High calorie, low nutrient food/beverage intake and video gaming in children as potential signals for addictive behavior

Video game playing and oral health in school-age children: A cross-sectional study in Turkey

AIM

The aim of this study is to evaluate the relationship of video game playing with oral/dental health and harmful oral habits in school-age children.

METHODS

The daily video gamer (n = 77) and occasional video gamer (n = 77) children between 6 and 12 years old were included in the study. A questionnaire inquiring socio-demographic characteristics, video gaming and abnormal oral habits of the children was filled by parents. The children were examined intraorally and decayed-missing-filled tooth, the International Caries Detection and the Assessment-II System scores, dental plaque and gingival indices were recorded.

RESULTS

Of the children; 42.9% daily video gamers played video games for between 1 and 2 h and 57.1% played for ≥2 h while all of the occasional video gamers spent for between 1 and 2 h on video game per day. The daily video gamer and occasional video gamer children were not different in terms of socio-demographic characteristics, frequency of having daily tooth brushing habit, using children's toothpaste and having regular dental checkup (P > 0.05). No statistically significant difference was present between the groups in terms of frequencies of abnormal oral habits and having at least one abnormal oral habit (P > 0.05). Severe gingivitis and advanced caries lesions were more common in daily video gamer group (14.2% vs. 3.9%, P = 0.025 and 90.9% vs. 70.9%, P = 0.026, respectively). Daily video gaming time was weakly correlated with plaque index (r = 0.26, n = 77, P = 0.024). Daily video gaming for ≥2 h increased the risk for severe gingivitis (odds (95% confidence interval) = 4.53 (1.07-19.23), P = 0.041) while daily video gaming for between 1 and 2 h decreased the risk for having abnormal oral habit (odds (95% confidence interval) = 0.39 (0.16-0.93), P = 0.034).

CONCLUSION

In school age, daily video gaming may worsen oral and dental health compared with occasional video gaming. Particularly, an excessive video gaming time seems to be associated with poor oral health in school children.

Children with lower ratings of executive functions have a greater response to the portion size effect

Deficits in executive functions (EFs), a set of cognitive processes related to self-regulation, are associated with the development of obesity. Prior studies from our group showed that lower food-cue related activation in brain regions implicated in self-regulation was related to a larger portion size effect. We tested the hypothesis that lower EFs in children would be positively related to the portion size effect. Healthy weight children aged 7-8 y (n = 88), who varied by maternal obesity status, participated in a prospective study. At baseline, the parent primarily in charge of feeding completed the Behavior Rating Inventory of Executive Function (BRIEF2) to assess child EFs, including Behavioral (BRI), Emotional (ERI), and Cognitive (CRI) indices. At 4 baseline sessions, children consumed meals in which the portion sizes of foods (pasta, chicken nuggets, broccoli, and grapes) varied by visit (total meal weight of 769, 1011, 1256, or 1492g). Intake increased with increasing portions in a linear trajectory (p < 0.001). EFs moderated the portion size effect such that lower BRI (p = 0.003) and ERI (p = 0.006) were associated with steeper increases in intake as portions increased. As amount of food increased, children in the lowest functioning tertiles for BRI and ERI increased intake by 35% and 36%, respectively, compared to children in the higher tertiles. Increases in intake among children with lower EFs were for higher- but not lower-energy-dense foods. Thus, in healthy weight children who varied by obesity risk, lower parentally reported EFs were associated with a larger portion size effect, and these results were independent of child and parent weight status. Therefore, EFs may be target behaviors that could be strengthened to help children moderate excess intake in response to large portions of energy-dense foods.

Association between dietary quality and executive functions in school-aged children with autism spectrum disorder

Background

It is well known that children with autism spectrum disorder (ASD) had executive functions deficit. However, it is still unclear whether the poor dietary quality is related to the impairment of executive functions. The current study aimed to explore the association between dietary quality and executive functions in children with ASD.

Methods

A total of 106 children with ASD (7.7 ± 1.3 years) and 207 typically developing (TD) children (7.8 ± 1.3 years) were enrolled from Guangzhou, China. The Chinese version of Behavior Rating Scale of Executive function (BRIEF), the working memory subscales of the Chinese version of Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), and the Stroop Color-Word Test (SCWT) were used to measure the participant's executive functions. The food frequency questionnaire (FFQ) was used to collect the dietary intake information, and the Chinese Diet Balance Index (DBI_16) was used to evaluate the dietary quality. Generalized linear models were used to estimate the association between dietary quality and executive functions.

Results

In children with ASD, Low Bound Score (LBS) was positively correlated with the working memory subscale score of BRIEF (β = 0.23, 95% CI: 0.02–0.44, P < 0.05), while High Bound Score (HBS) and LBS were positively correlated with the organizable subscale score of BRIEF (β = 0.44, 95% CI: 0.11–0.77, P < 0.01; β = 0.19, 95% CI: 0.01–0.37, P < 0.05). Compared to TD children, children with ASD had a higher proportion of moderate and high levels of insufficient dietary intake (moderate level, 37.7% vs. 23.2%, high level, 4.7% vs. 1.4%) and moderate level of unbalanced dietary intake (36.8% vs.21.3%), higher scores on all subscales of BRIEF (P < 0.01), and lower score on the working memory (81.3 ± 32.3 vs. 104.6 ± 12.5, P < 0.01), while there was no difference on the SCWT.

Conclusion

Poor dietary quality was associated with the impairment of working memory and organizational capacity in children with ASD. This study emphasized the importance of dietary quality in executive functions among children with ASD, and attention should be paid to improving their dietary quality.

The Physiological and Cardiologic Effects of Long Video Gaming Sessions in Adult Males

The effect of long gaming sessions on energy intake, caffeine intake, blood pressure, heart rate, heart rate variability, and biochemical cardiac injury markers is unknown. The objective of this exploratory study was to investigate the changes in healthy male adults during two consecutive 18-hour sedentary video gaming sessions. Nine participants were enrolled in the study. Energy intake was noted in food diaries. Heart rate variability was monitored continuously; blood pressure and cardiac injury markers were measured every three to six hours. During the 42-hour study, the participants had an energy and caffeine intake of 8004.9 kcal and 1354.4 mg, respectively. The participants had a significant decrease in energy intake in the second session (p=0.01). A strong, negative correlation was found between body mass index and total energy intake (R=–0.84, p=0.005) and waist circumference and total energy intake (R=–0.70, p=0.036) in the first session. No nightly dip in blood pressure or heart rate was observed. Based on this study, long-term adverse effects of gaming cannot be ruled out. The non-dip of HR and BP suggests that long gaming sessions could be detrimental to cardiovascular health long term.

Improved Executive Functions and Reduced Craving in Youths with Methamphetamine Addiction: Evidence from Combined Transcranial Direct Current Stimulation with Mindfulness Treatment

Objective

Transcranial direct current stimulation (tDCS) and mindfulness practices have been proposed as a potential approach to improve executive functions (EFs) and reduce craving in persons with substance use disorders. Based on the neural mechanisms of action of each of these interventions, the combination of both non-pharmacological interventions might have additive effects. In the current study, the effects of tDCS combined with mindfulness-based substance abuse treatment (MBSAT) to improve EFs and reduce craving were investigated in early abstinent methamphetamine abuse.

Methods

Eighty (youths aged between 18 and 21) early-abstinent methamphetamine users were randomly assigned to the research groups (tDCS group [n = 20], mindfulness group [n = 20], combined mindfulness-tDCS group [n = 20], and sham group [n = 20]). Active tDCS (1.5 mA,20 min, 12 sessions) or sham tDCS was appliedover the left dorsolateral prefrontal cortex and the MBSAT protocol was used over twelve 50-min sessions.

Results

Both in the post-test phase (immediately after the intervention) and follow-up phase (one month after the intervention), performance in most EFs tasks significantly improved in the combination group which received real tDCS ＋ MBSAT, as compared to baseline values and sham stimulation group. Similarly, a significant reduction in craving was observed after intervention inall treatment groups, but not the sham stimulation group. Interestingly, the increase in EFs and the reduction in craving post versus pre tDCS ＋ MBSAT intervention were correlated.

Conclusion

Findings from the current study provide initial support for the clinical effectiveness of combination tDCS ＋ MBSAT, possibly influencing cognitive/affective processes.

Caracterización del trastorno por videojuegos: ¿Una problemática emergente?

Objetivo. Sistematizar la literatura actual disponible en torno a la caracterización del trastorno por videojuegos (VDJ), aportando a la comprensión de este fenómeno en el contexto latinoamericano y su incidencia en la población infanto-juvenil. Método. Se utilizó una revisión sistemática de literatura, de corte analítico. Como eje de búsqueda se consideraron las categorías: (a) uso de las TIC, (b) videojuegos, (c) adicción y (d) trastorno por videojuegos, de acuerdo con estudios publicados en las bases de datos PubMed, ScienceDirect y Google Scholar, teniendo como referencia el DSM-V y CIE-11. Resultados. Las manifestaciones clínicas descritas para su uso adictivo son aún heterogéneas. También, se pudo observar que, cuanto más temprano se empieza, mayor será la frecuencia de su uso en edades posteriores, lo que aumenta las conductas de riesgo en el futuro y su incidencia en el tiempo de ocio y la recreación cotidiana. Conclusión. Los efectos que puede generar el uso problemático de dispositivos tecnológicos en el desarrollo de las personas, se contrapone al uso de los VDJ en el tratamiento de diversos trastornos como en el plano educativo. Adicionalmente, se reafirma el desafío de construir saberes e investigaciones multidisciplinares en torno al uso problemático de estos dispositivos.

Psychosocial factors and multiple health risk behaviors among early adolescents: a latent profile analysis

Early adolescence is a pivotal developmental period when multiple health risk behaviors, such as obesity and substance use, are often established. Several psychosocial factors, often considered traits, have been independently associated with these increases, including executive function (EF), mindfulness disposition (MD), perceived stress, distress tolerance (DT), and anhedonia. However, these factors have not been evaluated for their conjoint relationships to determine whether different patterns may signal greater or lesser risk for obesity and substance use, and whether the same patterns relate to obesity and substance use in the same ways (same magnitude of risk). To evaluate these patterns, a latent profile analysis was conducted, resulting in a three-profile model. Profile 1 (8% of sample) was characterized by the lowest levels of EF, MD, DT and highest levels of stress and anhedonia, profile 2 (44%) intermediate levels, and profile 3 (48%) the highest levels of EF, MD, DT and lowest levels of stress and anhedonia. Youth classified to profile 1 reported significantly greater levels of both obesogenic and substance use behaviors relative to other profiles. Findings suggest that adolescents engaging in obesogenic and substance use behaviors may share common profiles of psychosocial risk.

Health behaviours associated with video gaming in adolescent men: a cross-sectional population-based MOPO study

BACKGROUND

Playing video games, a form of sedentary behaviour, is associated with poor well-being and increased risk of morbidity due to chronic disease. However, the association between health behaviours and video gaming is poorly understood. The purpose of this population-based study was to reveal the differences in dietary habits and physical activity for adolescent men with high amount of video games on weekdays, as compared to their peers who play less often.

METHODS

Seven hundred ninety-six adolescent men (age: mean = 17.8, SD = 0.6) attended compulsory conscription for military service in 2013 and completed a questionnaire regarding the amount and frequency of their video gaming. They also participated in a medical examination and underwent physiological measurements. The participants who played video games more than 3 h/d on weekdays were compared with those who played 3h/d or less. The association between health behaviours and the amount of playing video gaming was analysed using multivariable logistic regression analysis.

RESULTS

24.1% (n = 192) of the participants reported video gaming in excess of 3 h/d. This group had higher incidence of having low physical fitness, having poor eating habits, and being obese. No differences were found in smoking or alcohol drinking habits. Other factors, including low leisure-time physical activity (OR = 1.94; 95% CI, 1.29-2.91), low consumption of vegetables and fruits (OR = 0.83; 95% CI, 0.72-0.97), high consumption of sweetened soft drinks (OR = 1.28; 95% CI, 1.06-1.55) and high amount of sitting time (OR = 1.40; 95% CI, 1.28-1.52), explained one-fourth of the difference.

CONCLUSION

In this population-based study, adolescent men who played video games a lot on weekdays had lower physical fitness, were more often obese, and had poorer dietary habits, as compared to their peers who played less often. Because playing video games typically adds to a person's total sedentary time, this activity may be associated with adverse health outcomes at a very young age- especially in combination with poor health behaviours. The results of this study can be utilized to promote health interventions targeted at adolescent men so as to raise their awareness of the disadvantages of excessive video gaming.

Problematic Video Gaming in a Young Spanish Population: Association with Psychosocial Health

Problematic video gaming (PVG) is a concern for psychologists attending children and adolescents. Uniform diagnostic criteria are lacking, and risk factors are poorly understood. Internet gaming disorder (IGD) was included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and scales derived from its diagnostic criteria may be helpful to assess PVG. A multicenter study was conducted in secondary schools using an IGD-derived scale (dichotomous Nine-Item Internet Gaming Disorder Scale [IGD-9]), analyzing PVG-related variables. Seven hundred eight students (55.8 percent male) with mean age 15.6 ± 2.7 years were included. Seventy-three percent were gamers and 22 percent heavy gamers (HGs). Forty-five percent reported online gaming and 6.6 percent massive multiplayer online role-playing games (MMORPGs). Fifty-nine students (8.3 percent) scored 5 or more in IGD-9 and were classified as IGD+. HG and IGD+ subjects were more frequently male and online and MMORPG gamers (p < 0.01). However, IGD+ subjects had significantly worse psychosocial scores than IGD- (p < 0.001), while HGs did not significantly differ from casual gamers (p > 0.01). The multivariate analysis showed that IGD+ scores were significantly associated with worse psychosocial health and adjustment (p < 0.001), while the other variables (male sex, online and MMORPG gaming, and HG) were not significantly associated (p > 0.01). The IGD-9 scale scored positive in 8.3 percent of our sample. Unlike gaming time, this scale was associated with psychosocial disturbances, making it potentially useful as a screening method to detect candidates for clinical intervention.

Chronic Stress and Impulsive Risk-Taking Predict Increases in Visceral Fat over 18 Months

OBJECTIVE

The aim of this study was to examine whether baseline chronic stress and impulsive risk-taking synergistically predict changes in visceral fat among healthy mothers in an observational, longitudinal, 18-month study.

METHODS

A prospective cohort of 113 adult women (age, mean ± SD: 42.83 ± 4.70; BMI, mean ± SD: 24.86 ± 4.32; 74%, n = 84 white) completed assessments at baseline and 18-month follow-up. Chronically stressed mothers caring for a child with an autism spectrum disorder ("caregivers"; n = 72 participants) were compared with lower stress mothers caring for a neurotypical child ("controls"; n = 41). This study objectively assessed impulsive risk-taking by using the Behavioral Analog Risk Task at baseline and assessed visceral fat at baseline and 18-month follow-up by using bioelectrical impedance (ViScan; Tanita Corporation, Tokyo, Japan).

RESULTS

The interaction of baseline chronic caregiving stress and impulsive risk-taking predicted an 18-month change in visceral fat, such that greater impulsive risk-taking was associated with greater 18-month increases in visceral fat among caregivers (ß = 0.423; P = 0.005) but not among controls (ß = -0.030; P = 0.802), both in unadjusted models and after accounting for covariates. Neither chronic stress nor impulsive risk-taking independently predicted 18-month changes in visceral fat.

CONCLUSIONS

The combination of high chronic stress and high impulsive risk-taking may increase risk for visceral fat gain over time and therefore may be an important intervention target in obesity prevention.

Prevalence of food addiction among Iranian children and adolescents: Associations with sociodemographic and anthropometric indices

Background: Food addiction has been defined as consuming palatable foods leading to addictive-like behaviors. Little studies have assayed food addiction in children and adolescents. Thus, we aimed at identifying the prevalence of food addiction and the relationship between food addiction, sociodemographic and anthropometric indicators among children and adolescents in southwestern Iran. Methods: This cross-sectional study was conducted on 222 elementary school students aged 7 to 13 years in Ahvaz, Iran, using a random sampling method. Sociodemographic and anthropometric indicators were obtained. The 25-item child version of the Yale Food Addiction Scale (YFAS-C) was applied to provide food addiction diagnosis and symptoms. A nonparametric analysis was used for data analysis. Results: The prevalence of food addiction was 17.3%. Also, the most common symptoms associated with food addiction were (1) inability to cut down, (2) withdrawal, and (3) tolerance. The students with food addiction diagnosis were older than the undiagnosed (p=0.04). The males and students older than 8 years showed a higher food addiction score than females and students under 8 years (p<0.05). In females, significant positive correlations were found between anthropometric indicators, including body mass index and body mass index z-score, with food addiction score (p<0.01). Conclusion: Food addiction diagnosis was more prevalent in males and students over 8 years. Females with higher YFAS-C scores had elevated body mass index z-scores, suggesting that food addiction may be a remarkable problem in childhood and early adolescence and may also be related to a risk of overweight/obesity in Iranian students.

A model linking video gaming, sleep quality, sweet drinks consumption and obesity among children and youth

There is a growing need to curb paediatric obesity. The aim of this study is to untangle associations between video-game-use attributes and obesity as a first step towards identifying and examining possible interventions. Cross-sectional time-lagged cohort study was employed using parent-child surveys (t1) and objective physical activity and physiological measures (t2) from 125 children/adolescents (mean age = 13.06, 9-17-year-olds) who play video games, recruited from two clinics at a Canadian academic children's hospital. Structural equation modelling and analysis of covariance were employed for inference. The results of the study are as follows: (i) self-reported video-game play duration in the 4-h window before bedtime is related to greater abdominal adiposity (waist-to-height ratio) and this association may be mediated through reduced sleep quality (measured with the Pittsburgh Sleep Quality Index); and (ii) self-reported average video-game session duration is associated with greater abdominal adiposity and this association may be mediated through higher self-reported sweet drinks consumption while playing video games and reduced sleep quality. Video-game play duration in the 4-h window before bedtime, typical video-game session duration, sweet drinks consumption while playing video games and poor sleep quality have aversive associations with abdominal adiposity. Paediatricians and researchers should further explore how these factors can be altered through behavioural or pharmacological interventions as a means to reduce paediatric obesity.

Differential Effects of Reward Drive and Rash Impulsivity on the Consumption of a Range of Hedonic Stimuli

Background and aims Impulsivity has consistently been associated with over-consumption and addiction. Recent research has reconceptualized impulsivity as a two-dimensional construct ( Dawe, Gullo, & Loxton, 2004 ). This study explores the relationship of the two components of impulsivity, reward drive (RD) and rash impulsivity (RI), on a broad group of 23 hedonic consumption behaviors (e.g., gambling, substance use, eating, and media use). We tentatively grouped the behaviors into three descriptive classes: entertainment, foodstuffs, and illicit activities and substances. Results RD and RI positively predicted elevated levels of consumption in a community sample (N=5,391; 51% female), for the vast majority of the behaviors considered. However, the effect sizes for RD and RI varied significantly depending on the behavior; a pattern that appeared to be at least partially attributable to the class of consumption. Results support the view that RD is related more strongly to the consumption of products that provide social engagement or a sense of increased status; whereas RI better reflects an approach toward illicit or restricted products that are intensely rewarding with clear negative consequences. Discussion and conclusion Results support the utility of the two-factor model of impulsivity in explaining individual differences in patterns of hedonic consumption in the general population. We discuss findings in terms of strengthening current conceptualizations of RI and RD as having distinct implications with respect to health-related behaviors.

Do gamblers eat more salt? Testing a latent trait model of covariance in consumption

A diverse class of stimuli, including certain foods, substances, media, and economic behaviours, may be described as 'reward-oriented' in that they provide immediate reinforcement with little initial investment. Neurophysiological and personality concepts, including dopaminergic dysfunction, reward sensitivity and rash impulsivity, each predict the existence of a latent behavioural trait that leads to increased consumption of all stimuli in this class. Whilst bivariate relationships (co-morbidities) are often reported in the literature, to our knowledge, a multivariate investigation of this possible trait has not been done. We surveyed 1,194 participants (550 male) on their typical weekly consumption of 11 types of reward-oriented stimuli, including fast food, salt, caffeine, television, gambling products, and illicit drugs. Confirmatory factor analysis was used to compare models in a 3×3 structure, based on the definition of a single latent factor (none, fixed loadings, or estimated loadings), and assumed residual covariance structure (none, a-priori / literature based, or post-hoc / data-driven). The inclusion of a single latent behavioural 'consumption' factor significantly improved model fit in all cases. Also confirming theoretical predictions, estimated factor loadings on reward-oriented indicators were uniformly positive, regardless of assumptions regarding residual covariances. Additionally, the latent trait was found to be negatively correlated with the non-reward-oriented indicators of fruit and vegetable consumption. The findings support the notion of a single behavioural trait leading to increased consumption of reward-oriented stimuli across multiple modalities. We discuss implications regarding the concentration of negative lifestyle-related health behaviours.

Two facets of stress and indirect effects on child diet through emotion-driven eating

OBJECTIVE

Stress has been associated with high-calorie, low-nutrient food intake (HCLN) and emotion-driven eating (EDE). However, effects on healthy food intake remain unknown. This study examined two facets of stress (self-efficacy, perceived helplessness) and food consumption, mediated by EDE.

METHODS

Cross-sectional data from fourth-graders (n=978; 52% female, 28% Hispanic) in an obesity intervention used self-report to assess self-efficacy, helplessness, EDE, fruit/vegetable (FV) intake, and high-calorie/low-nutrient (HCLN) food.

RESULTS

Higher stress self-efficacy was associated with higher FV intake, β=.354, p<0.001, and stress perceived helplessness had an indirect effect on HCLN intake through emotion-driven eating, indirect effect=.094, p<0.001; χ(2)(347)=659.930, p<0.001, CFI=0.940, TLI=0.930, RMSEA=0.030, p=1.00, adjusting for gender, ethnicity, BMI z-score, and program group.

CONCLUSIONS AND IMPLICATIONS

Stress self-efficacy may be more important for healthy food intake and perceived helplessness may indicate emotion-driven eating and unhealthy snack food intake. Obesity prevention programs may consider teaching stress management techniques to avoid emotion-driven eating.

Parent, peer, and executive function relationships to early adolescent e-cigarette use: a substance use pathway?

INTRODUCTION

Little is known about influences on e-cigarette use among early adolescents. This study examined influences that have been previously found to be associated with gateway drug use in adolescents: demographic (age, gender, ethnicity, free lunch), social contextual influences of parents and peers, and executive function deficits (EF).

METHODS

A cross-sectional survey was administered to 410 7th grade students from two diverse school districts in Southern California (M age;=12.4years, 48.3% female, 34.9% on free lunch (low socioeconomic status), 45.1% White, 25.4% Hispanic/Latino, 14.9% Mixed/bi-racial.) Logistic regression analyses examined influences of demographic, parent e-cigarette ownership and peer use, and EF on lifetime e-cigarette, and gateway drug use (cigarette and/or alcohol use).

RESULTS

Lifetime use prevalence was 11.0% for e-cigarettes, 6.8% for cigarettes, and 38.1% for alcohol. Free lunch and age were marginally related to e-cigarette use (p<.10). Parent e-cigarette ownership was associated with use of all substances, while peer use was associated with gateway drug use (p's<.05-.001). EF deficits were associated with use of all substances five times more likely than others to use e-cigarettes and over twice as likely to use gateway drugs.

CONCLUSIONS

E-cigarette and gateway drug use may have common underlying risk factors in early adolescence, including parent and peer modeling of substance use, as well as EF deficits. Future research is needed to examine longitudinal relationships of demographics, parent and peer modeling, and EF deficits to e-cigarette use in larger samples, trajectories of e-cigarette use compared to use of other substances, and the potential of EF skills training programs to prevent e-cigarette use.

Children's executive function and high-calorie, low-nutrient food intake: mediating effects of child-perceived adult fast food intake

OBJECTIVE

This study tested the relationships among child executive function (EF), child-perceived parent fast food intake, and child self-reported subsequent consumption of high-calorie, low-nutrient (HCLN) food.

DESIGN

One year and 6-month longitudinal observation from a larger randomized controlled trial.

SETTING

Southern California elementary schools.

PARTICIPANTS

Fourth- and fifth-grade children (N = 1,005) participating in the Pathways to Health obesity prevention program.

RESULTS

Child EF problems were associated with higher concurrent HCLN intake (B = 0.29, SE = 0.10, p < .001) and had a significant indirect effect through higher perceived frequency of parent fast food intake (indirect effect = 0.17, 95% confidence interval [CI] = [0.11, 0.25], p < .001). Longitudinally, child EF problems did not significantly predict higher HCLN intake a year and a half later (B = 0.01, SE = 0.10, p = .92, n = 848) but did have a significant indirect effect through higher perceived parent fast food intake (indirect effect = 0.05, 95% CI = [0.02, 0.10], p < .001).

CONCLUSIONS

Children's EF difficulties may increase their perception of parent concurrent fast food intake, contributing to their own unhealthy food intake. However, EF problems may not directly affect HCLN intake across time, except when problems are associated with child perception of more frequent parent consumption of convenience foods. Future research is needed to investigate the possibility that helping children perceive and understand role models' convenience food consumption may improve child dietary consumption patterns.