Associations between markers of social functioning and depression and quality of life in survivors of head and neck cancer: Findings from the Head and Neck Cancer 5000 study.

OBJECTIVE: To investigate associations between markers of social functioning (trouble with social eating and social contact), depression and health-related quality of life (QOL) among head and neck cancer survivors. METHODS: This cross-sectional analysis included individuals with oral cavity, oropharynx, larynx, salivary gland and thyroid cancers from Head and Neck 5000 alive at 12 months. Trouble with social eating and social contact were measured using items from EORTC QLQ-H&N35 and QOL using EORTC QLQ-C30; responses were converted into a score of 0-100, with a higher score equalling more trouble or better QOL. A HADS subscale score of ≥8 was considered significant depression. Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multivariable logistic and linear regression (with robust errors), respectively. RESULTS: Of 2561 survivors, 23% reported significant depression. The median QOL score was 75.0 (interquartile range 58.3-83.3). For trouble with social eating, after confounder adjustment, those in the intermediate and highest tertiles had higher odds of depression (intermediate: OR = 4.5, 95% CI 3.19-6.45; high: OR = 21.8, 15.17-31.18) and lower QOL (intermediate:ß = -8.7, 95% CI -10.35 to -7.14; high: ß = -24.8, -26.91 to -22.77). Results were similar for trouble with social contact. CONCLUSION: We found strong clinically important associations between markers of social functioning and depression and QOL. More effective interventions addressing social eating and contact are required. These may help survivors regain their independence, reduce levels of isolation and loneliness, and depression, and improve QOL outcomes generally.

Gender-based eating norms, the family environment and food intake among Costa Rican adolescents.

OBJECTIVE: To examine the association between family environment variables (parenting styles, family meal atmosphere), gender-based stereotypes and food intake in Latin American adolescents. DESIGN: Structural equation modelling applied to cross-sectional data, 2017. SETTING: Urban and rural sites of San José, Costa Rica. PARTICIPANTS: n 813; 13-18 years old. RESULTS: Data suggest direct associations between gender-based stereotypes and intake of fruits and vegetables (FV) (ß = 0·20, P < 0·05), unhealthy foods (fast food (FF)) (ß = -0·24, P < 0·01) and ultra-processed foods (ß = -0·15, P < 0·05) among urban girls; intake of legumes among rural girls (ß = 0·16, P < 0·05) and intake of sugar-sweetened beverages (SSB) among rural boys (ß = 0·22, P < 0·05). Family meal atmosphere was associated with legume intake (ß = 0·19, P <·05) among rural girls. Authoritative parenting style was associated with FV intake (ß = 0·23, P < 0·05) among urban boys and FF intake (ß = 0·17, P < 0·05) among urban girls. Authoritarian parenting style was associated with FV consumption (ß = 0·19, P < 0·05) among rural boys, and with SSB and FF consumption (ß = 0·21, P < 0·05; ß = 0·14, P < 0·05, respectively) among urban girls. CONCLUSIONS: Findings are the first to describe the complex family environment and gender-based stereotypes within the context of a Latin American country. They emphasise the need for culturally relevant measurements to characterise the sociocultural context in which parent-adolescent dyads socialise and influence food consumption.

Social eating initiatives and the practices of commensality.

Social eating initiatives are a mode of food provisioning and eating that have become increasingly popular in the UK. These organisations provide a menu of low-cost meals prepared using food surpluses and deliberately serve food communally to improve social inclusion. Although these community initiatives have grown rapidly in popularity, research into their value from the perspective of participants is currently limited. This article presents data from a concurrent multi-method study conducted across multiple sites of the Nottingham Social Eating Network to explain the emergence of these novel social configurations. The results show this form of commensality, or group eating practice, is not simply a consequence of reducing food waste or food insecurity. Instead these initiatives are enacted through a series of intersecting social practices, which include: the restructuration of the shared mealtime; alimentary contribution; and performances of care. The findings provide important insights into the values expressed in these emergent initiatives and are therefore useful for framing social eating in public policy.

How media appeals depicting social eating contexts increase the appetitive motivational processing of healthy foods.

Research suggests that depictions of social groups can improve the processing of pronutritional media promoting healthy foods. Drawing on a framework of motivational processing, which regulates the automatic emotional and attentional responses to stimuli with adaptive significance to the organism (Cacioppo, Gardner, & Berntson, 1999; Compton, 2003; Ito, Cacioppo, & Lang, 1998), two mixed-factorial experiments examined how adolescents process pronutritional media depicting various social versus alone eating contexts. Based on motivational theories of information processing and emotional contagion, we predicted that pronutritional media depicting social eating contexts capture attention, emotion, and memory formation, indicative of appetitive motivational processing. Study 1 (N = 58; aged 12-18; 54% female) examined how the depicted social eating contexts improve the processing of pronutritional media by increasing their attentional selection, attentional processing, the emotional affect, and arousal responses to them. As the models' faces-which automatically attract priority processing-are oriented towards the foods in the social eating contexts, the pronutritional images depicting social eating contexts were predicted to attract greater attention and mental resources, and to further direct them to the foods. Study 2 (N = 165; aged 12-18; 53% female) investigated how the depicted social eating contexts further improve the processing of the healthy foods in the pronutritional media, by directing the visual attentional focus to the foods and attracting memory formation for them. Visual attentional focus was assessed through eye-tracking and memory was operationalized via visual recognition. As hypothesized, healthy foods became noticeable, highly-arousing, and memorable stimuli with adaptive significance to the organism when promoted through depictions of shared meals in social groups. The findings illustrate how healthy foods can be promoted more effectively through depictions of social eating contexts, and how the appetitive motivational processing explicates their greater effectiveness.

Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders.

BACKGROUND/AIM: Recovery from eating disorders is a challenging process. Emerging literature suggests that occupational therapists may provide a useful contribution in delivering purposeful eating-related interventions as a potential treatment to support sustained cognitive and behavioural changes for individuals with eating disorders. This study aimed to evaluate participants' perceptions of the contribution of occupational therapy practical food groups (food based outings and cooking groups) in supporting their functional recovery. METHODS: Individuals attended practical food groups as part of standard treatment at an outpatient eating disorders day program. Ninety-nine participants completed questionnaires at discharge and up to three follow-up points (6, 12 and 24 months). Questions related to practical food groups were analysed, exploring participants' experiences and perceived usefulness of groups using rating-scale and open-ended questions. Open-ended responses were analysed using thematic analysis. Descriptive statistics were calculated for responses to rating-scale questions. RESULTS: At discharge, participants rated the importance and usefulness of practical food groups as high (4.73 and 4.43 on 5-point scales, respectively), but tended to rate their enjoyment of the groups lower (3.50 on a 5-point scale). Some skill transfer was typically reported by participants at discharge (3.92 on a 5-point scale). One core theme, 'success through participation', emerged from qualitative comments. Six subthemes were also identified: helpful components of practical food groups; perceived benefit of exposure; impact of applying cognitive and behavioural skills; challenges affecting participation; facilitating adaptation; and influence of eating disorders on challenging feared foods. CONCLUSION: This study highlights that participation in practical food groups was perceived as useful in assisting individuals to improve eating behaviours and, in some circumstances, transfer these skills into their lives outside of day program. Results suggest that occupational therapists may have an important contribution in delivering these interventions to support recovery and facilitate application of adaptive coping strategies.

Perceived eating norms and children's eating behaviour: An informational social influence account.

There is initial evidence that beliefs about the eating behaviour of others (perceived eating norms) can influence children's vegetable consumption, but little research has examined the mechanisms explaining this effect. In two studies we aimed to replicate the effect that perceived eating norms have on children's vegetable consumption, and to explore mechanisms which may underlie the influence of perceived eating norms on children's vegetable consumption. Study 1 investigated whether children follow perceived eating norms due to a desire to maintain personal feelings of social acceptance. Study 2 investigated whether perceived eating norms influence eating behaviour because eating norms provide information which can remove uncertainty about how to behave. Across both studies children were exposed to vegetable consumption information of other children and their vegetable consumption was examined. In both studies children were influenced by perceived eating norms, eating more when led to believe others had eaten a large amount compared to when led to believe others had eaten no vegetables. In Study 1, children were influenced by a perceived eating norm regardless of whether they felt sure or unsure that other children accepted them. In Study 2, children were most influenced by a perceived eating norm if they were eating in a novel context in which it may have been uncertain how to behave, as opposed to an eating context that children had already encountered. Perceived eating norms may influence children's eating behaviour by removing uncertainty about how to behave, otherwise known as informational social influence.

The persistence of and resistance to social norms regarding the appropriate amount to Eat: A preliminary investigation.

We conducted a preliminary investigation on the resistance to, and persistence of, social influence regarding the appropriate amount to eat, defined in terms of eating an amount similar to that eaten by a confederate. Participants ate pizza both alone and in the presence of remote confederates presenting either a high or low eating norm. In the portion of the experiment examining resistance to social influence, participants given an initial opportunity to form a personal eating norm by eating alone for one session in the absence of social influence were no more resistant to low eating norms than were those who had no such opportunity; however, those who ate alone for two or three prior sessions did show resistance. For the high eating norm, it took three eating alone sessions to create resistance. In the portion of the experiment examining persistence of social influence, when participants ate alone following a session with norm-setting remote confederates, the effect of the social influence persisted. However, the persistence effect varied by norm and weakened over time. Participants modeled a low eating norm for only one additional session and the size of the effect was markedly weaker. By contrast, the high norm persisted for all of the remaining sessions. Thus, individuals' social influence histories can affect their eating.

Encouraging children to eat more fruit and vegetables: Health vs. descriptive social norm-based messages.

Traditional intervention approaches to promote fruit and vegetable consumption outline the health benefits of eating fruit and vegetables. More recently, social norm-based messages describing the healthy eating habits of others have been shown to increase fruit and vegetable intake in adults. Here we report two experimental studies which investigated whether exposure to descriptive social norm-based messages about the behaviour of other children and health-based messages increased fruit and vegetable intake in young children. In both studies children were exposed to messages whilst playing a board-game. After exposure to the messages, children were able to consume fruit and vegetables, as well as high calorie snack foods. Although findings were inconsistent across the two individual studies, in a pooled analysis we found evidence that both health messages and descriptive social norm-based messages increased children's fruit and vegetable intake, relative to control condition messages (p < .05). Whether descriptive social norm-based messages can be used to promote meaningful changes to children's dietary behaviour warrants further study.

Examining evidence for behavioural mimicry of parental eating by adolescent females. An observational study.

Behavioural mimicry is a potential mechanism explaining why adolescents appear to be influenced by their parents' eating behaviour. In the current study we examined whether there is evidence that adolescent females mimic their parents when eating. Videos of thirty-eight parent and female adolescent dyads eating a lunchtime meal together were examined. We tested whether a parent placing a food item into their mouth was associated with an increased likelihood that their adolescent child would place any food item (non-specific mimicry) or the same item (specific mimicry) in their mouth at three different time frames, namely, during the same second or within the next fifteen seconds (+15), five seconds (+5) or two second (+2) period. Parents and adolescents' overall food intake was positively correlated, whereby a parent eating a larger amount of food was associated with the adolescent eating a larger meal. Across all of the three time frames adolescents were more likely to place a food item in their mouth if their parent had recently placed that same food item in their mouth (specific food item mimicry); however, there was no evidence of non-specific mimicry. This observational study suggests that when eating in a social context there is evidence that adolescent females may mimic their parental eating behaviour, selecting and eating more of a food item if their parent has just started to eat that food.

Awareness of social influence on food intake. An analysis of two experimental studies.

There is consistent evidence that the amount of food we consume can be influenced by the eating behaviour of other people. Some previous experimental studies reported that consumers are unaware of this influence on their behaviour. The present research tested whether people may be more aware of social influence on their eating than previously assumed. In two studies, participants (total n = 160) were exposed to information about the amount of snack food other people had been eating shortly before being served the same snack food and eating as much as they liked. After this, participants responded to questions regarding whether they thought their food intake had been socially influenced, and reported the reasons why they believed they had or had not been influenced. Of the 160 participants, 34% reported that they had been influenced, 10% were unsure and 56% reported they had not been influenced. Crucially, participants' reports of social influence appeared to be accurate; the food intake of participants reporting social influence was significantly affected by the amount of food other people had been eating, whereas the food intake of participants denying social influence was unaffected. Individuals may be more aware of the effect that social influence has on their eating behaviour than previously assumed. Further work is needed to identify the factors which determine whether people are susceptible to social influence on eating behaviour.

The Change in Social Eating over Time in People with Head and Neck Cancer Treated with Primary (Chemo)Radiotherapy: The Role of Swallowing, Oral Function, and Nutritional Status.

This study aimed at investigating the change in social eating problems from diagnosis to 24 months after primary (chemo)radiotherapy and its associations with swallowing, oral function, and nutritional status, in addition to the clinical, personal, physical, psychological, social, and lifestyle dimensions. Adult patients from the NETherlands QUality of life and BIomedical Cohort (NET-QUBIC) treated with curative intent with primary (chemo)radiotherapy for newly-diagnosed HNC and who provided baseline social eating data were included. Social eating problems were measured at baseline and at 3-, 6-, 12-, and 24-month follow-up, with hypothesized associated variables at baseline and at 6 months. Associations were analyzed through linear mixed models. Included patients were 361 (male: 281 (77.8%), age: mean = 63.3, SD = 8.6). Social eating problems increased at the 3-month follow-up and decreased up to 24 months (F = 33.134, p < 0.001). The baseline-to-24 month change in social eating problems was associated with baseline swallowing-related quality of life (F = 9.906, p < 0.001) and symptoms (F = 4.173, p = 0.002), nutritional status (F = 4.692, p = 0.001), tumor site (F = 2.724, p = 0.001), age (F = 3.627, p = 0.006), and depressive symptoms (F = 5.914, p < 0.001). The 6-24-month change in social eating problems was associated with a 6-month nutritional status (F = 6.089, p = 0.002), age (F = 5.727, p = 0.004), muscle strength (F = 5.218, p = 0.006), and hearing problems (F = 5.155, p = 0.006). Results suggest monitoring social eating problems until 12-month follow-up and basing interventions on patients' features.

The Health and Well-being Impacts of Community Shared Meal Programs for Older Populations: A Scoping Review.

Background and Objectives: There are social and economic benefits to supporting individuals to live independently for as long as possible. Structured shared meal programs provide opportunities for older individuals to connect in their communities and likely impact their health and well-being. Research in this area has not been summarized in recent years. This scoping review was undertaken to explore the impact shared meal programs may have for older community-dwelling adults. Research Design and Methods: Nine databases were systematically searched in 2020, and 5,996 unique studies were identified. Two independent reviewers screened titles, abstracts, and full text for inclusion. Reference lists of included papers were hand searched, and the search was updated in 2021. Eighteen studies were included in the final review. Results: Studies were published between 1980 and 2021 and most were published in the United States. Most studies were cross-sectional, two adopted a qualitative design, one a cohort design. Significant associations were reported between shared meal programs and improved dietary intake; however, minimal improvements were reported for physical health measures. The programs had a positive impact on attendees' social networks and perceived well-being. Discussion and Implications: Structured shared meal programs show promise in supporting the health and well-being of older adults in the community. They provide additional nutrition, opportunities for social connection, and are perceived to contribute to perceived well-being. More investigation is required to understand how these programs work to facilitate health and well-being, and how they can best be used to improve health outcomes for older populations.

Trends in, and predictors of, swallowing and social eating outcomes in head and neck cancer survivors: A longitudinal analysis of head and neck 5000.

OBJECTIVE: To investigate the recovery trajectory and predictors of outcome for swallowing difficulties following head and neck cancer treatment in a large prospective cohort. MATERIALS AND METHODS: Data from 5404 participants of the Head and Neck 5000 study were collected from 2011 to 2014. Patient-reported swallowing was measured using the EORTC HN35, recorded at baseline (pre-treatment) and 4 and 12 months post-baseline. Mixed-effects linear multivariable regression was used to investigate time trends, compare cancer sites, and identify associations between clinical, socio-demographic and lifestyle variables. RESULTS: 2458 participants with non-recurrent oral (29%) oropharyngeal (46%) and laryngeal (25%) cancer were included in the analysis. There was a clinically significant deterioration in scores between baseline and four months for swallowing (11.7 points; 95% CI 10.7-12.8) and trouble with social eating (17.9 points; 95% CI 16.7-19.2), but minimal difference between baseline and 12 months. Predictors of better swallowing and social eating were participants with larynx cancer, early-stage disease, treatment type, age, gender, co-morbidity, socio-economic status, smoking behaviour and cohabitation. CONCLUSION: Swallowing problems persist up to a year after head and neck cancer treatment. These findings identify disease and demographic characteristics for particularly vulnerable groups, supporting the need for holistic interventions to help improve swallowing outcomes. People diagnosed with head and neck cancer at risk of severe eating and drinking problems following treatment can be identified earlier in the pathway, receive more accurate information about early and late post-treatment side-effects, which can inform shared decision-making discussions.

The Longitudinal Associations between Perceived Descriptive Peer Norms and Eating and Drinking Behavior: An Initial Examination in Young Adults.

Experimental and cross-sectional studies indicate that perceptions of the eating and drinking behavior of one's peers (perceived descriptive peer norms) are associated with the types, frequency and quantity of food, and beverages a person chooses to consume. At present, we know very little about the longitudinal association between perceived descriptive peer norms and future eating or drinking behavior. In this study, we examined whether perceived descriptive peer norms for different food/beverage types predicted frequency of consumption of food/beverages in university students. Three hundred and forty participants completed measures at baseline and follow-up for frequency of consumption of cakes/pastries, sugar containing beverages, and alcoholic beverages, as well as measures of perceived descriptive peer norms at both time points. Perceived descriptive peer norms predicted consumption of pastries/cakes at follow up when controlling for changes in these perceptions over time; believing that one's peers frequently consumed cakes/pastries was associated with an increased frequency of consumption over time, although the magnitude of this effect was small. There was no significant association between perceived descriptive peer norms and changes in frequency of consumption of sugar containing beverages or alcohol over time. In the present longitudinal study of young adults, beliefs about how often one's peers eat or drink specific food and beverages types had limited effect on future eating and drinking behavior.

'I come for the friendship': Why social eating matters.

OBJECTIVES: To explore an innovative social eating programme model for older Tasmanians, Eating with Friends (EWF), from the perspectives of its participants, to establish how successfully it is meeting the organisational aims of strengthening community, reducing social isolation and enhancing mental well-being. METHODS: Focus groups and in-depth interviews, together with brief individual questionnaires, were undertaken with participants in four EWF groups: two urban and two rural, and with two well-established and two recently established groups. RESULTS: The study found that EWF was meeting the social eating needs of its participants, doing so through nurturing a sense of community. CONCLUSION: The flexible model used by EWF was key to its success in achieving its aims. This allowed individual groups to evolve in ways which fitted the needs and aspirations of participants. While participants enjoyed their meals, the social environment and meal settings were determining factors for ongoing participation in EWF.

Perceived social norms and eating behaviour: An evaluation of studies and future directions.

Social norms refer to what most people typically do or approve of. There has been some suggestion that perceived social norms may be an important influence on eating behaviour. We and others have shown that perceived social norms relating to very specific contexts can influence food intake (the amount of food consumed in a single sitting) in those contexts; these studies have predominantly sampled young female adults. Less research has examined whether perceived social norms predict dietary behaviour (the types of food people eat on a day to day basis); here, most evidence comes from cross-sectional studies, which have a number of limitations. A small number of intervention studies have started to explore whether perceived social norms can be used to encourage healthier eating with mixed results. The influence that perceived social norms have on objective measures of eating behaviour now needs to be examined using longitudinal methods in order to determine if social norms are an important influence on eating behaviour and/or can be used to promote meaningful behaviour change.

"You can't get a side of willpower": nutritional supports and barriers in The Villages, Florida.

Good nutrition in late life is key to the health of older adults and demands the attention of health promoters. To assess how the social lives and community environmental supports and barriers affect older adults' nutritional health, we conducted 29 focus groups with 144 residents of The Villages, Florida. Participants reside in one of the largest retirement communities in the United States. Thematic analysis revealed that the high social connectedness of residents confers both positive and negative influences on the nutritional lives of residents. Neighbors and friends are essential to a resident's ability to access foods in times of need. Conversely, many social functions in the community revolve around the consumption of foods of low nutrient density. Friends and neighbors may provide the best point of entry for nutritional interventions, such as food assistance strategies and health promotion and education. Policy and practice implications are also discussed.