Understanding the relationships between acculturation, food insecurity, and food parenting practices among socioeconomically/racially diverse parents.

Research suggests that acculturation and food insecurity are factors that are separately associated with the use of specific food parenting practices among United States (US) families. Certain food parenting practices, such as coercive control and unstructured food parenting practices, are related to negative health consequences in children, such as disordered eating behaviors. The current study aimed to explore associations between acculturation strategies and food parenting practices in a sample of 577 Latinx, Hmong, Somali/Ethiopian, and Multiracial families. A secondary objective was to understand whether food security status significantly modified the relationships between acculturation strategies and food parenting practices. Results showed that acculturation strategies were significantly related to food parenting practices, and patterns in these relationships differed across race and ethnicity. Further, food security status significantly modified the relationship between acculturation strategies and food parenting practices for Latinx, Hmong, and Somali/Ethiopian families, but not for Multiracial families. These results point to the complex relationships among acculturation strategies, food security status, and food parenting practices in immigrant populations in the US. Longitudinal studies exploring the temporal relationships between acculturation strategies, food security status, and food parenting practices would help tease apart how food parenting practices may evolve upon migrating to the US.

Spillover from parent stress to family meals among diverse families: An ecological momentary assessment study.

Family meals are beneficial for youth healthy development. However, parents' experiences of daily stressors may hinder their capacity to facilitate family meals, serve healthful foods, and have implications for the family meal atmosphere. Using data from ecological momentary assessment, we examined whether family meals are less likely to occur, meals are less healthful, and meal atmosphere is less positive on days when parents experience higher-than-usual stress and whether coparenting support buffers these associations. We also explored the role of family stressors in these links. Participants were 497 parents (Mage = 35.86 years; 91% female) of 5- to 9-year-old children who identified as Asian (15%), Black (17%), Hispanic (10%), Native American (10%), Native Hawaiian (< 1%), White (38%), multiracial (8%), or other (< 1%). Results from multilevel models indicated that daily deviations in parents' stress levels were not correlated with family meal occurrence, healthfulness, or positive atmosphere. However, on days when the source of parents' stress was family related (e.g., family demands), odds of a positive meal atmosphere were significantly lower (OR = 0.92, 95% CI [0.88, 0.96]), adjusting for other sources of stress. Coparenting relationship quality was positively associated with family meal occurrence (OR = 1.34, 95% CI [1.01, 1.79]) and healthfulness (γ = 0.20, p < .001), however, it did not moderate links between stress and family meal occurrence, healthfulness, or atmosphere. Findings suggest that day-to-day fluctuations in parents' stress levels may not disrupt whether a family meal occurs, the healthfulness of foods served, or the atmosphere of family meals. However, family stressors and coparenting relationship quality merit investigation as potential intervention targets. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disparities in Medical Assessment Practices for Adolescents at Risk for Eating Disorders.

PURPOSE: The United States Preventative Services Task Force found insufficient evidence to support universal screening for eating disorders (EDs) but did recommend assessing high-risk adolescents through laboratory tests, close follow-up, and referrals to other specialties. Yet, it is unclear whether youth at high risk for EDs receive such assessment and whether patient characteristics influence such practices. METHODS: Using the Rochester Epidemiological Project, we identified adolescents (13-18 years) at risk for EDs (i.e., weight loss, underweight, or loss of appetite not explained by a medical condition) who presented for a medical appointment between January 1, 2005 to December 31, 2017 (n = 662; M age = 15.8 years; 66% female; 76% white). Patient and visit characteristics, assessment practices (i.e., tests, referrals, and follow-up), and ED diagnoses within 5 years following index visit were extracted. RESULTS: Adolescents who received referrals to other providers were 4 times more likely to be diagnosed with a future ED (p < .001) and were diagnosed 137.8 days sooner (Est = -137.8, p = .04) compared to those who did not receive referrals. Compared to males, females were 2.2 times more likely to receive referrals (p < .001). Compared to those presenting at a lower body mass index, adolescents with a higher body mass index were more likely to receive medical tests (HR = 1.0, p < .01) and less likely to receive recommendations to improve eating/weight (HR = 0.99, p < .01) or follow up visits (HR = 0.99, p < .01). DISCUSSION: Disparities in assessment practices for adolescents at high-risk for EDs underscore the need for improved tools to enhance early detection and treatment.

How Parental Feeding Practices Relate to Young People's Intuitive Eating: Cross-Sectional and Longitudinal Associations by Gender and Weight Concern.

PURPOSE: To evaluate cross-sectional and longitudinal associations between controlling parental feeding practices in adolescence (i.e., restrictive feeding and pressure-to-eat [PE]) and intuitive eating (IE) in adolescence and emerging adulthood; and explore child gender and parental concern about child weight as moderators. METHODS: The sample included participants (N = 1,383) from the population-based EAT 2010-2018 study who provided data in adolescence (14.4 ± 2.0 years) and emerging adulthood (22.0 ± 2.0 years) and had at least one caregiver complete surveys in adolescence. Generalized estimating equations evaluated cross-sectional and longitudinal associations between restrictive feeding and PE in adolescence and IE in adolescence and emerging adulthood. Interactions with gender and parental concern over child weight in adolescence were explored. RESULTS: Restrictive feeding was cross-sectionally associated with lower IE in adolescence (b = -0.04), though evidence of moderation by parental weight concern indicated this association was only observed in the context of low parental weight concern. Greater PE was associated with lower adolescent IE among boys but higher IE among girls. Longitudinally, the association between PE in adolescence and IE in emerging adulthood differed by parental weight concern; greater PE predicted higher emerging adult IE at high parental weight concern, but lower IE at low parental weight concern. DISCUSSION: Controlling feeding practices in adolescence displayed differential associations with child IE in adolescence and emerging adulthood based on child gender and parental concern over child weight. Notably, PE was associated with greater IE among adolescent girls but lower IE among boys. Results suggest that parental feeding is a valuable intervention target.

The interplay between food insecurity and family factors in relation to disordered eating in adolescence.

This study examined the association between food insecurity and both binge eating and unhealthy weight-control behaviors (UWCBs) and assessed whether such associations differ by factors within the family environment. Data were collected from a diverse sample of adolescents (Mage = 14.5 years; 54.1% female) and their parents/guardians (N = 2137 dyads) participating in EAT 2010 (Eating and Activity over Time). Food-insecure adolescents were more likely to report binge eating (prevalence ratio [PR] = 1.94; 95% confidence interval [CI]: 1.41-2.69) and UWCBs (PR = 1.34; 95% CI: 1.21-1.49) than food-secure adolescents. Family meal importance (p = .03) and family communication (p < .001) significantly moderated the association between food insecurity and UWCBs, such that the association was weaker at lower levels of these factors. Significant interactions with parental weight talk/concern (p < .001) and weight teasing (p = .04) indicated a weaker association between food insecurity and UWCBs in the presence of these factors. Findings indicate that the association between food insecurity and UWCBs among youth is less salient in the absence of family protective factors and in the presence of family risk factors for UWCBs, indicating the importance of targeting food insecurity itself, regardless of the presence of family risk or protective factors for UWCBs.

Weight- and Health-focused Conversations in Racially/Ethnically Diverse Households With and Without a Child with Overweight/Obesity.

Studies indicate parent conversations focused on child weight, shape, or size are associated with unhealthy child weight and weight-related behaviors, whereas health-focused conversations are not. Little research has examined what these types of conversations sound like, how parents respond to them, and whether households with or without a child with overweight/obesity approach these conversations differently. This study used qualitative data to identify the weight- and health-focused conversations occurring in racially/ethnically diverse households. Children ages 5-7 and their families (n=150) from six racial/ethnic groups (i.e., African American, Hispanic, Hmong, Native American, Somali, White) participated in this mixed-methods study. Results showed that parents from households with and without a child with overweight/obesity engaged in similar weight- and health-focused conversations (qualitative themes = focus on growth; health consequences of having overweight/obesity; focus on dietary intake and physical activity; being direct about weight, shape or size; mixing weight- and health-focused conversations). In addition, findings showed that parents also engaged in different types of weight- and health focused conversations depending on whether the household had a child with overweight/obesity (qualitative themes = weight-based teasing; critiquing own weight) or without overweight/obesity (qualitative themes = differences in body shape and size are the norm; focus on modeling rather than talking). Results may be useful for informing public health interventions and for health care providers working with parents regarding weight- and health-focused conversations occurring in home environments of diverse children.

Body Mass Index Trajectories and Biomarkers of Cardiometabolic Risk in Children from Low-Income and Racially and Ethnically Diverse Households.

Background: This study examined the associations between BMI trajectories and emerging cardiometabolic risk (CMR) in children living in low-income and racially and ethnically diverse households in the United States. Methods: Data were drawn from NET-Works randomized intervention trial and NET-Works 2 prospective follow-up study (N = 338). BMI was measured across 6 follow-up visits and biomarkers of cardiometabolic risk (CMR) at the sixth visit. Group-based trajectory modeling identified child BMI trajectories. Adjusted multivariable linear regressions evaluated the associations between BMI trajectories and CMR. Results: We identified two BMI trajectories: 25% followed a trajectory of steep BMI increase, and 75% followed a moderate decreasing BMI trajectory over time. Relative to children in the moderate decreasing trajectory, children in the increasing trajectory had higher adjusted mean levels of C-reactive protein [CRP; 3.3; 95% confidence interval (CI): 1.6 to 5.0], leptin (63.1; 95% CI: 44.3 to 81.8), triglycerides (35.4; 95% CI: 22.1 to 48.6), triglyceride/high-density lipoprotein (HDL) ratio (1.2; 95% CI: 0.8 to 1.6), hemoglobin A1c (HbA1C; 0.1; 95% CI: 0.03 to 0.2), fasting glucose (1.8; 0.1 to 3.5) and insulin (8.8; 95% CI: 6.5 to 11.0), overall CMR score (0.7; 95% CI: 0.5 to 0.9), and lower adiponectin (-1.3; 95% CI: -2.5 to -0.1) and HDL (-10.8; 95% CI: -14.3 to -7.4). Conclusions: Children with high BMIs early in childhood were more likely to maintain an accelerated BMI trajectory throughout childhood, which was associated with adverse CMR in pre-adolescence. To advance health equity and support children's healthy weight and cardiovascular health trajectories, public health efforts are needed to address persistent disparities in childhood obesity and CMR.

Household food insecurity is associated with greater prevalence and 18-month incidence of a range of disordered eating behaviors in a racially and ethnically diverse sample of parents.

This study examined cross-sectional and longitudinal associations between household food insecurity (FI) and a range of disordered eating behaviors (DEBs) and explored whether associations differ by Supplemental Nutrition Assistance Program (SNAP)/Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Data came from 1120 racially/ethnically diverse parents (Mage = 35.7 ± 7.8 years at baseline) in the Family Matters longitudinal cohort study. Parents reported on household FI and SNAP/WIC participation at baseline, and on past-year restrictive weight-control behaviors (WCBs; e.g., fasting), compensatory WCBs (e.g., self-induced vomiting), and binge eating at baseline and 18-month follow-up. Sociodemographics-adjusted modified Poisson regressions examined baseline household FI in relation to baseline prevalence and 18-month incidence (i.e., new onset) of each type of DEB. Moderation by SNAP/WIC participation was also tested. Household FI affected 29.6 % of participants and was associated with significantly greater baseline prevalence (prevalence ratios ranging from 1.38 to 2.69) and 18-month incidence (risk ratios ranging from 1.63 to 2.93) of each type of DEB examined. The association between household FI and incident compensatory WCBs differed significantly by SNAP/WIC participation, such that household FI significantly predicted new-onset compensatory WCBs at follow-up only among those participating in SNAP/WIC. Results from this study are the first, to our knowledge, to demonstrate that FI is longitudinally associated with restrictive and compensatory DEBs, thereby highlighting FI as a risk factor not only for binge eating, but for a range of DEBs. These findings emphasize the importance of screening for FI in clinical settings and the need to address structural barriers to food security.

Lifetime Prevalence of Psychiatric Disorders in Adolescents with Unexplained Weight Loss, Underweight, or Poor Appetite.

BACKGROUND: When adolescents present with symptoms of unexplained weight loss, underweight, or poor appetite, eating disorders (EDs) are commonly on the list of differential diagnoses. However, the relationship of these symptoms to other psychiatric disorders is often less clear. METHODS: Using the Rochester Epidemiology Project database, a retrospective cohort study of adolescents (13-18 years) with billing diagnoses of weight loss, underweight, or loss of appetite was conducted between January 2005 and December 2017. Patients who presented with conditions commonly associated with weight loss, underweight, or poor appetite (e.g., cancer) were excluded. This study sought to examine the proportion of patients who received ED and psychiatric diagnoses within 5 years of the index visit and patient characteristics associated with these diagnoses. RESULTS: Of 884 patients diagnosed with symptoms of unexplained weight loss, underweight, or poor appetite, 662 patients ( M age = 15.8; SD = 1.6; 66.0% female) met study criteria. Within 5 years of the index visit, the lifetime prevalence of all psychiatric disorders was 70% (n = 461) and of EDs was 21% (n = 141). For both psychiatric disorders and EDs, sex and race were significantly associated with receiving a diagnosis within 5 years. Decrease in body mass index (BMI) percentile was associated with receiving an ED diagnosis, whereas the highest historical BMI percentile was associated with receiving a psychiatric diagnosis. CONCLUSION: Patients presenting with symptoms of unexplained weight loss, underweight, or poor appetite are at risk not only for EDs but also for other psychiatric disorders that may require further assessment and follow-up.

A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design.

BACKGROUND: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. METHODS/DESIGN: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. DISCUSSION: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. TRIAL REGISTRATION: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

A Three-Arm Randomized Controlled Trial Using Ecological Momentary Intervention, Community Health Workers, and Video Feedback at Family Meals to Improve Child Cardiovascular Health: The Family Matters Study Design.

Background: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. Methods/design: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI+Virtual Home Visiting with CHW+Video Feedback; and (3) EMI+Hybrid Home Visiting with CHW+Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n=525) with increased risk for cardiovascular disease (i.e., BMI ≥75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. Discussion: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary assessment, intervention, video feedback and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. Trial Registration: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

Associations Between Weight Talk and Biopsychosocial Outcomes in Children from Racially/Ethnically Diverse Households.

Weight talk in the home-parents talking to their children about their weight, shape or size-has been associated with many negative health outcomes in children and adolescents, although the majority of research has been with adolescents. This study explored associations between weight talk in the home and a broad range of child biopsychosocial outcomes (e.g., weight status, diet quality, psychological well-being, peer problems), in addition to child sex and race/ethnicity. Parents of 5-7 year old children from six racial/ethnic groups (White, African American, Hmong, Latino, Native American, Somali) (n=150) completed an online survey and completed 24-hour dietary recalls on the child. Additionally, anthropometric measurements were taken on the 5-7 year old child and parent. Over one-third of parents reported engaging in weight talk with their child. Overall, weight talk was associated with child weight status, but not with child diet quality. The presence of weight talk differed by race/ethnicity and child weight status. Most psychological (e.g., emotional problems) and social (e.g., peer problems) outcomes differed significantly by race/ethnicity with the following pattern: (1) no significant associations between weight talk and biopsychosocial outcomes were found for Hmong and Latino children; (2) a negative association (e.g., less healthy functioning) was found for African American and Somali children; (3) a positive association (e.g., healthier functioning) was found for Native American children. Future research should investigate why psychological and social outcomes differ by race/ethnicity in children experiencing weight talk. This study confirms the need to develop best practices for helping parents concerned about their child's weight to talk to children in a healthful way.

Do Weight Perception Transitions in Adolescence Predict Concurrent and Long-Term Disordered Eating Behaviors?

PURPOSE: Perceiving one's weight as "overweight" is associated with disordered eating in adolescence. Yet, it is unknown whether weight perceptions change during adolescence, or whether these weight perception transitions predict disordered eating. This study aims to: (1) characterize weight perception transitions from early to late adolescence among a population-based sample and (2) examine whether weight perception transitions in adolescence predict concurrent and future disordered eating into young adulthood. METHODS: Eating and Activity in Teens and Young Adults (N = 1,414) survey data were used to examine correlates of weight perception transitions from early (Mage = 14.9 ± 1.6 years) to late adolescence (Mage = 19.4 ± 1.6 years). Adjusted generalized estimating equations were used to determine whether weight perception transitions in adolescence predicted concurrent and future disordered eating in emerging adulthood (Mage = 25.2 ± 1.6 years) and young adulthood (Mage = 31.0 ± 1.6 years). RESULTS: Weight perceptions were stable from early to late adolescence for 77.2% of adolescents, whereas 15.5% transitioned to perceiving their weight as "overweight" and 7.3% stopped perceiving "overweight" in late adolescence. Perceived "overweight", especially in late adolescence, was associated with higher concurrent and long-term disordered eating up to 10 years later. For example, the predicted prevalence of binge eating in young adulthood among individuals who perceived their weight as "overweight" throughout adolescence was 20.1% compared to 6.6% for those who never perceived their weight as "overweight" in adolescence. DISCUSSION: Adolescent weight perception was relatively stable in this population-based sample. However, weight perception transitions that involved perceiving "overweight", particularly in late adolescence, were associated with long-term higher risk of disordered eating.

Impacts of COVID-19 on the home food environment and eating related behaviors of families with young children based on food security status.

This mixed-methods study endeavored to expand the current understanding of how early pandemic related disruptions impacted the home food environment and parent feeding practices of families with young children. Data for this study are taken from the Kids EAT! Study, a racially/ethnically diverse cohort of families with 2-5 year old children. Individual interviews were conducted by phone and video conference with mothers (n = 25) during August/September of 2020 and were coded using a hybrid deductive/inductive analysis approach. Parents also reported on their family's food insecurity status enabling qualitative findings to be stratified by family-level food security status. Two overarching themes were identified related to how families in this sample describe the COVID-19 pandemic's impact on their home food environment. Themes included 1) Impacts on obtaining food for one's family, and 2) Specific changes in parent feeding practices. Findings indicated variation within each theme by family food security status. Overall, families experiencing food insecurity more frequently discussed using various coping strategies, including stocking up, rationing food, and use of supplemental food resources, to overcome challenges associated with obtaining food brought on by COVID-19. Families with food insecurity also reported having more time for home cooked meals and more frequently discussed enforcing less structure (timing of meal, place) related to meals/snacks consumed at home during the pandemic. The impacts of the COVID-19 persist, ranging from ongoing economic challenges, inconsistent access to childcare for families, and the emergence of new, more contagious, variants. With this, interventions to address food insecurity amongst families with young children should consider how to optimize the home food environment and promote healthful parent feeding practices within the families they serve in the face of an evolving public health crisis.

Relative food abundance predicts greater binge-eating symptoms in subsequent hours among young adults experiencing food insecurity: Support for the "feast-or-famine" cycle hypothesis from an ecological momentary assessment study.

Food insecurity (FI) may increase risk for binge eating through a "feast-or-famine" cycle, where fluctuations in food availability correspond to alternating periods of food restriction and opportunities for binge eating, but research on this topic is limited. To clarify the relationship between food availability and binge eating in the context of FI, this study examined the association between momentary food security level and subsequent binge-eating symptoms among individuals in food-insecure households and investigated how this association differs by factors that may modify the extent to which food availability fluctuates. Ecological momentary assessment data were collected in 2020-2021 from 75 young adults (Mage = 25.3 ± 1.8 years; 72% female; 72% Black, Indigenous, or a Person of Color) in the United States who had experienced past-month household FI. For 14 days, participants reported four times per day on food security and eating episodes, and binge-eating symptoms were assessed for each reported eating episode. About 35% of the variance in momentary food security ratings was accounted for by within-person variability over time. A significant within-person association was observed in multilevel analyses, indicating that instances of greater food security relative to one's average level predicted greater subsequent binge-eating symptoms. Moderation analyses revealed that this association was significant only among individuals reporting use of food assistance programs, high engagement in resource trade-off coping strategies (e.g., skipping bill payments to buy food), or low food security-related self-efficacy. Overall, findings offer support for the "feast-or-famine" cycle hypothesis as an explanation for the link between FI and binge eating, emphasize the importance of identifying approaches to promote more stable access to adequate food, and suggest potential intervention targets to reduce risk for binge eating in populations experiencing FI.

Social Isolation in a Population-Based Sample of Emerging Adults: Who Is on Their Own?

Purpose: This study aimed to identify the associations between social isolation, social contextual factors, and behavioral and psychological health during emerging adulthood. Methods: Participants (n = 1,568) were drawn from EAT 2018 (mean age = 22.1 ± 2.0). Logistic regressions tested the associations between social isolation, contextual factors, and behavioral and psychological health. Results: Approximately 16% of the sample reported social isolation. Emerging adults with socially marginalized identities (e.g., racial/ethnic, socioeconomic), who were unemployed, and/or lived alone had higher odds of experiencing social isolation. Social isolation was associated with more risky health behaviors and lower self-esteem. Discussion: Emerging adults who were socially disadvantaged (e.g., unemployed) had greater risk of social isolation. Findings suggest that social isolation is more strongly linked with behavioral health than psychological health. Generally, findings suggest that access to community resources and areas wherein social connections can be formed may to be important for behavioral health in emerging adulthood.

Identification of positive parenting practices among parents of young children living in low-income and racially, ethnically, and culturally diverse households.

Using the positive deviance approach, the purpose of this study was to identify parent feeding practices that might be protective against early childhood obesity among children with lower weight status (BMI percentile ≥5th-<85th) relative to higher weight status (BMI percentile ≥85th). Qualitative interviews were conducted with 71 parents of children aged 2-5 years old (48% girls) enrolled in the Minnesota Special Supplemental Nutrition Program for Women Infants and Children (WIC). Children were identified as having lower weight status (defined as 'positive deviants') (n = 36) or 'higher weight status' (n = 35), and were African American [n = 22], Hispanic [n = 23], or Hmong [n = 26]). Parents were asked about approaches to child feeding and health- and weight-related practices. Findings indicated that relative to caregivers of children with higher weight status, parents of children identified as positive deviant were more likely to report having a consistent routine for providing meals, using a guided choices approach, serving small portions of food during mealtimes, and trusting their child hunger and satiety cues. Moreover, parents of children identified as positive deviant were more likely to promote healthful eating and physical activity engagement and implement clear rules and limits for screen time than parents of children with higher weight status. Results suggest specific parent feeding behaviors and health-related practices that may influence child weight status among children living in low-income and racialized households. The findings of this study also provide research evidence and support the tenets of the Satter Division of Responsibility in Feeding framework. Parenting practices and strategies among parents of children identified as positive deviant are expected to be feasible and should be explored and communicated in future interventions to support age- and sex-recommended weight and health-related outcomes among young children to promote health equity.

Adverse childhood experiences and disordered eating among middle-aged adults: Findings from the coronary artery risk development in young adults study.

Adverse childhood experiences (ACEs) include childhood abuse, neglect, and household substance abuse. Childhood abuse is a risk factor for disordered eating (DEB). Less well established are associations of childhood neglect and household substance abuse with DEB, and little research has examined ACE associations with DEB in middle adulthood. The objective of this study was to examine associations between ACEs and DEBs among middle-aged adults and examine sex differences. ACEs prior to age 18 were retrospectively assessed in the Coronary Artery Risk Development in Young Adults study in 2000-2001 (N = 3340, ages 32 to 46). DEB outcomes (i.e., concerns about weight and shape, anxiety about eating or food, unhealthy weight control behaviors, chronic dieting, overeating, and binge eating) were assessed in 1995-1996 (ages 27 to 41). Modified Poisson regressions estimated risk ratios (RRs) for associations of a history of any ACE, each ACE, and cumulative ACEs with DEB outcomes. Among women, emotional abuse, physical neglect, and emotional neglect were each modestly associated with most DEBs (RRs = 1.21-1.35, 1.21-1.45, and 1.23-1.41 across DEBs, respectively) after adjustment for sociodemographic variables, BMI, and depressive symptoms. A cumulative ACE score was associated with all DEBs in a stepwise manner (p for trend ≤0.05) except concerns about weight and shape and overeating. Among men, emotional abuse was most consistently related to the majority of DEBs (RRs = 1.23-1.92); household substance abuse was modestly associated with overeating (RR = 1.26, 95% CI = 1.04-1.53). ACEs were cumulatively associated with unhealthy weight control behaviors, overeating, and binge eating (p for trend <0.01).

Experiences with Public Health Recommendations for COVID-19: A Qualitative Study of Diverse Mothers with Young Children in the United States.

Background: Despite the increased availability of vaccines, masking and social distancing remain important strategies to mitigate COVID-19 transmission. This qualitative study aimed to better understand experiences navigating public health recommendations to slow the spread of COVID-19 among economically and ethnically diverse mothers with young children. Methods: Mothers of preschoolers (n=25) were recruited from Project EAT 2010-2018 (Eating and Activity over Time) longitudinal cohort. Participants completed a virtual semi-structured interview about their experiences during COVID-19. Interview transcripts were coded using deductive and inductive content analysis and analyzed using thematic analysis to identify themes. Results: The first identified theme, "Selective adherence to recommendations" included subthemes highlighting how social distancing was more challenging than mask wearing, family and children were primary reasons for reduced adherence, and concern for the wellbeing of others influenced adherence. The second theme, "Personal experiences and relationships were important determinants of perceived severity of the virus and critical aspects of desired support," included subthemes on feelings of uncertainty, personal experiences with the virus, and desired community supports. Participants felt stressed and confused about what information to trust. Personal experiences with COVID-19 influenced perceptions of its seriousness, and mothers were more confident about following recommendations when they them from trusted medical professionals and desired for communities to work together. Conclusions: How findings among this diverse population of mothers can help inform future public health messaging and policies throughout the remainder of this pandemic, its aftermath, and future public health emergencies, in which masking and social distancing will be needed, are discussed.

Participant characteristics and dietary correlates of SNAP and other assistance programs among families with children from racially and ethnically diverse households.

The objective of this study was to describe food purchasing behaviors and the home food environment across families simultaneously receiving SNAP (Supplemental Nutrition Assistance Program) and other cash and food assistance benefits, and assess how child dietary intake varied across three distinct categories of assistance (i.e., SNAP and other assistance programs, assistance programs other than SNAP, and not enrolled in any assistance program). This cross-sectional study was conducted with parents of children aged 5-9 years (N = 1033) from low-income and racially and ethnically diverse households, living in Minneapolis and Saint Paul, Minnesota, metropolitan areas. In an online survey, parents reported enrollment in seven assistance programs (SNAP, WIC [Special Supplemental Nutrition Program for Women, Infants and Children Program], free or reduced-cost school breakfast, free or reduced-cost school lunch, SSI [Supplemental Security Income Program], MFIP [Minnesota Family Investment Program], daycare assistance), food purchasing behaviors, the home food environment, and child dietary and fast-food intake. Descriptive statistics were computed to describe food purchasing behaviors and the home food environment. Multivariable linear regressions were used to evaluate the association between assistance categories and child dietary intake factors. Models were adjusted for child age, parent and child sex, race and ethnicity, household income, primary caregiver's educational attainment, employment status, and place of birth. Relative to families participating in assistance programs other than SNAP and not enrolled in any assistance program, families participating in SNAP and other assistance programs had less reliable modes of transportation to go food shopping (use 'my own car or vehicle' 57% vs. 90% and 83%, respectively), shopped less frequently during the month ('1 big trip a month and small trips in between' 35% vs. 19% and 24%, respectively], had a somewhat higher presence of energy-dense (e.g., 'French fries' 60% vs. 35% and 25%, respectively) and high-sodium food items in the home (e.g., 'canned pasta' meals 48% vs. 35% and 20%, respectively), and some aspects of children's dietary intake that were not congruent with current dietary recommendations (e.g., consumption of 'fried vegetables' 3.9 times/week [95% CI 3.4, 4.4] vs. 2.9 [2.3, 3.5] and 2.8 [2.1, 3.6], respectively). Findings could inform targeted strategies to maximize the impact of simultaneous programs' benefits on improving child dietary intake and reaching eligible households not enrolled in assistance programs.