminant validity were then conducted.

Methods

In this cross-cultural study, a total of 2059 parent-child dyads from these four regions were recruited, and the parents were asked to complete the IHERCS. An exploratory structural equational modelling approach was employed to examine two higher-order factor models of children's eating behaviours and FHFEs in the IHERCS and its cross-cultural measurement invariance.

Results

The findings demonstrated robust factor structures of the scales of children's eating behaviours and FHFEs in the IHERCS (i.e., CFI and TLI > 0.90; RMSEA and SRMR < 0.08) and an acceptable level of internal consistency (i.e., Cronbach's α = 0.55-0.84). Full configural invariance and metric invariance were established across the four cultural contexts, but full scalar invariance was not achieved. Partial scalar invariance was found only in the scale of FHFEs. The convergent validity and discriminant validity were supported.

Conclusion

Overall, the current findings provided preliminary support for the construct validity and measurement invariance of the IHERCS. It provides a reliable, valid and comprehensive assessment of eating behaviours and FHFEs among children in different cultural settings.

Association between children's caregivers time preferences and childhood overweight and obesity in Mexico

BACKGROUND

Parents or children's primary caregivers are a key influence on child weight as both decision makers and role models for eating patterns, physical activity, and other social behaviors. It is unknown whether caregivers' time preferences are associated with overweight or obesity in children. The primary objective was to estimate the association between parents' or caregivers' time preferences and children having overweight or obesity in Mexico.

METHODS

A cross-sectional study was conducted using a representative survey of the Mexican population. A multinomial logistic model was used to examine the association between parents' or caregivers' time preferences (patience and time consistency) and child overweight or obesity, adjusting for potential confounders.

RESULTS

The study included 9,102 children (mean age 10, 43% female) and 5,842 caregivers (mean age 37; 95% female). Intertemporal preference was strongly associated with increased odds of overweight or obesity in children. A medium patient caregiver had higher odds of having overweight (adjusted OR: 1.73; 95% CI: 1.19, 2.52). Similarly, having a caregiver with a present (OR: 2.52; 95% CI: 1.72, 3.70) or future bias (OR: 1.48; 95% CI: 1.11, 1.98) was associated with higher odds of obesity.

CONCLUSION

Caregivers' time preferences were associated with having overweight and obesity in children and should be considered when developing policies to reduce children's obesity status.

Transgenerational transmission of eating habits

OBJECTIVE

To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits.

DATA SOURCE

A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity.

DATA SYNTHESIS

The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle.

CONCLUSIONS

Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed.

Study Protocol for a Controlled Trial of Nutrition Education Intervention about Celiac Disease in Primary School: ZELIAKIDE Project

The only treatment for celiac disease (CD) is a strict and lifelong gluten-free diet (GFD), which must be safe and nutritionally balanced. Avoiding gluten brings difficulties with following the diet and can affect the social life of people with CD. The Zeliakide Project is a nutrition education program aimed at increasing the knowledge of the general population about healthy diets, CD and GFD, and, therefore, to improve the social inclusion and quality of life of people with CD. It is a one-month intervention program, two-armed cluster, non-randomised and controlled trial, conducted among 10-12-year-old children. Pre- and post-intervention evaluation and 1 month follow-up will be carried out to assess the effectiveness of the program. It is based on competencies and their respective learning outcomes. The teaching methodology chosen is a STEAM methodology: inquiry-based learning (IBL). A teaching unit has been created to develop the project, which, in the future, will be useful for the self-application of the program. This study will provide a valid and useful tool to achieve changes in the diet at the school level and will help to promote the social inclusion of people with CD. Moreover, it will enforce the STEAM competences of children.

Using Non-Violent Discipline Tools: Evidence Suggesting the Importance of Attunement

Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiveness of caregivers towards their children and has been found to be central to the formation of secure attachment bonds and development of self-regulation. It includes understanding or being "in tune with" the child's needs and signals, matching these with appropriate responses. The objective of this paper is to explore attunement in relation to non-violent discipline. Peer-reviewed systematic reviews previously included in a systematic overview of evidence on non-violent discipline options were screened for information relevant to attunement. All reviews were published in English between 1999 and 2018 and offered evidence on at least one non-violent discipline tool. Although no reviews explicitly addressed attunement, evidence was found suggesting its importance in the use and effectiveness of discipline methods. Research directly investigating attunement in discipline is needed.

Pediatric obesity education and counseling in otolaryngology clinics: A survey of ASPO members

BACKGROUND

Adenotonsillectomy can cure pediatric obstructive sleep apnea (OSA) in 80% of children without obesity but only 20-30% of children with obesity. Despite this, there is a current lack of consistent guidelines and practices around pediatric obesity management in otolaryngology. This study evaluated the extent of counseling, referrals, confidence, and barriers in addressing childhood obesity in pediatric otolaryngology.

METHODS

A 20-question electronic survey assessing pediatric obesity practice patterns regarding sleep-disordered breathing (SDB) and OSA was distributed to all American Society of Pediatric Otolaryngology (ASPO) members. Descriptive statistics were performed. Pediatric otolaryngologists were compared using logistic regression models based on their practice type and frequency of counseling and referral.

RESULTS

Of all ASPO members, 19.6% (114/583) completed the survey. Half (50.0%) of physicians counsel and 14.0% refer to obesity management >75% of the time. Only 8.8% of physicians are confident their counseling helps reduce their patient's obesity, and 35.9% of physicians are satisfied with their services available for referral. Most physicians cite time/clinical workload (81.6%) and parent/rearing habits (50.0%) as barriers to obesity counseling. Non-academic physicians had lower odds of counseling and referring their patients >50% of the time (aOR 0.23 [95%CI 0.06-0.81], aOR 0.23 [95%CI 0.06-0.83]). Almost all (92.1%) physicians counsel on residual SDB or OSA after adenotonsillectomy >75% of the time if the child is obese.

CONCLUSIONS

Most pediatric otolaryngologists do not regularly counsel or refer patients to available obesity management programs, with differences seen between academic and non-academic surgeons. Confidence is low in currently available measures to reduce pediatric obesity. These results highlight the challenges of pediatric obesity and provide context for guideline implementation and additional resource development for pediatric otolaryngologists.

Cooking with the Seasons for Health (CwS4H): An Innovative Intervention That Links Nutrition Education, Cooking Skills, and Locally Grown Produce to Increase Vegetable Intake among Limited-Resource Parent-Child Dyads in Rural Washington

Although children from limited-resource families in rural areas are at great risk for nutrition-related chronic diseases, few hands-on programs have been implemented that simultaneously engage both parents and children and include local produce in a single program. This study reports on the development, implementation, and evaluation of Cooking with the Seasons for Health (CwS4H). Parent-child pairs participated in six sessions (two weekly sessions during each of three growing seasons), which included food tasting, a spotlight vegetable, interactive mini nutrition lesson, a child-focused cooking lesson, hands-on meal preparation, distribution of materials as family guides, and a take-home bag of fresh produce. Pre- and postprogram survey data were collected from 23 parents and 22 children. Children reported improvements in nutrition knowledge, vegetable preference, and self-efficacy in food preparation and cooking. Parents reported gains in nutrition knowledge, nutritional behaviors, vegetable preference, attitude toward food preparation/cooking, involvement of the child in food preparation/cooking, confidence in preparing vegetables, and the child's vegetable intake. Parents commented on the value children placed on food preparation and produce selection and how the program enhanced the parent-child relationship. By focusing CwS4H on a variety of fresh vegetables, this intervention helped to impact children's vegetable intake behaviors by engaging children in preparing and choosing the food they eat.

See Me, Hear Me, Know Me: Perspectives on Diet and Physical Activity Influences among Teens Living in Rural Texas Communities

Teens in rural communities are at greater risk of obesity than teens in urban areas. Diet and physical activity influence obesity risk. Understanding their perspectives is an important step in intervention design. This qualitative investigation explored teen perspectives on how living in a rural community influenced their diet and physical activity choices. Forty parent-teen pairs were recruited. Data collection included surveys and telephone interviews. This paper reports teen perspectives identified in the first interview. Thematic analysis was used to code and analyze the data. Findings revealed that the primary factor driving teens' diet and physical activity behaviors was the teens themselves. They clearly understood their role in the choices they made, although they acknowledged not always making the healthiest choice. This belief was driven by their motivation to engage in healthy behaviors, which was influenced by the perceived benefits derived from making healthy choices and from the synergistic relationship between diet and physical activity. Diet and physical activity, in turn, were influenced by the environment, particularly the home, social, and community environments. Family and friends were particularly influential, as well as resource availability. These findings can serve as a foundation for designing interventions tailored to this population.

Mexican Parents' Beliefs About Drinking Plain Water in Front of Their Preschoolers

Because children learn habits from observing their parents, we assessed the top-of-the-mind beliefs held by parents about "drinking plain water in front of their preschool child during lunch one day this coming weekend." We recruited a convenience sample of 34 Mexican parents from daycares in Guadalajara and conducted a content analysis. Main advantage identified was getting healthier, followed by being a good example for the child. Few parents identified disadvantages. Most reported to have at least one approver within their families. The most frequent facilitator was "having it," while "not having it" was the main barrier.

Are adolescent diet quality and emotional eating predicted by history of maternal caregiving quality and concurrent inhibitory control?

The risk for unhealthy eating behaviour, including poor diet quality and emotional eating, is heightened in adolescence and could result in profound and long-lasting psychological and physical implications. Caregiving quality and adolescents' regulatory skills, such as inhibitory control, may play an essential role in the development of adolescent eating behaviour. This preregistered study investigated whether maternal caregiving throughout the first 14 years of life predicts adolescent diet quality and emotional eating and whether potential associations are mediated by adolescents' inhibitory control. In this low-risk community cohort, maternal caregiving quality was observed at child ages five weeks, 12 months, 2.5, 10, and 14 years. At age 14, diet quality and emotional eating were assessed through self-report. Adolescent inhibitory control was assessed with three behavioural tasks and a maternal report. Mediation analyses were performed with structural equation modelling in R. No evidence was found for links between maternal caregiving quality and adolescent diet quality and emotional eating. Higher levels of adolescent inhibitory control predicted better adolescent diet quality. Longitudinal and experimental studies are needed to investigate directionality, and replication studies are needed in more representative samples (e.g. including high-risk families). Such studies will shed further light on potential links between the history of caregiving behaviour and adolescent regulatory and eating behaviour.

SNAP Participation Moderates Fruit and Vegetable Intake Among Minority Families With Low Income

OBJECTIVE

To examine the moderation effect of Supplemental Nutrition Assistance Program (SNAP) participation on the baseline fruit and vegetable (FV) intake of Hispanic/Latino and African American children and parents participating in the Brighter Bites program.

DESIGN

Cross-sectional.

SETTING

Houston, Austin, and Dallas, TX; Washington, DC; and Southwest Florida.

PARTICIPANTS

Self-reported surveys (n = 6,037) of Hispanic/Latino and African American adult-child dyads enrolled in Brighter Bites in Fall 2018.

VARIABLES MEASURED

Dependent variable, child FV intake; Independent variable, parent FV intake, and FV shopping behavior; Effect Measure Modifier, SNAP participation.

ANALYSIS

Quantitatively used mixed effects linear regression models to test if the effect of parental baseline FV intake and shopping behavior on a child's baseline FV intake differed by SNAP participation. Analyses were performed using STATA with significance set at P < 0.05 and 95% confidence intervals (CIs).

RESULTS

For parents that consumed FV ≥ 2 times/d at baseline, there was a 0.1 times increase in child FV intake at baseline among those who participated in SNAP as compared with those who did not participate in SNAP (ß = 0.1; 95% CI, 0.1-0.2; P = 0.001), and for parents who shopped at convenience stores ≥ 2 times/wk for FV, there was 0.6 times increase in child FV intake at baseline for those who participated in SNAP as compared with those that did not participate in SNAP (ß = 0.6; 95% CI, 0.3-0.9; P < 0.001).

CONCLUSIONS AND IMPLICATIONS

Supplemental Nutrition Assistance Program participation moderated the associations between FV intake among African American and Hispanic/Latino parents and children and FV shopping at convenience stores and child FV intake. Findings indicate a need for future interventions to promote SNAP participation among those eligible and improve access to FV.

[Déterminants de la qualité de vie liée à la santé chez les adolescents : le rôle de la diète méditerranéenne]

BACKGROUND

A number of physical, emotional, cognitive and psychological changes shape the adolescence phase, which may influence health and well-being. Therefore, it is important to develop healthy eating habits that will persist into adulthood.

OBJECTIVE

This study was conducted in order to investigate in depth the association between components of the Mediterranean diet (MD) and health-related quality of life (HRQoL), along with its different subscales, among Lebanese adolescent students attending schools in Tripoli, North Lebanon.

METHODS

A cross-sectional survey was undertaken among 798 teenagers aged 11 to 18. All responded to a questionnaire that evaluated their HRQoL, sociodemographic characteristics and adherence to the Mediterranean diet.

RESULTS

The results of the study revealed that only 15.9% of the students had a high adherence to the MD. With regard to the components of the MD associated with the HRQoL, it was revealed that fruit intake by the students (once daily) was associated with a better general well-being (P = 0.047). In addition, fish consumption (two to three times per week) and daily intake of a dairy product for breakfast were positively associated with the total KIDSCREEN score (P < 0.001 and P = 0.003, respectively). Finally, skipping breakfast was correlated with a poorer general well-being (P = 0.013).

CONCLUSION

Our results suggest a strong correlation between MD adherence and HRQoL in Lebanese adolescents. However, future studies are warranted in order to strengthen the evidence of this association.

Lifestyle Risk Behaviours and Nutritional Status Associated with Mental Health Problems among Myanmar Adolescents: Secondary Analysis of a Nationwide 2016 School Survey

Engaging in unhealthy lifestyles may be considered a risk factor for mental health problems, but there is limited evidence. This study aimed to identify the relationship between unhealthy lifestyles and mental health problems among Myanmar school-going adolescents. Global School Based Student Health Survey (GSHS) data from 2838 school-going adolescents from Myanmar were analysed. Bivariable and multivariable logistic regression analyses were applied. After adjusting for confounding variables, adolescents who were seated for more than three hours per day had higher odds of loneliness, anxiety-induced sleep disturbance, suicide ideation, and suicide attempts compared to others. Moreover, students who ate fruit less than one time per day were more likely to experience anxiety-induced sleep disturbance and suicidal ideation. Being a current drinker was significantly associated with suicidal ideation and attempt. Obese students were more likely to feel lonely compared to normal weight students. Our study indicates there is a strong association between unhealthy lifestyle behaviours and mental health problems among school adolescents in Myanmar.

Associations between parental and pre-adolescents' physical activity and diet quality: The role of parental child care involvement and child's sex

BACKGROUND

Research has demonstrated the importance of the family environment in the eating and activity levels of offspring. We examined the cross-sectional associations between moderate-to-vigorous physical activity (MVPA) and diet quality of parents and the MVPA and diet quality of pre-adolescents. Interactions were tested to assess whether the child's sex and the parental level of involvement in daily child care moderated these associations.

METHODS

Data from 2467 pre-adolescents (age 11.5 ± 0.2 years; collected in 2015-2016) and their parents or caregivers from a large-scale prospective birth cohort study in Amsterdam (ABCD-study) was used. Parents and pre-adolescents individually reported their diet quality and physical activity. Child care involvement was assessed using the Caregiver Child Interaction Scale. With hierarchical linear regression analyses, we assessed the independent contribution of fathers and mothers.

RESULTS

An association between mother-child MVPA was found (β = 0.013; 95 % CI: 0.006;0.021). The association between father-child MVPA was only significant for highly involved fathers (β = 0.014; 95 % CI: 0.004;0.023). The child's sex did not change these MVPA associations. Regarding diet quality, associations were found between mother-child diet quality score (DQS) (β = 0.254; 95 % CI: 0.192;0.316) and father-child DQS, with stronger associations between fathers and sons (β = 0.234; 95 % CI: 0.169;0.298) than between fathers and daughters (β = 0.114; 95 % CI: 0.047;0.181). Parental levels of involvement did not change these associations.

CONCLUSION

These findings demonstrate that both parental behaviours represent an important factor in physical activity and diet quality in pre-adolescents in a sex-specific manner. As such, it is essential to include both parents in research to obtain the necessary insights for developing effective interventions to promote children's healthy eating and physical activity behaviours.

Associations between parenting strategies and BMI percentile among Latino children and youth with intellectual and developmental disabilities

Introduction

Maintaining healthy weight is a challenge for all children, and particularly for children with IDD compared to nondisabled children and for Latino children compared to non-Latino White children. Parenting practices related to food intake and physical activity have been found to be important in maintaining children's weight. In this study, we describe the prevalence of overweight and obesity status among Latino children with IDD and their maternal caregivers and determine the relationship between food and physical activity parenting practices and childhood obesity among Latino children with IDD.

Methods

We interviewed 94 Latino parent/child dyads and collected information about parenting practices, home environment, and parent and child height and weight using standardized measures. Parent body mass index (BMI) and child BMI percentile were calculated from height and weight.

Results

The combined overweight/obesity status for children in our sample was high (60.3%) compared to national rates among nondisabled Latino children (56%) and non-Latino White children with autism (37%). Contrary to research on nondisabled children, we found that greater parental use of controlling dietary strategies was associated with lower BMI percentile in Latino children with IDD. These findings may be indicative of the fact that children with IDD tend to have unique dietary behaviors that warrant more disability and culturally sensitive strategies.

Discussion

Our findings suggest that overweight and obesity is especially prevalent for Latino children with IDD and that more research is needed on family factors that promote health in Latino families of children with IDD.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Qualitative Research on the Perceptions of Factors Influencing Diet and Eating Behaviors Among Primarily Latinx Seventh-Grade Students

BACKGROUND

Latinx youth are a population of concern, at elevated risk for chronic diseases and with poor adherence to dietary recommendations.

OBJECTIVES

To examine Latinx seventh-grade students' perceptions of the factors that influence their diet and eating behaviors.

DESIGN

This qualitative research used focus groups and an inductive content analysis approach.

PARTICIPANTS/SETTING

Five sex-stratified focus groups (three groups with females) with 35 primarily Latinx seventh-grade students were conducted at two local Title 1 public middle schools in a large metropolitan area of the Southwestern United States.

MAIN OUTCOME MEASURES

The discussion protocol included questions about participants' food choices, the role of their parents in their diet, and healthy body-related concerns among their peers.

ANALYSES

Verbatim transcripts were coded in NVivo 12 on the basis of specificity, extensiveness, and frequency. Themes emerged from group dialogue, detailed conversations, and predominant topics of discussion, and aligned with ecological systems theory.

RESULTS

Participants referred to factors influencing Latinx seventh-grade students' eating behaviors at the individual, family, household, and school levels. At the individual level, participants described their eating as unhealthy and perceived it as determined by taste, convenience, ease of preparation, and home availability. Participants expressed concerns about diabetes because of their body weight and family history, and identified those concerns as reasons for acceptance of healthy foods and the desire for parents to model healthy eating behaviors. Family-level factors perceived as influencing dietary behaviors included the role of parents as providers of food and models of unhealthy eating, budget constraints, and availability (or lack thereof) of healthy foods at home. Similarly, the identified school-level factors aligned with availability and quality of foods in that environment.

CONCLUSIONS

Family- and household-related factors emerged as important influences on seventh-grade students' dietary behaviors. Future diet interventions should incorporate strategies targeting these multiple-level factors that influence dietary intake for Latinx youth and that address the concerns related to disease risk.

Prevalence of healthy diet and activity behaviours among U.S. Latino preschool children living in an emerging Latino community

This pilot study provides preliminary insights into whether Latino preschool children living in an emerging Latino community (ELC) are meeting recommendations for healthy diet and activity behaviours and whether those behaviours are associated with sociodemographic or home environment variables. Secondary data analysis was conducted utilising cross-sectional baseline survey data from ANDALE Pittsburgh, a home-based intervention study. Measures included parent-reported information on child dietary intake, screen time and the home environment, and objectively measured physical activity and anthropometry. χ² and Fischer's exact tests were used to determine associations. The study was conducted in an ELC in western Pennsylvania in the US. Fifty-one Latina mothers (age: 33⋅5 ± 6⋅1 years; 63 % Mexican origin; 86 % low acculturation) and their children (age: 3⋅9 ± 1⋅3 years; 55 % male) 2-5 years of age. On average, children consumed 2⋅25 ± 1⋅44 cups of fruits/vegetables, viewed 98⋅7 ± 74⋅2 min of screen time, accumulated 12⋅9 ± 2⋅9 min/h of total physical activity and consumed 15⋅5 ± 26⋅0 kcals of sugar-sweetened beverages per day. Forty-one percent met the fruit/vegetable recommendation, 54 % met the screen time recommendation, 27 % met the physical activity recommendation and 58 % met the sugary drink recommendation. Country of origin (P = 0⋅032) and acculturation (P = 0⋅048) were significantly associated with children meeting sugary drink recommendations. No other relationships were significant. The proportion of children in this sample meeting diet and activity recommendations was mixed. More research with larger sample sizes is needed in ELCs to identify effective intervention strategies for improving health behaviours.

Family Mealtimes: A Systematic Umbrella Review of Characteristics, Correlates, Outcomes and Interventions

Systematic reviews have examined the multitude of studies investigating family mealtimes and their importance to child/adolescent health and psychosocial outcomes, but the focus of each is limited to specific aspects of family meals (e.g., frequency) and/or specific outcomes (e.g., nutrition). Their findings require synthesis and so a systematic umbrella review was undertaken. Databases were searched to identify systematic reviews (with or without meta-analysis/meta-synthesis) addressing at least one of the following questions: what are the characteristics and/or correlates of family mealtimes; what outcomes are associated with family mealtimes; are interventions aimed at promoting family mealtimes effective? Forty-one eligible reviews were retrieved. Their findings demonstrate that families with children/adolescents typically eat together at least a few days each week. More frequent family meals are predicted by a more positive mealtime environment, more positive attitudes towards family meals, the presence of younger children, and families having more time. Greater family meal frequency protects children/adolescents against a poorer diet, obesity, risk behaviours, poorer mental health and wellbeing, and poorer academic outcomes. Findings from interventions seeking to promote family mealtimes are mixed. This umbrella review provides a comprehensive and integrated understanding of research into family mealtimes, establishing where evidence is sound and where further research is needed.

Fruit and Vegetable Intake and Home Nutrition Environment among Low-Income Minority Households with Elementary-Aged Children

Racial/ethnic and socioeconomic differences were shown to have an influence on child fruit and vegetable intake. This study examined the associations between parent and child fruit and vegetable intake and the home nutrition environment among Hispanic/Latino and African American families. Through a cross-sectional study design, self-reported surveys (n = 6074) were obtained from adult-child dyad participants enrolled in Brighter Bites, an evidence-based health promotion program, in the fall of 2018. For every once/day increase in frequency of parent FV intake, there was an increase in child FV intake by 0.701 times/day (CI: 0.650, 0.751, p < 0.001) and 0.916 times/day (CI: 0.762, 1.07; p < 0.001) among Hispanic/Latinos and African Americans, respectively. In Hispanic/Latino participants, significant positive associations were found between fruits as well as vegetables served at mealtimes ≥3 times/week (p < 0.001), family mealtimes 7 times/week (p = 0.018), parent-child communication about healthy eating and nutrition at least sometimes during the past 6 months (p < 0.05), and frequency of child FV intake, after adjusting for covariates. In African American participants, a significant positive association was found in fruits served at mealtimes ≥1 times/week (p < 0.05), and vegetables served at mealtimes ≥5 times/week (p < 0.05). Meals cooked from scratch a few times a day/all the time were significantly positively associated with frequency of child FV intake for both Hispanic/Latino (p = 0.017) and African American (p = 0.007) groups. The relationship between home nutrition environment and child FV intake varied by race and ethnicity. Future programs should consider designing culturally tailored interventions to address racial/ethnic-specific influences that match the child's race, culture, and ethnicity.

Understanding drivers of micro-level disparities in childhood body mass index, overweight, and obesity within low-income, minority communities

The focus of childhood obesity disparities has been mainly on macro-level disparities, such as, between lower versus higher socioeconomic groups. But, less is known about micro-level disparities, that is disparities within minority and low-income populations. The present study examines individual and family level predictors of micro-level obesity disparities. We analyze data on 497 parent-child dyads living in public housing communities in Watts, Los Angeles. Cross-sectional multivariable linear and logistic regression models were estimated to examine whether individual and family level factors predict children's BMI z-scores, overweight, and obesity in the sample overall and separately by child's gender and age group. Child characteristics of our study sample included mean age 10.9 years, 74.3% Hispanic, 25.7% Non-Hispanic Black, 53.1% female, 47.5% with household income below $10,000, 53.3% with overweight or obesity, and 34.6% with obesity. Parental BMI was the strongest and most consistent predictor of child zBMI, overweight, and obesity, even after controlling for parent's diet and activity behaviors and home environment. The parenting practice of limiting children's screentime was also protective of unhealthy BMI in younger children and females. Home environment, parental diet and activity behaviors, and parenting practices related to food and bedtime routines were not significant predictors. Overall, our findings show that there is considerable heterogeneity in child BMI, overweight, and obesity even within low-income communities with similar socioeconomic and built environments in their neighborhoods. Parental factors play an important role in explaining micro-level disparities and should be an integral part of obesity prevention strategies in low-income minority communities.

Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers

Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.

Association between unmet social needs and healthy lifestyle parenting behaviors

Objective

To examine cross-sectional associations of food and housing security risks and healthy lifestyle parenting behaviors related to nutrition and physical activity among families with children with overweight/obesity.

Methods

We surveyed 407 parents of children ages 6-12 years with overweight/obesity. Exposures were measures of food and housing insecurity risk. Outcomes were healthy lifestyle parenting behaviors related to nutrition and physical activity. Logistic regression models for each exposure-outcome relationship were adjusted for parental educational attainment, parental cohabitation status, household size, and household income.

Results

In multivariable-adjusted models, food insecurity was associated with significantly lower odds of parent modeling exercise {aOR 0.60 [95% confidence interval (CI): 0.37, 0.96]} and parent modeling eating healthy foods [aOR 0.42 (95% CI: 0.24, 0.73)]. Housing insecurity was associated with significantly lower odds of parent modeling exercise [aOR 0.57 (95% CI: 0.35, 0.95)].

Conclusions

Food insecurity and housing insecurity may be barriers to parents adopting and modeling healthy lifestyle parenting behaviors related to physical activity and nutrition.

Associations between variety of fruits and vegetables consumed, diet quality and socio-demographic factors among 8th and 11th grade adolescents in Texas

OBJECTIVE

To examine demographic and dietary correlates of consumption of a variety of fruits and vegetables (FV) among Texas adolescents. Different types of FV are needed for adequate dietary intake of vitamins and phytochemicals for proper development and functioning throughout the lifespan.

DESIGN

Cross-sectional analysis from the Texas Surveillance of Physical Activity and Nutrition (Texas SPAN) data comparing consumption of a variety of fruit and vegetables by gender, race/ethnicity and region (Texas-Mexico border/non-border).

SETTING

Middle, high schools in Texas.

PARTICIPANTS

8th, 11th grade Texas adolescents (n 9056 representing n 659 288) mean age 14·8 years.

RESULTS

Within this sample, mean fruit and vegetable variety scores (0-7) ranged from 2·47 to 2·65. Boys consumed a significantly greater variety of fruit than girls (mean = 1·12 compared with 1·04). Adolescents in non-border regions consumed a greater variety of vegetables and FV compared with those in border regions. FV variety was associated with healthier eating in the full sample, particularly in the highest socio-economic status (SES) tertile. Within the highest SES tertile, a one-unit increase in variety of fruit, vegetable and FV was associated with significant increases (P < 0·001) in a healthy eating measure, the SPAN Healthy Eating Index: Fruit variety (β = 1·33, se = 0·29), vegetable variety (β = 0·90, se = 0·28) and FV variety (β = 0·81, se = 0·19).

CONCLUSIONS

Consumption of a greater variety of FV appears to be associated with a healthier overall diet. Associations of FV variety with healthy eating were most significant in the highest SES tertile. These findings support the need to further examine consuming a variety of FV within healthy eating behaviour.

Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent-Adolescent Dyads

Healthy eating is vital in preventing obesity and long-term non-communicable diseases. This study explores potential family facilitators of, barriers to and strategies for healthy eating among adolescents in Chinese families to guide the development of effective interventions in the future. Parent-adolescent dyads were purposively sampled by age, gender, fruit and vegetable intake and household income. Key family factors were identified by thematic analysis. Fourteen themes under five domains were identified: family health with (1) illness experienced in the family; parental knowledge of (2) dietary recommendations, (3) the preparation of healthy food and (4) healthy food choice; parental attitudes towards (5) the importance of healthy eating and (6) the priority of family health; socioeconomic factors of (7) time concerns and (8) cost concerns; and food parenting practices in (9) nutritional education, (10) role modeling, (11) food provision, (12) child involvement, (13) parental supervision and (14) the cultivation of food preference. Useful strategies included incorporating healthy ingredients in adolescents' favorite recipes and providing a variety of fruit and vegetables at home. There is a need to empower parents with practical nutrition knowledge, to be more authoritative in food parenting practices, to discuss healthy eating with children and to acquire practical skills related to time- and cost-saving healthy cooking.

Prospective association of family members' sugar-sweetened beverages intake with children's sugar-sweetened beverages consumption in China

PURPOSE

We aimed to investigate whether parental and siblings' sugar-sweetened beverage (SSB) intake had prospective impact on children's SSB consumption, and the potential sex difference in these associations.

METHODS

This study included a total of 904 children and their parents enrolled from 2004 to 2011 China Health and Nutrition Survey (CHNS) cohort study. SSB consumption information was estimated using a short dietary questionnaire and total energy intake was assessed with three-day 24-h dietary assessments at recruitment and follow-up surveys. Multivariate logistic or linear regression analyses were used to assess the association for SSB consumption between parents, siblings and children after adjusting for age, body mass index (BMI) z-score, household income and parental educational level.

RESULTS

In this study, a majority (87.6%) of children consumed SSB. Among them, the median consumption of SSB was 70.3 ml/day per capita and 205.4 ml/day per consumer. Parental SSB consumption was relevant to children's SSB consumption, and this association was more pronounced in boys than in girls. Meanwhile, fathers seemed to have a stronger impact on whether children consume SSB than mothers which was reflected by lower P and higher OR. Additionally, children's SSB intake was prospectively associated with their older siblings' SSB consumption (P _{for trend} < 0.03).

CONCLUSIONS

Parental and older siblings' SSB consumption was relevant to children's SSB intake. Particularly, boys were more susceptible to parental impact than girls, and fathers seemed to have a greater influence on children than mothers.

What are the determinants of vegetable intake among adolescents from socioeconomically disadvantaged urban areas? A systematic review of qualitative studies

BACKGROUND

Evidence available on the determinants of vegetable intake in young populations is inconsistent. Vegetable intake is particularly low in adolescents from less-affluent backgrounds, yet no systematic review of qualitative studies investigating determinants for vegetable intake specifically has been conducted to date in this group. This systematic review aimed to identify determinants of vegetable intake in adolescents from socioeconomically disadvantaged urban areas located in very high-income countries reported in qualitative studies.

METHODS

Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO and ERIC) were searched until August 2022. The search strategy used combinations of synonyms for vegetable intake, adolescents, and qualitative methodologies. Main inclusion criteria were studies exploring views and experiences of motivators and barriers to vegetable intake in a sample of adolescents aged 12-18 years from socioeconomically disadvantaged urban areas in very high income countries. Study quality assessment was conducted using criteria established in a previous review.

RESULTS

Sixteen studies were included out of the 984 screened citations and 63 full texts. The synthesis of findings identified the following determinants of vegetable intake: sensory attributes of vegetables; psychosocial factors (nutrition knowledge, preferences/liking, self-efficacy, motivation); lifestyle factors (cost/price, time, convenience); fast food properties (taste, cost, satiety); home environment and parental influence; friends' influence; school food environment, nutrition education and teachers' support; and availability and accessibility of vegetables in the community and community nutrition practices. Studies attained between 18 and 49 out of 61 quality points, with eleven of 16 studies reaching ≥ 40 points. One main reason for lower scores was lack of data validation.

CONCLUSION

Multiple determinants of vegetable intake were identified complementing those investigated in quantitative studies. Future large scale quantitative studies should attempt to examine the relative importance of these determinants in order to guide the development of successful interventions in adolescents from socioeconomically disadvantaged backgrounds.

The association of problematic gaming characteristics with dietary habits among Finnish vocational school students

Digital gaming is a popular pastime among young people, but its links to dietary habits have been little studied. The purpose of the study was to describe dietary habits and to examine their associations to problematic gaming behavior with regard to the degree of daily digital gaming time and the overall levels of disordered-like gaming behavior among students in vocational education in the Oulu region of Finland. This cross-sectional study consisted of a total of 773 first-year vocational school students who had played digital games regularly. Data was collected by using an online survey measuring sociodemographic information, dietary habits, amount of digital gaming time, and symptoms of problematic gaming behavior. Most prevalent weekly consumed food types were chicken (90.1%), chips (87.7%), and sausages/cold cuts (85.4%). Around one-fourth of students skipped breakfast on weekdays and at weekends. A higher amount of digital gaming time was associated with skipping breakfast on weekdays. More elevated levels of disordered gaming behavior were particularly associated with the use of a group of food types encompassing carbohydrate-dense and fast food. Current research provides indications that digital gaming may have an impact on youths' dietary habits, while at the same time, however, emphasizing that the issue can be affected by several interrelated and complex factors.

Association between the dietary literacy of children's daily diet providers and school-age children's nutritional status and eating behaviours: a cross-sectional study

BACKGROUND

Overweight and obesity rates have increased rapidly in Chinese school-age children, and previous studies have indicated that poor dietary literacy can lead to unhealthy eating behaviours. However, few studies have investigated the association between the dietary literacy of daily diet providers and the eating behaviours and nutritional status of school-age children raised by the providers. Thus, we aimed to explore this association.

METHODS

We collected data on the eating behaviours and nutritional status of children in two primary schools in Anhui Province, as well as the dietary literacy of their daily diet providers. T-tests, one-way ANOVA, chi-square tests, and multiple linear regression were used to analyse the association.

RESULTS

We found significant differences in the scores on the Questionnaire of Children's Daily Diet Providers' Dietary Literacy (QCDDPDL) by region, relationship with the child, age, and educational level of the daily diet provider (all p < .05). Moreover, the children in the low QCDDPDL score group were inclined to engage in unhealthy eating behaviours such as emotional undereating and overeating (p < .05). In addition, the incidence of overweight and obesity was higher in the low QCDDPDL attitude score group than in the high score group (p = .006).

CONCLUSIONS

Our study showed that the dietary literacy of diet providers may influence children's health and eating behaviours. Improving the dietary literacy of diet providers may promote the health status and eating behaviours of school-age children.

Physical Activity, Sleep Patterns and Diet Habits as Well as the Prevalence of Obesity among Adolescents: A Cross Sectional Study from Ha'il City in Saudi Arabia

Obesity is expected to increase in the Kingdom of Saudi Arabia (KSA). Therefore, the objective of this study was to determine the physical activity, sleep patterns and diet habits as well as the prevalence of obesity among adolescents from Ha’il City. A cross-sectional study was conducted with 1598 adolescent students (663 males and 935 females) aged 12−15 years who were randomly selected from different schools in Ha’il. Body mass index (BMI) was used to classify participants as underweight, normal weight, overweight and obese (class and class II). Moreover, physical activity, sleep patterns and diet habits were recorded. The prevalence of obesity was 52.1%. Obesity is significantly more prevalent in females compared to males (62.9% vs. 36.59%, p < 0.001). Moreover, students in the third grade are the most obese in comparison with the first and the second educational level (p < 0.001). Additionally, students aged 15 years old are the most obese compared to 12 years, 13 years and 14 years (p < 0.001). Additionally, the results showed that students who suffer from obesity eat food when they feel higher stress and tension scores and that they do not eat their meals regularly. Additionally, 79% of those who eat fried food daily are obese. It was reported that 61.1% of students in this study were physically inactive. Furthermore, 58.4% of students have a higher proportion of insufficient sleeping duration (>7 h per night) (p < 0.001). This increased rate of obesity is higher in females compared to males and it was related to inactivity as well as perturbed sleep and eating habits. Therefore, we recommend an obesity prevention program including health education in Ha’il City, KSA.

Positive parenting, adolescent adjustment, and quality of adolescent diet in nine countries

INTRODUCTION

We sought to understand the relation between positive parenting and adolescent diet, whether adolescents' internalizing and externalizing behaviors mediate relations between positive parenting and adolescent diet, and whether the same associations hold for both boys and girls and across cultural groups.

METHODS

Adolescents (N = 1334) in 12 cultural groups in nine countries were followed longitudinally from age 12 to 15. We estimated two sets of multiple group structural equation models, one by gender and one by cultural group.

RESULTS

Modeling by gender, our findings suggest a direct effect of positive parenting at age 12 on a higher quality diet at age 15 for males (β = .140; 95% CI: 0.057, 0.229), but an indirect effect of positive parenting at age 12 on a higher quality diet at age 15 by decreasing externalizing behaviors at age 14 for females (β = .011; 95% CI: 0.002, 0.029). Modeling by cultural group, we found no significant direct effect of positive parenting at age 12 on the quality of adolescent diet at age 15. There was a significant negative effect of positive parenting at age 12 on internalizing (β = -.065; 95% CI: -0.119, -0.009) and externalizing at age 14 (β = -.033; 95% CI: -0.086, -0.018).

CONCLUSIONS

We founder gender differences in the relations among positive parenting, adolescents' externalizing and internalizing behaviors, and adolescent diet. Our findings indicate that quality of parenting is important not only in promoting adolescent mental health but potentially also in promoting the quality of adolescents' diet.

Diet Quality and Contextual Factors Influencing Food Choice among Adolescents with Food Security and Food Insecurity in Baltimore City

This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14–19 years old living in Baltimore, Maryland, USA in 2020–2021. All adolescents were sampled from households eligible for the Supplemental Nutrition Assistance Program in 2020. There were no significant differences in overall diet quality or components between adolescents with food security and those with food insecurity in this sample, except for seafood and plant proteins, which was higher for adolescents with food insecurity. Qualitative analysis found that adolescents were largely influenced by their parents and the home food environment, and that workplace environments enabled adolescents to eat foods high in refined grains, sugar, and saturated fat. These findings provide insight about the experiences of low-income adolescents during times when they are home for prolonged periods (i.e., emergency school closures, summer, and winter breaks). Programs and policies that aim to improve healthy food access may positively impact adolescent food security and diet quality, and it is important to ensure that healthy foods are available and accessible to adolescents in the places where they spend the most time. Multilevel interventions in the home, school, and workplace may be most effective in encouraging healthy eating behaviors among adolescents.

Contribution of home availability, parental child-feeding practices and health beliefs on children's sweets and salty snacks consumption in Europe: Feel4Diabetes-Study

Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children's snacking such as food home availability, parenting practices, and parents' health beliefs. In this cross-sectional study 12 039 children, 49·4% boys 5-12 years, participating in the European Feel4Diabetes-Study were included. Children's weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent's opinions on deterministic health beliefs with children's consumption of sweets and salty snacks. Results showed that home availability (sweets: OR_adj: 4·76, 95 % CI: 4·32, 5·23; salty snacks: OR_adj: 6·56, 95 % CI: 5·64, 7·61), allowing to consume (sweets: OR_adj: 3·29, 95 % CI: 2·95, 3·67; salty snacks: OR_adj: 3·41, 95 % CI: 2·98, 3·90) and rewarding with sweets/salty snacks (sweets: OR_adj: 2·69, 95 % CI: 2·23, 3·24; salty snacks: OR_adj: 4·34, 95 % CI: 3·57, 5·28) 'sometimes/or less frequently' compared to 'always/or often' were associated with lower weekly consumption of sweets and snacks. Parents' disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.

Effects of maternal dietary patterns and maternal obesity on children's obesity

Aim: The effects of dietary patterns and dietary statuses of mothers on childhood obesity have not been understood clearly yet. This study aims to evaluate the dietary patterns of mothers and their dietary statuses on the obesity of children. Material and Method: This cross-sectional study included 295 mothers and their children, who were 2-6 years old. The participants' anthropometric measurements were carried out and the frequency of food consumption was also collected from the mothers in the study. Results: In the study, it was determined that the children of the participating mothers, who had high levels of income and education, had higher probabilities of being overweight/obese. Overweight/obesity in children was found to be significantly associated with maternal overweight/obesity (B=4.04, p

Results from Scotland's 2021 report card on physical activity and health for children and youth: Grades, secular trends, and socio-economic inequalities

Background

The 2021 Active Healthy Kids Scotland Report Card aimed to identify secular trends and socio-economic inequalities, and to assess the physical activity and health of children and youth prior to COVID-19.

Methods

An expert panel searched for data published in 2018-2020. Grades were assigned to nationally representative data using the Active Healthy Kids Global Alliance methodology.

Results

The expert panel, following national consultation, awarded the following grades: Community/Environment B-, Organized Sport and Physical Activity B-, Government/Policy C-/C+, Active Transportation C-, Family/Peers D-, Recreational Screen Time F. Five indicators were graded inconclusive (INC): Overall Physical Activity; Active Play; Physical Fitness; Diet; Obesity. Grades have remained stable or declined, and surveillance has reduced, increasing the number of INC grades. There were marked socio-economic inequalities for eight indicators (Recreational Screen Time; Overall Physical Activity; Organized Sport & Physical Activity; Active Transportation; Diet; Obesity; Family/Peers; Community/Environment).

Conclusions

Despite a decade of favorable policy, physical activity and health of children and youth has not improved, and marked socio-economic inequalities continue to persist in Scotland. There is a clear need for greater monitoring of physical activity and health, and improved policy implementation and evaluation, particularly as many indicators and related inequalities may have worsened following the COVID-19 pandemic.

Parent and child dietary changes in a 6-month mobile-delivered weight loss intervention with tailored messaging for parents

Objective

To examine changes in parent and child dietary intake, associations between program adherence and parent dietary changes, and the association between parent and child dietary changes in a mobile-delivered weight loss intervention for parents with personalized messaging.

Methods

Adults with overweight or obesity and who had a child aged 2-12 in the home were recruited for a randomized controlled trial comparing two types of dietary monitoring: calorie monitoring (Standard, n = 37) or "red" food monitoring (Simplified, n = 35). Parents received an intervention delivered via a smartphone application with lessons, text messages, and weekly personalized feedback, and self-monitoring of diet, activity, and weight. To measure associations between parent and child dietary changes, two 24-h recalls for parents and children at baseline and 6 months measured average daily calories, percent of calories from fat, vegetables, fruit, protein, dairy, whole grains, refined grains, added sugars, percent of calories from added sugars, and total Healthy Eating Index-2015 score.

Results

Higher parent engagement was associated with lower parent percent of calories from fat, and greater days meeting the dietary goal was associated with lower parent daily calories and refined grains. Adjusting for child age, number of children in the home, parent baseline BMI, and treatment group, there were significant positive associations between parent and child daily calories, whole grains, and refined grains. Parent-child dietary associations were not moderated by treatment group.

Conclusions

These results suggest that parent dietary changes in an adult weight loss program may indirectly influence child diet.

Fruit and Vegetable Intake Is Associated with Food Knowledge among Children Aged 9–14 Years in Southwestern Ontario, Canada

Interventions to improve dietary quality and intake of fruits and vegetables (FV) among Canadian children have had modest success, and it has been suggested that food knowledge could be key to improvement. Programs have been criticized for insufficiently connecting food knowledge with food skills and decision making about dietary intake. The objective of this study was to investigate factors associated with FV consumption by elementary school children, aged 9–14 years, in Ontario, Canada, including food knowledge, socioeconomic status, sociodemographic characteristics, and the food environment. In 2017–2019, a cross-sectional survey was administered to 2443 students at 60 elementary schools across Southwestern Ontario (SWO), Canada. A parent survey was used to validate self-reported sociodemographic variables. The mean intake of FV reported by these participants was 2.6 (SD 1.1) and 2.4 (SD 1.2) servings/day, respectively. A FV intake below WHO guidelines was reported by 40.7% of respondents. Knowledge score, child age, and parent employment status significantly predicted higher reported intake of FV. This study shows that FV intake among this population group is low, and increased intake is associated with higher food knowledge. To encourage healthy eating, school-based food and nutrition programs that incorporate multiple components and emphasize food literacy are needed.

Psychometric properties of the item-reduced version of the comprehensive general parenting questionnaire for caregivers of preschoolers in a Finnish context

Introduction

Many instruments for assessing general parenting have been reported as burdensome and are thus seldom used in studies exploring children’s energy balance-related behaviors or weight. This study evaluates the factorial structure of the item-reduced version of the Comprehensive General Parenting Questionnaire (CGPQ), which assesses five constructs of general parenting.

Methods

The study uses data from two cross-sectional studies: Study 1 in 2014 (n = 173) and Study 2 in 2015–16 (n = 805). Parents of children aged three to six answered the CGPQ; in Study 1 the 69-item version, and in Study 2 the 29-item version. The reduction was based on the results of the confirmatory factor analyses (CFA) in Study 1. In both datasets, internal consistency, as Cronbach’s alphas and intraclass correlations between the items of each construct, was tested. A combined assessment of the CFA and items response theory evaluated the construct validity and the item importance for the 29-item version, and a further the reduced 22-item version.

Results

In Study 1, the highest Cronbach’s alphas were shown for the five constructs in the 69-item version. A higher intraclass correlation was found between the constructs in the 69- and 29-item versions, than between the 69- and the 22-item version. However, a high concordance was found between the constructs in the 29- and 22-item versions in both Study 1 and in Study 2 (0.76–1.00). Testing the goodness-of-fit of the CFA models revealed that the 22-item model fulfilled all the criteria, showing that it had a better factorial structure than the 29-item model. Standard estimations ranged from 0.20 to 0.76 in the 22-item version.

Conclusion

The reduced 22- and 29-item versions of the 69-item CGPQ showed good model fit, the 22-item version the better of the two. These short versions can be used to assess general parenting without overburdening the respondents.