Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth

Validation of the Childhood Family Mealtime Questionnaire in Mexican Adolescents with Obesity and Their Caregivers

BACKGROUND

Childhood obesity is a significant public health concern in Mexico, with far-reaching implications for the nation's healthcare system and economy. In light of this challenge, our study sought to validate the Childhood Family Mealtime Questionnaire (CFMQ) in Mexican adolescents living with obesity and their primary caregivers.

METHODS

A sample of 56 adolescents ages 13 to 17 years and their primary caregivers from one pediatric obesity clinic participated in the study. We conducted a comprehensive assessment of the CFMQ's consistency, reliability, and construct validity among all participants. Internal consistency was determined using Cronbach's α, and the questionnaire's reliability was assessed through test-retest and intraclass correlation coefficients. Construct validity was assessed through an exploratory factor analysis.

RESULTS

Our findings confirmed strong internal consistency and reliability for both adolescents and caregivers. Construct validity was established through exploratory factor analysis, refining the questionnaire while preserving its original seven dimensions. This validation of the CFMQ highlights its applicability in evaluating family mealtime experiences in this context, providing valuable insights into the dynamics that influence adolescent nutrition and health.

CONCLUSION

The CFMQ proves to be a reliable tool for assessing family mealtime experiences in Mexican adolescents living with obesity and their caregivers who seek care at third-level public hospitals.

Family functioning within the context of families with adolescent children in urban India

Research on family functioning within given cultural contexts is needed. This study aims to describe salient dimensions of family functioning in two urban contexts in India and to examine differences in family functioning by sociodemographic groups. We measured differences in family functioning using cross-sectional survey questionnaire data collected from 13 to 15-year-old adolescents and one of their parents/primary caregivers in Mumbai (n = 843) and Kolkata (n = 913) during 2019-2020. We drew a multi-stage sample representative of neighborhoods and households in both cities. We assessed a multi-dimensional family functioning latent factor that included parent-reported measures (parent-adolescent communication, family cohesion, and parent monitoring of peers) and adolescent-reported measures (parent support, family cohesion, and parent supervision). Our results support an overall measure of family functioning manifested by multiple dimensions for parent- and adolescent-reported data. Families with male adolescents had worse adolescent-reported family functioning in Mumbai and parent-reported family functioning in Kolkata. Higher socioeconomic status was associated with better parent-reported family functioning in both cities and better adolescent-reported family functioning in Kolkata. Muslim religious identification in Kolkata and the Hindi native language in both cities were associated with better adolescent-reported family functioning. Our findings indicate heterogeneity in family functioning across demographic and social-cultural groups within the two urban contexts of India. This study may inform the development of culturally congruent prevention interventions for families with adolescents in India.

Caregiving Strain, family functioning, and effort to change diet for patients with gastrointestinal cancer: A cross-sectional descriptive study

PURPOSE

Among patients with cancer, it has been found that the family system influences health-related behaviors and may promote a healthy diet. This study assessed the associations among cancer patients between family caregiver strain, family functioning, and efforts to change diet.

METHODS

This cross-sectional descriptive study was conducted in gastrointestinal outpatient units at two tertiary university hospitals in South Korea. This study included 401 main family caregivers of patients with gastrointestinal cancer. The caregivers were evaluated using structured, face-to-face questionnaires measuring family strain, family functioning, and effort to change diet.

RESULTS

Greater effort to change diet was associated with higher family functioning, having a spouse, and more caregiving time per week. Less effort to change diet was associated with greater levels of caregiving strain and with a son providing caregiving.

CONCLUSION

The efforts of family caregivers to alter diet are influenced by family strain and family functioning, as well as family caregivers' characteristics, such as marital status, health problems due to caregiving, care time and duration, and relationship with the patient. This study suggested that reducing family strain and improving family functioning in clinical settings facilitate the success to change dietary strategies for cancer families.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Levels of Physical Activity, Family Functioning and Self-Concept in Elementary and High School Education Students: A Structural Equation Model

In the adolescent population there is great concern about low levels of physical activity and low levels of family awareness of the benefits of physical exercise on physical and mental health. This study aims to determine the influence of physical activity levels, family functioning and self-concept in primary and secondary school students, as well as to develop a structural equation model as a function of weekly physical activity time. A descriptive, cross-sectional, comparative study was conducted on whether students engage in more than three hours of physical activity per week. To collect the data, instruments validated by the scientific community were used, such as the Adaptability, Partnership, Growth, Affection, and Resolve family questionnaire (APGAR) and the self-concept questionnaire form 5. The results show that those students who engage in more than 3 h of physical activity per week have higher levels of family functioning than those who do not meet this sport criterion. In addition, physically active students show higher scores on all dimensions of self-concept than those who practice less than 3 h of physical activity per week. Finally, as a conclusion, it can be affirmed that the amount of physical activity practice brings benefits to student's mental health.

Adverse childhood experiences and adult diet quality

Childhood trauma is strongly associated with poor health outcomes. Although many studies have found associations between adverse childhood experiences (ACEs), a well-established indicator of childhood trauma and diet-related health outcomes, few have explored the relationship between ACEs and diet quality, despite growing literature in epidemiology and neurobiology suggesting that childhood trauma has an important but poorly understood relationship with diet. Thus, we performed a cross-sectional study of the association of ACEs and adult diet quality in the Southern Community Cohort Study, a largely low-income and racially diverse population in the southeastern United States. We used ordinal logistic regression to estimate the association of ACEs with the Healthy Eating Index-2010 (HEI-10) score among 30 854 adults aged 40-79 enrolled from 2002 to 2009. Having experienced any ACE was associated with higher odds of worse HEI-10 among all (odds ratio (OR) 1⋅22; 95 % confidence interval (CI) 1⋅17, 1⋅27), and for all race-sex groups, and remained significant after adjustment for adult income. The increasing number of ACEs was also associated with increasing odds of a worse HEI-10 (OR for 4+ ACEs: 1⋅34; 95 % CI 1⋅27, 1⋅42). The association with worse HEI-10 score was especially strong for ACEs in the household dysfunction category, including having a family member in prison (OR 1⋅34; 95 % CI 1⋅25, 1⋅42) and parents divorced (OR 1⋅25; 95 % CI 1⋅20, 1⋅31). In summary, ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.

Development and preliminary validation of the Adolescent Food Parenting Questionnaire: Parent and adolescent version

Suitable instruments for measuring Food Parenting Practices (FPP) among adolescents and their parents that also measure the perception of adolescents about their parent's FPP are rare. The current study describes the development and preliminary testing of a short 16-item Adolescent Food Parenting Questionnaire (AFPQ) for parents (AFPQ-p) and adolescents (AFPQ-a) that may enable future large-scale research on potentially eminent parent-child FPP discrepancy. Participants included 381 parents (73.8 % mothers; M_age 45.9, 26.2% fathers; M_age 49.1) and their adolescent children (aged 12-16) who participated in the Dutch "G(F)OOD together" study. Most parents finished higher professional education (mothers: 44.3 %; fathers: 34.4 %) and performed a paid job of 32 h per week or more (mothers: 22.1 %; fathers: 60.0 %). The theoretical framework of Vaughn (2016) was leading in the development of the AFPQ. Exploratory factor analysis (EFA) was performed on a random split sample of parent-adolescent dyads and confirmatory factor analysis (CFA) was performed on the other half. The EFA in both parent and adolescent samples resulted in a clear 5 factor solution explaining 61.6 % (AFPQ-p) and 64.2 % (AFPQ-a) of the variance respectively, representing the factors Autonomy Support (α = 0.79/.82), Coercive Control (α = 0.85/.83), Snack Structure (α = 0.79/75), Healthy Structure (α = 0.78/74) and Modelling (α = 0.69/85). CFA confirmed good model fit for the AFPQ-p and the AFPQ-a. Associations with adolescent self-reported food intake were in the expected direction, confirming the preliminary convergent validity of the instrument among a moderate to highly educated group of parent-adolescent dyads. Although the AFPQ provides a promising short instrument, future research in more diverse samples is needed to build evidence on the instrument's psychometric characteristics in other groups.

Family Functioning in Families Affected by Parental Mental Illness: Parent, Child, and Clinician Ratings

Family functioning is often impaired in families with a parent with mental illness and is linked to child mental health. This study aims to gain a better understanding of family functioning in affected families by comparing ratings among family members and by analyzing associations with clinician-rated family functioning. The cross-sectional sample comprised 210 families with ratings of 207 patients, 139 partners, and 100 children. Parents with a mental illness as well as their partners and children completed the German version of the Family Assessment Measure (FAM). Clinician ratings were obtained by the Global Assessment of Relational Functioning Scale (GARF). We conducted several mixed models to compare ratings of family functioning while accounting for family cluster. Family dysfunction was consistently elevated compared to a normative sample. On several domains, parents with a mental illness perceived family functioning to be worse compared to their partners and children. Partners and children did not differ in their perceptions of family functioning. Ratings of family members were moderately associated with clinician ratings. We discuss the importance of multi-informant assessment of family functioning and the implementation of family-based interventions for families with a parent with mental illness.

Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12–16 years; N = 16) and young adults (18–24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom’s role as primary caregiver and dad’s role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

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

INTRODUCTION

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

STUDY DESIGN

This study was an RCT.

SETTING/PARTICIPANTS

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

INTERVENTION

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Targeting family functioning, acculturative stress, and sugar-sweetened beverage consumption for obesity prevention: findings from the Hispanic community children's health study/study of Latino youth

Background

Maintaining a bond with one’s family as well coping with stress while acculturating to the US may protect Hispanic/Latino youth from increased sugar-sweetened beverages (SSB) consumption, which heightens the risk for overweight and obesity. This study aims to examine associations between acculturative stress, family functioning, and SSB consumption by acculturation status among U.S. Hispanic/Latino youth.

Methods

With cross-sectional data on 1465 youth 8-16y (49.6% females) participating in the Hispanic Community Children’s Health Study/Study of Latino Youth, we classified youths into four acculturation groups – assimilated, integrated, marginalized/separated, and unclassified. SSB consumption was assessed through two 24-h diet recalls and defined as intake frequency of soda, fruit juice, sweetened soft and fruit drinks. Multi-group path regression models were used to test associations of Hispanic/Latino youth’ acculturative stress and family functioning with SSB consumption, as well as the moderating role of acculturation status.

Results

When controlling for age, sex, and study site, acculturative stress (β = − 0.13, p = 0.01) was inversely associated with SSB, and poor family functioning (β = 0.11, p = 0.07) was only marginally associated with SSB consumption among youth classified as assimilated but not among youth classified as integrated, marginalized/separated, or unclassified.

Conclusions

A socio-ecological perspective that incorporates the role of key acculturation-related factors across multiple levels may aid efforts to identify mechanisms that influence the relationship between acculturation status and diet among Hispanic/Latino youth and their families.

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

Background

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

Methods

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

Results

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

Conclusion and implications

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

Psychometric properties of an abbreviated Childhood Family Mealtime Questionnaire among overweight and obese Hispanic adolescents

The current family mealtime literature shows that assessments of the mealtime environment are typically self-report, yet few studies discuss validation techniques or report using validated scales. As such, the current analysis was conducted to validate one of the only published measures to assess the mealtime environment from the adolescent perspective. Specifically, the Childhood Family Mealtime Questionnaire (CFMQ) was evaluated in a sample of 280 overweight and obese Hispanic adolescents to address the need for a validated measure of the family mealtime environment in a demographic that is disproportionately affected by the current obesity epidemic. Results of exploratory and confirmatory factor analyses to evaluate the optimal factor structure, reliability, and validity for a revised, abbreviated CFMQ are presented here. The concurrent validity of the CFMQ was evaluated using correlations between the factor structures and the previously used, culturally appropriate comparable measure of family functioning. Correlations were also computed between factor scores and obesogenic outcomes (fruit and vegetable intake, added sugar intake, and physical activity). Analyses produced a revised, abbreviated version that includes 22 items (reduced from a total of 69 items) and consists of the following 4 factors: family mealtime communication (5 items), family mealtime stress (7 items), appearance weight control (5 items), and mealtime structure (6 items). Cronbach's alphas are reported for reliability. When examining CFMQ concurrent validity with the family functioning latent variable, results showed the family mealtime communication subscale ranked highest. Additionally, the family mealtime communication subscale was associated with all three obesogenic outcomes. This abbreviated CFMQ may be a useful tool for those studying family mealtime environments and their influence on obesity and its associated lifestyle behaviors.