Impact of the COVID-19 pandemic on pediatric faculty: a report from nine academic institutions.

BACKGROUND: The COVID-19 pandemic affected home and work routines, which may exacerbate existing academic professional disparities. Objectives were to describe the impact of the pandemic on pediatric faculty's work productivity, identify groups at risk for widening inequities, and explore mitigation strategies. METHODS: A cross-sectional study of faculty members was conducted at nine U.S. pediatric departments. Responses were analyzed by demographics, academic rank, and change in home caregiving responsibility. RESULTS: Of 5791 pediatric faculty members eligible, 1504 (26%) completed the survey. The majority were female (64%), over 40 years old (60%), and assistant professors (47%). Only 7% faculty identified as underrepresented in medicine. Overall 41% reported an increase in caregiving during the pandemic. When comparing clinical, administrative, research, and teaching activities, faculty reported worse 1-year outlook for research activities. Faculty with increased caregiving responsibilities were more likely to report concerns over delayed promotion and less likely to have a favorable outlook regarding clinical and research efforts. Participants identified preferred strategies to mitigate challenges. CONCLUSIONS: The COVID-19 pandemic negatively impacted pediatric faculty productivity with the greatest effects on those with increased caregiving responsibilities. COVID-19 was particularly disruptive to research outlook. Mitigation strategies are needed to minimize the long-term impacts on academic pediatric careers. IMPACT: The COVID-19 pandemic most negatively impacted work productivity of academic pediatric faculty with caregiving responsibilities. COVID-19 was particularly disruptive to short-term (1-year) research outlook among pediatric faculty. Faculty identified mitigation strategies to minimize the long-term impacts of the pandemic on academic pediatric career pathways.

Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities.

BACKGROUND: Preschool-aged children's physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children's PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples - Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA). METHODS: The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children's PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child's ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects. RESULTS: Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children's PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children's PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children's PA and negatively related to ST, while parental promotion of ST was positively associated with children's ST. Correlates of children's PA and ST did not differ by city. CONCLUSIONS: The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children's health-promoting activity levels.

Vegetable parenting practices vary by feeding styles among middle class mothers of young children.

The optimal approach to feeding preschool children balances expectation setting (demandingness) with responsivity to the child (responsiveness), and ideal feeding practices use environmental structuring and covert, non-directive control strategies while maintaining responsiveness. However, research has not examined the extent to which demandingness and responsiveness in feeding style is concordant with structure, responsiveness and control (directive and non-directive) in feeding practices. We classified the feeding style of 122 parents of preschoolers as authoritative (high demandingness/high responsiveness), authoritarian (high demandingness/low responsiveness), indulgent (low demandingness/high responsiveness), or uninvolved (low demandingness/low responsiveness). Parents reported on their frequency of use of 31 vegetable parenting practices (VPPs), that were classified into the domains of structure, control and responsiveness, and subcategorized as effective (likely to obtain the desired change without increasing child obesity risk) or ineffective (unlikely or increases risk) by expert consensus. We hypothesized that parents with an authoritative feeding style would have the highest effective structure, responsiveness and control VPPs, and the authoritarian style would differ with less responsiveness VPPs. We also hypothesized that the indulgent feeding style would have low levels of structure and control VPPs and high ineffective responsiveness VPPs. As expected, we found that parents with an authoritative feeding style reported using more effective structure and responsiveness VPPs. Surprisingly, parents with an authoritarian feeding style did not have VPPs which differed from those with an authoritative feeding style, and parents with an indulgent feeding style had surprisingly high effective control VPPs. Further research into the similarities and differences between parents' overall approach to feeding and their use of feeding practices related to specific foods is warranted, which may help inform the design of more effective interventions aimed at improving child dietary quality.

Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender.

Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.

Selection and use of vegetable parenting practices did not vary by parent feeding styles: Mixed methods investigation.

Parents influence their child's vegetable intake through their feeding style, i.e. the emotional tone established around feeding, and vegetable parenting practices (VPPs), i.e. the specific behaviors employed to influence their child's vegetable intake. A model of precision food parenting proposes that child healthy dietary intake could be optimized by the selection and implementation of effective food parenting practices. Parents use and learn from these complex interactions with their child, which are reflective of feeding style. Intervention research has targeted VPPs in general without a delineation of which practices were selected, which were used, or why they were selected. It is not clear how these users were influenced by feeding style, nor what the parent learned from the interaction. The current study used mixed methods wherein middle socioeconomic status parents of 3-5 year old children were categorized within feeding style groups (n = 122), asked to select two VPPs, implemented them for a week (n = 63), and qualitatively interviewed about their experience. Responsiveness VPPs were most commonly selected, primarily due to their perceived ease of implementation. Parents believed there would be long term positive outcomes, e.g. more vegetable intake from using the practices selected. Frequency of use depended in part on opportunity, e.g. food purchase parenting practices could only be employed during intermittent shopping events. Few differences were detected by parent feeding styles in the types of VPPs selected, frequency of use, or effectiveness. Food parenting interventions can encourage selection of specific VPPs to employ and do not appear to have to tailor the types of VPPs offered to parent feeding style. Research is needed with larger, socioeconomically diverse samples to assess optimal categorization into feeding styles and confirm the present results.

Maternal feeding style and child weight status among Hispanic families with low-income levels: a longitudinal study of the direction of effects.

BACKGROUND: The home environment is a central and modifiable influence on the development of childhood obesity. Evidence supports the central role of parents in shaping problematic child eating behaviors and excess weight. Most studies of feeding emphasize parent-driven influences without taking into account the child's role in eating interactions. Few studies have addressed the bi-directional nature of feeding dynamics in studies of young children. METHODS: The goals of this study were: 1) to examine if parental feeding styles during preschool (4-5 years) predict child weight status at 7-9 years, and 2) to examine the direction of effects between parental feeding styles and child weight status over time. Participants were part of a larger longitudinal study of Hispanic Head Start families living in the West South Central United States. Data from mother/child dyads were collected at three time points: Time 1 (ages 4-5), Time 2 (ages 5 ½-6 ½), and at Time 3 (ages 7-9). Only data from the Times 1 and 3 were used in the current analyses. A total of 128 mothers and their children had data on all variables needed for the analyses. Assessments included parent-reported feeding styles, feeding practices, acculturation, child eating behaviors, and child height and weight. Hierarchical regression was used to examine the first aim; a cross-lagged panel analysis examined the second aim. RESULTS: An indulgent parental feeding style at ages 4-5 was associated with increased child BMI z-score at ages 7-9. Indulgent feeding significantly contributed to child BMI z-score beyond demographics, baseline child BMI z-score, parental acculturation, and child eating behaviors. Regarding the direction of effects in parental feeding interactions, the cross-lagged analyses showed that both indulgent feeding style and authoritative feeding style at Time 1 positively predicted child BMI z-scores at Time 3. Child effects were significant as well. Child BMI z-score at Time 1 positively predicted indulgent feeding and negatively predicted authoritarian feeding at Time 3. CONCLUSIONS: Indulgent feeding should be addressed in future family-focused childhood obesity initiatives focused on young children and their parents.

Identifying and predicting food parenting practice profiles among Canadian parents.

BACKGROUND: Food parenting practices (FPP) can affect children's eating behaviours, yet little is known about how various FPP co-occur. The primary aim was to identify profiles of FPPs use among Canadian parents. Secondary aims included examining sociodemographic correlates of FPP profiles and evaluating whether children's eating behaviours differed across FPP profiles. METHODS: Parents (n = 799) of 5-12-year-old children completed a validated FPP Item Bank and the Children's Eating Behaviour Questionnaire. Latent Class Analysis (LCA) was used to identify distinct FPP profiles. Regression analyses were used to explore associations between FPP profiles, sociodemographic variables (race, sex and education) and children's eating behaviours (emotional overeating, food responsiveness, food fussiness and satiety responsiveness). RESULTS: LCA revealed 6 FPP profiles: healthy eating environment, high engagement, reactive, high structure, controlling and low engagement. Relative to their non-White counterparts, White parents were more likely to belong in the healthy eating environment, high structure and low engagement profiles. Relative to fathers, mothers were more likely to fall in the healthy eating environment compared to low engagement profile. Parents with some post-secondary education were more likely to belong in the healthy eating environment, high structure and reactive profiles compared to the controlling profile. Emotional overeating and food responsiveness scores were lowest for healthy eating environment, high structure, low engagement profiles. Parents in the healthy eating environment profile also reported lower food fussiness scores compared to parents in the high engagement, high structure, reactive and controlling profiles. CONCLUSIONS: Findings suggest that a continuum of 6 FPP profiles may be present among Canadian parents, representing parents who use either all (high engagement), some (healthy eating environment, reactive, high structure, controlling) or little (low engagement) of the FPP examined. Future longitudinal research should evaluate how various FPP profiles influence the development of children's eating behaviors, dietary intakes and weight status.

Later sleep timing predicts accelerated summer weight gain among elementary school children: a prospective observational study.

OBJECTIVES AND BACKGROUND: Social demands of the school-year and summer environment may affect children's sleep patterns and circadian rhythms during these periods. The current study examined differences in children's sleep and circadian-related behaviors during the school-year and summer and explored the association between sleep and circadian parameters and change in body mass index (BMI) during these time periods. METHODS: This was a prospective observational study with 119 children ages 5 to 8 years with three sequential BMI assessments: early school-year (fall), late school-year (spring), and beginning of the following school-year in Houston, Texas, USA. Sleep midpoint, sleep duration, variability of sleep midpoint, physical activity, and light exposure were estimated using wrist-worn accelerometry during the school-year (fall) and summer. To examine the effect of sleep parameters, physical activity level, and light exposure on change in BMI, growth curve modeling was conducted controlling for age, race, sex, and chronotype. RESULTS: Children's sleep midpoint shifted later by an average of 1.5 h during summer compared to the school-year. After controlling for covariates, later sleep midpoints predicted larger increases in BMI during summer, (γ = .0004, p = .03), but not during the school-year. Sleep duration, sleep midpoint variability, physical activity levels, and sedentary behavior were not associated with change in BMI during the school-year or summer. Females tended to increase their BMI at a faster rate during summer compared to males, γ = .06, p = .049. Greater amounts of outdoor light exposure (γ = -.01, p = .02) predicted smaller increases in school-year BMI. CONCLUSIONS: Obesity prevention interventions may need to target different behaviors depending on whether children are in or out of school. Promotion of outdoor time during the school-year and earlier sleep times during the summer may be effective obesity prevention strategies during these respective times.

Are fathers' and mothers' food parenting practices differentially associated with children's eating behaviors?

Little is known about how fathers' food parenting practices (FPP) are linked with children's eating behaviors and whether these associations differ from mothers. This study examined associations between paternal and maternal FPP and eating behaviors among children aged 5-12 years. A sample of 565 parents (53% fathers) completed: 1) the FPP item bank, which measured 11 FPP constructs from three domains of parenting (control, autonomy promotion, and structure) and 2) the Children's Eating Behavior Questionnaire (CEBQ), to assess four constructs (emotional overeating, food responsiveness, satiety responsiveness and food fussiness). Multivariable linear regressions evaluated associations between FPP and CEBQ constructs, and models were run separately for fathers and mothers. Similarities emerged between fathers and mothers: 1) use of restriction for weight practices were positively associated with emotional overeating and food responsiveness; 2) use of practices to accommodate the child around food and use of practices to involve the child were positively and negatively associated, respectively, with food fussiness; and 3) use of practices to accommodate the child, or coercive controlling practices, was positively associated with emotional overeating. Differences emerged between fathers and mothers in terms of FPP associated with children's food and satiety responsiveness, with a greater number of fathers' FPP predictive of these behaviors. Although similarities exist between mothers and fathers, these findings suggest that fathers likely exert a unique influence on their children's eating behaviors and stress the need for interventions to account for the role each parent plays promoting healthy eating habits.

Calibration of the food parenting practice (FPP) item bank: tools for improving the measurement of food parenting practices of parents of 5-12-year-old children.

PURPOSE: There has been a call to improve measurement rigour and standardization of food parenting practices measures, as well as aligning the measurement of food parenting practices with the parenting literature. Drawing from an expert-informed conceptual framework assessing three key domains of food parenting practices (autonomy promotion, control, and structure), this study combined factor analytic methods with Item Response Modeling (IRM) methodology to psychometrically validate responses to the Food Parenting Practice item bank. METHODS: A sample of 799 Canadian parents of 5-12-year-old children completed the Food Parenting Practice item bank (129 items measuring 17 constructs). The factorial structure of the responses to the item bank was assessed with confirmatory factor analysis (CFA), confirmatory bi-factor item analysis, and IRM. Following these analyses, differential Item Functioning (DIF) and Differential Response Functioning (DRF) analyses were then used to test invariance properties by parents' sex, income and ethnicity. Finally, the efficiency of the item bank was examined using computerized adaptive testing simulations to identify the items to include in a short form. RESULTS: Overall, the expert-informed conceptual framework was predominantly supported by the CFA as it retained the same 17 constructs included in the conceptual framework with the exception of the access/availability and permissive constructs which were respectively renamed covert control and accommodating the child to better reflect the content of the final solution. The bi-factor item analyses and IRM analyses revealed that the solution could be simplified to 11 unidimensional constructs and the full item bank included 86-items (empirical reliability from 0.78 to 0.96, except for 1 construct) and the short form had 48 items. CONCLUSION: Overall the food parenting practice item bank has excellent psychometric properties. The item bank includes an expanded version and short version to meet various study needs. This study provides more efficient tools for assessing how food parenting practices influence child dietary behaviours. Next steps are to use the IRM calibrated item bank and draw on computerized adaptive testing methodology to administer the item bank and provide flexibility in item selection.

The physical activity parenting practices (PAPP) item Bank: a psychometrically validated tool for improving the measurement of physical activity parenting practices of parents of 5-12-year-old children.

BACKGROUND: Many tools have been developed to measure physical activity parenting practices (PAPP). Currently, there is little standardization on how PAPP constructs are operationalized for 5-12 year-old children. Given this lack of consistency our team have started the process of standardizing the measurement of PAPP by developing an item bank which was conceptually informed by 24 experts from 6 countries. PURPOSE: The purpose of this paper is to present the psychometric properties of the PAPP item bank using the expert-informed PAPP conceptual framework. METHODS: A sample (N = 626) of Canadian parents completed the PAPP item bank (100 items measuring 12 constructs). Confirmatory Factor Analyses (CFA), confirmatory bi-factor item analyses, and Item Response Modeling (IRM) were used to assess the structural validity of scores derived from the PAPP item bank. Differential Item Functioning (DIF) and Differential Response Functioning (DRF) were used to determine whether the PAPP items are invariant by parent sex, ethnicity of parent, and household income. Finally, Computerized Adaptive Testing (CAT) simulations were used to determine the efficiency of the item bank - this involved ascertaining whether each construct can be assessed with fewer items. RESULTS: The PAPP expert-informed conceptual framework was mainly supported by the CFA analyses. Notable changes included: a) collapsing smaller constructs into one general construct (modeling, co-participation, and monitoring constructs were collapsed into a construct assessing nondirective support); or b) splitting a construct into two smaller constructs (restrict for safety reason construct was split into indoor physical activity restriction and allowance for unsupervised outside physical activity). While the CFA analyses supported the structural validity of 11 constructs, the bi-factor item analyses and IRM analyses supported collapsing correlated constructs into more general constructs. These analyses further reduced the number of constructs measured by the PAPP item bank to nine constructs (65 items - reliability ranging from .79 to .94). As seven of the PAPP constructs had reliability greater than .80, CAT simulations further reduced the number of items to 31 items. CONCLUSION: Overall, the PAPP item bank has excellent psychometric properties and provides an efficient way to assess PAPP.

Cultural adaptation of 'Healthy Dads, Healthy Kids' for Hispanic families: applying the ecological validity model.

BACKGROUND: Healthy Dads Healthy Kids (HDHK) is a unique lifestyle obesity intervention for fathers and children that demonstrated weight loss among the fathers and behavior change among fathers and children in Australia. The program is gender-tailored to specifically target fathers for weight loss and 5-12 year old children for obesity prevention. The aim of this formative study was to examine an Expert Panel's and Hispanic Family Panel's perceptions about the program and suggestions for the cultural adaptation of HDHK for Hispanic families in southwestern US. METHODS: Forty-four Hispanic participants (22 fathers, 13 mothers and 9 children) made up the Family Panel. They participated in 1-5 study contacts (focus groups, online survey, and/or interviews). The scripts and qualitative guides assessed participants' perceptions of the HDHK content and material using the Ecological Validity Model. Studies were conducted in English or Spanish, depending on the preference of the participant. Focus groups and interviews were audio-recorded, transcribed, translated, and thematically coded. Findings were reviewed with the Expert Panel who helped inform the cultural adaptation. RESULTS: 80% of parents were foreign-born, 57% spoke only Spanish at home, and 60% did not graduate from high school. Several themes emerged to inform the cultural adaptation of the program. Parents agreed with the HDHK goals and recommended the program place greater emphasis on parenting and limiting children's screen time. Some mothers and fathers wanted greater mother engagement. Weekly videos and a Facebook group emerged as favorite alternative options to engage mothers. Greater promotion of familism (inclusion and impact on whole family) was recommended for the program goals and activities. Gender roles for mothers and fathers, and differences in how fathers interact with male and female children, emerged and should be considered in program activities. Several barriers to father engagement surfaced, including lack of time due to work schedules, physically demanding jobs, concerns of caring for children without mother, fathers' current fitness/weight, and lack of knowledge of how to eat more healthfully. The reading level of the HDHK materials was too high for some parents. CONCLUSION: Findings from these formative qualitative studies informed the cultural adaptation of HDHK for Hispanic families, to account for literacy level, cultural values, and barriers to participation and engagement.

Child weight status and accuracy of perceived child weight status as predictors of Latina mothers' feeding practices and styles.

This study focused on the relationship between low-income Latina mothers' perceptions of their preschool children's weight status and maternal feeding practices and styles, also considering the effects of actual child weight status and maternal concern about child weight. A total of 186 low-income Latina mother-child dyads participated. The vast majority of mothers underestimated the weight status of their child, but this varied by child weight status. Although only 30% of mothers of healthy weight children underestimated their child's weight status, 97% of mothers of overweight or obese children did so. No mother overestimated her child's weight status. Contrary to our hypotheses, in most cases, maternal perceptions of child's body weight were not related to maternal feeding styles, nor were many feeding practices predicted by concern about child weight. Instead, children's actual weight status was the strongest predictor of maternal feeding practices and feeding styles. Mothers of children with higher BMI z-scores reported higher levels of healthy eating guidance and responsiveness during feeding and lower levels of pressure to eat, food as reward, and using food to regulate the child's emotions. These mothers were more likely to show an indulgent and less likely to show an authoritarian feeding style. Concern about child weight did not account for any of these significant correlations. Maternal perceptions only mattered for restriction for weight purposes where there were independent effects of both perceived and actual weight status. Implications for understanding the development of child obesity in low-income, Latino populations are considered, along with recommendations for future research and for childhood obesity prevention programs.

The association of TV viewing during dinner meals with quality of dietary intake and BMI z-scores among low income, ethnic minority preschool children.

BACKGROUND: TV viewing has been associated with children's weight status and is thought to be mediated mostly through children's dietary intake. However, the mechanisms underlying this association are not understood. OBJECTIVE: Assess the associations of having the TV on and the child watching TV during dinners with the dietary quality consumed at that meal and with the child's weight status. METHODS: Secondary analysis of a directly-observed study of 144 preschool-aged African American and Hispanic, low-income children's dinner meals. Three home dinners were video recorded per child (428 meals observed) and what children were served and consumed measured. The Healthy Eating Index-2010 assessed dietary quality of dinners served and consumed. Child height and weight were measured and parents completed questionnaires. Videos were coded for whether the TV was on and the proportion of the dinner the child watched TV. Mixed models with meal observations nested within child assessed the associations. RESULTS: 77% of children consumed at least one dinner with the TV on. The proportion of the meal the child watched TV was not associated with lower dietary quality consumed. TV on was associated with the dietary quality consumed only in the fully adjusted model (p < 0.05). The dietary quality of dinner served was most strongly associated with the dietary quality consumed (p < 0.0001). Neither having the TV on nor child watching the TV while eating were associated with the child's BMI z-score. CONCLUSION: Having the TV on during meals was common, but watching TV during the meal was not associated with the dietary quality of what the children consumed. Further controlled studies should evaluate if turning the TV off during dinner directly improves the dietary quality children consume at that meal.

Stability in the feeding practices and styles of low-income mothers: questionnaire and observational analyses.

BACKGROUND: During the last two decades, researchers have devoted considerable attention to the role of maternal feeding behaviors, practices, and styles in the development of obesity in young children. Little is known, however, about the consistency of maternal feeding across settings and time. The purpose of this paper was to provide data on this issue by examining the consistency of observed maternal feeding behavior across multiple eating occasions, as well as examine the consistency of observed and self-reported maternal feeding behavior across 18 months. METHODS: Videotapes from two studies of low-income mothers and their preschool children were coded for feeding practices, dimensions, and styles: a study of 137 low-income, African American and Latina mothers and their children observed during three meals in their homes over a two to three week period, and a study of 138 low-income, Latina mothers observed during a buffet meal in a laboratory setting on two separate occasions 18 months apart. Videotapes from both studies were coded for a wide range of maternal feeding behaviors and strategies. Mothers in the second study also completed three validated, self-report questionnaires on their feeding practices and styles. RESULTS: Overall, both observed and self-reported feeding practices and styles showed only moderate levels of stability across meals and over time. Maternal attempts to regulate children's eating showed more stability across meals and over time than the content of general mealtime conversation. Also, greater stability was found in what mothers were trying to get their children to do during the meals than in the strategies they used to influence child behavior. Self-reports of feeding showed greater stability over time than observational measures. Across meals and across 18 months, the stability of general feeding styles was between 40% and 50%. CONCLUSIONS: The findings demonstrate that maternal feeding behavior was only moderately stable across meals and over time-that is, feeding behavior varied considerably across situations. The lack of high levels of consistency in feeding behavior suggests that situational factors may play a major role in influencing maternal behavior as well. Family-focused childhood obesity programs should focus not only on helping parents change their feeding practices and styles, but also focus on increasing parents' sensitivity to situational factors that affect their approach to feeding their children.

Predicting preschool children's eating in the absence of hunger from maternal pressure to eat: A longitudinal study of low-income, Latina mothers.

Early work by Klesges et al. (1983, 1986) suggested that mothers who frequently prompt their children to eat have children at greater risk for obesity. This is consistent with the hypothesis that controlling feeding practices override children's responsiveness to their internal fullness cues, increasing the risk of overeating and obesity (e.g., Johnson & Birch, 1994). Subsequent cross-sectional research on pressure to eat, however, has been inconsistent. Most studies have shown that maternal self-reports of pressure to eat are negatively associated with childhood obesity, and observational studies showed inconsistent relationships with child weight status. In the present study we examined the association between low-income, Latina mothers' pressure to eat and their preschool children's eating in the absence of hunger using both self-report and observational measures of feeding practices. A longitudinal design examined eating in the absence of hunger over 18 months; children's BMI at the initial timepoint was statistically controlled to address the tendency of mothers of underweight children to pressure their children to eat. At each timepoint, mothers completed the Child Feeding Questionnaire (Birch et al., 2001) and were observed feeding their child a meal in a laboratory setting. Eating in the absence of hunger (Fisher & Birch, 1999) was assessed at both timepoints as well. A cross-lagged panel model showed that observed maternal prompts to eat a different food at time one predicted kcal consumed in the absence of hunger at time two (controlling for kcal consumed in the absence of hunger at first timepoint: beta = 0.20, p < 0.05). Results suggest that pressure to eat alone may not be what contributes to eating in the absence of hunger, but that the nature of that pressure may be more important.

Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition experts input.

BACKGROUND: Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. METHOD: A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. RESULTS: The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. CONCLUSION: The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

What do US and Canadian parents do to encourage or discourage physical activity among their 5-12 Year old children?

BACKGROUND: Parents have the potential to substantively influence their child's physical activity. This study identified the parenting practices of US and Canadian parents to encourage or discourage their 5-12 year-old child's physical activity and to examine differences in parenting practices by country, parental sex, age of child, and income. METHODS: The sample consisted of 134 US and Canadian parents (54.5% US; 60.4% female) recruited from a web-based panel by a polling firm. The parents answered open-ended questions about what they and other parents do to encourage or discourage their child to be active. Responses were coded using a scheme previously developed to code items used in the published literature. Coded responses were summarized by domain and dimension with differences in responses by country, parental sex, age of child, or household income assessed with a log-linear analysis. RESULTS: The 134 parents provided 649 and 397 responses to ways that parents encourage or discourage their child's physical activity, respectively. Over 70% of responses for practices that encourage physical activity were related to structure of the environment, parental encouragement, and co-participation. The most common response was co-participation in activity with the child. Of the practices that discourage physical activity, 67% were related to structure of the environment, lack of parental control, and modeling poor behaviors. The most common response was allowing screen time. There were no differences in response by country, parental sex, child age, or household income. CONCLUSIONS: Parents most often encouraged physical activity through structure and emotional support and discouraged physical activity through lack of structure and control. Understanding how parents influence their child's physical activity may help improve intervention strategies. The current results will inform the development of a physical activity parenting practices instrument.

Conceptualizing physical activity parenting practices using expert informed concept mapping analysis.

BACKGROUND: Parents are widely recognized as playing a central role in the development of child behaviors such as physical activity. As there is little agreement as to the dimensions of physical activity-related parenting practices that should be measured or how they should be operationalized, this study engaged experts to develop an integrated conceptual framework for assessing parenting practices that influence multiple aspects of 5 to 12 year old children's participation in physical activity. The ultimate goal of this study is to inform the development of an item bank (repository of calibrated items) aimed at measuring physical activity parenting practices. METHODS: Twenty four experts from 6 countries (Australia, Canada, England, Scotland, the Netherlands, & United States (US)) sorted 77 physical activity parenting practice concepts identified from our previously published synthesis of the literature (74 measures) and survey of Canadian and US parents. Concept Mapping software was used to conduct the multi-dimensional scaling (MDS) analysis and a cluster analysis of the MDS solution of the Expert's sorting which was qualitatively reviewed and commented on by the Experts. RESULTS: The conceptual framework includes 12 constructs which are presented using three main domains of parenting practices (neglect/control, autonomy support, and structure). The neglect/control domain includes two constructs: permissive and pressuring parenting practices. The autonomy supportive domain includes four constructs: encouragement, guided choice, involvement in child physical activities, and praises/rewards for their child's physical activity. Finally, the structure domain includes six constructs: co-participation, expectations, facilitation, modeling, monitoring, and restricting physical activity for safety or academic concerns. CONCLUSION: The concept mapping analysis provided a useful process to engage experts in re-conceptualizing physical activity parenting practices and identified key constructs to include in measures of physical activity parenting. While the constructs identified ought to be included in measures of physical activity parenting practices, it will be important to collect data among parents to further validate the content of these constructs. In conclusion, the method provided a roadmap for developing an item bank that captures key facets of physical activity parenting and ultimately serves to standardize how we operationalize measures of physical activity parenting.

Predicting habits of vegetable parenting practices to facilitate the design of change programmes.

OBJECTIVE: Habit has been defined as the automatic performance of a usual behaviour. The present paper reports the relationships of variables from a Model of Goal Directed Behavior to four scales in regard to parents' habits when feeding their children: habit of (i) actively involving child in selection of vegetables; (ii) maintaining a positive vegetable environment; (iii) positive communications about vegetables; and (iv) controlling vegetable practices. We tested the hypothesis that the primary predictor of each habit variable would be the measure of the corresponding parenting practice. DESIGN: Internet survey data from a mostly female sample. Primary analyses employed regression modelling with backward deletion, controlling for demographics and parenting practices behaviour. SETTING: Houston, Texas, USA. SUBJECTS: Parents of 307 pre-school (3-5-year-old) children. RESULTS: Three of the four models accounted for about 50 % of the variance in the parenting practices habit scales. Each habit scale was primarily predicted by the corresponding parenting practices scale (suggesting validity). The habit of active child involvement in vegetable selection was also most strongly predicted by two barriers and rudimentary self-efficacy; the habit of maintaining a positive vegetable environment by one barrier; the habit of maintaining positive communications about vegetables by an emotional scale; and the habit of controlling vegetable practices by a perceived behavioural control scale. CONCLUSIONS: The predictiveness of the psychosocial variables beyond parenting practices behaviour was modest. Discontinuing the habit of ineffective controlling parenting practices may require increasing the parent's perceived control of parenting practices, perhaps through simulated parent-child interactions.