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Tate AD, Fertig AR, de Brito JN, Ellis ÉM, Carr CP, Trofholz A, Berge JM. Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment. JMIR Form Res 2024; 8:e49512. [PMID: 38656787 PMCID: PMC11079761 DOI: 10.2196/49512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. OBJECTIVE This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. METHODS The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question "Overall, how difficult was it for you to fill out the surveys today?" on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. RESULTS The burden was low at 1.2 (SD 1.14) indicating "a little" burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English-speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (β=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. CONCLUSIONS The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives.
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Affiliation(s)
- Allan D Tate
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, United States
| | - Junia N de Brito
- Department of Family Medicine and Community Health, University of Minnesota Medical School, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Émilie M Ellis
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Christopher Patrick Carr
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Jerica M Berge
- Department of Family Medicine and Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Edwards K, Croker H, Farrow C, Haycraft E, Herle M, Llewellyn C, Pickard A, Blissett J. Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study. JMIR Res Protoc 2024; 13:e55193. [PMID: 38502178 PMCID: PMC10988368 DOI: 10.2196/55193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents' daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children's healthy eating behavior. OBJECTIVE We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. METHODS Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. RESULTS Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. CONCLUSIONS The findings from this study will provide an understanding of caregivers' daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children's avid eating behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55193.
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Affiliation(s)
- Katie Edwards
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Helen Croker
- World Cancer Research Fund International, London, United Kingdom
| | - Claire Farrow
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Clare Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Abigail Pickard
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Jacqueline Blissett
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
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Berge JM, Hazzard VM, Trofholz A, Noser AE, Hochgraf A, Neumark-Sztainer D. Longitudinal associations between family meal quality and quantity: Does one matter more for child, parent, and family health and well-being or are they synergistic? Appetite 2023; 191:107080. [PMID: 37832722 PMCID: PMC11006826 DOI: 10.1016/j.appet.2023.107080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/15/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
It is unknown how family meal quantity (i.e., frequency) and quality (i.e., meal healthfulness and interpersonal quality) are associated with child, parent, and family health and well-being over time. This study aimed to examine longitudinal associations between family meal quantity and quality and child, parent, and family health and well-being and whether there was a synergistic effect between family meal quantity and quality. Children ages 5-9 and their parents from six racial/ethnic groups participated in this longitudinal cohort study. Regression models adjusted for socio-demographic characteristics examined family meal quantity, interpersonal quality, and nutritional quality at baseline and interactions between quantity and quality, in relation to changes in child, parent, and family health outcomes from baseline to 18-month follow-up. Higher family meal quantity predicted reduced obesity prevalence, improved diet quality and less food fussiness, food responsiveness, and conduct problems among children at follow-up. Higher family meal quality predicted improved diet quality, lower emotional problems, less food responsiveness, and fewer peer relationship problems among children, improved diet quality and reduced psychological distress for parents, and less family chaos at follow-up. One interaction between family meal quantity and quality was found for child peer relationship problems. Overall, family meal quantity and quality were independently important for child health and well-being and for some parent and family health outcomes. Clinicians working with families may want to emphasize the importance of both family meal quantity and quality, as these longitudinal findings suggest potential benefits for the entire family.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Vivienne M Hazzard
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Amy E Noser
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anna Hochgraf
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
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Berge JM, Fertig AR, Trofholz A, de Brito JN. Real-time predictors of food parenting practices and child eating behaviors in racially/ethnically diverse families. Int J Behav Nutr Phys Act 2023; 20:86. [PMID: 37434195 PMCID: PMC10337081 DOI: 10.1186/s12966-023-01476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Prior research has shown associations between controlling food parenting practices (e.g., pressure-to-eat, restriction) and factors that increase risk for cardiovascular disease in children (e.g., low diet quality, obesity). This study aimed to examine associations between real-time parental stress and depressed mood, food parenting practices, and child eating behaviors in a longitudinal cohort study. METHODS Children ages 5-9 years and their families (n = 631) from six racial/ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited for this study through primary care clinics in a large metromolitan area in the US (Minneapolis/St. Paul, MN) in 2016-2019. Ecological momentary assessment was carried out over seven days with parents at two time points, 18 months apart. Adjusted associations between morning stress and depressed mood of parents on food parenting practices and child eating behaviors at the evening meal were examined. Interactions tested whether food security, race/ethnicity and child sex moderated associations. RESULTS High levels of parental stress and depressed mood experienced earlier in the day were associated with controlling food parenting practices and child food fussiness at dinner the same night. Results were dependent on food security status, race/ethnicity, and child sex. CONCLUSIONS Health care professionals may want to consider, or continue, screening parents for stress, depression, and food insecurity during well-child visits and discuss the influence these factors may have on food parenting practices and child eating behaviors. Future research should use real-time interventions such as ecological momentary intervention to reduce parental stress and depressed mood to promote healthy food parenting practices and child eating behaviors.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55414, USA.
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55414, USA
| | - Junia N de Brito
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55414, USA
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Daragan C, Tate AD, Trofholz AC, Berge JM. Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals. Appetite 2023; 184:106480. [PMID: 36736904 PMCID: PMC10033380 DOI: 10.1016/j.appet.2023.106480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine parent-reported key family meal characteristics to advance the conceptualization of how parents perceive family meals to inform public health interventions and clinical practice. DESIGN Cross-sectional study design using ecological momentary assessment (EMA) and online survey data from a racially and ethnically diverse population. PARTICIPANTS Parent/child dyads (N = 631) with children ages 5-9 years old from diverse, low-income households. ANALYSIS Multi-level logistic regression, conditional fixed effects estimators and multi-level logistic models with inverse probability weights. RESULTS Characteristics of meals that parents considered family meals (N = 3328) included: homemade, prepared by the caregivers, eaten at home (table/counter), most of the nuclear family gathered, having a conversation and an enjoyable atmosphere (p < 0.001). Characteristics of meals that parents deemed as non-family meals (N = 562) included: watching TV/tablets, non-family members joining, chaotic/rushed atmosphere (p < 0.001). CONCLUSIONS AND IMPLICATIONS Parents consider family meals to be meals that take place at home around a table/counter, with homemade food prepared by the caregivers, and most family members gathered enjoying a conversation without other distractions. Study findings indicated that parents endorse specific characteristics as key for defining what "counts" as a family meal. These findings can be used by clinicians as recommendations for improving one's family meal experience and by future research as the basis for intervening on family meal characteristics and standardization of a definition of family meals.
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Affiliation(s)
- Christina Daragan
- University of Minnesota Medical School, 515 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Allan D Tate
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 202 B.S. Miller Hall, 101 Buck Rd, Athens, GA, 30602, USA.
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Delaware Street SE Room 425, MMC 381, Minneapolis, MN, 55455, USA
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Delaware Street SE Room 425, MMC 381, Minneapolis, MN, 55455, USA.
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Berge JM, Trofholz AC, Aqeel M, Norderud K, Tate A, Fertig AR, Loth K, Mendenhall T, Neumark-Sztainer D. A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design. BMC Public Health 2023; 23:708. [PMID: 37072737 PMCID: PMC10112996 DOI: 10.1186/s12889-023-15504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. METHODS/DESIGN The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. DISCUSSION This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. TRIAL REGISTRATION This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA.
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Marah Aqeel
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Kristin Norderud
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Allan Tate
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Angela R Fertig
- University of Minnesota, Humphrey School of Public Affairs, Minneapolis, MN, USA
| | - Katie Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Tai Mendenhall
- Department of Family Social Science, University of Minnesota, Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Loth KA, Ji Z, Wolfson J, Fisher J, Berge J, Neumark-Sztainer D. Momentary predictors of a broad range of food parenting practices within a population-based sample of parents of preschool-aged children. Front Public Health 2023; 10:944734. [PMID: 36726615 PMCID: PMC9885496 DOI: 10.3389/fpubh.2022.944734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction The current study sought to understand the influence of momentary factors within the home and family environment, including parent stress, parent and child mood and child behaviors, on parents' use of a broad range of food parenting practices later that same day. Methods Ecological Momentary Assessment (EMA) was used to evaluate parents' use of coercive, indulgent, structured and autonomy support food parenting practices, as well as numerous potentially salient momentary predictors, including parental stress, parent and child mood, and child behavior. Data were collected from 109 parents of preschool aged children multiple times per day over the course of a ten-day data collection period, allowing for temporal sequencing of momentary predictors and use of food parenting practices. Results With some notable exceptions, study findings align with study hypotheses in that parent stress, parent and child low mood, and child negative behaviors early in the day were found to be associated with the use of less supportive food parenting practices later that same day. For example, greater parent negative mood earlier in the day was associated with a decrease in use of feeding practices from within the structure domain later on that same day (-2.5%, p < 0.01), whereas greater parent positive mood earlier in the day was associated with an increase in use of structure later on that same day (+3.7%, p < 0.01). Greater parent stress earlier in the day was associated with an increase in the use of coercive control (+3.2%, p < 0.01) and indulgent (+3.0%, p < 0.01) practices later that same day; surprisingly, a similar increase in stress earlier in the day was also found to be associated with an increase in the use of autonomy support (5.6%, p < 0.01) feeding practices later on that same day. Discussion Developing an understanding of the types of momentary factors that influence a parent's use of particular food parenting practices across multiple contexts is a crucial next step toward developing effective interventions aimed at teaching parents to use food parenting practices that are supportive of healthful child dietary intake and eating behaviors in a way that is responsive to shifting factors.
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Affiliation(s)
- Katie A. Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Ziyu Ji
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Jennifer Fisher
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jerica Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Parker H, Burkart S, Reesor-Oyer L, Smith MT, Dugger R, von Klinggraeff L, Weaver RG, Beets MW, Armstrong B. Feasibility of Measuring Screen Time, Activity, and Context Among Families With Preschoolers: Intensive Longitudinal Pilot Study. JMIR Form Res 2022; 6:e40572. [PMID: 36173677 PMCID: PMC9562053 DOI: 10.2196/40572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital media has made screen time more available across multiple contexts, but our understanding of the ways children and families use digital media has lagged behind the rapid adoption of this technology. OBJECTIVE This study evaluated the feasibility of an intensive longitudinal data collection protocol to objectively measure digital media use, physical activity, sleep, sedentary behavior, and socioemotional context among caregiver-child dyads. This paper also describes preliminary convergent validity of ecological momentary assessment (EMA) measures and preliminary agreement between caregiver self-reported phone use and phone use collected from passive mobile sensing. METHODS Caregivers and their preschool-aged child (3-5 years) were recruited to complete a 30-day assessment protocol. Within 30-days, caregivers completed 7 days of EMA to measure child behavior problems and caregiver stress. Caregivers and children wore an Axivity AX3 (Newcastle Upon Tyne) accelerometer to assess physical activity, sedentary behavior, and sleep. Phone use was assessed via passive mobile sensing; we used Chronicle for Android users and screenshots of iOS screen time metrics for iOS users. Participants were invited to complete a second 14-day protocol approximately 3-12 months after their first assessment. We used Pearson correlations to examine preliminary convergent validity between validated questionnaire measures of caregiver psychological functioning, child behavior, and EMA items. Root mean square errors were computed to examine the preliminary agreement between caregiver self-reported phone use and objective phone use. RESULTS Of 110 consenting participants, 105 completed all protocols (105/110, 95.5% retention rate). Compliance was defined a priori as completing ≥70%-75% of each protocol task. There were high compliance rates for passive mobile sensing for both Android (38/40, 95%) and iOS (64/65, 98%). EMA compliance was high (105/105, 100%), but fewer caregivers and children were compliant with accelerometry (62/99, 63% and 40/100, 40%, respectively). Average daily phone use was 383.4 (SD 157.0) minutes for Android users and 354.7 (SD 137.6) minutes for iOS users. There was poor agreement between objective and caregiver self-reported phone use; root mean square errors were 157.1 and 81.4 for Android and iOS users, respectively. Among families who completed the first assessment, 91 re-enrolled to complete the protocol a second time, approximately 7 months later (91/105, 86.7% retention rate). CONCLUSIONS It is feasible to collect intensive longitudinal data on objective digital media use simultaneously with accelerometry and EMA from an economically and racially diverse sample of families with preschool-aged children. The high compliance and retention of the study sample are encouraging signs that these methods of intensive longitudinal data collection can be completed in a longitudinal cohort study. The lack of agreement between self-reported and objectively measured mobile phone use highlights the need for additional research using objective methods to measure digital media use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-36240.
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Affiliation(s)
- Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Layton Reesor-Oyer
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Michal T Smith
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Roddrick Dugger
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Loth KA, Ji Z, Wolfson J, Neumark-Sztainer D, Berge JM, Fisher JO. A descriptive assessment of a broad range of food-related parenting practices in a diverse cohort of parents of preschoolers using the novel Real-Time Parent Feeding Practices Survey. Int J Behav Nutr Phys Act 2022; 19:22. [PMID: 35236392 PMCID: PMC8889698 DOI: 10.1186/s12966-022-01250-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Much of the research to-date on food parenting has evaluated typical use of various parent feeding practices via questionnaire. The Real-Time Parent Feeding Practices Measurement survey was developed for use within an Ecological Momentary Assessment (EMA) protocol to capture momentary use of parent feeding practices in real-time. Methods This manuscript describes the development of the EMA-based Real-Time Parent Feeding Practices survey and highlights initial descriptive data on the real-time use of 22 individual parent feeding practices (e.g., pressure-to-eat, guided choices, etc.) as reported via EMA by parents of preschool-aged children (n = 116) over a 10-day data collection time period. A total of 3382 eating occasions were reported, with an average of 29.2 reported eating occasions per participant. Results Results revealed that most participants used a variety of food-related parenting practices day-to-day that span four higher-order domains: structure, autonomy support, coercive control and indulgence. Supportive feeding practices, defined as those from the structure and autonomy support domains, were reported most frequently, with one or more structure behavior (e.g., specific mealtime rules/routines) was used at 88.9% of reported eating occasions and one or more autonomy support behavior (e.g., involvement of the child in meal preparation) was used at 87.3% of eating occasions. While unsupportive feeding practices, defined as practices from within the coercive control (e.g., pressure-to-eat) and indulgent (e.g., anticipatory catering) feeding domains, were reported less frequently, one or more behaviors from each of these domains were still reported at over 25% of all eating occasions. Conclusions Results of the current study take a next step towards deepening our understanding of the use of a broad range of food-related parenting practices in real-time. Findings revealed that the vast majority of practices used by parents fall within the structure and autonomy support domains. However, most parents did not exclusively use supportive or unsupportive practices, rather they used a combination of food-related parenting practices across all domains. Future research should continue to explore a broad range of food-related parenting practices and seek to understand how parent approaches to feeding are associated with long-term child outcomes, including dietary intake, food preferences, and eating patterns.
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Affiliation(s)
- K A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA. .,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA. .,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA. .,College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Z Ji
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,College of Public Health, Temple University, Philadelphia, PA, USA
| | - J Wolfson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,College of Public Health, Temple University, Philadelphia, PA, USA
| | - D Neumark-Sztainer
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,College of Public Health, Temple University, Philadelphia, PA, USA
| | - J M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,College of Public Health, Temple University, Philadelphia, PA, USA
| | - J O Fisher
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,College of Public Health, Temple University, Philadelphia, PA, USA
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10
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Reesor-Oyer L, Parker H, Burkart S, Smith MT, Dugger R, von Klinggraeff L, Weaver RG, Beets MW, Armstrong B. Measuring Micro Temporal Processes Underlying Preschoolers Screen Use and Behavioral Health: Protocol for the Tots & Tech Study (Preprint). JMIR Res Protoc 2022; 11:e36240. [PMID: 36169993 PMCID: PMC9557980 DOI: 10.2196/36240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 12/19/2022] Open
Abstract
Background Excessive screen time is associated with poor health and behavioral outcomes in children. However, research on screen time use has been hindered by methodological limitations, including retrospective reports of usual screen time and lack of momentary etiologic processes occurring within each day. Objective This study is designed to assess the feasibility and utility of a comprehensive multibehavior protocol to measure the digital media use and screen time context among a racially and economically diverse sample of preschoolers and their families. This paper describes the recruitment, data collection, and analytical protocols for the Tots and Tech study. Methods The Tots and Tech study is a longitudinal, observational study of 100 dyads: caregivers and their preschool-age children (aged 3-5 years). Both caregivers and children will wear an Axivity AX3 accelerometer (Axivity Ltd) for 30 days to assess their physical activity, sedentary behavior, and sleep. Caregivers will complete ecological momentary assessments (EMAs) for 1 week to measure child behavioral problems, caregiver stress, and child screen time. Results The Tots and Tech study was funded in March 2020. This study maintains rolling recruitment, with each dyad on their own assessment schedule, depending on the time of enrollment. Enrollment was scheduled to take place between September 2020 and May 2022. We aim to enroll 100 caregiver-child dyads. The Tots and Tech outcome paper is expected to be published in 2022. Conclusions The Tots and Tech study attempts to overcome previous methodological limitations by using objective measures of screen time, physical activity, sedentary behavior, and sleep behaviors with contextual factors measured by EMA. The results will be used to evaluate the feasibility and utility of a comprehensive multibehavior protocol using objective measures of mobile screen time and accelerometry in conjunction with EMA among caregiver-child dyads. Future observational and intervention studies will be able to use this study protocol to better measure screen time and its context. International Registered Report Identifier (IRRID) DERR1-10.2196/36240
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Affiliation(s)
- Layton Reesor-Oyer
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Hannah Parker
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Sarah Burkart
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michal T Smith
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Roddrick Dugger
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Lauren von Klinggraeff
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - R Glenn Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michael W Beets
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
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