Impostor phenomenon in registered dietitians: an exploratory survey

BACKGROUND

Impostor phenomenon, also referred to as imposter syndrome or impostorism, was initially identified among high achieving women who felt undeserving of their successes because they felt they were earned through luck or chance, rather than skill or experience. It's prevalence has been identified in many health professions; however, there are no known studies of Registered Dietitians' (RDs) perceptions of impostor phenomenon. This study assesses the following among RDs: [1] prevalence of impostor phenomenon and differences in impostor phenomenon levels, if any, based on [2] highest educational level achieved and [3] years of experience as an RD.

METHODS

A cross-sectional survey was sent electronically to 5,000 RDs credentialed by the Commission on Dietetic Registration in the United States. Respondents' agreement with 20 impostor phenomenon statements from the Clance Impostor Phenomenon Scale were measured. The sum score from the scale was used to classify levels of impostor phenomenon. Descriptive statistics and chi square analyses for comparison were evaluated.

RESULTS

Of the 445 (9%) who began the survey, 266 (5%) completed it and were included in analyses. Over 76% of 266 individuals reported at least moderate impostorism (score of 40 or fewer points out of 100). No difference was seen based on educational level (p = .898); however, those with less than five years' experience reported higher impostor phenomenon (p < .05). Among those with five to 39 years' experience, over 40% reported moderate impostorism.

CONCLUSION

Impostor phenomenon is prevalent among RDs. Moderate impostorism was pervasive among all those with less than 40 years' experience and could potentially negatively impact these respondents. Future research could explore ways to reduce impostor phenomenon in RDs.

Motivational and self-regulatory processes associated with weight-related parenting behaviors

Background

Parents play an influential role on their child's eating and physical activity. How maternal personality and individual differences, such as motivation and self-regulation, are associated with their weight-related parenting has yet to be studied. The current study examined relationships of mothers' motivational and self-regulatory characteristics with weight-related parenting practices.

Methods

Mothers (N = 149, MAge = 42.78 years, 49% Hispanic/Latino) of school-aged children (ages 10-14 years, 55.7% female) completed questionnaires assessing behavioral inhibition system/behavioral activation system (BIS/BAS), self-control, and weight-related parenting practices (i.e., role modeling, food restriction, rule enforcement, limiting, discipline, pressure to eat). Structural equation modeling examined associations of BIS, BAS, and self-control with parenting practices.

Results

Among mothers, higher avoidance motivation was associated with difficulty with rule enforcement. Higher approach motivation was associated with less limiting of unhealthy food and sedentary behavior. Higher self-control predicted more role modeling and less difficulty with rule enforcement.

Conclusion

Findings support associations of maternal motivational and self-regulatory processes with weight-related parenting behaviors. Results may inform tailored strategies based on individual differences for family-based interventions for parenting.

Development and Rasch Analysis of the 18-Item Health Resilience Profile (HRP)

Existing resilience measures have psychometric shortcomings, and there is no current gold-standard resilience measure. Previous work indicates adults enrolled in a health coaching program may benefit from a resilience measure that is tailored and contextualized to this sample. This two-part study aimed to develop and evaluate a resilience instrument focused on health behavior change in adults in a health coaching program. Two studies were conducted to (1) create a resilience instrument (Health Resilience Profile; HRP) specific to adults attempting health behavior change (n = 427; female = 83.8%; age = 44.5 ± 11.9 years) and to (2) optimize the instrument performance using Rasch analysis (n = 493; female = 62.1%; age = 49.8 ± 12.5 years). Study 1 identified two issues: (1) four unacceptable misfit items and (2) inappropriate rating scale functioning. Study 2 evaluated an improved instrument based on the outcome of study 1 resulting in one more misfit item, and unidimensionality was supported. The new four-category rating scale functioned well. The item-person map indicated that item difficulty distribution was well matched to participants' resilience level, and items were free from measurement error. Finally, items did not show differential item functioning across age, sex, alcohol use, and obesity status. The 18-item HRP is optimized for adults in a health coaching program.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

The Nutritarian Women’s Health Study (NWHS): Cohort 1

Plant-based dietary patterns are associated with chronic disease risk reduction, prevention, and reversal. As such, the Nutritarian diet is a dietary plan grounded in the daily consumption of micronutrient-dense, plant-rich foods that satisfy nutrient needs with a corresponding improvement in overall health. The Nutritarian Women’s Health Study was a fully-online intervention that included supportive, automated email messages, with participants self-reporting dietary adherence and anthropometric measurements quarterly. Changes in Body Mass Index (BMI) were not significant. The groups with the lowest baseline Waist-to-Height-Ratio (WHtR) showed an initial increase followed by a decrease. Responses related to dietary adherence showed that most participants easily consumed greens, beans, onions/garlic, berries, and seeds, avoided animal products, alcohol, and refined foods, but had difficulty with regularly consuming mushrooms and tomatoes. A midpoint questionnaire revealed participants consumed an overwhelming amount of their meals/snacks according to the dietary plan and about half found it easy/very easy to eat strictly Nutritarian. A large majority reported a positive change in health from participating in the study. The barriers to following the dietary plan include a busy lifestyle and the opposing views/pressures from friends, family, co-workers, and/or spouse/partner. It is important to evaluate this fully-online approach when considering future interventions.

The INFINITE Study: Pilot Research Exploring Plant-Based Nutrition in Treatment for Substance Use Disorders

Standard treatment for substance use disorders (SUDs) rarely incorporates a dietary intervention. The purpose of this research is to explore how nutrition might influence early recovery outcomes. Participants (N = 33) self-selected into the 10-week treatment (whole food, plant-based diet) or control group (standard treatment center diet). Both received weekly nutrition education lessons to complement the diet. At baseline, week 3, and week 10, participants completed assessments to track mental health markers. Mean values were calculated for Healthy Eating Index-2015 (HEI-2015) and Plant-based Diet Indices (PDI). Semi-structured interviews were gathered and analyzed using grounded theory. The intervention group had significantly higher scores for HEI-2015 and PDI scores (all P’s < .001). For all psychosocial outcomes, there was a statistically significant effect of time ( P’s < .001-.02), but not by condition. A significant condition by time interaction was seen with the Rosenberg Self-Esteem outcome ( P = .043). Resilience at 10-weeks was significantly higher in the high PDI group ( P = .031). Qualitative data showed that all participants found meaning and value in the experience. Early addiction treatment outcomes show modest but important effects of whole food plant-based nutrition and suggest value in further exploration of its use in SUD treatment.

Nutrition availability for those incarcerated in jail: Implications for mental health

PURPOSE

Using a seven-day cycle menu and commissary items at a rural county jail, this study aims to describe provisions of micronutrients known to be associated with mental health disorders and if they meet dietary guidelines.

DESIGN/METHODOLOGY/APPROACH

The nutritional content of a seven-day cycle menu and four available commissary food packs were evaluated using NutritionCalc® Plus software (McGraw-Hill Education version 5.0.19) and compared to Dietary Reference Intakes (DRI).

FINDINGS

Menu mean values of Vitamin B6, Vitamin B12, Vitamin C and zinc met DRI recommendations. However, Vitamin D (for men and women), magnesium (for men only) and omega-3s (for men only) did not meet the DRI recommendations.

ORIGINALITY/VALUE

As deficits of Vitamin D, magnesium and omega-3s are known to exacerbate bipolar disorder, anxiety and depression, small changes to food would increase the offerings and potential intake of nutrients that may improve mental health.

Two-year outcomes of Faith in Action/Fe en Acción: a randomized controlled trial of physical activity promotion in Latinas

Background

Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas.

Methods

The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference.

Results

After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference.

Conclusions

Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits.

Trial registration

NCT01776632, Registered March 18, 2011.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01329-6.

Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis

BACKGROUND

The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%).

METHODS

Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis.

RESULTS

A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed.

CONCLUSION

Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.

Examination of three-factor eating questionnaire subscale scores on weight loss and weight loss maintenance in a clinical intervention

Background

The purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity.

Methods

TFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight.

Results

Participants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months.

Conclusion

Dietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.

Associations among affect, diet, and activity and binge-eating severity using ecological momentary assessment in a non-clinical sample of middle-aged fathers

PURPOSE

Knowledge of within-day factors associated with binge-eating severity among middle-aged fathers is limited. The purpose of the current report was to examine within-day associations of affect, diet, and activity in relation to binge-eating severity using ecological momentary assessment (EMA) in men.

METHODS

Twenty-three middle-aged fathers completed 8 days of EMA and wore accelerometers to objectively assess activity. Generalized estimating equations assessed relationships among affect, diet, and activity and binge-eating severity.

RESULTS

When positive affect was above average, men reported greater binge-eating severity in the next 2 h. Oppositely, when negative affect was above average, men reported less binge-eating severity in the next 2 h. At times when men reported consumption of sweets and fast food, they reported higher binge-eating severity during the same 2-h window. Men with greater average levels of light activity reported less overall binge-eating severity.

CONCLUSIONS

Findings show that affect, unhealthy food intake, and light activity could be targeted among middle-aged fathers to reduce binge-eating severity and prevent eating disorders.

LEVEL OF EVIDENCE

Level III: Evidence obtained from cohort or case-control analytic studies.

Blue Zones-Based Worksite Nutrition Intervention: Positive Impact on Employee Wellbeing

“Blue Zones” are geographical regions where people live to be non-agenarians and centenarians with significantly better rates of mental wellness when compared to the average American. It was discovered that these areas have nine unique evidenced-based lifestyle principles, with one of their main principles being the consumption of a plant-based diet. With this in mind, we performed a worksite intervention with the objective of understanding the relationships among Blue Zones knowledge, a plant-based lifestyle, and improvements in overall mental wellness during the COVID-19 pandemic. During spring 2021, we recruited 52 employees from a public, mid-sized university in the southwestern United States to participate in an 8-week virtual intervention that included weekly topic presentations, cooking demonstrations, and Blue Zones education. Participants were also assigned to weekly wellness counseling groups integrating Motivational Interviewing based principles that included additional, relevant conversation topics and support. The final sample (n = 52 participants) had a mean age of 45.6 ± 10.6 years. Participants were predominantly women (84.6%) and nearly half were married (44.2%). The majority attended graduate school (59.6%) and identified as White (84.6%). Paired-samples t-tests indicated significant improvements in all mental wellness outcomes and Healthy Eating Index-2015 (HEI-2015) scores over time (p's &lt; 0.001 to 0.02). Multiple linear regression models revealed that Blue Zones knowledge (β = −0.037, p = 0.010) significantly negatively predicted Patient Health Questionnaire-9 (PHQ-9) scores at 8-weeks. Additionally, multiple linear regression models indicated small group attendance (β = −1.51, p = 0.003) and Blue Zones knowledge (β = −0.81, p = 0.012) significantly negatively predicted sleep scores at 8-weeks. When HEI-2015 total scores were also included at baseline and 8-weeks (post-intervention), Blue Zones knowledge (β = −0.031, p = 0.049) was a borderline significant predictor of PHQ-9 at 8-weeks. Additionally, small group sessions (β = −1.52 p = 0.005) were a significant predictor of sleep at 8-weeks. The intervention illustrated that virtual intervention strategies can improve nutrition and mental wellness for future advancement in life quality and wellbeing.

Sodium content of menu and commissary provisions in rural jail exceeds heart-healthy dietary recommendations

PURPOSE

This paper determined sodium provisions from a seven-day cycle menu and commissary at a rural Southwest County jail and compared it to Dietary Reference Intakes (DRI) and Dietary Approaches to Stop Hypertension (DASH) recommendations for sodium.

DESIGN/METHODOLOGY/APPROACH

A seven-day cycle menu and commissary items were used to determine sodium content for each meal and commissary pack. Estimates for the menu and commissary packs paired with the menu (commissary scenarios) were converted to a daily average of sodium and compared to DRI and DASH recommendations.

FINDINGS

Menu provisions provided 167% of daily DRI sodium recommendations and 256% of daily DASH sodium recommendations. The sodium content for individual commissary scenarios averaged 218% of DRI and 334% of DASH recommendations. Commissary items are notably high in sodium and if eaten can significantly exceed dietary recommendations.

ORIGINALITY/VALUE

Small changes to one meal within the cycle menu and the inclusion of fresh or frozen produce could reduce sodium content to align with DRI and DASH recommendations.

SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools

BACKGROUND

Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely.

METHODS

We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1 (sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners, and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured.

RESULTS

We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p < 0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face-covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ + T cell responses, and reduced monocytes.

CONCLUSIONS

Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses.

IMPACT

Successful COVID-19 mitigation was implemented across a diverse range of schools. School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning. Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Patterns of Weight Change in a Commercial Weight Loss Program

Objectives: In this study, we examined compliance and progress factors associated with weight loss and maintenance, individual patterns of weight trends following weight loss, and impact of early weight loss on longer-term weight change. Methods: We conducted secondary analysis of pre-post data. Participants were 8769 persons (mean age = 47.63 ± 13.78 years; 77.74% women; mean weight = 97.20 ± 22.82 kilograms; BMI = 34.09 ± 6.84) in a commercial weight management program. We carried out multiple regression analyses on weight change and percentage, and used ANOVA and the Pearson chi-square test to examine participant characteristics, weight change patterns, and early weight loss success. Results: Participants were active in the program for 222 ± 158 days, completed 15 ± 13 appointments, achieving -8.53 ± 7.87 kilograms lost (-8.61% ± 7.64%). Greater weight loss was associated with appointment frequency (β = -0.46) and total spending (β = -2.89) (p < .01). We identified 5 weight change patterns (F = 37.56, p < .001) (total weight loss for each group was: Stable = -10.4% [N=2036]; Minimal Regain = -10.5% [N=3766]; Modest Regain = -8.8% [N=1476]; Large Regain = -7.3% [N=753]; No Loss/Gain = +3.7% [N=737]; all p < .05). Over 5000 participants achieved early weight loss (losing > 5%) within the first 2 months resulting in significantly greater final weight loss (-8.43% to -14.56% vs -1.18% to -3.15%). Conclusions: We identified several weight patterns; increased health coaching attendance was associated with greater weight loss.

SARS-CoV-2 Acquisition and Immune Pathogenesis Among School-Aged Learners in Four Diverse Schools

Background

Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely.

Methods

We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1(sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners; and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured.

Results

We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p<0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ+ T cell responses, and reduced monocytes.

Conclusion

Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses.

Key Points

Successful COVID-19 mitigation was implemented across a diverse range of schools.School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning.Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Development of the systematic observation of COVID-19 mitigation (SOCOM): Assessing face covering and distancing in schools

INTRODUCTION

During the COVID-19 pandemic, some K-12 schools resumed in-person classes with varying degrees of mitigation plans in the fall 2020. Physical distancing and face coverings can minimize SARS-CoV-2 spread, the virus that causes COVID-19. However, no research has focused on adherence to mitigation strategies during school days. Thus, we sought to develop a systematic observation protocol to capture COVID-19 mitigation strategy adherence in school environments: The Systematic Observation of COVID-19 Mitigation (SOCOM).

METHODS

We extended previously validated and internationally used tools to develop the SOCOM training and implementation protocols to assess physical-distancing and face-covering behaviors. SOCOM was tested in diverse indoor and outdoor settings (classrooms, lunchrooms, physical education [PE], and recess) among diverse schools (elementary, secondary, and special needs).

RESULTS

For the unique metrics of physical-distancing and face-covering behaviors, areas with less activity and a maximum of 10-15 students were more favorable for accurately capturing data. Overall proportion of agreement was high for physical distancing (90.9%), face covering (88.6%), activity type (89.2%), and physical activity level (87.9%). Agreement was lowest during active recess, PE, and observation areas with ≥20 students.

CONCLUSIONS

Millions of children throughout the USA are likely to return to school in the months ahead. SOCOM is a relatively inexpensive research tool that can be implemented by schools to determine mitigation strategy adherence and to assess protocols that allow students return to school safely and slow the spread of COVID-19.

Within-Subject Effects of Stress on Weight-Related Parenting Practices in Mothers: An Ecological Momentary Assessment Study

BACKGROUND

Stress may compromise parenting practices related to children's dietary intake, physical activity, and sedentary behavior.

PURPOSE

The current study used Ecological Momentary Assessment (EMA) to examine microtemporal sequences underlying maternal stress and subsequent weight-related parenting practices.

METHODS

Mothers (n = 199) of children aged 8-12 years participated in two separate 7-day waves of EMA with up to eight randomly prompted surveys per day during children's nonschool time. EMA items assessed stress and weight-related parenting practices.

RESULTS

When mothers reported experiencing greater stress than usual, they subsequently engaged in less physical activity parenting (e.g., encouraging physical activity; p < .05) and more sedentary screen behavior parenting (e.g., limiting TV/video games; p < .05) over the next 2 hr.

CONCLUSIONS

Addressing within-day variations in maternal stress may be an important component of parent-focused child obesity prevention interventions.

Investigating the momentary association between maternal support and children's fruit and vegetable consumption using ecological momentary assessment

Despite compelling evidence that fruit and vegetable (F/V) consumption can reduce the risk of obesity and chronic disease, most children fail to meet the daily recommendations for dietary consumption. Theoretical models and empirical findings suggest that parents play a key role in guiding children's overall dietary behaviors. To extend previous findings, the current study utilized ecological momentary assessment (EMA) on smartphones to assess the within-subject and between-subject effects of maternal support (i.e., encouragement, preparation) of F/V on their child's F/V consumption. Mother-child dyads (n = 191) completed six semi-annual 7-day waves of EMA surveys. EMA assessed mothers' past 2-h support for F/V and children's F/V consumption. At the within-subject level, greater maternal encouragement for F/Vs (OR = 2.41) and maternal preparation of F/Vs (OR = 1.43) than usual were associated with increased odds of their child eating F/V during the same 2-h window. At the between-subject level, greater maternal preparation of F/V (OR = 5.99), compared to other mothers, was associated with increased odds of their child eating F/V. Children with lower BMI (vs. higher BMI) were more likely to consume F/Vs when their mothers encouraged them to eat F/V (OR = 0.74). These findings suggest that maternal support may have a strong and immediate effect on children's F/V consumption. Theoretical models on behavior change should consider how explanatory factors, such as parental support, may vary at the momentary level. Boosting maternal support at the momentary level may be a critical component of future mobile-based interventions to address childhood obesity.

Within-Subject Associations of Maternal Physical Activity Parenting Practices on Children's Objectively Measured Moderate-to-Vigorous Physical Activity

OBJECTIVE

Longitudinal within-subject (WS) associations of mothers' momentary assessed physical activity (PA) parenting practices were examined with children's objectively measured PA during the same 2-hr time frame.

METHOD

Mother-child dyads (n = 189) completed five ecological momentary assessment (EMA) measurement bursts over 3 years. During each 7-day burst, mothers EMA-reported their past 2 hr PA parenting practices (i.e., encouraging their child to be physically active, taking their child someplace to be physically active), and children (Mage=9.6 years, SD = 0.9) wore an accelerometer to measure moderate-to-vigorous PA (MVPA). Two-part multilevel models were used, with zero portions representing not meeting MVPA and positive portions representing any MVPA, controlling for demographic covariates. Cross-level interaction terms of child sex and age with parenting were created to test moderation effects.

RESULTS

When mothers reported taking their child to be physically active, children were more likely to get some MVPA (b = -0.56, p < .001). When mothers reported taking their child to be physically active more, children had higher levels of MVPA (b = 0.24, p < .001). When mothers reported encouraging their child to be physically active, children were less likely to get any MVPA (b = 0.27, p < .05). However, when mothers reported encouraging their child to be physically active more, children had higher levels of MVPA (b = 0.29, p < .001). These effects were not moderated by child sex or age.

CONCLUSIONS

WS variations of mothers' support for PA across the day were associated with changes in children's MVPA. Future research should consider promoting mothers' provision of support for increasing children's PA.

The Association of Maternal Perceived Stress With Changes in Their Children's Healthy Eating Index (HEI-2010) Scores Over Time

BACKGROUND

Few studies have examined the role of maternal stress in relation to their children's dietary quality and its trajectory over time.

PURPOSE

The objective of this longitudinal study was to examine the effect of baseline maternal stress on the change in their 8- to 12-year-old children's dietary quality over 1 year.

METHODS

Mother-child dyads (N = 189) from the greater Los Angeles area participating in the Mothers' and their Children's Health (MATCH) study in 2014-2016 completed assessments at baseline, 6 months, and 12 months. At baseline, mothers (mean age = 41.0 years, standard deviation [SD] = 6.1) completed the 10-item Cohen's Perceived Stress Scale (PSS). At each time point, children (51% female, mean age = 9.6 years, SD = 0.9) completed up to two 24-hr dietary recalls. Dietary data were used to calculate each child's Healthy Eating Index 2010 (HEI-2010) score at each time point. Multilevel models examined the effect of time on the patterns of change in children's HEI-2010 scores over 1 year and the cross-level interaction between baseline maternal PSS score and time on the change in children's HEI-2010 scores.

RESULTS

On average, there was no significant linear change in child HEI-2010 across 1 year (b = -0.410, p = .586). Controlling for covariates, the rate of change in HEI-2010 differed depending on mother's baseline PSS (i.e., significant cross-level interaction effect) (b = -0.235, p = .035).

CONCLUSIONS

Our results showed that higher-than-average maternal stress at baseline was associated with greater decline in children's dietary quality over 1 year. Family-based dietary interventions that incorporate maternal stress reduction could have positive effects on children's dietary quality.

Dual Versus Single Parental Households and Differences in Maternal Mental Health and Child's Overweight/Obesity

Objectives Mothers report higher levels of psychological stress than fathers. s. Psychological stress is posited to influence parenting practices that could increase children's obesity risk. However, previous studies have not investigated several aspects of maternal mental health and the moderating role of household structure on children's obesity risk. The objective was to investigate associations of maternal mental health with child obesity risk, and whether these associations differed by household structure (single-parent vs. dual parent/multigenerational). Methods Mothers and their 8-12 year old children (N = 175 dyads) completed baseline questionnaires on mothers' mental health and child anthropometrics. Separate logistic regressions assessed associations of standardized maternal mental health indicators with the odds of child overweight/obesity, controlling for child age, and women's BMI, age, education, employment status, and annual income. Household structure was investigated as a moderator of these relationships.Results There were no statistically significant relationships between maternal mental health characteristics and odds of child overweight/obesity. Among single mothers only, greater anxiety was associated with higher risk of child overweight/obesity [OR (95% CI) = 3.67 (1.27-10.62); p = 0.0163]; and greater life satisfaction was marginally associated with lower risk of child overweight/obesity [OR (95% CI) = 0.44 (0.19-1.01); p = 0.0522]. Mothers' life satisfaction may lower risk for their children's overweight/obesity, whereas higher anxiety may increase this risk, particularly among children living in single-mother households. Conclusions for Practice Future interventions could increase resources for single mothers to buffer the effects of stress and lower pediatric obesity risk.

Parenting styles, food-related parenting practices, and children's healthy eating: A mediation analysis to examine relationships between parenting and child diet

Parents exert a strong influence on their children's diet. While authoritative parenting style is linked to healthier weight and dietary outcomes in children, and authoritarian and permissive parenting styles with unhealthy eating, little is known about the mechanisms that mediate these relationships. Feeding styles are often examined in relation to child diet, but they do not consider the social and physical environmental contexts in which dietary behaviors occur. Therefore, this study examined whether parenting styles (authoritative, authoritarian, and permissive) were associated with three specific food-related parenting practices - mealtime structural practices (e.g., eating meals as a family), parent modeling of healthy food, and household food rules and whether these parenting practices mediated the association between parenting styles and children's diet. Participants were 174 mother-child dyads. Mothers (68% married, 58% college graduates, M_age = 41 years [SD = 6.2]) reported on their parenting practices using validated scales and parenting style using the Parenting Styles and Dimensions Questionnaire. Children (52% female, M_age = 10 years [SD = 0.9]) completed two telephone-based 24-hour dietary recalls. Dietary outcomes included the Healthy Eating Index (HEI)-2010 score, and fruit and vegetables and added sugar intake. Using PROCESS, multiple mediation cross-sectional analyses with parallel mediators using 10,000 bootstraps were performed. Significant indirect effects were observed with mealtime structure and the relationships between authoritative parenting and HEI-2010 score (b = 0.045, p < .05, CI = [0.006, 0.126]), authoritarian parenting and HEI-2010 score (b = -0.055, p < .05, CI = [-0.167, -0.001]), and permissive parenting and HEI-2010 score (b = -0.093, p < .05, CI = [-0.265, -0.008]). Child diet quality is affected by mealtime structural practices. Further examination of the features by which mealtime structural practices serve as a mechanism for parents to support healthy eating among their children may improve children's diet quality.

Promoting healthier children's meals at quick-service and full-service restaurants: Results from a pilot and feasibility study

High-calorie restaurant foods contribute to childhood overweight. Increased consumer demand for healthier kids' meals may motivate the restaurant industry to provide additional healthy options. This study pilot-tested a combination of four strategies (toy incentive, placemats, server prompts, signage) designed to increase demand for healthier kids' meals, which were defined as those eligible for the National Restaurant Association's Kids LiveWell program. Relative sales of healthier kids' meals were examined before (n = 3473 total kids' meal orders) and during Month 1 (n = 3546 total kids' meal orders) and Month 2 of implementation (n = 3645 total kids' meal orders) of an 8-week intervention in two locations each of a quick-service (QSR) and full-service (FSR) restaurant chain. Convenience samples of children (n = 27) and their parents (n = 28) were surveyed regarding parent and child perceptions of intervention components. Findings regarding the effectiveness and feasibility of the intervention were mixed. At the FSRs, the relative percentage of monthly sales from healthier kids' meals increased from 5.0% of kids' meal orders at baseline to 8.3% during Month 1, ending at 6.4% during Month 2. At the QSRs, the relative percentage of monthly sales from healthier kids' entrees decreased from 27.5% at baseline to 25.2% during Month 1, ending at 25.9% during Month 2. Implementation quality tracking showed that consistent implementation of intervention components was a challenge; parent- and child-reported awareness of intervention components supported this finding. Future directions are discussed, aiming to build upon these findings and maximize the feasibility, effectiveness, and sustainability of efforts to promote healthier eating in restaurants.

Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders

OBJECTIVE

Assess parents', children's, and restaurant executives' perspectives on children's meals in restaurants.

DESIGN

Cross-sectional.

SETTING

Parents and children completed predominantly quantitative surveys at 4 quick- and full-service restaurant locations. Telephone interviews were conducted with executives representing additional restaurants.

PARTICIPANTS

Parents (n = 59) and their first- through fourth-grade children (n = 58); executives (n = 4).

VARIABLES MEASURED

Parent/child perspectives on child meal selection and toy incentives in restaurants; executives' views on kids' meals and barriers to supplying healthier kids' meals.

ANALYSIS

Frequencies, thematic analysis.

RESULTS

A total of 63% of children ordered from children's menus, 8% of whom ordered healthier kids' meals. Half of parents reported that children determined their own orders. Taste was the most common reason for children's meal choices. Most (76%) children reported visiting the restaurant previously; 64% of them placed their usual order. Parents' views on toy incentives were mixed. Themes from executive interviews highlighted factors driving children's menu offerings, including children's habits and preferences and the need to use preexisting pantry items. Executives described menu changes as driven by profitability, consumer demand, regulation, and corporate social responsibility.

CONCLUSIONS AND IMPLICATIONS

Findings can inform the development of restaurant interventions that are effective in promoting healthier eating and are acceptable to parents, children, and restaurant personnel.

Reducing calories, fat, saturated fat, and sodium in restaurant menu items: Effects on consumer acceptance

OBJECTIVE

To assess consumer acceptance of reductions of calories, fat, saturated fat, and sodium to current restaurant recipes.

METHODS

Twenty-four menu items, from six restaurant chains, were slightly modified and moderately modified by reducing targeted ingredients. Restaurant customers (n = 1,838) were recruited for a taste test and were blinded to the recipe version as well as the purpose of the study. Overall consumer acceptance was measured using a 9-point hedonic (like/dislike) scale, likelihood to purchase scale, Just-About-Right (JAR) 5-point scale, penalty analysis, and alienation analysis.

RESULTS

Overall, modified recipes of 19 menu items were scored similar to (or better than) their respective current versions. Eleven menu items were found to be acceptable in the slightly modified recipe version, and eight menu items were found to be acceptable in the moderately modified recipe version. Acceptable ingredient modifications resulted in a reduction of up to 26% in calories and a reduction of up to 31% in sodium per serving.

CONCLUSIONS

The majority of restaurant menu items with small reductions of calories, fat, saturated fat, and sodium were acceptable. Given the frequency of eating foods away from home, these reductions could be effective in creating dietary improvements for restaurant diners.

Mixed Messages: Ambiguous Penalty Information in Modified Restaurant Menu Items

Restaurant menu items from six national or regional brands were modified to reduce fat, saturated fat, sodium and total calories. Twenty-four items were tested with a current recipe, and two modifications (small and moderate reductions) for 72 total products. Approximately 100 consumers tested each product for acceptability as well as for desired levels of tastes/flavor, amounts of key ingredients and texture/consistency using just-about-right (JAR) scales. Penalty analysis was conducted to assess the effects of non-JAR ratings on acceptability scores. Situations arose where JAR ratings and penalty analyses could yield different recommendations, including large groups with low penalties and small groups with high penalties. Opposing groups with moderate to high penalties on opposite sides of the same JAR scale were also seen. Strategies for dealing with these observances are discussed.

Childhood obesity prevention and control in city recreation centres and family homes: the MOVE/me Muevo Project

BACKGROUND

Interventions to prevent and control childhood obesity have shown mixed results in terms of short- and long-term changes.

OBJECTIVES

'MOVE/me Muevo' was a 2-year family- and recreation centre-based randomized controlled trial to promote healthy eating and physical activity among 5- to 8-year-old children. It was hypothesized that children in the intervention group would demonstrate lower post-intervention body mass index (BMI) values and improved obesity-related behaviours compared with the control group children.

METHODS

Thirty recreation centres in San Diego County, California, were randomized to an intervention or control condition. Five hundred forty-one families were enrolled and children's BMI, diet, physical activity and other health indicators were tracked from baseline to 2 years post-baseline. Analyses followed an intent-to-treat approach using mixed-effects models.

RESULTS

No significant intervention effects were observed for the primary outcomes of child's or parent's BMI and child's waist circumference. Moderator analyses, however, showed that girls (but not boys) in the intervention condition reduced their BMI. At the 2-year follow-up, intervention condition parents reported that their children were consuming fewer high-fat foods and sugary beverages.

CONCLUSIONS

Favourable implementation fidelity and high retention rates support the feasibility of this intervention in a large metropolitan area; however, interventions of greater intensity may be needed to achieve effects on child's BMI. Also, further research is needed to develop gender-specific intervention strategies so that both genders may benefit from such efforts.

Neighborhood Income Matters: Disparities in Community Recreation Facilities, Amenities, and Programs

Physical activity is important for children's development and their current and future health; national recommendations are for them to engage in at least 60 minutes of moderate to vigorous physical activity daily. Most of children's physical activity occurs outside of school hours; thus, access to and the quality of community recreation facilities and programming are particularly relevant. Researchers have identified strong links among socioeconomic disparities, physical inactivity, and poor health, but a limited number of studies have examined how access to community recreation facilities and physical activity programming are affected by local socioeconomic conditions. In many low-income communities, park and recreation facilities may be the only place for children to be physically active outside of school; thus, it is important to understand the connection between community environmental characteristics and child use of facilities. We were interested in determining whether the characteristics of community recreation center environments would be associated with neighborhood income and children's use of the centers. To do this we designed a study to identify whether neighborhood income disparities were associated with recreation center environmental characteristics and whether those characteristics were associated with young children's use of the center. We believed that findings to these questions could inform policy decisions within recreation centers and recreation departments to improve equity, facility use, and levels of physical activity. Thirty community recreation centers and 541 nearby families with children aged 5-8 years in five cities in Southern California participated in the study. To generate data we used multiple research instrumentation including (a) a structured physical activity survey of program offerings and barriers to children's participation in physical activity at the center [completed by recreation center supervisors], (b) direct observation of the presence and condition of recreation center facilities and amenities by trained assessors, and (c) a parent questionnaire on child use of the center. Results indicated that the condition of the community center facilities and amenities, but not their number, was positively related to neighborhood income (p < .05). As well, the number of cost-free, but not total, youth physical activity programs was inversely associated with neighborhood income (p < .05). Parent's report of their children using centers was positively associated with the number of amenities observed there (p < .05). The results suggest that policy makers and community recreation center staff should consider both neighborhood economic issues and environmental characteristics in their efforts to promote children's physical activity at recreation centers.

Parent awareness of young children's physical activity

OBJECTIVE

Parents who overestimate their child's physical activity (PA) level may not encourage their children to increase their PA. We assessed parental awareness of child PA, and investigated potential correlates of overestimation.

METHOD

Child PA (accelerometer) and parent-classified child PA ['active' ≥ 60 min/day vs. 'inactive' <60 min/day moderate and vigorous PA (MVPA)] were measured over 7 days [n=329, 44% male, 39% Latino; mean (SD) 9.1 (0.7)years] in an obesity prevention study in San Diego (Project MOVE). Agreement between date-matched objective MVPA and parent-classified child PA was assessed; % days parental overestimation was the outcome variable. Associations between parental overestimation and potential correlates were investigated using three-level mixed-effects linear regression.

RESULTS

Children met the PA guidelines on 43% of days. Parents overestimated their children's PA on 75% of days when children were inactive. Most parents (80%) overestimated their child's PA on ≥ 1 measurement day. Parental support for child PA (transport, encouragement and participation with child) (p<0.01) was positively associated with higher overestimation. Parents of girls showed more overestimation than parents of boys (p=0.04).

CONCLUSION

Most parents incorrectly classified their child as active when their child was inactive. Strategies addressing parental overestimation may be important in PA promotion.

Examining multiple parenting behaviors on young children's dietary fat consumption

OBJECTIVE

To understand the association between parenting and children's dietary fat consumption, this study tested a comprehensive model of parenting that included parent household rules, parent modeling of rules, parent mediated behaviors, and parent support.

DESIGN

Cross-sectional.

SETTING

Baseline data from the MOVE/me Muevo project, a recreation site-based obesity prevention and control intervention trial.

PARTICIPANTS

Five hundred forty-one parents of children between the ages of 5 and 8 years and living in San Diego County.

MAIN OUTCOME MEASURE

Children's fat consumption based on parent report using a short food frequency questionnaire.

ANALYSIS

A hierarchical linear regression was conducted. In exploratory analyses, a stepwise backward elimination approach was used.

RESULTS

Children's fat consumption was positively associated with parent household rules (P < .01) and negatively associated with parent modeling of rules (P < .01).

CONCLUSIONS AND IMPLICATIONS

Controlling parenting behaviors, such as rule setting, are associated with more frequent fat consumption, whereas role modeling healthful behaviors is associated with less frequent fat consumption. Changing parenting behaviors with regard to how they feed their children is a logical avenue for improving eating behaviors.

Parent support and parent-mediated behaviors are associated with children's sugary beverage consumption

Consumption of sugary beverages has been identified as a contributor to childhood obesity. Studies have established the importance of specific parenting practices to children's beverage consumption; however, no study has examined multiple operationalizations of parenting to better understand where to focus future interventions. The present study examined the relationship between children's sugary beverage consumption and a parenting model that included household food rules, parent modeling of food rules, parent-mediated behaviors, and parent support. Baseline data from Project MOVE/me Muevo were used. Participants included 541 children, aged 5 to 8 years old, and their parents. Parents completed a 45-minute self-administered survey in Spanish or English, providing information about their child's dietary intake, as well as their parenting practices. Children's sugary beverage consumption included nondiet soda, noncarbonated sugary drinks, and sport drinks. Household food rules and parent modeling of food rules were assessed with seven items each. Parent-mediated behaviors consisted of four behaviors. Parent support was assessed with five items. Parent support and parent-mediated behaviors, including total screen time and eating at fast-food restaurants at least weekly, were associated with greater consumption of sugary beverages in children. No other parenting variables were significant. Encouraging caregivers to promote healthy dietary behaviors and provide healthy choices, limiting children's television and computer use, and reducing fast-food consumption can contribute to reductions in sugary beverage consumption among children.