New Jersey Leaves No Bite Behind: A Climate Change and Food Waste Curriculum Intervention for Adolescents in the United States

Food waste is a major contributor to climate change. Schools offer a unique opportunity to educate on this issue while also reducing food waste generation; however, few climate-change education curricula that include a food waste component have been developed and tested with fidelity. Thus, the purpose of this cluster randomized controlled study was to assess the effectiveness of a climate change and food waste education program called NJ Leaves No Bite Behind (NJLNBB) among fifth-grade students. Lessons on food waste and sustainable food behaviors were developed that aligned with NJ Student Learning Standards for Climate Change and Next-Generation Science Standards. Participants (n = 162) completed pre- and post-test surveys that assessed knowledge, attitudes, self-efficacy, and behaviors. Post-test, the experimental group (n = 102) had significantly (p < 0.05) higher mean scores in knowledge, social norms, behavioral intentions, and perceived behavioral control compared to the control group (n = 60), with medium effect sizes, as determined by partial eta-squared. There were no significant between-group differences in mean score attitudes, self-efficacy, motivation to comply, or climate-friendly behaviors post-test. Almost three-quarters of participants who received the program agreed or strongly agreed the lessons were fun (75.5%), liked the card games (72.5), and learned a lot (78.4%). These findings are promising in terms of teaching adolescents the impacts of food waste on the climate.

Relationships of Maternal Employment and Work Impact with Weight-Related Behaviors and Home Environments of Mothers and Their School-Age Children

The prevalence of obesity continues to rise. Preventing obesity, especially childhood obesity, is critically important. Parents, especially mothers, play a vital role in preventing childhood obesity. Numerous factors, such as maternal employment, may influence maternal weight-related practices and home environment characteristics that affect the risk of childhood obesity. Given the prevalence of both childhood obesity and maternal employment, this study was conducted to examine how weight-related maternal, child, and household behaviors as well as home environment characteristics differ by maternal employment hours and extends existing research by examining work impact on behaviors and home characteristics. U.S. mothers (n = 527) with at least one school-age child (6 to 11 years), who were between the ages of 25 and 54 years and the main food gatekeeper in the household completed an online survey. ANOVA comparisons of non-working, part-time employed, and full-time employed mothers revealed few differences in any of the variables studied. Cluster analysis of the 336 employed mothers based on six work impact scale scores found three unique clusters characterized as Enthusiastic Earners, Indifferent Earners, and Strained Earners. Few differences in sociodemographic and job characteristics occurred among clusters and the differences noted had small effect sizes. Clusters did not differ by maternal BMI or perceived child weight status. However, the clusters differed in numerous weight-related behaviors and home environment characteristics. Future research should aim to determine the direction of the associations of work impact with weight-related behaviors and home environments as well as identify potential strategies for overcoming the negative effects of employment on weight-related behaviors and environments and weight status as well as clarify other factors that may affect maternal work impact, such as time management, reasons for employment, and stress.

Evaluating the Adherence of Popular Diet and Nutrition Apps to Evidence-Based Guidelines for Adult Weight Management

Objectives

To assess the adherence of popular, commercially available diet and nutrition apps to the Academy of Nutrition and Dietetics’ Adult Weight Management (AWM) guideline recommendations and to discern associations between the guideline adherence and indicators of the perceived popularity of an app among consumers.

Methods

A preliminary search for apps was conducted in Apple App Store and Google Play Store using keywords “diet” and “weight loss” in October 2020. Selection criteria screened to only include calorie-tracking apps with greater than 10 million installations, focused on weight management as a primary outcome. Apps addressing other health outcomes, disease management, or specific dietary approaches were excluded. Selected apps were assessed with iPads using a prescribed 7-day dietary intake and collected data were recorded.

Results

There were no significant correlations between any of the individual recommendation categories and app metadata attributes (app ratings, installations, subscription cost). Greatest recommendation adherence was observed in those corresponding to nutrition intervention (n = 9 recommendations; 65.9%) and monitoring and evaluation categories (n = 2 recommendations; 75%).

Conclusions

Popular, commercially available diet and nutrition apps offer limited adherence to expert guideline recommendations for adult weight management.

Funding Sources

The authors of this article disclose no funding source in support of this work.

Disordered eating in college women: associations with the mother-daughter relationship and family weight-related conversations

PURPOSE

Extensive work in the field has found multiple risk factors of disordered eating among women; however, there is limited research regarding the associations of maternal influence and family weight-related conversations during childhood with eating disorder psychopathology later in adulthood. Thus, the purpose of this study was to explore how the mother-daughter relationship and family weight-related conversations may influence the development of disordered eating in college-aged women.

METHODS

A diverse sample of 551 college-aged women completed an online survey with instruments that assessed disordered eating risk (dependent variable) with the following independent variables: aspects of the mother-daughter relationship (maternal regard and responsibility) and family weight-related conversations (emphasis on maternal weight, appearance weight control, and parent weight talk). Mediation analysis was performed using hierarchical regression analyses to examine the influence of maternal factors in combination with family weight-related conversations with disordered eating risk.

RESULTS

Using hierarchical regression analyses, aspects of the mother-daughter relationship were significantly associated with risk of disordered eating. However, this significant relationship was diminished in the presence of family weight-related conversations. Furthermore, a test of the mediation suggests that family weight-related conversations may act as a pathway for influencing perceived maternal factors in the development of disordered eating.

CONCLUSIONS

Findings illustrate the important role mothers may have in shaping their daughters eating attitudes and behaviors. Future disordered eating prevention programs and interventions may consider developing strategies in educating parents on conversations regarding weight.

LEVEL OF EVIDENCE

Descriptive cross-sectional study, Level V.

Health care provider's experiences, practices, and recommendations for interventions and screening of cystic fibrosis patients with disordered eating: A qualitative analysis

OBJECTIVES

To investigate health care providers' perspectives on their experiences and practices with cystic fibrosis patients exhibiting disordered eating behaviors and their recommendations for interventions and screening of this population.

METHODS

Experienced health care providers (N = 17) were recruited from the Cystic Fibrosis Foundation listserv to participate in a semi-structured interview via phone. Two trained qualitative researchers independently coded audio-recorded interview scripts. Major themes were generated from questions inquiring health care providers' perspectives on their experiences and practices with cystic fibrosis patients exhibiting disordered eating behaviors and their recommendations for better interventions and screening of disordered eating.

RESULTS

The most prominent disordered eating behaviors observed by health care providers in cystic fibrosis patients were misusing pancreatic enzyme medication (53%), food restriction behaviors (47%), binge eating (29%), and skipping meals (29%). Over half (53%) of health care providers reported not having policies or procedures for disordered eating of cystic fibrosis patients. All health care providers thought it would be beneficial to have a cystic fibrosis-specific disordered eating screening tool. Recommendations by health care providers included developing a national standard protocol for cystic fibrosis disordered eating and educational training for health care providers.

DISCUSSION

Ongoing development of evidence-based guidelines for screening and treating disordered eating among cystic fibrosis patients is warranted including development of a cystic fibrosis-specific disordered eating screening tool.

Feature Availability Comparison in Free and Paid Versions of Popular Smartphone Weight Management Applications

OBJECTIVE

Characterize capabilities of nutrition applications (apps) for weight management and associations between features, ratings, and app installations.

DESIGN

Calorie tracking apps with weight management as a primary outcome were selected from the Apple App Store and Google Play Store using keywords "diet" and "weight loss."

METHODS

Reviewers assessed free and upgraded versions of nutrition apps (n = 15) for features within 4 categories: (1) dietary intake, (2) anthropometrics, (3) physical activity, and (4) behavior change strategies.

OUTCOME MEASURES

Presence of specific app features, app ratings, and app installations.

ANALYSIS

Descriptive statistics of free and paid app versions. Spearman rank-order correlations were used to determine associations between feature inclusion, app ratings, and installations.

RESULTS

The apps had the greatest number of features in the dietary intake category. Additional dietary intake features were those most likely obtained through a subscription purchase. Behavior change content was absent from most apps. The macronutrient adjustment feature was strongly associated with average app ratings (r_s = 0.74; P < 0.002) and with subscription costs (r_s = 0.60; P < 0.019).

CONCLUSIONS AND IMPLICATIONS

This study found most nutrition apps possess an abundance of features dedicated to dietary intake, anthropometric, and physical activity tracking while also being notably devoid of behavior change content features.

GAD-7, GAD-2, and GAD-mini: Psychometric properties and norms of university students in the United States

OBJECTIVE

The Generalized Anxiety Disorder (GAD-7 & GAD-2) scales are reliable and valid instruments for assessing generalized anxiety symptoms in the general and clinical populations. However, little attention has been given to the psychometric qualities of GAD-7 and reduced length versions in a diverse sample of young adult college students stratified by sex. Thus, the aims for this study are to test psychometric properties and normative values of GAD-7, GAD-2, and GAD-Mini scales.

METHOD

U.S university students (N = 4128; females n = 2527, males n = 1601) ages 18-26 years completed an online survey composed of the GAD-7, Patient Health Questionnaire (PHQ-2), and demographic questions.

RESULTS

Exploratory principal components analysis yielded a one factor solution for GAD-7 across sexes. In reducing scale length, iterative confirmatory principal components analyses stratified by sex revealed a two-item scale (GAD-Mini) with high factor loading items, internal consistency (α ≥ 0.85), and construct validity with PHQ-2 (r ≥ 0.55). Normative data indicate that regardless of whether GAD-7, GAD-2, or GAD-Mini scores were considered, about three-quarters of men and two-thirds of women scored below the reasonable cut-points in screening for GAD.

CONCLUSION

Findings from this study may help health care providers and researchers better understand the interpretation of these scales among university students when screening for GAD.

Hassle Exposure and Reactivity Links with Obesogenic Health Behaviors

Objectives: In this study, we explored associations between daily "hassles" (irritating inconveniences) and obesogenic health behaviors of college students. Methods: Students (N = 406, 62% female) completed a survey including the 5-point Brief College Student Hassle Scale which quantifies hassles experienced in the last month in 9 domains (eg, preparing meals, exercising, adequate sleep) and hassle reactivity (ie, upset from hassles), with scores categorized as low (< 2.5), moderate (≥ 2.5 to ≤ 3.5), or high (> 3.5). Results: Females had significantly (p < .05) greater hassles in all domains than males, except for work, personal relationships, and living environment. ANOVA revealed both sexes in the high hassle exposure groups tended to have poorer eating behaviors than the low hassle exposure group. Additionally, high hassle exposure females and males slept less, and had poorer sleep quality, satisfaction with life, and physical and mental health than lower hassle exposure groups. Multiple linear regression analyses examining associations of hassle exposures and hassle reactivity with each health behavior, adjusted for sex and body mass index, revealed all models were statistically significant, except fruit and vegetable intake. Conclusions: Lower hassle during college is associated with healthier weight-related behaviors and better health status. Future nutrition interventions targeting college students may be strengthened by incorporating strategies for effectively coping with daily hassles.

Psychometric Properties of the Generalized Anxiety Disorder-7 and Generalized Anxiety Disorder-Mini in United States University Students

Background: Generalized anxiety disorder (GAD) is common in young adults, yet few studies have established the psychometric properties of the GAD-7 screener in college students. Methods: A secondary analysis of three studies was conducted to determine GAD-7 factor structure stability, create a GAD-Mini version using standard procedures, and evaluate the psychometric properties, validity, sensitivity, specificity, and predictive values of both versions in young adults. Results: Exploratory and confirmatory principal components analysis indicated the GAD-7 has a single factor structure with strong loadings, reliability, and stability across data collected in three studies. Data from all studies met criteria indicative of good to excellent model fit. Iterative confirmatory principal components analyses revealed the most parsimonious group of items that maintained scale unidimensionality, strong loadings, and high reliability was two items (not able to stop or control worrying and worried too much). Both the GAD-7 and GAD-Mini exhibited good construct and convergent validity. Specificity, sensitivity, and negative predictive value were high, and positive predictive value was moderate to high for the GAD-Mini. Conclusions: The GAD-Mini is a psychometrically sound tool that can serve as a step toward universal screening in clinical practice and contribute to early treatment and improved health outcomes for GAD.

SAT0271 THE “GOLD STANDARD” DIAGNOSTIC TEST FOR GCA IS THE WHOLE GCA FAST TRACK PATHWAY COMBINED

Background:

We have been developing a rheumatologist-led ultrasound driven giant cell arteritis (GCA) fast-track pathway (FTP), which in year 3 had the following structure:

Objectives:

To compare security of GCA diagnosis, sight loss rate and TAB rate in Year 3 to previous years

To assess sensitivity and specificity of all components of the Yr 3 FTP for diagnosis of GCA

Methods:

As in Yr 2, TAUS was performed by VQ with an Esaote Mylab7, 6-15MHz probe for axillaries, 22MHz for temporal arteries (TAs). In Yr 1 VQ used a GES8 with ML6-15 for axillaries, 18MHz probe for TAs. Year 3 audit data were compared to previous audits

Results:

Year 3 Luton GCA FTP compared to previous years

Traditional ModelYear 1Year 2Year 3Audit period201512 months1/1/16-31/3/1715 months1/4/17-31/3/1812 months1/4/18-31/3/1912 monthsPathway structureNo rapid access to RASTAB, no TAUS servicePatients seen ad-hoc for RAS + TAUSTAB requested in all appropriate cases to compare TAUS to TABRapid access for RAS + TAUS,2 slots/wk2nd test in selected patientsRapid access for RAS + TAUS,3 slots /wk2nd test in selected patientsProtocolised withdrawal prednisoloneNo. referrals with suspected GCA/yrNK50.47090Cases GCA /yr9241825Cases GCA excluded /yrNK26.45265% GCA patients with imaging/TAB +ve GCA44.463.383.392% GCA patients with clinical GCA(high CP-GCA,no +ve test)55.636.716.68% referred whereGCA excluded on clinical grounds aloneNK11.15.75.6% referred whereTAUS performed and TAB avoidedNANA38.650.0% referred who had TABNK (total 27)84.142.831.1% referred where TAUS, then LVI performed instead of TABNA4.812.813.3Mean days on prednisolone for GCA before TAUS (median, range)NA10.6(7, 0-81)4.4(2, 0-54)5.9(3, 0-57)% GCA patients with permanent sight loss due to GCA3323.311.28

NA: Not applicable NK: not known

Performance of components of Year 3 Luton GCA FTP compared to final diagnosis at >6 months*

Diagnostic ToolNo. pts**Sensitivity %Specificity %PPV %NPV %Rheumatologist CP GCA (High)***906098.393.886.1Rheumatologist CP GCA (Moderate & High)***908863.548.993Any halo on TAUS8581.591.481.591.4Bilateral positive TAUS8559.398.394.183.8TAB2869.210010078.9LVI (CT or CTPET)128010010087.5Combined diagnostic tests in the whole FTP (bilateral positive TAUS +/or positive TAB +/or positive LVI)889298.395.896.7

*using patient record to Oct 2019 **2 patients passed through twice ***before imaging/TAB

Conclusion:

Unlike Yr 2, the higher secure diagnosis rate in Yr 3 could not be attributed to shorter time on prednisolone or better equipment. The increase was likely due to several factors including further improved sonographer skill and increased confidence to withdraw steroids in insecure cases with low/moderate CP-GCA. This approach did not increase sight loss. Further reduction in TAB rate financially justified a 3rd FTP slot/wk created in Yr 3.

Each component of the FTP was an inadequate diagnostic tool. Combinations of diagnostic tools are needed to obtain the highest sensitivity and specificity for GCA diagnosis. FTPs limit tests to the minimum required for secure diagnosis. The “gold standard” diagnostic test for GCA is the whole FTP combined.

References:

[1]Schäfer et alRheum (Ox) 2017:56(9);1479-83

[2]van der Geest et alARDdoi: 10.1136/annrheumdis-2019-216343

Disclosure of Interests:

Vanessa Quick Consultant of: Roche, Speakers bureau: Roche, Mark Hughes: None declared, Chi-Hwa Chan: None declared

Exploring Relationships of Sleep Duration with Eating and Physical Activity Behaviors among Canadian University Students

BACKGROUND

Students pursuing postsecondary education are a population described as vulnerable for sleep problems, poor dietary habits, weight gain, and reduced physical activity. The primary goal of this study was to examine relationships of sleep behaviors with eating and physical activity behaviors in a sample of undergraduate health sciences students.

METHODS

Using a cross-sectional design, undergraduate health sciences students in a small Canadian university were recruited to complete an on-line questionnaire about their sleep, eating, and physical activity behaviors using valid and reliable instruments. Key sociodemographic characteristics and self-reported height and weight data were also captured.

RESULTS

The participants (n = 245) were on average 23 years of age, female (86%), and the majority were full-time students (92%). The mean BMI was within a healthy range (mean 24.58 SD 5.55) with the majority reporting low physical activity levels (65%). Despite self-reports of very or fairly good (65%) sleep quality in the past month, the mean global sleep scores (scores > 5, mean 7.4, SD 3.3) indicated poor overall sleep quality. Poorer sleep quality was associated with higher BMIs (r = 0.265, p < 0.001).

CONCLUSIONS

The findings highlight the need to expand the scope of on-campus wellness programs to promote healthy sleep habits in a vulnerable university population.

Eating-disordered behavior among male and female college students in Iran

OBJECTIVE

Few studies of eating-disorder behaviors (EDBs) in Iran have been conducted and no study has examined the occurrence of these behaviors (EDBs) among young Iranian men. This cross-sectional study examined the occurrence of EDBs, as assessed by the Eating Disorder Examination Questionnaire (EDE-Q), among young men and women in Iran.

METHOD

Male (n = 253) and female (n = 384) college students completed the EDE-Q. Mean scores on the EDE-Q subscales and the occurrence and regular occurrence of EDBs, namely, binge eating, self-induced vomiting, laxative misuse, extreme dietary restriction and excessive exercise, were compared between male and female participants.

RESULTS

Female students had higher scores on the EDE-Q Shape Concern subscale than males, whereas scores on the other subscales did not differ by gender. Male students were more likely to report self-induced vomiting (any occurrence: 10.4% vs. 3.2%) and excessive exercise (28.0% vs. 20.0%) than female students. The occurrence of other EDBs did not differ by gender and binge eating was the most common EDB in both men (regular occurrence = 24.7%) and women (27.5%).

CONCLUSION

The findings suggest that EDBs are relatively common among college students in Iran and that most EDBs are equally common among male and female students. Prevention and health promotion programs designed to reduce the occurrence and adverse impact of EDBs may be increasingly important in Iran.

Nutritional Risks Among Female Athletes

Background: Limited research studies have been conducted on nutritional risks among female athletes. Therefore, this literature review focuses on rigorously designed studies that examined nutritional risks among female athletes with further recommendations for athletes, coaches, parents, and health professionals, which would help improve the health of female athletes. Methods: This review evaluates the most recent research on nutritional risk among female athletes. Inclusion criteria included peer-reviewed studies of original research on human subjects 13 years of age or older; sample size of N ≥ 19; and studies with a thorough description of their sample and methods. A systematic search of the databases PubMed and Cochrane for published studies (from year 2000 to year 2019) was conducted to identify articles that met inclusion criteria. Bibliographies of identified articles were also searched for relevant articles. Results: Of the 11 studies that met our inclusion criteria, most were mainly cross-sectional in design with few rigorous controls. Findings reveal that strategies to enhance nutrition patterns among female athletes may be important to avoid risks of disordered eating, eating disorders, low energy availability, and symptoms of relative energy deficiency in sports. In addition, general nutrition knowledge is lacking among athletes, sports teams, and coaches. Conclusions: This review highlights the scarcity of evidence-based, rigorous studies examining nutritional risks among female athletes. Findings suggest that interdisciplinary working groups, comprising physicians, sports dietitians, and other supportive health professionals, would be beneficial for female athletes in helping to improve their overall diet, performance, and health.

Stability of Differences in Weight-Related Characteristics of Mothers across Economic, Cultural, Social, and Environmental-Health Indicators of Socioeconomic Status

This study explored the differences in weight-related characteristics when socioeconomic status (SES) was assessed by economic, cultural, social, and environmental-health capital individually and as a composite with the goal of determining the stability of differences across types of capital and to ascertain whether single or a combination of capital indicators of SES should be used in nutrition and public health studies. Mothers (n = 557) of young children completed a survey assessing capital and weight-related characteristics. Mothers with higher economic, cultural, and social capital and composite SES had fewer sugar-sweetened beverage servings, fewer meals in front of the TV, more food security, and greater neighborhood space/supports for physical activity than comparators. Few differences occurred among environmental-health capital groups. Composite SES performed similarly to individual economic, cultural, and social capital measures. Findings suggest single SES indicators may be sufficiently stable to capture differences in weight-related characteristics. Each capital type captures a unique aspect of SES; thus, assessing an array of capital types could advance understanding of SES aspects on weight-related characteristics.

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

OBJECTIVE

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

DESIGN

Cross-sectional online survey.

SETTING

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

PARTICIPANTS

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

OUTCOME MEASURE

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

ANALYSIS

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

RESULTS

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

CONCLUSIONS

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

Generational Differences: A Comparison of Weight-Related Cognitions and Behaviors of Generation X and Millennial Mothers of Preschool Children

A ‘generation’ is an identifiable group sharing birth years and significant life events at critical developmental ages. There is a paucity of literature examining how parental cognitions and lifestyle behaviors differ by generation and whether generational differences are substantial enough to warrant consideration during the development of health interventions. This study compared generational differences in weight-related cognitions and lifestyle behaviors of mothers of young children who were categorized as Generation X (born 1965–1981, n = 158) and Generation Y (aka Millennials; born 1982–1999, n = 162). Survey results indicated that Generation X had significantly higher family affluence; thus, this was controlled in subsequent analyses. Analysis of covariance indicated that Millennials had more positive expectations about the benefits of engaging in healthy eating and physical activity than comparators, but not significantly so. Millennial mothers placed significantly higher value on physical activity for themselves than Generation X mothers, but both generations were neutral on the value of personal physical activity. No generational differences were noted in self-efficacy of mothers for promoting childhood obesity-prevention practices to children and self-efficacy for personally engaging in weight-protective behaviors. Millennial mothers had significantly more family meals/week, however generations did not differ on the value placed on family meals, where family meals were eaten, or whether media devices were used at mealtime. Few differences were noted between the generations for most child feeding behaviors, except that Millennials reported placing significantly less pressure on children to eat. Mothers’ modeling of weight-related behaviors as a means for children’s observational learning about healthy eating, physical activity, and sedentary behaviors did not differ by generational group. The eating behaviors of mothers differed little between generations. Millennial mothers allowed significantly more media devices in children’s bedrooms and personally engaged in more screen time daily than comparators. Overall, the two generational groups were more similar than different in weight-related cognitions as well as for personal and parenting lifestyle behaviors. The results suggest that tailoring interventions for individuals at a similar life-stage (e.g., mothers of young children) by generation may not be warranted.

Psychometric properties and factor structure of the adapted Self-Regulation Questionnaire assessing autonomous and controlled motivation for healthful eating among youth with type 1 diabetes and their parents

BACKGROUND

The purpose of this cross-sectional study was to examine the psychometric properties of 2 adapted Self-Regulation Questionnaire (SRQ) measures assessing youth with type 1 diabetes motivation internalization for healthful eating and their parents motivation internalization for providing healthy meals for the family.

METHODS

External validity of the adapted SRQ was evaluated with respect to healthy eating attitudes (healthful eating self-efficacy, barriers, and outcome expectations) assessed by questionnaire, diet quality (Healthy Eating Index-2005 [HEI-2005]; Nutrient-Rich Foods Index 9.3 [NRF9.3]; Whole Plant Food Density [WPFD]) assessed by 3-day food records, and body mass index assessed by measured height and weight in youth with type 1 diabetes (N = 136; age 12.3 ± 2.5 years) and their parents.

RESULTS

Exploratory factor analysis with varimax rotation yielded a 2-factor structure with the expected autonomous and controlled motivation factors for both youth and parents. Internal consistencies of subscales were acceptable (α = .66-.84). Youth autonomous and controlled motivation were positively correlated overall (r = 0.30, p < .001); however, in analyses stratified by age (<13 vs. ≥13 years), the correlation was not significant for youth ≥13 years. Autonomous motivation was significantly associated (p < .001) with greater self-efficacy (youth: r = 0.39, parent: r = 0.36), positive outcome expectations (youth: r = 0.30, parent: r = 0.35), and fewer barriers to healthful eating (youth: r = -0.36, parent: r = -0.32). Controlled motivation was positively correlated with negative outcome expectations for parents (r = 0.29, p < .01) and both positive (r = 0.28, p < .01) and negative (r = 0.34, p < .001) outcome expectations for youth. Autonomous motivation was positively associated (p < .05) with diet quality indicators for parents (NRF9.3 r = 0.22; WPFD r = 0.24; HEI-2005 r = 0.22) and youth ≥13 years (NRF9.3 r = 0.26) but not youth < 13years. Among parents, but not youth, body mass index was associated negatively with autonomous motivation (r = -.33, p < .001) and positively with controlled motivation (r = .27, p < .01).

CONCLUSIONS

Findings provide initial support for the SRQ in this population and suggest potential developmental differences in the role of motivation on healthful eating among children, adolescents, and adults.

An Exploratory Study Examining Obesity Risk in Non-Obese Mothers of Young Children Using a Socioecological Approach

This cross-sectional, exploratory study aimed to (1) develop an obesity risk score using a comprehensive set of variables assessing mothers’ intrapersonal weight-related characteristics and those of their homes’ interpersonal and physical environments, and (2) determine how weight-related characteristics differ by obesity risk level. U.S. mothers (N = 550) of preschool-aged children completed an online survey that assessed maternal self-report weight status, sociodemographics, health-related characteristics, and maternal intrapersonal and their homes’ interpersonal and physical environment weight-related characteristics. Binomial logistic regression analysis identified variables significantly associated with obesity. Scores for all obesity risk variables were summed to create a weighted obesity risk score for non-obese participants (n = 386). Analysis of variance and Tukey post-hoc tests determined how non-obese mothers’ sociodemographic, health-related, and intrapersonal and their homes’ interpersonal and physical environment characteristics differed among obesity risk score tertiles. Results revealed that eight variables explained 53 percent of maternal obesity risk, including African American race, lower education level, more children in household, poorer maternal health, higher weight teasing history, higher body dissatisfaction, primary relative with obesity, and greater concern about children’s overweight risk. Non-obese mothers in the highest obesity risk tertile had greater food insecurity risk, lower family affluence, worse sleep quality, less fruit/vegetable availability, and reported less frequent modeling of healthy behaviors and more family conflict. In conclusion, eight characteristics that explained more than half of the risk for obesity in non-obese mothers of young children, may help healthcare professionals identify mothers at increased risk of obesity and offer preventive care early.

Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study

BACKGROUND

Limited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk.

OBJECTIVE

The purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children.

METHODS

Mothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother's fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward's method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings.

RESULTS

Of the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward's hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion).

CONCLUSIONS

Findings may have implications in tailoring future obesity prevention interventions among families with young children.

The marketing plan and outcome indicators for recruiting and retaining parents in the HomeStyles randomized controlled trial

Background

Despite the critical importance of successful recruitment and retention to study integrity, reporting of recruitment and retention strategies along with factors associated with successful recruitment and retention of participants in health-related interventions remain rare, especially for health and obesity prevention programs. Thus, the purpose of this article is to retrospectively examine the recruitment and retention marketing plan used in the online HomeStyles randomized controlled trial (RCT) and discuss outcomes associated with completion of the intervention.

Methods

The HomeStyles RCT is an online intervention developed to motivate parents of young children to gain the skills and self-confidence needed to shape home environments and lifestyles to be protective against childhood obesity. Using the seven Ps of services marketing (i.e., people, place, product, physical evidence, price, promotion, and process), a comprehensive and systematic plan for recruitment and retention was implemented and outcomes assessed.

Results

A total of 489 parents with a young child aged 2 to < 6 years were eligible to participate, a final capture rate of 33%. Only 23% of Hispanic participants chose to use the Spanish-language version of HomeStyles intervention materials, below the demand anticipated. However, Hispanic enrollment overall was substantially higher than the U.S. population proportion (i.e., 17%). The number of participants prematurely leaving the study was similar in both treatment groups, indicating attrition was not differential. Completers reported high satisfaction of HomeStyles, using a 1–5 scale (strongly disagree to strongly agree) on guide attractiveness, interestingness, and usefulness. Despite all the retention efforts, the average monthly recruitment accrual rate of ~ 33 eligible enrolled participants at baseline (i.e., 489 participants/15-month recruitment period), declined to ~ 18, 11, 9, and 8 remaining recruited participants/month at midpoint, post, follow-up, and long-term follow-up surveys, respectively. In general, survey completers were significantly more likely to be female and perceived their child’s health status to be better, and they were significantly less likely to be restrictive of their child’s food intake.

Conclusions

The findings of the present study highlight the need for far-reaching, concentrated, and varied recruitment strategies; sufficient time in the research plan for recruitment and retention activities; and creative, tireless, flexible, persistent project staff for health-related interventions.

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

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

Systematic review of control groups in nutrition education intervention research

Background

Well-designed research trials are critical for determining the efficacy and effectiveness of nutrition education interventions. To determine whether behavioral and/or cognition changes can be attributed to an intervention, the experimental design must include a control or comparison condition against which outcomes from the experimental group can be compared. Despite the impact different types of control groups can have on study outcomes, the treatment provided to participants in the control condition has received limited attention in the literature.

Methods

A systematic review of control groups in nutrition education interventions was conducted to better understand how control conditions are described in peer-reviewed journal articles compared with experimental conditions. To be included in the systematic review, articles had to be indexed in CINAHL, PubMed, PsycINFO, WoS, and/or ERIC and report primary research findings of controlled nutrition education intervention trials conducted in the United States with free-living consumer populations and published in English between January 2005 and December 2015. Key elements extracted during data collection included treatment provided to the experimental and control groups (e.g., overall intervention content, tailoring methods, delivery mode, format, duration, setting, and session descriptions, and procedures for standardizing, fidelity of implementation, and blinding); rationale for control group type selected; sample size and attrition; and theoretical foundation.

Results

The search yielded 43 publications; about one-third of these had an inactive control condition, which is considered a weak study design. Nearly two-thirds of reviewed studies had an active control condition considered a stronger research design; however, many failed to report one or more key elements of the intervention, especially for the control condition. None of the experimental and control group treatments were sufficiently detailed to permit replication of the nutrition education interventions studied.

Conclusions

Findings advocate for improved intervention study design and more complete reporting of nutrition education interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0546-3) contains supplementary material, which is available to authorized users.

A Socio-Ecological Examination of Weight-Related Characteristics of the Home Environment and Lifestyles of Households with Young Children

Home environment and family lifestyle practices have an influence on child obesity risk, thereby making it critical to systematically examine these factors. Thus, parents (n = 489) of preschool children completed a cross-sectional online survey which was the baseline data collection conducted, before randomization, in the HomeStyles program. The survey comprehensively assessed these factors using a socio-ecological approach, incorporating intrapersonal, interpersonal and environmental measures. Healthy intrapersonal dietary behaviors identified were parent and child intakes of recommended amounts of 100% juice and low intakes of sugar-sweetened beverages. Unhealthy behaviors included low milk intake and high parent fat intake. The home environment’s food supply was found to support healthy intakes of 100% juice and sugar-sweetened beverages, but provided too little milk and ample quantities of salty/fatty snacks. Physical activity levels, sedentary activity and the home’s physical activity and media environment were found to be less than ideal. Environmental supports for active play inside homes were moderate and somewhat better in the area immediately outside homes and in the neighborhood. Family interpersonal interaction measures revealed several positive behaviors, including frequent family meals. Parents had considerable self-efficacy in their ability to perform food- and physical activity-related childhood obesity protective practices. This study identified lifestyle practices and home environment characteristics that health educators could target to help parents promote optimal child development and lower their children’s risk for obesity.

HomeStyles, A Web-Based Childhood Obesity Prevention Program for Families With Preschool Children: Protocol for a Randomized Controlled Trial

Background

The home environment is where young children spend most of their time, and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied, and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights.

Objective

The aim of the HomeStyles randomized controlled trial (RCT) is to determine whether the Web-based HomeStyles intervention enables and motivates parents to shape the weight-related aspects of their home environments and lifestyle behavioral practices (diet, exercise, and sleep) to be more supportive of their preschool children’s optimal health and weight.

Methods

A rigorous RCT utilizing an experimental group and an attention control group, receiving a bona fide contemporaneous treatment equal in nonspecific treatment effects and differing only in subject matter content, will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework, and will assess: intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-preventive practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home.

Results

Enrollment for this study has been completed and statistical data analyses are currently underway.

Conclusions

This paper describes the HomeStyles intervention with regards to: rationale, the intervention’s logic model, sample eligibility criteria and recruitment, experimental group and attention control intervention content, study design, instruments, data management, and planned analyses.

Relationships of Sleep Duration With Weight-Related Behaviors of U.S. College Students

This study describes sleep behaviors of U.S. college students (N = 1,252; 18-24 years old; 59% female) and examines associations of sleep duration with weight-related behaviors. More than one quarter of participants slept < 7 hr/night and had mean Pittsburgh Sleep Quality Index (PSQI) scores indicating poor sleep quality. There were significant differences for all PSQI scales among sleep duration categories, < 7 hr (n = 344), 7-8 hr (n = 449), ≥ 8 hr (n = 459) sleep/night. Compared to those who slept ≥ 8 hr, those who slept < 8 hr had significantly more negative eating attitudes (2% higher), poorer internal regulation of food (4% lower), and greater binge eating (4% higher) scores. Findings advocate for health care professionals to evaluate sleep behaviors of college students during office visits and promote good sleep behaviors.

Validity and reliability of HOP-Up: a questionnaire to evaluate physical activity environments in homes with preschool-aged children

BACKGROUND

Early identification of physical activity (PA) opportunities in the home and neighborhood environment may help obesity prevention efforts in households with young children. This cross-sectional study's purpose was to develop a brief, easy-to-use, self-report inventory called Home Opportunities for Physical activity check-Up (HOP-Up), to evaluate the availability and accessibility of PA space and equipment in and near homes with preschool children, and establish its validity and reliability.

METHODS

The HOP-Up was field tested by two trained researchers and parents of preschool-aged children (n = 50; 71% white). To establish criterion validity, researchers were the 'gold standard' and visited participants' homes to assess their PA environments using the HOP-Up, while participants separately completed their HOP-Up. Two weeks later, parents completed the HOP-Up online for test-retest reliability. After minor survey refinements, exploratory and confirmatory factor analysis using a split-half cross validation procedure was conducted in a larger sample of participants (n = 655, 60% white) who completed the HOP-Up online to examine its factor structure. To establish convergent validity, correlations were conducted to compare HOP-Up scales from the factor solution generated with PA behavior and cognitions, and reported screen time.

RESULTS

Intra-class correlations (ICCs) examining HOP-Up item agreement between researcher and parents revealed slight to substantial agreement (range 0.22 to 0.81) for all items. ICCs for all HOP-Up items ranged from fair to substantial agreement between parent responses at both time points (range 0.42 to 0.95). Exploratory factor analysis revealed a five factor solution (18 items), supported eigen values, scree plots, review for contextual sense, and confirmatory factor analysis. Additionally, there were significant (p < 0.05) positive correlations among nearly all five HOP-Up scales with parent and child physical activity levels (range 0.08 to 0.35), and values parents placed on PA for self and child (range 0.16 to 0.35), and negative correlations of Neighborhood Space & Supports for PA scale with parent and child reported screen time (r = -0.11, r = -0.13, respectively).

CONCLUSIONS

Findings support the psychometric properties of this brief, easy-to-use, HOP-Up questionnaire, which may help parents, prevention researchers, residential planners, and practitioners increase their understanding of how the home environment-inside, outside, and the neighborhood- impacts preschool children's physical activity levels.

Reliability and criterion validity of self-measured waist, hip, and neck circumferences

Background

Waist, hip, and neck circumference measurements are cost-effective, non-invasive, useful markers for body fat distribution and disease risk. For epidemiology and intervention studies, including body circumference measurements in self-report surveys could be informative. However, few studies have assessed the test-retest reliability and criterion validity of a self-report tool feasible for use in large scale studies.

Methods

At home, mothers of young children viewed a brief, online instructional video on how to measure their waist, hip, and neck circumferences. Afterwards, they created a homemade paper measuring tape from a downloaded file with scissors and tape, took all measurements in duplicate, and entered them into an online survey. A few weeks later, participants visited an anthropometrics lab where they measured themselves again, and trained technicians (n = 9) measured participants in duplicate using standard equipment and procedures. To assess differences between self- and technician-measured circumferences, duplicate measurements for participant home self-measurements, participant lab self-measurements, and technician measurements each were averaged and Wilcoxon signed-rank tests conducted. Agreement between all possible pairs of measurements were examined using Intraclass Correlations (ICCs) and Bland-Altman plots.

Results

Participants (n = 41; aged 38.05 ± 3.54SD years; 71 % white) were all mothers that had at least one child under the age of 12 yrs. Technical error of measurements for self- and technician- duplicate measurements varied little (0.08 to 0.76 inches) and had very high reliability (≥0.90). Intraclass Correlations (ICC) comparing self vs technician were high (0.97, 0.96, and 0.84 for waist, hip, and neck). Comparison of self-measurements at home vs lab revealed high test-retest reliability (ICC ≥ 0.87). Differences between participant self- and technician measurements were small (i.e., mean difference ranged from −0.13 to 0.06 inches) with nearly all (≥93 %) differences within Bland-Altman limits of agreement and <10 % exceeding the a priori clinically meaningful difference criterion.

Conclusions

This study has demonstrated a simple, inexpensive method for teaching novice mothers of young children to take their own body circumferences resulting in accurate, reliable data. Thus, collecting self-measured and self-reported circumference data in future studies may be a feasible approach in research protocols that has potential to expand our knowledge of body composition beyond that provided by self-reported body mass indexes.