Mothers' experiences of reducing family mealtime screen use in Australian households with young children.

OBJECTIVE: Screen use at mealtimes is associated with poor dietary and psychosocial outcomes in children and is disproportionately prevalent among families of low socio-economic position (SEP). This study aimed to explore experiences of reducing mealtime screen use in mothers of low SEP with young children. DESIGN: Motivational interviews, conducted via Zoom or telephone, addressed barriers and facilitators to reducing mealtime screen use. Following motivational interviews, participants co-designed mealtime screen use reduction strategies and trialled these for 3-4 weeks. Follow-up semi-structured interviews then explored maternal experiences of implementing strategies, including successes and difficulties. Transcripts were analysed thematically. SETTING: Australia. PARTICIPANTS: Fourteen mothers who had no university education and a child between six months and six years old. RESULTS: A range of strategies aimed to reduce mealtime screen use were co-designed. The most widely used strategies included changing mealtime location and parental modelling of expected behaviours. Experiences were influenced by mothers' levels of parenting self-efficacy and mealtime consistency, included changes to mealtime foods and an increased value of mealtimes. Experiences were reportedly easier, more beneficial and offered more opportunities for family communication, than anticipated. Change required considerable effort. However, effort decreased with consistency. CONCLUSIONS: The diverse strategies co-designed by mothers highlight the importance of understanding why families engage in mealtime screen use and providing tailored advice for reduction. Although promising themes were identified, in this motivated sample, changing established mealtime screen use habits still required substantial effort. Embedding screen-free mealtime messaging into nutrition promotion from the inception of eating will be important.

Parent meal self-efficacy and practices in households with healthy home food environments in the face of economic hardship.

Some families who experience economic hardship demonstrate remarkable strength and resourcefulness to sustain a healthy home food environment. This ability to navigate economic barriers could be associated with parent meal practices that promote children's healthful dietary intake. Therefore, this study aimed to examine 1) whether parent meal self-efficacy and practices were associated with economic assistance status and home fruit and vegetable (FV) availability and 2) how parent meal self-efficacy and practices differed by home FV availability and economic assistance status. Analyses utilized baseline data from 274 parent/child dyads from two childhood obesity prevention trials: HOME Plus (urban) and NU-HOME (rural). Parents in households with high FV availability (regardless of economic assistance) had significantly higher self-efficacy in preparing healthy foods, family dinner routines, frequency of child's plate being half filled with FV, frequency of family dinner and breakfast, and lower frequency of purchasing dinner from fast food restaurants. Economic assistance was not associated with parent meal self-efficacy and practices. Four family groups were created and defined by economic assistance (yes/no) and home FV availability (high/low). About 31% of families that received economic assistance and had high home FV availability were food insecure. Families (n = 39) receiving economic assistance and having high home FV availability had greater frequency of family dinners compared to those in households with economic assistance and low home FV availability (n = 47) (p = 0.001); no other parent meal self-efficacy or practices differed between groups. Our findings suggest some families can maintain healthy home food environments despite economic hardship and frequent family dinners may be an important strength for these families. More research is needed to investigate asset-based models to understand the family strengths that enable them to thrive during difficult times.

Frequency of family meals and food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study.

A family meal is defined as a meal consumed together by the members of a family or by having ≥ 1 parent present during a meal. The frequency of family meals has been associated with healthier food intake patterns in both children and parents. This study aimed to investigate in families at high risk for developing type 2 diabetes across Europe the association (i) between family meals' frequency and food consumption and diet quality among parents and (ii) between family meals' frequency and children's food consumption. Moreover, the study aimed to elucidate the mediating effect of parental diet quality on the association between family meals' frequency and children's food consumption. Food consumption frequency and anthropometric were collected cross-sectionally from a representative sample of 1964 families from the European Feel4Diabetes-study. Regression and mediation analyses were applied by gender of children. Positive and significant associations were found between the frequency of family meals and parental food consumption (ß = 0.84; 95% CI 0.57, 1.45) and diet quality (ß = 0.30; 95% CI 0.19, 0.42). For children, more frequent family meals were significantly associated with healthier food consumption (boys, ß = 0.172, p < 0.05; girls, ß = 0.114, p < 0.01). A partial mediation effect of the parental diet quality was shown on the association between the frequency of family meals and the consumption of some selected food items (i.e., milk products and salty snacks) among boys and girls. The strongest mediation effect of parental diet quality was found on the association between the frequency of family breakfast and the consumption of salty snacks and milk and milk products (62.5% and 37.5%, respectively) among girls. CONCLUSIONS: The frequency of family meals is positively associated with improved food consumption patterns (i.e., higher intake of fruits and vegetables and reduced consumption of sweets) in both parents and children. However, the association in children is partially mediated by parents' diet quality. The promotion of consuming meals together in the family could be a potentially effective strategy for interventions aiming to establish and maintain healthy food consumption patterns among children. TRIAL REGISTRATION: The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov , March 20, 2015. WHAT IS KNOWN: • Parents' eating habits and diet quality play an important role in shaping dietary patterns in children • Family meals frequency is associated with improved diet quality of children in healthy population What is New: • Frequency of family meals was significantly associated with healthier food consumption among parents and children in families at high risk of type 2 diabetes in six European countries. • Parental diet quality mediates the association between family meals frequency and the consumption of some selected food items among children.

A dialectic of control and acceptance: Mealtimes with children on the autism spectrum.

Shared family meals have important implications for child health and wellbeing, however, mealtimes with children on the autism spectrum are often characterized by stress and problematic behavior. A better understanding of the underlying processes can elucidate the mealtimes challenges that families with children on the spectrum face as well as how families overcome those challenges in order to promote family health and wellbeing. Through a grounded theory analysis of mealtime observations, parent interviews, and child interviews with 16 families in the United States, we identified a theory of A Dialectic of Control and Acceptance. Integral to the role of mealtimes is for parents to express love through control and acceptance, however, these parallel processes are in tension with one another. How parents negotiate this tension dictates the degree to which their expectations are well aligned with their children's strengths and challenges and are able to provide effective support.

What can families gain from the family meal? A mixed-papers systematic review.

The family meal has been associated with numerous health and wellbeing benefits for both adults and children. However, the majority of the research in this area is correlational, unable to prove a causal relationship between family meals and health and wellbeing outcomes. The objectives of this systematic review were to determine the causal relationship between family meals and health and wellbeing and explore family members' perceptions of the family meal. A systematic search across five databases was undertaken to identify both intervention studies and qualitative studies investigating the family meal. Thirty-two articles were deemed eligible for inclusion in this review. Qualitative data were synthesised via the meta-aggregation approach; however, the quantitative data were too heterogeneous to perform meta-analysis. Only one intervention included in this review exclusively targeted the family meal, the remaining studies had other target strategies as part of their intervention (e.g. physical activity, snacking, sleep routines). Only two of the eight interventions reported a statistically significant difference between control and intervention groups for family meal frequency or quality, therefore we were unable to fully explore the causal relationship between family meals and health and wellbeing outcomes. The qualitative studies identified multiple barriers to the family meal, including scheduling conflicts, exhaustion and lack of time, and reported family connection and communication as the main perceived benefits of the family meal. There is a gap between the benefits and barriers to the family meal identified through qualitative research, and current intervention strategies, with few interventions exclusively targeting the family meal. Interventions that are informed by qualitative literature and exclusively target the family meal are needed to further investigate the causal relationship between family meals and potential health and wellbeing outcomes.

A qualitative investigation of how mothers from low income households perceive their role during family meals.

BACKGROUND: Having regular family meals has been shown to be protective for child dietary intake (e.g., higher intake of fruit and vegetables). Mothers appear to be most responsible for preparing family meals. Therefore, understanding how mothers perceive their roles around family meals may help identify ways in which to help more families have regular family meals. METHODS: United States mothers (n = 83) from the Twin Cities, Minnesota were interviewed during an in-home visit. Researchers trained in qualitative interviewing used a semi-structured approach and asked questions regarding the mothers' overall perception of their role during family meals. Interviews were coded using a mixed deductive and inductive content analysis approach. The majority of mothers were from minority and low-income households. RESULTS: Mothers described their roles during family meals as the follows: 1) Helping children make healthy choices at family meals; 2) Making the meal happen; 3) Monitoring children's food intake; 4) Managing behavior at the family meal; 5) Making the family meal atmosphere enjoyable; and 6) Facilitating conversation/communication. Two secondary research questions also emerged about the specifics of the mothers' perception of her role at family meals (i.e., How do mothers deal with fighting or arguing if it occurs at family meals? and What do mothers talk about with children at family meals?) CONCLUSIONS: Results show that mothers have a large and varied role during family meals. Additionally, they are willing to put effort into family meals and want them to be enjoyable. Findings also suggest that mothers can be supported by encouraging fuller family participation in family meals and by offering mothers quality nutrition and parent feeding practice information.

The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications.

Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40 years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.

Early school-age family meal characteristics matter for the later development of boys and girls.

Objective: Sharing a meal together offers an innovative approach to study the family environment. How often families eat together may not capture the distinct experience for sons and daughters. Instead, studying family meal characteristics might be more enlightening. This study aims to examine the prospective associations between family meal environment quality at age 6 years and later well-being at age 12 years in 734 boys and 758 girls. Method: Participants are from the Quebec Longitudinal Study of Child Development birth cohort. When children were aged 6 years, parents reported on their family meal environment experience. At age 12 years, child outcomes included parent-reported healthy lifestyle habits, teacher-reported academic achievement, and self-reported social adjustment. The relationship between early family meal environment quality and later child outcomes were analyzed using multivariate linear regressions. Results: For girls, better family meal environment quality at age 6 years predicted an earlier bedtime, a lower consumption of soft drinks and sweet snacks, more classroom engagement, and fewer behavior problems at age 12 years. For boys, better family meal environment quality at age 6 years predicted an earlier bedtime and less anxiety and more prosocial behaviour at age 12 years. These significant relationships were adjusted for a multitude of child/family characteristics. Conclusion: From a population-health perspective, our findings suggest that family meals represent a cost-efficient, effective protective factor that likely has long-term influences on bio-psycho-social development. Information campaigns that promote family meals as a health intervention could optimize the well-being of boys and girls.

Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study.

BACKGROUND: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. OBJECTIVE: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. METHODS: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis-St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. RESULTS: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). CONCLUSIONS: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment.

Promoting family meals: a review of existing interventions and opportunities for future research.

Evidence suggests that regular family meals protect against unhealthy eating and obesity during childhood and adolescence. However, there is limited information on ways to promote family meals as part of health promotion and obesity prevention efforts. The primary aim of this review was to synthesize the literature on strategies to promote family meals among families with school-aged children and adolescents. First, we reviewed interventions that assess family meals as an outcome and summarized strategies that have been used in these interventions. Second, we reviewed correlates and barriers to family meals to identify focal populations and target constructs for consideration in new interventions. During May 26-27, 2014, PubMed and PsycInfo databases were searched to identify literature on family meals published between January 1, 2000 and May 27, 2014. Two reviewers coded 2,115 titles/abstracts, yielding a sample of 139 articles for full-text review. Six interventions and 43 other studies presenting data on correlates of or barriers to family meals were included in the review. Four interventions resulted in greater family meal frequency. Although there were a small number of interventions, intervention settings were diverse and included the home, community, medical settings, the workplace, and the Internet. Common strategies were goal setting and interactive group activities, and intervention targets included cooking and food preparation, cost, shopping, and adolescent influence. Although methodological nuances may contribute to mixed findings, key correlates of family meals were employment, socioeconomic and demographic factors, family structure, and psychosocial constructs. Barriers to consider in future interventions include time and scheduling challenges, cost, and food preferences. Increasing youth involvement in mealtime, tailoring interventions to family characteristics, and providing support for families experiencing time-related barriers are suggested strategies for future research.

Frequency of family meals and risk of eating disorders in adolescents in Spain and Peru / Frecuencia de comidas en familia y riesgo de trastornos de la conducta alimentaria en adolescentes de España y Perú

Abstract The prevalence of eating disorders is between 0.27% and 6.41% in Spain and between 7.3% and 11.4% in Peru. Much research has been focused on the study of the main risk factors for eating disorders, but little is known about the potential protective factors (such as family meals) in samples of young people that include participants from different countries. This study estimates the contribution of the frequency of family meals on the risk for eating disorders in a large sample of adolescents recruited in Spain and Peru (n=916, with a mean age of 14.6 years old and age range of 12 to 17 years old). Results showed a double interaction parameter between the participants' sex and origin with the frequency of family meals: the risk for eating disorders is modified specifically for girls from both countries, and adolescents of both sexes born in Spain. This empirical evidence suggests that sex and cultural differences could be related to disordered eating patterns during adolescence and so could act as moderators for the impact of risk and protective factors for this clinical condition. The study of the contribution of the frequency of family meals on the risk of eating disorders in young people should take cultural differences into consideration with the aim of designing more targeted prevention and intervention programs.

Resumen La prevalencia de los trastornos de la conducta alimentaria en España se encuentra entre 0.27 % y 6.41% y en Perú entre el 7.3% y el 11.4%. Se dispone de numerosas investigaciones sobre los factores de riesgo para estos trastornos, pero escasos estudios han analizado posibles factores protectores, como las comidas familiares, en muestras jóvenes que incluyan participantes de diferentes países. Este artículo analiza la contribución de la frecuencia de las comidas familiares sobre el riesgo de trastornos de conducta alimentaria en una muestra de adolescentes (n = 916, edad media de 14.6 años, rango de edad 12 a 17 años) procedentes de España y Perú. Los principales resultados mostraron un doble parámetro de interacción entre el sexo y el origen de los participantes con la frecuencia de las comidas familiares: el riesgo de estos trastornos se modifica específicamente en mujeres y adolescentes nacidos en España. Estas evidencias empíricas sugieren que el sexo y las diferencias culturales podrían estar influyendo en los desórdenes alimentarios durante la etapa adolescente y podrían actuar moderando el impacto del riesgo y los factores protectores de la patología alimentaria. Se recomienda ampliar la investigación sobre la contribución de las comidas familiares en el riesgo de los trastornos de la conducta alimentaria en adolescentes considerando posibles diferencias culturales con el fin de diseñar programas de prevención e intervención más eficientes.

La comida en familia: La idealización de un evento social / The family meal: An idealization of a social event

RESUMEN Ante las alarmantes cifras de obesidad, se han implementado distintas estrategias de salud pública que tienen por objetivo modificar los hábitos de las personas y así combatir la obesidad. Una de las estrategias utilizadas para esto, ha sido la promoción de la comida en familia. Sin embargo, distintas investigaciones cuestionan los beneficios asociados a ésta. En este artículo realizamos una revisión de la literatura que investiga la comida en familia, distinguiendo tres corrientes principales: aquellas que enfatizan las funciones de ésta, las que analizan sus estructuras sociales y las que la consideran como resultado de un estilo de vida. Con esta revisión de los principales lineamientos teóricos, argumentamos cómo la comida en familia es una institución idealizada, discusión que busca contribuir al debate de las futuras intervenciones de salud que tienen por objetivo modificar los hábitos de salud de las personas.

ABSTRACT Faced with alarming obesity figures, various public health strategies that aim to change the habits of people and combat obesity have been implemented. One strategy has been promoting family meals. However, various studies question the benefits associated with this strategy. This article presents a review of the literature investigating the family meal. We present three primary perspectives: those that emphasize function, those that discuss social structure and articles that consider the family meal as a result of lifestyle. In this review of the main theoretical guidelines, we argue that the family meal is an idealized institution, a discussion that seeks to contribute to the debate of future health interventions that aim to change people's health habits.