Emotion-Driven Eating and Overeating Among Fourth Graders: The Roles of Body Image, Academic Achievement, and Peer and School Factors.

BACKGROUND: Eating patterns such as breakfast consumption and fruit and vegetable intake have been associated with academic achievement and cognitive function. METHOD: The purpose of this study was to learn more about psychological (emotion-driven eating) and behavioral (over-eating) eating patterns and motives, and the roles of body image, academic achievement (reading and math), and social supports (peer acceptance and school attachment), among 378 fourth-grade students (55% boys) from 14 classrooms across 6 schools within a large Midwestern urban area. RESULTS: Results were analyzed through a 2-group (male and female) path analysis. Boys' overeating (R2 = 9%) was not significantly predicted. Their emotional eating (R2 = 22.2%) was negatively, significantly predicted by peer acceptance and interaction of peer acceptance and school attachment. Girls' overeating (R2 = 13.6%) was negatively, significantly predicted by positive body image. Girls' emotional eating (R2 = 24.1%) was negatively significantly predicted by positive body image, math scores, and peer acceptance. CONCLUSIONS: Boys' and girls' eating patterns are differentially affected by their school experiences.

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents.

Grocery store environments are recognized as one of the most crucial community settings for developing and maintaining healthy nutritional behaviors in children. This is especially true for disadvantaged ethnic minority families, such as immigrants, who reside in the Detroit Metropolitan area and have historically experienced inequities that result in poor health outcomes. Rates of obesity and type II diabetes have affected Detroit 38% more than the rest of the state and nationwide. In 2019, almost 54% of children aged 0-17 in Metro Detroit lived in poverty, and 21.6% experienced food insecurity, compared with the state level of 14.2%. Moreover, nearly 50% of ethnic minority children in Metro Detroit consume sports drinks, and 70% consume soda or pop in an average week. The primary purpose of this study was to explore immigrant parents' perspectives on (1) how in-store Sugar-Sweetened Beverage (SSB) marketing impacts the purchasing behaviors of parents and the eating behaviors of toddlers, and the secondary objective was to (2) determine strategies to reduce SSB purchases and consumption within grocery environments from the viewpoints of immigrant parents. A qualitative multiple-case study design was used to achieve the aims of this study. Semi-structured individual interviews were completed with 18 immigrant parents of children aged 2 to 5 years old who were consumers in 30 independently owned full-service grocery stores within the immigrant enclaves of Detroit, Dearborn, Hamtramck, and Warren, Michigan. Three key thematic categories emerged from the parents' narratives. These themes were: (1) non-supportive grocery store environments; (2) acculturation to the American food environment; and (3) strategies to support reduced SSB consumption among young immigrant children. The findings of this study revealed widespread SSB marketing targeting toddlers within the participating independently owned grocery stores. Even if families with young children practiced healthy nutritional behaviors, the prices, placements, and promotion of SSBs were challenges to establishing and sustaining these healthy eating habits. The parents believed that planning and implementing retail-based strategies in collaboration with families and considering families' actual demands would assist in managing children's eating patterns and reducing early childhood obesity.

Enhanced Measurement of Sugar-Sweetened Beverage Marketing to Young Immigrant Children in Grocery Store Environments.

The marketing of Sugar-Sweetened Beverages (SSBs) within grocers is an obesogenic factor that negatively impacts children's nutritional behavior, specifically for people from racial and ethnic minority groups, such as immigrants. We aimed to develop and employ a methodology that more precisely assesses the availability, price, and promotion of SSBs to young immigrant children within independently owned grocery stores. A case comparison design was used to explore the differences in the grocery store landscape of SSB marketing by conducting an enhanced Nutrition Environment Measures Survey-SSB (NEMS-SSB) within 30 grocery stores in the Hispanic and Latino enclaves in Southwest Detroit, in the Arab and Chaldean enclaves in North-central Detroit, and in Warren, Hamtramck, and Dearborn, in comparison with 48 grocers in Metro Detroit. Unsweetened, plant-based, and organic toddler and infant beverages, as well as questions about marketing, were added to the original NEMS to capture the promotion tactics used in marketing SSBs. NEMS-SSB scores revealed that, in the immigrant enclaves, there was a significantly higher availability of SSBs in grocery stores (-2.38), and they had lower prices than those in the comparison group (-0.052). Unsweetened, plant-based, and organic beverages were unavailable in 97% of all participating grocery stores across both groups. Signage featuring cartoon characters was the most frequent in-store SSB marketing tactic across both groups. Widespread SSB marketing toward toddlers within the grocery stores in immigrant enclaves could be linked with the higher early childhood obesity prevalence among the immigrant population. Our findings can assist local and national organizations in developing and implementing healthy eating interventions. This study must be repeated in other immigrant enclaves across states to provide comparable results.

The Association Between Home or Community Garden Access and Adolescent Health.

Little is known about the influence of home or community garden (HCG) access on adolescent health. The objective of this study was to determine the association between adolescent self-rated health, nutrition knowledge, attitudes, and intake with HCG access. Urban high school students (n = 401) completed a questionnaire prior to a nutrition education intervention. Point biserial correlations and one-way analyses of variance evaluated garden access and health variables. Garden access differed by race ( P < .001), and students with HCG access consumed more vegetables than students who did not ( P = .003) and rated themselves as healthier ( P = .034). Findings suggest that garden access is associated with higher adolescent vegetable consumption and higher self-rated health. Future research should investigate adolescent levels of engagement in HCGs.

Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting.

A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit's healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.

Nutrition Supports Deconstructed and Disrupted: An Evaluation of a Multilevel School-Based Intervention during the Time of COVID.

The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver-child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in breakfast consumption at home and a decrease in use of the school breakfast program (F(1.78, 74) = 19.64, p < 0.001, partial η2 = 0.21) and school lunch program (F(1.51, 74) = 23.30, p < 0.001, partial η2 = 0.24). Rates of FS and eating behaviors did not change significantly over time. Correlations of program usage and eating behaviors demonstrate the importance of promoting participation in school meal programs. BFF may have prevented significant decreases in FS during COVID-19.

Effects of a Comprehensive School Health Program on Elementary Student Academic Achievement.

BACKGROUND: Improving the academic achievement of youth in the United States is an area of interest and a critical indicator of the future success of the youth. The purpose of this study was to examine the impact of a comprehensive school physical activity and healthy eating program on 5th-grade students' academic achievement, specifically reading and math. METHODS: Overall, 628 (intervention: 377, 54% girls; comparison: 251, 49% girls) 5th-grade children participated across the 6 schools in a year-long comprehensive health intervention, completing curriculum-based academic achievement measures at 2 time-points. RESULTS: Results showed that even after controlling for class clustering, age, sex, race, and T1 reading and math variables, students' T2 reading and math achievement were significantly higher in the intervention group than the comparison group. CONCLUSIONS: Comprehensive health programming can enhance the health and academic achievement of youth.

BMI and related risk factors among U.S. Marshallese with diabetes and their families.

Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (ß = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.

Managing Outliers in Adolescent Food Frequency Questionnaire Data.

OBJECTIVE: The goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data. DESIGN: This secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial. PARTICIPANTS: African American adolescents (n = 181) were recruited from outpatient clinics and community health fairs. VARIABLES MEASURED: Data collected included self-reported FFQ and mediators of weight (food addiction, depressive symptoms, and relative reinforcing value of food), caregiver-reported executive functioning, and objectively measured weight status (percentage overweight). ANALYSIS: Descriptive statistics examined patterns in study variables at baseline and follow-up. Correlational analyses explored the relationships between FFQ data and key study variables at baseline and follow-up. RESULTS: Compared with not removing outliers, using decision rules reduced the number of cases and restricted the range of data. The magnitude of baseline FFQ-mediator relationships was attenuated under all decision rules but varied (increasing, decreasing, and reversing direction) at follow-up. Decision rule use increased the magnitude of change in FFQ estimated energy intake and significantly strengthened its relationship with weight change under 2 fixed range decision rules. CONCLUSIONS AND IMPLICATIONS: Results suggest careful evaluation of outliers and testing and reporting the effects of different outlier decision rules through sensitivity analyses.

College women's physical activity, health-related quality of life, and physical fitness: a self-determination perspective.

This study applied self-determination theory to examine Chinese college women motivational profiles and their association with physical activity involvement, health-related quality of life, and physical fitness. 292 Chinese college women completed questionnaires assessing relevant psychological constructs and physical activity involvement. Their physical fitness was measured based on the China National Fitness Test Program including body shape, pulmonary function, and body fitness. A two-step cluster analysis determined the profiles that resulted from the interactions among motivation variables reflecting the degree of self-determination. Four distinct clusters of college women were identified: low self-determination/high control, low combination, high combination, and high self-determination/low control. There were significant differences among the clusters in physical activity involvement (p < .01, η2 = .11), health-related quality of life (p < .01, η2 = .18), and physical fitness (p < .01, η2 = .04). Findings support the importance of developing self-determination in Chinese college women' physical activity, fitness and health-related quality of life.

Knowledge, Attitudes, Self-Efficacy, and Healthy Eating Behavior Among Children: Results From the Building Healthy Communities Trial.

Background/Aim. Increased knowledge, attitudes, and beliefs about a topic and behavioral capability and self-efficacy for healthy eating are often a precursor to behavior change. The purpose of this study is to determine the effectiveness of the multicomponent school-based program on children's healthy eating knowledge, attitudes, and self-efficacy for healthy eating, and on their eating habits over time. Method. Quasi-experimental (4 treatment, 2 comparison) in a metropolitan area using a pretest-posttest method. Participants were 628 fifth-grade youth (377 treatment, 251 comparison) with a mean age of 9.9 years. The Building Healthy Communities (BHC) program is an 8-month school-wide healthy school transformation program and includes six main components. Outcome measures include children's healthy eating knowledge, attitudes, self-efficacy, and behavior. Missing data were imputed, confirmatory factor analysis tested scale factor structure, and path analysis determined a parsimonious path explaining behavior change. Results. The Student Attitudes and Self-Efficacy (SASE) scale had good measurement model fit. BHC group's healthy eating knowledge and behaviors increased significantly, while SASE remained moderate. For both groups, the students' knowledge and SASE significantly predicted their healthy eating behaviors; however, the intervention group accounted for a greater amount of variance (35% vs. 26%). Discussion. The BHC program was effective in improving healthy eating knowledge and behavior among youth, and the relationship between variables did not vary by group. Healthy eating knowledge is a significant predictor of both future knowledge and behavior.

Parental social support, perceived competence and enjoyment in school physical activity.

BACKGROUND: Beginning in the elementary school years, there are differences among children on how they perceive their competence in physical activity (PA). Children's competence perceptions may influence their affective reactions to PA. A crucial question is how to motivate children who hold low competence perceptions to enhance their enjoyment and PA involvement. Because parents play critical roles in children's development and socialization, social support from parents can be an important factor to complement teachers' effort to enhance children's enjoyment and PA involvement. In this research we identified the associations among children's beliefs about parental social support, perceived competence, and enjoyment in school PA. METHODS: Three hundred and twenty children (9-11 years old) participated in a two-wave study. At the first wave, children completed questionnaires measuring their beliefs about parental social support, perceived competence, and enjoyment in school PA; they reported their enjoyment again 8 months later at the second wave. RESULTS: Both concurrent and longitudinal analyses revealed that beliefs about parental social support were important factors associated with children's enjoyment in school PA, especially among girls with low competence perceptions. CONCLUSION: Family socialization factors should be taken into consideration. The efficacy of individual and community-level strategies should be included and evaluated when designing effective intervention strategies that enhance children's PA in school.

Building healthy communities: A comprehensive school health program to prevent obesity in elementary schools.

Obesity among children is highly prevalent and can lead to risk factors for chronic disease in adulthood. Key organizations have called on schools to play a larger role by increasing children's physical activity and nutrition by adopting an overall culture of health. This study examined the impact of a socioecological theory driven school-wide nutrition and physical activity intervention on 5th graders' central adiposity and obesity level. In 2015-2016, in the Midwest region of U.S., four treatment and two control schools, including 628 (377 treatment) 5th grade children participated in an eight-month intervention. Children in the treatment schools participated in a comprehensive healthy school transformation program consisting of six components. Waist-to-Height Ratio (WHtR) and Body Mass Index (BMI) was calculated and used as the measure of obesity. ANCOVA revealed a significant difference in WHtR among treatment and control groups at time two (T2) FMI(1,6148.14) = 4.43, p = .035, R2 = 0.64, R2Treament = 0.01, with no significant differences based on age, sex, and race. Additionally, the ANCOVA for BMI revealed a marginally significant lower BMI among the treatment than comparison group students FMI(1, 614) = 3.575, p = .059, R2 = 0.01 (Mdiff = -0.23, 95%CI upper boundary: -0.03). The healthy school intervention led to significant differences in obesity levels, regardless of age, sex, or race, across the 8-month program between 5th grade children in treatment and non-treatment schools. This supports the ability of schoolwide programs to significantly and positively impact student health and chronic disease prevention.

Access to primary care child weight management programs: Urban parent barriers and facilitators to participation.

The prevalence and comorbidities of childhood obesity among low-income urban children are a significant health issue in the United States. Programs designed to assist families are underutilized. The aim of this study is to describe barriers and facilitators relevant to intervention program participation from the perspective of parents who have children who are overweight or obese. Systematic thematic analysis of focus groups and semi-structured interviews with parents from multiple urban pediatrics and family medicine practices were used to gather data. A framework analysis approach was used and a codebook of themes was developed. Transcripts were coded independently by the research team and consensus among researchers was reached. Forty-eight parents participated in the study. Perceived barriers to participation included (1) varied referral process (lack of follow-up or varying referral experience), (2) costs (time and program fee), (3) logistics (location and program schedule), and (4) child motivation. Perceived facilitators to participation included (1) systematic referral process (in-office referral and timely follow-up), (2) program content and organization, and (3) no cost. Multiple barriers and facilitators affect weight management program participation among families, which should be specifically targeted in future obesity interventions in order to effectively reach urban, minority parents and children.

A Reciprocal Effects Model of Children's Body Fat Self-Concept: Relations With Physical Self-Concept and Physical Activity.

This study investigated a reciprocal effects model (REM) of children's body fat self-concept and physical self-concept, and objectively measured school physical activity at different intensities. Grade four students (N = 376; M age = 9.07, SD = .61; 55% boys) from the midwest region of the United States completed measures of physical self-concept and body fat self-concept, and wore accelerometers for three consecutive school days at the beginning and end of one school year. Findings from structural equation modeling analyses did not support reciprocal effects. However, children's body fat self-concept predicted future physical self-concept and moderate-to-vigorous physical activity (MVPA). Multigroup analyses explored the moderating role of weight status, sex, ethnicity, and sex*ethnicity within the REM. Findings supported invariance, suggesting that the observed relations were generalizable for these children across demographic groups. Links between body fat self-concept and future physical self-concept and MVPA highlight self-enhancing effects that can promote children's health and well-being.

Sexual Health Knowledge, Self-Efficacy and Behavioral Intentions Following a Health Fair for Adolescents.

High rates of human immunodeficiency virus (HIV) exist among urban African American youth. There is a need to provide HIV information to youth prior to the onset of sexual activity. The Stomping Out HIV intervention combines a health fair and step show to increase awareness and healthy behaviors among this population. Questionnaires were administered to youth and parents before and after Stomping Out, and focused on health knowledge, satisfaction with Stomping Out, intended behavior changes and self-efficacy to make healthier choices related to HIV and STI prevention. Youth and adults reported increased knowledge and self-efficacy after Stomping Out. These findings suggest that health initiatives focusing on sociocultural issues can greatly impact adults and youth.

Friend and Family Support for Weight Loss in Adolescent Females.

BACKGROUND: Overweight and obesity rates in children and adolescents are concerning, particularly among girls. Social support from friends has been associated with healthier eating and higher levels of physical activity, yet little is known about the relationship between social support and weight loss among adolescents. This aim of this study was to prospectively examine the relationship between baseline social support from friends and family, changes in social support, and weight loss. METHODS: Sixty-five adolescent girls completed a one-year weight loss intervention trial. Data were collected at baseline, 6 months, and 12 months. RESULTS: At baseline, family support was higher compared to friend support; however, lower friend support at baseline and increases in friend support from baseline to 6 months and 12 months were associated with weight loss. When controlling for other predictors of weight loss, change in friend support for healthy eating was predictive of weight loss at 12 months. CONCLUSIONS: These findings suggest that weight loss interventions for adolescent females might consider including strategies to elicit or to create and promote social support for healthy eating from peers. Future studies are needed to test this relationship.

The relationship between teacher burnout and student motivation.

BACKGROUND: Teacher burnout is regarded as a serious problem in school settings. To date, studies on teachers' stress and burnout have largely centred on teachers' own characteristics, socialization, and behaviours, but few have explored the connection between teachers' burnout and students' motivation via their own perceptions of teachers' behaviour and emotional well-being. AIMS: This study adopted Maslach et al.'s (2001, Annu. Rev. Psychol., 52, 397) job burnout construct and self-determination theory to investigate the relationships between teachers' burnout and students' autonomous motivation over one-semester physical education classes. SAMPLE: A total of 1,302 high school students and their 33 physical education teachers in 20 high schools from two school districts in a major Midwest metropolitan area in the United States. The two school districts were demographically similar. METHODS: Students and physical education teachers completed questionnaires assessing relevant psychological constructs. There were two time points for collecting students' data. One was at the beginning of a fall semester, and the other was at the end of that semester. Hierarchical linear modelling analyses were conducted. RESULTS: It was revealed that teachers' emotional exhaustion was negatively related to students' perceived teacher autonomy support (TAS); in turn, there was a negative relationship between teachers' feeling of depersonalization and students' autonomous motivation development even when controlling for inadequate TAS. CONCLUSION: The dimensions of teachers' burnout might play different roles in the transmission from teachers to students. Teachers' status of burnout is an important environmental factor associated with students' quality of motivation.

Brief report: A randomized controlled trial examining peer support and behavioral weight loss treatment.

Peer support among adolescents has been positively associated with heath behaviors; however, enhancing peer support for weight loss has rarely been studied among adolescents. This study examined whether a peer support training component delivered to enhance a standard weight loss program led to improved outcomes. Forty-one overweight adolescent females were randomly assigned to a Standard or Enhanced Peer Support intervention. The Enhanced group received in person peer support skills training and practiced skills using social networking. At 16 weeks, participants in the Enhanced condition reported significantly increased perceptions of friend support. Both groups demonstrated significant weight loss (6.4 lbs, ± 8.3). Attendance and self-monitoring were associated with weight loss. Perceptions of peer support can be increased with a peer training component, but did not increase weight loss during the short term.

Peer support enhanced social support in adolescent females during weight loss.

OBJECTIVES: To describe the development of a peer support intervention and test an enhanced version compared to a standard protocol. METHODS: Participants (N = 36 females) were assigned to an Enhanced Peer Support (PS) vs Standard weight loss group for 4 months. The PS component consisted of skills training and practice between sessions using social networking. RESULTS: The PS group perceived significantly more peer support and experienced higher levels of social interaction. When meeting frequency decreased, the PS group showed an increase in overall types of support from group members. CONCLUSIONS: Findings suggest that an intervention targeting peer support skills results in greater feelings of peer support.