Development and preliminary validation of the Parenting around SNAcking Questionnaire (P-SNAQ).

Snacking makes significant contributions to children's dietary intake but is poorly understood from a parenting perspective. This research was designed to develop and evaluate the psychometrics of a theoretically grounded, empirically-informed measure of snack parenting. The Parenting around SNAcking Questionnaire (P-SNAQ) was developed using a conceptual model derived from current theory and mixed-methods research to include 20 hypothesized snack parenting practices along 4 parenting dimensions (autonomy support, structure, coercive control and permissiveness). Expert panel evaluation and cognitive interviews were used to refine items and construct definitions. The initial instrument of 105 items was administered to an ethnically diverse, low-income sample of 305 parents (92% mothers) of children aged 1-6 y participating in three existing cohort studies. The sample was randomly split into two equal samples. Exploratory factor analysis was conducted with the first sample to identify snack parenting practices within each parenting dimension, followed by confirmatory factor analysis with the second sample to test the hypothesized factor structure. Internal consistency of sub-scales and associations with existing measures of food parenting practices and styles and child weight status were evaluated. The final P-SNAQ scale included 51 items reflecting 14 snack parenting practices across four parenting dimensions. The factor structure of the P-SNAQ was consistent with prior theoretical frameworks. Internal consistency coefficients were good to very good for 12 out of 14 scales and subscale scores were moderately correlated with previously validated measures. In conclusion, initial evidence suggests that P-SNAQ is a psychometrically sound measure for evaluating a wide range of snack parenting practices in young children.

Interrelationships of child appetite, weight and snacking among Hispanic preschoolers.

BACKGROUND: Snacking among US preschoolers has increased in recent decades, raising questions about whether snacking contributes to dietary excess. OBJECTIVES: This research aimed to characterize snacking contributions to dietary excess and to evaluate associations with appetite and weight among preschool-aged children. METHODS: This study is a cross-sectional, observational study of 187 Hispanic low-income preschoolers. Three 24-h dietary recalls were used to assess snacking frequency and parameters of dietary excess including energy, saturated fat, trans fats and added sugars. Parental reports of child satiety responsiveness, food responsiveness, and enjoyment of food were obtained. Child height and weight were measured. RESULTS: Children consumed 28% (395 kcal) of daily energy from snacks eaten at 2.3 ± 1.0 occasions per day. Greater snacking frequency was associated with greater daily intakes of energy (p < 0.05) and added sugars (p < 0.001). Among overweight/obese children, higher enjoyment of food was associated with more frequent snacking and greater energy intake from snacks (p = 0.01). Inverse associations of enjoyment of food with snacking frequency and energy intake were seen among normal weight children (p < 0.05). CONCLUSIONS: More frequent snacking among low-income Hispanic preschoolers may contribute to excessive intakes of energy and added sugars, particularly among overweight/obese children with greater motivation to eat.

Obesity status transitions across the elementary years: use of Markov chain modelling.

OBJECTIVE: The objective of this study was to assess overweight and obesity status transition probabilities using first-order Markov transition models applied to elementary school children. METHOD: Complete longitudinal data across 11 assessments were available from 1494 elementary school children (from 7599 students in 41 out of 45 schools in a Southeast Texas school district) from kindergarten to the beginning of the fifth grade. Heights and weights were measured by trained school nurses using standard procedures at the beginning and end of each school year for the 11 consecutive assessments. To estimate the transition probabilities, first-order three-state (healthy weight, overweight and obese) Markov transition models were fit to the longitudinal weight status data of all assessment periods. RESULTS: While there was a gradual shift to more children in the overweight or obese category over 5 years, children were most likely to stay in the same weight category as the previous assessment. A consistent seasonal difference in the probability of changing weight status category was seen, with a greater probability of becoming overweight and obese during the summer compared with the school year. The transition probabilities to obesity were higher among boys, Hispanic and non-Hispanic Black, and lower socioeconomic status children. CONCLUSIONS: This study provides the first application of a Markov transition model to child weight status data. The transitions into the overweight and obese categories were small, but persistent, with smaller percentages transitioning out of overweight or obese. Early monitoring and summer intervention strategies are needed to prevent the slow, but relentless, transition into the overweight and obese categories.

External influences on children's self-served portions at meals.

OBJECTIVE: Large portions promote intake among children, but little is known about the external influences of the eating environment on children's self-selected portion sizes. This research experimentally tested effects of the amount of entree available and serving spoon size on children's self-served entree portions and intakes at dinner meals. A secondary objective was to identify child and family predictors of self-served entree portion sizes. DESIGN: A 2 × 2 within-subjects design was used, in which the amount of a pasta entree available for self-serving (275 vs 550 g) and the serving spoon size (teaspoon vs tablespoon) were systematically varied. The serving bowl size and portion sizes of all other foods offered were held constant across conditions. Conditions were spaced 1 week apart and randomly assigned. Weighed self-served entree portions and food intakes as well as demographics, maternal feeding styles and child/maternal anthropometrics were measured. SUBJECTS: Participants were 60 ethnically diverse children aged 4-6 years and their mothers. RESULTS: Mixed models revealed that children served themselves 40% more entree when the amount available was doubled (P<0.0001) and 13% more when the serving spoon size was tripled (P<0.05). Serving spoon size and the amount of entree available indirectly influenced children's intake, with larger self-served portion sizes related to greater entree intakes (P<0.0001). Greater self-served portions and energy intakes at the meal were seen among those children whose mothers reported indulgent or authoritarian feeding styles (P<0.001). CONCLUSION: Children's self-served portion sizes at meals are influenced by size-related facets of the eating environment and reflect maternal feeding styles.

Physical activity parenting: a systematic review of questionnaires and their associations with child activity levels.

Insufficient physical activity (PA) is considered a critical contributor to childhood overweight. Parents are a key in influencing their child's PA through various mechanisms of PA parenting, including support, restriction of PA and facilitation of enrolment in PA classes or activities. However, study findings are difficult to compare because instruments vary in terms of constructs, psychometric assessment and type of PA assessed. The goal of the current review was to identify existing PA parenting questionnaires and report on the validation of these measures through findings of their psychometric performance and correlation to youth's PA. The search of eligible studies was restricted to instruments with multiple items. Eleven unique PA parenting questionnaires were identified, and 46 studies that used these instruments were included. Extracted data include sample characteristics, as well as type and assessment methods of parental influence and PA. Findings highlight the tremendous variation in the conceptualization and measurement of PA parenting, common use of non-validated instruments and lack of comprehensive measures. The development of theory-based PA parenting measures (preferably multidimensional) should be prioritized to guide the study of the parental role in promoting child's PA as well as the design of family-based PA interventions.

The Alcohol Abstinence Self-Efficacy scale.

This study describes the development and the initial psychometric properties of a 20-item, self-report measure to assess Bandura's construct of self-efficacy applied to alcohol abstinence. Efficacy expectations are theorized to mediate behavior change and moderate effort and effective action. The sample was 174 male and 92 female subjects who came to an outpatient alcoholism treatment clinic. Abstinence efficacy was assessed with subject ratings on a 5-point Likert scale of confidence to abstain from alcohol across 20 different high-risk situations. A parallel set of items assessed subjects' temptation to drink in each situation. This Alcohol Abstinence Self-Efficacy scale (AASE) demonstrated a solid subscale structure and strong indices of reliability and validity. The four 5-item subscales measured types of relapse precipitants labeled negative affect, social positive, physical and other concerns, and withdrawal and urges. Both in structure and mean scores the AASE demonstrated no substantive gender differences. The AASE represents a brief, easily usable and psychometrically sound measure of an individual's self-efficacy to abstain from drinking.

Defining patterns of drinking in adolescence: a cluster analytic approach.

Most empirical approaches to defining patterns of adolescent alcohol consumption focus on frequency of drunkenness. In an attempt to define patterns of drinking in a more comprehensive way, the present study used measures of social context in addition to frequency and quantity of alcohol use. Subjects' scores on frequency, quantity and five social context variables were cluster analyzed separately for males and females. Results yielded four socially appropriate drinking patterns and three problem drinking patterns (two for males and one for females). Socially appropriate patterns for both sexes were light drinkers, light party drinkers, family drinkers and dating drinkers. Problem drinking patterns included school drinkers and solitary/stranger drinkers for males, and solitary/school drinkers for females. These groups of subjects showed significant differences on reasons for drinking and on drinking consequences even after differences due to frequency and quantity were statistically controlled. Effects of drinking primarily attributable to frequency and quantity appeared to be limited to differences concerning the physiological effects of alcohol.

Stages of change profiles in outpatient alcoholism treatment.

While few believe in the uniformity myth about alcoholics, discovering relevant dimensions that usefully divide the treatment population and guide intervention has been a difficult task. This study evaluated a stages of change assessment measure with a group of 224 adults entering outpatient alcoholism treatment. Subjects' scores on the precontemplation, contemplation, action, and maintenance stage subscales of the URICA were subjected to cluster analysis yielding five distinct and theoretically consistent profiles. Profiles were labeled as follows: 1. Precontemplation (n = 63) 2. Ambivalent (n = 30) 3. Participation (n = 51) 4. Uninvolved (n = 27), and 5. Contemplation (n = 53). These five groups of subjects demonstrated no differences on demographic characteristics but significantly differed on Alcohol Use Inventory subscales, a temptation to drink and abstinence self-efficacy measure as well as several outcome variables. Group differences support the validity of the cluster analytic profiles, confirm the interpretation of profile groups, and provide interesting contrasts consistent with the stages of change model. Classification of individuals on the stages of change offers a useful perspective for alcoholism treatment matching research.

Improved skin adherence and patient acceptance in a new transdermal nitroglycerin delivery system.

Sixty-five patients with angina pectoris participated in a two-week, randomized, crossover, open-label, multicenter trial to compare patient preferences between two transdermal nitroglycerin delivery systems: Minitran and Nitro-Dur II (ND II). Patients were enrolled if they had stable angina pectoris and had been on a stabilized dose (5, 10, or 15 mg/24 hr) of Transderm-Nitro (TDN) for at least one month before entering the study. Patients with a bias against ND II or with any of the contraindications for transdermal nitroglycerin therapy were excluded. During the first one-week treatment period, the patients received their prestudy dose regimen of either Minitran or ND II. During the second week, the patients were crossed over to the transdermal delivery system that they had not received in the first week. Patients completed daily diaries, weekly questionnaires, and poststudy patient preference evaluation forms. Two patients, one in each treatment group, withdrew from the study because of increased angina, which was probably not related to the use of transdermal nitroglycerin. Fifty-seven percent of the patients preferred Minitran overall (P less than or equal to 0.05), 27% preferred ND II, and 16% had no overall preference.

Speech acts and the pragmatic deficits of autism.

In a videotaped free-play session with a parent, autistic children were compared with mental-age matched Developmental Language Delay (DLD) children and with normally developing (ND) 2-year-olds in the use of communicative acts by parent and child. Groups were matched for language level. Autistic children had more incidents of no responses, produced less affirming, turn-taking vocalization, and gesture, and were less likely to initiate communication than other children. Parent groups differed only in a greater amount of initiating and use of imperatives by parents of autistic children. Few relations between parent behaviors and child behaviors were found. Nonresponses by all children were concentrated subsequent to parent imperatives and questions, but no group differences were found in the distribution of nonresponses to various parent communicative acts. Results are interpreted to support the hypothesis that autistic children's language can serve a number of useful functions but that their pattern of language functions differs from that of nonautistic language-impaired children and much younger normal children of similar language level.