Relationships of family conflict, cohesion, and chaos in the home environment on maternal and child food-related behaviours

Household chaos and childhood obesity-related health outcomes

OBJECTIVE

Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity.

METHODS

Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns.

RESULTS

The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos.

CONCLUSIONS

Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study

BACKGROUND

Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood.

OBJECTIVE

The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity.

METHODS

The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child's height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child's physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child's mental health, as well as a 1-day dietary assessment for their child.

RESULTS

Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study's sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children's mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ≥CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication.

CONCLUSIONS

Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48549.

Culinary Comfort: Understanding the Connection between Food and Well-Being

This study investigated the complex interaction between individuals' culinary tastes, at-home dining habits, and their broader impact on general well-being and relationships dynamics. An all-encompassing tool for assessing the impact of dietary choices on emotions related to coziness, social interaction, and general wellness, the multidimensional Culinary Comfort and Connection Index (CCCI) focuses on traditional home-cooked meals, in particular. We used an online-based survey to validate the CCCI. With a Cronbach alpha of 0.844, this scale is reliable and valid. It covers a wide range of aspects including self-care advocacy, traditional values, and a preference for handmade food. We performed descriptive and stratified analyses and tested correlations. The CCCI shows complicated patterns when analyzed with respect to gender, education level, and family income that demonstrate a myriad of factors impacting people's views on food and its relationship to health. While some patterns emerged, the results imply that dietary choices do not necessarily correlate with overall health. The research highlights the complex interaction between cultural, societal, and personal elements in determining perspectives on nutrition and health by drawing on theoretical models like Bronfenbrenner's ecological systems theory and the Theory of Planned Behavior. Future research should incorporate broader age ranges, longitudinal designs, different populations, objective measurements, and intervention trials to better understand the dynamic link between dietary preferences and health outcomes.

Food Insecurity and Feeding Experiences Among Parents of Young Children in Australia: An Exploratory Qualitative Study

BACKGROUND

Responsive feeding is a reciprocal process between caregiver and child that is primarily child-led. It is linked to the development of positive eating behaviors and food preferences. There is evidence that household chaos, family dynamics, the quality of mealtime routines, financial hardship, and food insecurity can impact the feeding relationship.

OBJECTIVE

This study explored factors influencing feeding experiences among Australian parents with young children experiencing financial hardship, including household chaos and food insecurity.

DESIGN

This qualitative semi-structured interview study was conducted as a component of a larger research program to design and evaluate a parent program to support responsive feeding practices in Australian families experiencing financial hardship and food insecurity.

PARTICIPANTS/SETTING

Participants were caregivers of a child aged 6 months to 3 years (n = 29), living in Australia, who self-identified as experiencing financial hardship. Interviews were conducted in person and via telephone between August 2021 and January 2022.

ANALYSIS

Transcripts were analyzed using the Framework Method of thematic analysis.

RESULTS

Five key themes were generated: family tensions heightened through hardship, making tradeoffs and sacrifices, the unseen mental load, the inescapable impact of COVID-19, and resiliency and being creative. Despite facing multiple hardships and challenges with feeding the family, parents demonstrated resilience and capabilities through creative food resource management and organizational skills. Parents experienced a high mental load through the cognitive and emotional work of planning, adapting, anticipating, and caring for the family's needs through meals and child feeding.

CONCLUSIONS

Programs to support child feeding need to consider the high mental load families with food insecurity experience and how this can impact parents' capacity. Program content should be contextually sensitive to the experience of food insecurity and consider the constraints inherent in families and communities while building on capabilities and strengths.

Dads at Mealtimes: Associations between Food Security, Household and Work Chaos, and Paternal Feeding Practices among Australian Fathers Living with Disadvantage

Understanding how fathers engage in feeding while experiencing disadvantage is important for family-focused interventions. A cross-sectional online survey involving 264 Australian fathers was conducted to explore feeding involvement and the relationships between feeding practices, food insecurity, and household and work chaos. Practices related to coercive control, structure, and autonomy support were measured for two age groups (<2 years and 2-5 years). Multivariable linear regression was used to examine the associations for each practice. Three-quarters of the sample were food insecure, impacting adults more than children, and correlated with household chaos. Food insecurity was associated with increased 'persuasive feeding' and 'parent-led feeding' in younger children. Household chaos was positively associated with coercive control practices in both younger and older child groups, with the strongest associations for 'using food to calm' and 'overt restriction', respectively. In older child groups, household chaos was negatively associated with 'offer new foods' and 'repeated presentation of new foods'. Structure practices had no significant relationships with any factors, and work chaos did not predict any feeding practices. These findings emphasize a need for societal and structural support to address food insecurity and household chaos. Tailored strategies are crucial to support fathers in responsive feeding.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

The relationship between family diet consumption, family environment, parent anxiety and nutrition status children during the COVID-19 pandemic: a longitudinal study

Background

The COVID-19 pandemic has exacerbated the trends of childhood overweight, obesity, and malnutrition, as well as increased psychological stress and family conflicts among family members. It is important to explore the relationship between changes in the family environment during the COVID-19 on child nutrition.

Objective

This study aims to analyze the nutritional status of Chinese children during the COVID-19 pandemic and its relationship with family diet, family environment, and parental anxiety, in order to provide evidence for further interventions in children's nutritional status.

Method

This study included 7,645 primary and secondary school students and their parents from five schools in Chengdu, China. Chi-square tests were used to analyze the categorical variables of children's malnutrition, overweight, obesity, and parental anxiety. T-tests were used to assess changes in the continuous variable of family environment between two rounds of follow-up surveys. Multiple logistic regression analysis was employed to examine the impact of changes in family diet during the COVID-19 pandemic on children's nutritional status. Generalized estimating equations were used to analyze the effects of family environment and parental anxiety on childhood obesity.

Result

The prevalence of malnutrition and obesity decreased from 11.64% and 11.60% in wave 1 to 4.96% and 10.50% in wave 2, and the rate of overweight increased from 13.11% in wave 1 to 13.73% in wave 2. Children whose families reduced consumption of staple foods during the COVID-19 were more likely to be frail, and families increased consumption of sugary drinks, take-out or meal delivery services, living in towns, family environmental barriers, and parental anxiety were risk factors for overweight obesity. Mother's education level in middle and high school and low age were protective factors for overweight obesity.

Conclusion

The physical environment of the family, the emotions of family members, and children's perceptions of the family's soft environment can influence children's eating behaviors, children's nutritional intake, and malnutrition and obesity in children under public health emergencies, and family-based dietary interventions may be effective. Parents can increase consumption of healthy foods and improve the family environment, which improve their growth.

Household disorder and blood pressure in mother-child dyads: A brief report

High blood pressure (BP) is the leading risk factor for cardiovascular disease (CVD). Although factors outside the home, such as crime and noise, have been associated with high BP in women and children, it is unknown if disorder within the home (household disorder) influences BP. We tested the hypothesis that women and children with more household disorder would have higher BP, independent of age, race, sodium intake, and body mass index (BMI). This study was a secondary analysis of data from mother-child dyads (n = 216). Mothers were 87% African American, 34 ± 5 years old, with BMI 33.59 ± 9.43 kg/m². Children were 7 ± 2 (range: 4-10) years of age with BMI z score 0.60 ± 2.07. Household disorder was measured by the Confusion Hubbub and Order Scale. Mother-child dyads were assessed for weight, height, BP (adults), BP percentile (children), energy intake, and sodium intake. The relationship between household disorder and BP was evaluated using Pearson's partial correlation coefficients. In fully adjusted models, household disorder was positively associated with systolic BP for mothers (r = 0.15, p < .05) and tended to be positively associated with diastolic BP (r = 0.11, p = .10). For the children, household disorder was not associated with systolic or diastolic BP percentile. This study's results suggest that household disorder is positively associated with higher BP in adult women, but not their children. Nevertheless, these data suggest that interventions to address household disorder could benefit maternal BP and potentially improve long-term CVD outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adolescents' reports of chaos within the family home environment: Investigating associations with lifestyle behaviours and obesity

OBJECTIVE

Disorganised and chaotic home environments may hinder the adoption of healthy lifestyle behaviours and contribute to excessive weight gain among adolescents. We examined whether self-reported level of chaos within the family home environment is associated with lifestyle behaviours and obesity in adolescent girls and boys.

METHODS

Cross-sectional data from the 3rd wave of the Québec Adipose and Lifestyle Investigation in Youth (QUALITY) study were analyzed. The sample consisted of n = 377 White adolescents with a history of parental obesity. Home environment chaos was measured using the Confusion, Hubbub, and Order Scale (CHAOS) analyzed both continuously and dichotomized as high vs. low chaos. Body Mass Index z-scores (zBMI) were computed using WHO standards from measured weight and height. Physical activity (7-day accelerometry), vegetable and fruit intake (three 24-hour diet recalls), and leisure screen time and sleep duration (questionnaire) were assessed. Sex-specific linear regression models were used to estimate associations between level of family home environment chaos, lifestyle behaviours and zBMI.

RESULTS

The overall level of chaos was low in our study sample, with higher reported levels among girls compared to boys. Among girls, high (vs low) chaos was associated with shorter sleep duration (hours/day) (B = - 0.44, 95% CI: -0.75, -0.14). No associations were observed for other lifestyle behaviours or for zBMI.

CONCLUSION

In this sample of adolescents with a parental history of obesity, higher household chaos was not associated with obesity or lifestyle behaviours, except for sleep duration among girls. Replication of findings in more diverse samples is indicated.

Influences of Child Temperament and Household Chaos on Preschoolers' Emotional Eating

Background: Emotional eating has been linked to child temperament and family environment factors, such as household chaos. However, few studies have examined how child and home characteristics independently and together influence children's overeating and undereating in response to negative emotions. Objective: The current study examined associations among child temperament, household chaos, and emotional eating in children 18-24 months of age, and interaction effects were also tested. Methods: The study included an analysis sample of 371 families participating in the larger STRONG Kids2 longitudinal birth cohort study (N = 468). The Early Childhood Behavior Questionnaire was used to assess child temperament at 18 months, and the Confusion, Hubbub, and Order Scale was used to assess disorganization in the household at 24 months. Child emotional eating at 24 months was assessed using parental reports of the Child Eating Behavior Questionnaire. Results: Negative affectivity and household chaos were independently associated with child emotional overeating. Negative affectivity, effortful control, and household chaos were significantly associated with emotional undereating. No significant interactions were found. Conclusions: Child temperament and household environment independently influence emotional eating in young children, highlighting the need to consider these factors in early prevention. Longitudinal studies are warranted to determine mechanisms that may be involved in these relations.

Family vulnerability, disruption, and chaos predict parent and child COVID-19 health-protective behavior adherence

INTRODUCTION

This study examined the role of family functioning in predicting family adherence to health-protective behaviors (HPBs) aimed at reducing COVID-19 spread. Pre-COVID-19 family functioning, disruptions to family functioning (cohesion, conflict, routines), and family chaos during the COVID-19 pandemic were tested as pathways to HPB adherence.

METHOD

We utilized a sample of N = 204 families, comprising parents who had children (MAge = 4.17). Parents (MAge = 27.43) completed one survey prior to COVID-19 onset in the United States, and twice during COVID-19, at a 2-week interval. Structural equation modeling was used to test three potential pathways between prepandemic family-level functioning and HPB adherence during the COVID-19 pandemic.

RESULTS

Findings indicated that families with higher levels of chaos during COVID-19 demonstrated consistently lower HPB adherence across all three models. Additionally, disruptions in family cohesion from pre-COVID was associated with lower levels of parent and child HPB adherence. Family conflict was indirectly associated with HPB adherence via family chaos during COVID-19; whereas family routines were not associated with HPB adherence at all.

DISCUSSION

These findings suggest that family functioning is a meaningful predictor of HPB adherence. Family-based support may be effective in improving HPB adherence by focusing on promoting cohesion and reducing conflict and chaos for families coping with reduced community support and resources. Strategies for family-based supports are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Impact of Household Chaos and Dietary Intake on Executive Function in Young Children

Children's executive functions (EFs) emerge over time and can be shaped by household environments and dietary intake. However, there is a lack of knowledge about how these factors influence EFs in children aged 18-24 months. This study tested a model exploring the relations between parent-reported dietary intake, household chaos, and child EF. The sample consisted of 294 families participating in the STRONG Kids2 birth cohort study of nutrition and child health. Caregivers completed the Food Frequency Questionnaire (FFQ), the Confusion, Hubbub, and Order Scale (CHAOS), and the Behavior Rating Inventory of Executive Function^®-Preschool Version (BRIEF-P) to assess model variables. Regression analyses revealed a significant and independent association between assorted snacks and processed foods and two EF subscales. There were also significant associations between household chaos and each EF subscale. There was no significant moderation effect. These findings suggest that family households characterized by dysregulation are associated with children's EF difficulties during early childhood and that the role of unhealthy dietary intake in child EF should be explored further. Future longitudinal studies that include multi-method approaches are needed to document the mechanisms through which household chaos impacts child EF over time.

Associations between Family-Based Stress and Dietary Inflammatory Potential among Families with Preschool-Aged Children

Chronic stress is known to influence dietary choices, and stressed families often report poorer diet quality; however, little is known about how family-based stress is linked with dietary patterns that promote inflammation. This study investigated associations between family-based stress and the inflammatory potential of the diet among preschool-aged children and their parents. Parents (n = 212 mothers, n = 146 fathers) and children (n = 130 girls, n = 123 boys; aged 18 months to 5 years) from 241 families participating in the Guelph Family Health Study were included in the analyses. Parents reported levels of parenting distress, depressive symptoms, household chaos, and family functioning. The inflammatory potential of parents' and children's diets was quantified using the Dietary Inflammatory Index (DII^®), adjusted for total energy intake (i.e., the E-DII^TM). E-DII scores were regressed onto family stress using generalized estimating equations to account for shared variance among family clusters. Compared to those in homes with low chaos, parents in chaotic homes had significantly more proinflammatory dietary profiles (β = 0.973; 95% CI: 0.321, 1.624, p = 0.003). Similarly, compared to those in well-functioning families, parents in dysfunctional families had significantly more proinflammatory dietary profiles (β = 0.967; 95% CI: 0.173, 1.761, p = 0.02). No significant associations were found between parents' E-DII scores and parenting distress or depressive symptoms, nor were any associations found for children's E-DII scores. Results were not found to differ between males and females. Parents in chaotic or dysfunctional family environments may be at increased risk of chronic disease due to proinflammatory dietary profiles. Children's dietary inflammatory profiles were not directly associated with family stress; however, indirect connections through family food-related behaviours may exist. Future research should prioritize elucidating these mechanisms.

The Forbidden Reward. The Emergence of Parent-Child Conflicts About Food Over Time and the Influence of Parents' Communication Strategies and Feeding Practices

One of the most critical arenas for conflicts between parents and their children relates to food. Although parent-child conflicts about food are a real occurrence, this form of parent-child interaction has been rarely examined. Given the special role of parents in shaping children's diet, we especially focus on the impact of parental measures. This study investigates how parental communication strategies (i.e., active vs. restrictive) and feeding practices (i.e., overt control vs. covert control) affect the emergence of parent-child conflicts about food over time. Based on previous research, we assessed overt control through parents' use of food as a reward and restriction of their children's access to specific food types. We explored the impact of our predictors on both conflicts about unhealthy and healthy food with a two-wave panel study including parents and their children (N = 541; children aged between 5 and 11) in Austria between fall 2018 and spring 2019. Results of two multiple linear regressions indicated that predominantly parents' use of unhealthy food as a reward is connected to both healthy and unhealthy food conflicts. Furthermore, inconsistent parental educational styles increased the respective conflict potential. Active food-related mediation and covert control did not relate to food-related conflicts about unhealthy and healthy food. Parents' increased use of overtly controlling and restrictive feeding practices might not be only counterproductive for children's diet but also for food-related parent-child interactions. Instead, a “health discourse” (i.e., active food-related mediation) might prevent food-related conflicts and foster a healthy growth in the future.

Young Children's Nutrition During the COVID-19 Pandemic Lockdown: A Comparative Study

During the COVID-19 pandemic, most countries took precautionary steps to save their citizens by initiating a lockdown and stopping all social activities by closing schools, companies, entertainment places, markets, gardens, and other social gathering places. As children stayed at home with no physical activities, their weight may have increased. The purpose of this study was to examine the link between fast food, sugars, or soft drinks and the ongoing domestic lockdown of the COVID-19 pandemic. This phenomenon was studied in three different cities from three different countries (Saudi Arabia, Britain, and Turkey) from the perspective of children's parents. The study sought to address three research questions regarding children's well-being during the COVID-19 lockdown period. First, was children's nutrition affected during this period? Second, did children's weight increase? Third, were there any statistically significant differences in children's dietary patterns based on their gender and nationality? A questionnaire was administered to 330 parents of children aged four to seven years in the three targeted countries. The study found that most parents cared about their children's nutrition and prepared food at home (96.1%) during the lockdown. Sixty-three percent of parents indicated that children did not gain weight. Additionally, differences in children's nutritional systems were found between Saudi and Turkish children; the nutritional system of the Turkish children was better than that of Saudi children during the lockdown. Additionally, there were statistically significant differences in children's nutrition due to gender, with better nutrition for boys than for girls.

Associations between Problematic Smartphone Use, Unhealthy Behaviors, and Mental Health Status in Korean Adolescents: Based on Data from the 13th Korea Youth Risk Behavior Survey (2017)

OBJECTIVE

We aimed to assess the associations between problematic smartphone use, unhealthy behaviors, and mental health status among adolescents.

METHODS

The data for this cross-sectional study were obtained from the 13th Korea Youth Risk Behavior Survey (2017). From among the 62,276 adolescents who participated in this nationwide web-based survey, 54,603 (87.7%) who used smartphones were selected as the study population. Unhealthy behaviors included smoking, drinking, physical inactivity, skipping breakfast, and fast food consumption. For the examination of mental health status, we considered sleep disturbances, stress, depressive symptoms, suicidal ideation, and suicide attempts. The associations between problematic smartphone use, unhealthy behaviors, and mental health were analyzed using multiple logistic regression analyses.

RESULTS

More than four hours of use on weekdays (31.3%) and weekends (61.3%) and the use of smartphones for communication (46.9%) were associated with unhealthy behaviors and mental health problems. Furthermore, adolescents who experienced conflicts with family (22.3%) and friends (25.8%) and academic problems (3.4%) were likely to have health problems.

CONCLUSION

The results suggest that problematic smartphone use may disrupt adolescents' health. Therefore, there is a need for prevention programs for problematic smartphone use at home and at school to improve adolescents' health.

Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial

BACKGROUND

Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children.

METHODS

A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap.

RESULTS

No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents.

CONCLUSIONS AND RECOMMENDATIONS

A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.

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

OBJECTIVE

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

DESIGN

Systematic literature review with meta-analysis.

METHODS

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

MAIN OUTCOME MEASURES

Diet and family functioning.

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review

BACKGROUND

Household chaos, represented by the level of disorganisation or environmental confusion in the home, has been associated with a range of adverse child and family outcomes. This review aims to (1) identify how household chaos is measured, (2) chart study details of household chaos literature, and (3) map the existing literature with respect to the relationship between household chaos and child, parent, and family outcomes. We expect that this review will highlight the need to consider the importance of household chaos in child well-being research, particularly in those families where children may be more vulnerable to the adverse effects of household chaos.

METHODS

We searched five electronic databases (last updated September 1st 2018) in addition to Google Scholar, and identified publications via a 3-stage screening process, which was conducted by two researchers. Published studies were included if they investigated the association between household chaos and child, parent, or family outcomes. Research that investigated household chaos as a mediator or moderator, or that investigated how the relationship between household chaos and the outcome of interest was mediated or moderated, were also included.

RESULTS

One hundred twelve studies in 111 publications were included. The majority were conducted in the United States (n = 71), and used either cross-sectional (n = 60) or longitudinal (n = 49) study designs. Outcomes of interest were categorised into seven categories: (1) cognitive and academic (n = 16), (2) socio-emotional and behavioural (n = 60), (3) communication (n = 6), (4) parenting, family, and household functioning (n = 21), (5) parent outcomes (n = 6), (6) hormone (n = 8), and (7) physical health and health behaviours (n = 19). There was consistent evidence for significant correlations between household chaos and adverse outcomes across all seven categories in diverse populations with respect to age, disease status, and socio-economic status (SES).

CONCLUSION

There is consistent evidence for associations between household chaos and a number of adverse child, parent, and family-level outcomes. Household chaos may also help describe variations in outcomes between low SES and child development.

Do bedroom screens and the mealtime environment shape different trajectories of child overweight and obesity? Research using the Growing Up in Scotland study

OBJECTIVE

To investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample.

METHODS

Growth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children's diet patterns, overall screen use, physical activity and sleep.

RESULTS

Five trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30-5.00]; 1.62 [1.01-2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99-6.77]; 1.75 [1.17-2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13-2.36]).

CONCLUSION

Bedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity.

A healthful home food environment: Is it possible amidst household chaos and parental stress?

PURPOSE

This study examines how household chaos and unmanaged parental stress are associated with and contribute to variance in markers of the home food environment (family meal frequency, perceived barriers to cooking, healthful home food availability). Obtaining a better understanding of these relationships could guide more effective family-based interventions to promote healthful home food environments.

METHODS

The analytic sample included 819 households with children in the population-based Project EAT-IV cohort with survey data from 2015 to 2016. Multiple linear regression was used to generate means and 95% confidence intervals of home food environment variables, and estimates for the contribution of household chaos (defined by frenetic activity, loud noises and disorder), and quartiles of unmanaged parental stress (ratio of perceived stress and ability to manage stress). Model fit was also examined.

RESULTS/FINDINGS

Both household chaos and quartiles of unmanaged parental stress were independently and inversely associated with family meal frequency (p's < 0.001) and positively associated with perceived mealtime preparation barriers (p's < 0.001). Unmanaged parental stress was also inversely associated with healthful home food availability (p = 0.004). Models including demographic characteristics, household chaos scores, and quartiles of unmanaged parental stress index showed significantly improved model fit for all outcomes compared to less comprehensive models. Among families with high chaos, those having 7 + family meals/week were significantly more likely to have lower mealtime preparation barrier scores, younger children and higher healthful home food availability scores than families eating together less often.

CONCLUSIONS

Interventions to assist with parental management of stress and chaos within the home environment (e.g., establishing routines) may increase family meal frequency and the quality of children's home food environments.

Associations of Mother's Behaviors and Home/Neighborhood Environments with Preschool Children's Physical Activity Behaviors

OBJECTIVE

Examining associations of mother's behaviors and home/neighborhood physical activity (PA) environments with preschoolers' PA and screen time.

DESIGN

Cross-sectional online survey.

SETTING

Mothers with a 2 to 5 years old preschooler were recruited from the US panel members of Survey Sampling International.

PARTICIPANTS

Five hundred thirty-one mothers with a preschool child aged 2 to 5 years old.

OUTCOME MEASURE

Child daily screen time and PA, mother-child inside- and outside-home co-PA.

ANALYSIS

K-mean cluster analysis and Logit and negative binomial regressions.

RESULTS

Mothers' healthy behaviors, such as decreased screen time, healthy eating habits, and increased PA, and perceived importance for PA were significantly (P < .05) associated with preschoolers' decreased screen time and increased PA. Available toys (P < .01) and maternal perceived neighborhood safety (P < .05) were negatively correlated with preschoolers' screen time, while available room space (P < .01) was positively correlated with preschoolers' PA. Variables positively correlated with mother-child co-PA included mothers' PA (P < .001) and healthy eating habits (P < .05), and home room space (P < .05) for inside-home, and yard space and quality (P < .05) for outside-home.

CONCLUSIONS

Mother's role modeling and home PA environment were positively associated with preschoolers' PA behavior.

Disrupted Relationships, Chaos, and Altered Family Meals in Food-Insecure Households: Experiences of Caregivers and Children

BACKGROUND

Regular family meals foster healthy physical and social development of children but often occur less frequently in households experiencing food insecurity. How food insecurity influences the quality of these interactions is not understood well.

OBJECTIVE

To better understand family meal experiences of caregivers and children living in food-insecure households.

DESIGN

A qualitative method with cross-sectional sample was used, collecting data using semistructured interview guides.

PARTICIPANTS

Twenty ethnically diverse caregiver-child (aged 9 to 15 years) dyads in South Carolina were interviewed.

STATISTICAL ANALYSIS

Data were analyzed using grounded theory in Nvivo 10.

RESULTS

Food-insecure households described family meals that varied in frequency, location, and quality of foods served, especially during times of food shortages. Interpersonal relationships drove the quality of mealtime interactions for these households. Household chaos not only influenced the frequency and location of meals, but also strained mealtime interactions in households with poor interpersonal relationships. In these homes, household chaos included conflicts with work and afterschool schedules, food shortages, coping with poverty and food insecurity (eg, working extra hours or seeking food assistance), and children visiting multiple homes, particularly when food was limited. All households experienced chaos, but strong interpersonal relationships were described as the primary reason for enjoyable mealtime experiences with few disruptions.

CONCLUSIONS

Exploring family meal experiences of children in food-insecure households highlights the importance of interpersonal relationships and regular, positive mealtime interactions that may strengthen emotional connections in families to improve child health outcomes.

Engaging Children to Support Parental Weight Loss: A Randomized Trial

Background. Despite evidence that social network members influence the eating behaviors of adults, no study to date has had the primary aim of examining children as support partners for parents in a weight loss intervention. Aim. To evaluate parent adherence with eating/exercise goals and weight loss in a 6-month study engaging children as support partners. Method. Adults with obesity (body mass index ≥ 30 kg/m², n = 102) and at least one child ≥12 years were randomized to a child support or control group. In the child support group, children enrolled with their parent and engaged in a supportive behavior 2 days/week. In the control group, there was no enrolled child support. Parents in both groups selected a healthy eating strategy and daily step goal. Results. There was no difference in weight loss between the child support and control groups (-5.97 vs. -5.42 lbs, p = .81). In the child support group, 30% of children did not engage in the study. The majority of parents whose children did not engage withdrew from the study. In secondary analyses, parent adherence with eating/exercise goals increased with the days of child support (p < .001). For all participants, low chaos in the home environment (p < .04) and increased parent adherence with follow-ups (p < .008) predicted weight loss. Conclusions. We found no treatment effect of child support on weight loss. Active child support of eating/exercise goals appeared to facilitate goal adherence, while anticipated but unrealized child support may have had iatrogenic consequences. Further investigation of family-focused weight loss interventions is warranted.

Household Chaos, Maternal Emotional Responsiveness, and Child Eating Behavior: A Moderation Analysis

OBJECTIVE

To address calls for a resilience-informed approach to understand the cause and prevention of childhood obesity, the current study aims to investigate the independent and interactive associations between household chaos, maternal emotional responsiveness, and eating behavior in early childhood.

METHOD

A sample of (n = 108) families of 18- to 24-month-olds completed self-report surveys and consented to home visits as part of the larger STRONG Kids 2 (N = 468) study. Videotapes of family mealtimes were collected during home visits and coded for observed maternal emotional responsiveness. Mothers completed questionnaires assessing maternal emotional responsiveness, household chaos, and child eating behaviors. Moderation analyses assessed independent and interactive effects of chaos and emotional responsiveness on child appetite self-regulation.

RESULTS

In moderation analyses controlling for demographic covariates, higher levels of chaos were associated with more emotional overeating and with more food responsiveness, but only among children of mothers observed engaging in low levels of responsiveness at mealtimes. There was no association between chaos and eating behavior among children of mothers observed engaging in high levels of emotional responsiveness at mealtimes. There was also no independent or interactive association between chaos and child eating behaviors characterized by food avoidance.

CONCLUSION

Preliminary evidence suggests that maternal emotional responsiveness at mealtimes may attenuate the deleterious effects of chaos on child overeating and food responsiveness. Future research should prioritize using longitudinal designs, developing observational assessments of early childhood eating behaviors, and understanding these processes among families exposed to greater socioeconomic adversity.

Exploring the Role of Family Functioning in the Association Between Frequency of Family Dinners and Dietary Intake Among Adolescents and Young Adults

IMPORTANCE

Eating meals, particularly dinner, with family members has been associated with improved dietary intake among youths. However, existing studies have not examined how family functioning may moderate or confound this association.

OBJECTIVE

To examine whether level of family functioning is associated cross-sectionally with frequency of family dinners and dietary intake among a US national sample of adolescents and young adults.

DESIGN, SETTING, AND PARTICIPANTS

Data from the 2011 questionnaire in the Growing Up Today Study 2 were used for this cross-sectional study. Linear regression models examined the extent to which family dinner frequency was associated with self-reported intake of fruits and vegetables, sugar-sweetened beverages, fast food, and takeout food among 2728 adolescents and young adults (age, 14-24 years). To explore effect modification by family functioning, an interaction term for family functioning and family dinner frequency was included for each dietary outcome. To explore confounding, models adjusted for family functioning were run. All models were stratified by sex and included participant age, educational attainment of mother's spouse or partner, and family structure as covariates. Statistical analysis was conducted between January 1, 2017, and August 31, 2018.

MAIN OUTCOMES AND MEASURES

Dietary intake measured by consumption of fruits and vegetables, sugar-sweetened beverages, takeout food, and fast food; family dinner frequency per week; and family functioning.

RESULTS

Among the 2728 participants, there were 1559 female and 1169 male participants who were 14 to 24 years of age (mean [SD] age, 19.4 [1.9] years) and were living with their parents in 2011. Most participants (2453 of 2649 [92.6%]) identified as white. More frequent family dinners were associated with higher-quality dietary intake regardless of level of family functioning; interactions between family functioning and family dinner frequency were not significant. Associations between family meal frequency and dietary intake outcomes did not change substantively when adjusting for family functioning. In adjusted models, more frequent family dinners were associated with higher intakes of fruits (female participants: β, 0.09 servings/d; 95% CI, 0.04-0.15 servings/d; male participants: β, 0.07 servings/d; 95% CI, 0.01-0.12 servings/d) and vegetables (female participants: β, 0.21 servings/d; 95% CI, 0.12-0.30 servings/d; male participants: β, 0.19 servings/d; 95% CI, 0.09-0.30 servings/d), and lower intakes of fast food (female participants: β, -0.04 times/wk; 95% CI, -0.07 to 0.00 times/wk; male participants: β, -0.10 times/wk; 95% CI, -0.15 to -0.04 times/wk) and takeout foods (female participants: β, -0.04 times/wk; 95% CI, -0.07 to -0.01 times/wk; male participants: β, -0.06 times/wk; 95% CI, -0.10 to -0.02 times/wk). More frequent family dinners were associated with lower intake of sugar-sweetened beverages for male participants only (β, -0.07 servings/d; 95% CI, -0.13 to -0.02 servings/d).

CONCLUSIONS AND RELEVANCE

More frequent family dinners are associated with healthful dietary intakes among youths, regardless of level of family functioning. Family dinners may be an appropriate intervention target for improving dietary intake among youths.

Relationships of family conflict, cohesion, and chaos in the home environment on maternal and child food-related behaviours

This study examined how food-related behaviours differed in mothers and their preschool children by levels of family functioning (cohesion and conflict) and household disorganization (chaos). A nationally representative sample of mothers of preschoolers completed an online survey assessing food-related behaviours of themselves and their children. Maternal and child diet, eating behaviours, and health status; household availability of fruits/vegetables, salty/fatty snacks, and sugar-sweetened beverages; family mealtime atmosphere; and family conflict, cohesion, and household chaos were assessed with valid, reliable scales. Cluster analyses assigned families into low, middle, and high conflict, cohesion, and chaos groups. Participants (n = 550) were 72% White, and 82% had some post-secondary education. Regression analysis examining the association of cluster grouping levels on diet-related behaviour measures revealed that positive home environments (i.e., low family conflict, high family cohesion, and low household chaos) were associated with healthier food-related behaviours (e.g., increased fruits/vegetables intake), whereas negative home environments (i.e., high family conflict, low family cohesion, and high household chaos) were associated with unhealthy food-related behaviours (e.g., greater % total calories from fat) even after controlling for sociodemographic and related behavioural factors. Findings suggest family functioning and household chaos are associated with food-related behaviours. This frequently overlooked component of family interaction may affect intervention outcomes and objectives of educational and interventional initiatives.