Illuminating Child and Adult Care Food Program Partnerships That Improved Food Access and Waiver Utilization for Feeding Young Children in Early Care and Education Programs During COVID-19: A Qualitative Study.

BACKGROUND: Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. OBJECTIVE: This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DESIGN: Qualitative semi-structured interviews with 24 participants representing 21 states across the United States. PARTICIPANTS/SETTING: Virtual interviews with CACFP directors from December 2020 through May 2021. ANALYSIS: Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. RESULTS: Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). CONCLUSIONS: The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.

Implementation of Federal Waivers for Feeding Children in Early Care and Education During the COVID-19 Pandemic.

OBJECTIVE: To capture Child and Adult Care Food Program (CACFP) state directors' experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019. DESIGN: Qualitative semistructured interviews. SETTING: Virtual interviews with state CACFP directors. PARTICIPANTS: Child and Adult Care Food Program directors from 21 states from December 2020 to May 2021. PHENOMENON OF INTEREST: Implementation of state-level waivers. ANALYSIS: Qualitative thematic analysis. RESULTS: State directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE. CONCLUSIONS AND IMPLICATIONS: Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

Introducing Dietary Self-Monitoring to Undergraduate Women via a Calorie Counting App Has No Effect on Mental Health or Health Behaviors: Results From a Randomized Controlled Trial.

BACKGROUND: Strong positive relationships between dietary self-monitoring and eating disorder risk are seen in population-based, observational studies. However, current evidence cannot establish causality. Furthermore, little is known about other mental and behavioral health consequences of dietary self-monitoring among college women, a population vulnerable to eating disorders. OBJECTIVE: To determine if introducing dietary self-monitoring via a popular smartphone app to undergraduate women impacts eating disorder risk, other aspects of mental health, or health behaviors including dietary intake and physical activity. DESIGN: Randomized controlled trial. PARTICIPANTS/SETTING: Undergraduate women who had not engaged in dietary self-monitoring in the past year and who were at low-risk for an eating disorder participated between May and October 2019 (n = 200). INTERVENTION: Participants were randomly assigned to engage in dietary self-monitoring via MyFitnessPal for approximately 1 month or to receive no intervention. MAIN OUTCOME MEASURES: Self-report data on eating disorder risk, other mental health outcomes, and health behaviors were collected at baseline and post-intervention. STATISTICAL ANALYSES PERFORMED: Linear and logistic regressions were utilized to test hypotheses. RESULTS: Adherence to the intervention was high, with participants recording their dietary intake via MyFitnessPal on average 89.1% of days between baseline and post-intervention. Assignment to the intervention was not associated with changes in eating disorder risk, anxiety, depressive symptoms, body satisfaction, quality of life, nutritional intake, physical activity, screen time, or other forms of weight-related self-monitoring (all P > .05). CONCLUSIONS: Among dietary self-monitoring naive undergraduate women with low-risk of an eating disorder, dietary self-monitoring via MyFitnessPal for 1 month did not increase eating disorder risk, impact other aspects of mental health, or alter health behaviors including dietary intake. The null results in our study may be due to the selection of a low-risk sample; future research should explore whether there are populations for whom dietary self-monitoring is contraindicated.

Comparative Effectiveness and Risks of Bowel Preparation Before Elective Colorectal Surgery.

OBJECTIVE: The objective of this study was to determine the relationship between bowel preparation and surgical site infections (SSIs), and also other postoperative complications, after elective colorectal surgery. BACKGROUND: SSI is a major source of postoperative morbidity/costs after colorectal surgery. The value of preoperative bowel preparation to prevent SSI remains controversial. METHODS: We analyzed 32,359 patients who underwent elective colorectal resections in the American College of Surgeons National Surgery Quality Improvement Program database from 2012 to 2014. Univariable and multivariable analyses were performed; propensity adjustment using patient/procedure characteristics was used to account for nonrandom receipt of bowel preparation. RESULTS: 26.7%, 36.6%, 3.8%, and 32.9% of patients received no bowel preparation, mechanical bowel preparation (MBP), oral antibiotics (OA), and MBP + OA, respectively. After propensity adjustment, MBP was not associated with decreased risk of SSI compared with no bowel preparation. In contrast, both OA and OA + MBP were associated with decreased risk of any SSI (adjusted odds ratio 0.49, 95% confidence interval 0.38-0.64; and adjusted odds ratio 0.45, 95% confidence interval 0.40-0.50, respectively) compared with no bowel preparation. OA and MBP + OA were associated with decreased risks of anastomotic leak, postoperative ileus, readmission, and also shorter length of stay (all P < 0.05). Bowel preparation was not associated with increased risk of cardiac/renal complications compared with no preparation. CONCLUSIONS: The use of MBP alone before elective colorectal resection to prevent SSI is ineffective and should be abandoned. In contrast, OA and MBP + OA are associated with decreased risks of SSI and are not associated with increased risks of other adverse outcomes compared with no preparation. Prospective studies to determine the efficacy of OA are warranted; in the interim, MBP + OA should be used routinely before elective colorectal resection to prevent SSI.

Family functioning and quality of parent-adolescent relationship: cross-sectional associations with adolescent weight-related behaviors and weight status.

BACKGROUND: Little is known about how factors within the general family environment are associated with weight and related behaviors among adolescents/young adults. METHODS: We studied 3768 females and 2614 males, 14-24 years old in 2011, participating in the Growing Up Today Study 2. We used generalized mixed models to examine cross-sectional associations of family functioning and quality of mother- and father-adolescent relationship with adolescent/young adult weight status, disordered eating, intake of fast food and sugar-sweetened beverages, screen time, physical activity, and sleep duration. In all models, we included participant's age and family structure. RESULTS: Eighty percent of participants reported high family functioning and 60% and 50% of participants reported high-quality mother and father relationship, respectively. Among both males and females, high family functioning was associated with lower odds of disordered eating (adjusted odds ratio [AOR] females = 0.53; 95% Confidence Interval [CI] = 0.45-0.63; AOR males = 0.48; CI = 0.39-0.60), insufficient physical activity, i.e., less than 1 h/day, (AOR females = 0.74; CI = 0.61-0.89; AOR males = 0.73; CI = 0.58-0.92), and insufficient sleep, i.e., less than 7 h/day, (AOR females = 0.56; CI = 0.45-0.68; AOR males = 0.65; CI 0.5-0.85). High family functioning was also associated with lower odds of being overweight/obese (AOR = 0.73; CI = 0.60-0.88) and eating fast food one or more times/week (AOR = 0.74; CI = 0.61-0.89) among females only. Among females, high-quality mother and father relationship were both associated with lower odds of being overweight/obese and disordered eating, eating fast food, and insufficient sleep and the magnitude of associations were similar for mother and father relationship quality (AOR range 0.61-0.84). Among males, high-quality mother and father relationship were both associated with lower odds of disordered eating, insufficient physical activity and insufficient sleep, but only father relationship quality was associated with lower odds of overweight/obesity. CONCLUSIONS: Adolescents/young adults reporting high family functioning and more positive relationships with their parents reported better weight-related behaviors. For weight status, females appear to be affected equally by the quality of their relationship with both parents, whereas males may be more affected by their relationship with fathers.

Associations between relationship status and day-to-day health behaviors and weight among diverse young adults.

Previous research has shown strong positive associations between physical and psychological health outcomes and being in a committed relationship, such as marriage; however, little research has investigated whether being in a committed relationship is protective for day-to-day health behaviors such as dietary patterns and physical activity. This research examined associations between relationship status and day-to-day health behaviors (e.g., dietary intake, physical activity) and weight status among a diverse cohort of young adults. This cross-sectional study used data from Project EAT-III, a 10-year longitudinal population-based study (N = 1,853) of Midwest young adults. Young adult participants had an average age of 25.3 years, and were 45% male and 55% female. Participants were socioeconomically and racially/ethnically diverse, including 48.4% White, 18.6% African American, 5.9% Hispanic, 19.6% Asian, 3.3% Native American, and 4.2% mixed or other race/ethnicity. Results indicated that married men were more likely to be overweight/obese (body mass index ≥ 25) compared with single/casually dating and committed dating/engaged men. Married women were more likely to eat breakfast ≥5 times per week compared with women in other relationship categories. No differences were observed in other health behaviors by relationship status. There were no significant interactions by race/ethnicity. Relationship status seems largely unrelated to young adults' participation in physical activity and dietary behaviors. However, findings suggest that being married may be a risk factor for overweight/obesity in young adult men and may be a protective factor for health-related behaviors associated with overweight/obesity such as breakfast intake for young adult women.

Self-weighing among adolescents: associations with body mass index, body satisfaction, weight control behaviors, and binge eating.

Among adolescent girls, the health effects of frequent self-weighing are unclear. This study examines cross-sectional and longitudinal associations between frequency of self-weighing and body mass index (BMI), body satisfaction, weight control behaviors, and binge eating among a diverse population of adolescent girls. The study was conducted in the Minneapolis/St Paul, MN, metropolitan area between 2007 and 2009. The study population included 356 adolescent girls (mean age 15.7 years); 46.2% of the girls were overweight or obese and >75% were from a racial/ethnic minority group. Anthropometric and survey data were collected at baseline and at follow-up 9 months later. Hierarchical linear regression models were developed to test associations. Cross-sectionally, frequent self-weighing was associated with lower body satisfaction (P=0.034) and higher rates of healthy (P=0.002), unhealthy (P=0.016), and extreme (P=0.038) weight control behaviors. A quadratic association was found between frequency of self-weighing and binge eating, with girls who weighed themselves least and most frequently reporting the highest prevalences of binge eating (P=0.014). No association was observed between frequency of self-weighing and girls' BMI (P=0.111). Short-term longitudinal associations between baseline frequency of self-weighing and changes in body satisfaction, weight control behaviors, binge eating, or BMI were not observed. Findings suggest that among adolescent girls, frequent self-weighing is cross-sectionally associated with both healthy and potentially harmful unhealthy weight control behaviors, and does not contribute to weight loss over time. Adolescents should not be encouraged to engage in frequent self-weighing.

Longitudinal and secular trends in parental encouragement for healthy eating, physical activity, and dieting throughout the adolescent years.

PURPOSE: Parental encouragement for healthy eating and physical activity has been found to be associated with the long-term healthy habits of adolescents, whereas parental encouragement to diet has been associated with disordered eating behaviors among adolescents. However, little is known about how parental encouragement changes as adolescents grow older (longitudinal trends), or how parental encouragement has changed over time (secular trends). This study examined 5-year longitudinal and secular trends in adolescents' report of their parents' encouragement to eat healthily, be physically active, and diet. METHODS: Project Eating Among Teens surveyed a cohort of Minnesota adolescents (n = 2,516) in the years 1999 and 2004. Mixed-model regressions were used to assess changes in adolescents' reports of parental encouragement from early to middle adolescence (middle school to high school) and from middle to late adolescence (high school to post-high school), and secular changes in parental encouragement among middle adolescents between the years 1999 and 2004. RESULTS: Longitudinally, there were significant decreases in parental encouragement to eat healthy food, be active, and diet between early and middle adolescence. Between middle and late adolescence, among males parental encouragement for all behaviors decreased, whereas among females parental encouragement to diet increased. Few secular changes in parental encouragement were observed between 1999 and 2004. CONCLUSION: Given the importance of parental support for healthy eating and physical activity, efforts should be made to help parents maintain a high level of encouragement for their children's healthy behavior throughout adolescence. Parents of late adolescent females should aim to decrease the pressure on their daughters to diet during these critical developmental years.

Familial correlates of adolescent girls' physical activity, television use, dietary intake, weight, and body composition.

BACKGROUND: The family environment offers several opportunities through which to improve adolescents' weight and weight-related behaviors. This study aims to examine the cross-sectional relationships between multiple factors in the family environment and physical activity (PA), television use (TV), soft drink intake, fruit and vegetable (FV) intake, body mass index (BMI), and body composition among a sample of sociodemographically-diverse adolescent girls. METHODS: Subjects included girls (mean age=15.7), 71% of whom identified as a racial/ethnic minority, and one of their parents (dyad n=253). Parents completed surveys assessing factors in the family environment including familial support for adolescents' PA, healthful dietary intake, and limiting TV use; parental modeling of behavior; and resources in the home such as availability of healthful food. Girls' PA and TV use were measured by 3-Day Physical Activity Recall (3DPAR) and dietary intake by survey measures. BMI was measured by study staff, and body fat by dual-energy X-ray absorptiometry (DXA). Hierarchical linear regression models tested individual and mutually-adjusted relationships between family environment factors and girls' outcomes. RESULTS: In the individual models, positive associations were observed between family support for PA and girls' total PA (p=.011) and moderate-to-vigorous PA (p=.016), home food availability and girls' soft drink (p<.001) and FV (p<.001) intake, and family meal frequency and girls' FV intake (p=.023). Across the individual and mutually-adjusted models, parental modeling of PA, TV, and soft drink and FV intake was consistently associated with girls' behavior. CONCLUSIONS: Helping parents improve their physical activity and dietary intake, as well as reduce time watching television, may be an effective way to promote healthful behaviors and weight among adolescent girls.

Are parents of young children practicing healthy nutrition and physical activity behaviors?

BACKGROUND: Although parenthood is a common life event in early adulthood, little is known about whether parenthood is associated with weight and weight-related health behaviors, including dietary intake and physical activity. OBJECTIVE: In this article we examine whether parents of young children (aged ≤5 years) report different dietary intake, physical activity, and BMIs compared with young adults without children. METHODS: Data for this analysis were drawn from the second and third waves of Project EAT (Eating and Activity in Teens and Young Adults), a longitudinal population-based cohort study. Young adults (838 women, 682 men) from diverse ethnic and socioeconomic backgrounds were included. Gender-stratified linear regression models were used to examine associations between parental status and dietary intake, hours of physical activity, and BMI. Results were adjusted for each health behavior outcome level 5 years earlier (time 2). RESULTS: Results indicate that although many dietary behaviors were the same between parents and nonparents, mothers reported greater consumption of sugar-sweetened beverages, total energy, and percent saturated fat compared with women without children. Both mothers and fathers had lower amounts of physical activity compared with nonparents. Mothers had higher mean BMIs than women without children. No difference was observed in BMIs between fathers and men without children. CONCLUSIONS: Our findings suggest that pediatricians and health care providers may want to consider discussing dietary intake and physical activity with new parents to identify ways to engage in healthful behaviors given the daily demands of parenthood, both to improve parents' own health and to help them model healthful behavior for their children.

The importance of families to adolescents' physical activity and dietary intake.

The family environment plays a key role in the development and maintenance of adolescent physical activity and dietary behaviors. Specifically, family support and encouragement, behavior modeling by parents, and resources available in the home are important mechanisms through which families can promote, or discourage, physical activity and healthful eating. In this article, we have provided a comprehensive review of the current body of literature examining the role of the family environment in adolescent physical activity and nutrition. Additionally, we discuss strategies to intervene on the family environment through work with schools, with the family unit, and by clinical providers.

Socio-environmental, personal and behavioural predictors of fast-food intake among adolescents.

OBJECTIVE: To identify the socio-environmental, personal and behavioural factors that are longitudinally predictive of changes in adolescents' fast-food intake. DESIGN: Population-based longitudinal cohort study. SETTING: Participants from Minnesota schools completed in-class assessments in 1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while in high school. SUBJECTS: A racially, ethnically and socio-economically diverse sample of adolescents (n 806). RESULTS: Availability of unhealthy food at home, being born in the USA and preferring the taste of unhealthy foods were predictive of higher fast-food intake after 5 years among both males and females. Among females, personal and behavioural factors, including concern about weight and use of healthy weight-control techniques, were protective against increased fast-food intake. Among males, socio-environmental factors, including maternal and friends' concern for eating healthy food and maternal encouragement to eat healthy food, were predictive of lower fast-food intake. Sports team participation was a strong risk factor for increased fast-food intake among males. CONCLUSIONS: Our findings suggest that addressing socio-environmental factors such as acculturation and home food availability may help reduce fast-food intake among adolescents. Additionally, gender-specific intervention strategies, including working with boys' sports teams, family members and the peer group, and for girls, emphasizing the importance of healthy weight-maintenance strategies and the addition of flavourful and healthy food options to their diet, may help reduce fast-food intake.

Parental influences on adolescents' physical activity and sedentary behavior: longitudinal findings from Project EAT-II.

BACKGROUND: The long-term role that parental encouragement and attitudes about fitness and exercise play in adolescents' physical activity and sedentary behavior habits remains unclear. This paper aims to longitudinally examine how parental encouragement to be physically active and parental concern about staying fit are associated with adolescents' physical activity and sedentary behavior habits five years later. METHODS: Project EAT-II adolescent and young adult participants (1130 male, 1386 female) completed surveys while in middle school or high school (1998-1999), and again 5 years later. Participants were asked whether their mother and father encourage them to be physically active and care about staying fit and exercising. Adolescent moderate and vigorous physical activity (MVPA) and TV/video watching (hours/week) were assessed. Linear regression models adjusted for socio-demographic characteristics and baseline behavior were used to examine the association of Time 1 parental factors with behavioral outcomes among adolescents and young adults five years later (Time 2). RESULTS: After adjustment for socio-demographic characteristics and baseline MVPA, adolescent-reported maternal and paternal encouragement to be active, and paternal care for fitness, were positively associated with weekly hours of MVPA after five years in young adult males (p for trend < or = .01). The positive relationship between maternal encouragement and MVPA approached significance among high-school aged females (p for trend = .06), and paternal encouragement was positively related to MVPA among high-school aged males (p for trend = .02). While maternal encouragement to be active was associated with decreased TV/video time among younger females (p for trend = .02), other parental factors were not associated with lower TV/video time among the other groups. CONCLUSION: Parental encouragement to be active was associated with increased physical activity among males and younger females 5 years later. Younger adolescents appear to be especially influenced by their same-sex parent. These findings suggest that encouragement may be more influential than parental concern for fitness on adolescents' physical activity habits. Further research is needed to determine how parents can help adolescents decrease sedentary behavior time.

Swimming upstream: faculty and staff members from urban middle schools in low-income communities describe their experience implementing nutrition and physical activity initiatives.

INTRODUCTION: Addressing childhood overweight has become a top priority in the United States. Modification of school policies and practices has been used in an attempt to address the overweight epidemic among children and adolescents. Culturally diverse urban schools in low-income communities attempting to improve nutrition and increase physical activity may face unique challenges in the school environment. A better understanding is needed about school environments and how they may affect the implementation, efficacy, and sustainability of initiatives designed to improve nutrition and physical activity. METHODS: We carried out a qualitative study in five urban middle schools in low-income communities that had recently implemented Planet Health, a nutrition and physical activity intervention, to assess which aspects of the schools' physical, social, and policy environments were facilitating or impeding the implementation of health promotion initiatives. Thirty-five faculty and staff members participated. We conducted one focus group per school, with an average of seven participants per group. We analyzed focus group transcripts using the thematic analysis technique to identify key concepts, categories, and themes. RESULTS: Teachers and staff members in our study identified many school-related environmental barriers to successful implementation of nutrition and physical activity initiatives in their schools. School personnel recommended that classroom-based nutrition interventions such as Planet Health be coordinated with school food services so that the healthy messages taught in the classroom are reinforced by the availability of healthy, culturally appropriate cafeteria food. They identified household food insufficiency and overly restrictive eligibility criteria of the federally subsidized meal program as critical barriers to healthy nutritional behaviors. They also identified weight-related teasing and bullying and unhealthy weight-control behaviors as challenges to promotion of healthy nutrition and physical activity. CONCLUSION: To maximize intervention efforts, researchers and practitioners must consider the effects of school environments on nutrition and physical activity initiatives.

"How can we stay healthy when you're throwing all of this in front of us?" Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity.

This study aimed to identify factors in school physical and social environments that may facilitate or compete with programs and policies to improve student physical activity and nutrition. Focus groups and interviews were conducted with students, faculty, and staff of two public middle schools. Participants identified numerous aspects of the school environments as significant. Competition, teasing and bullying, time, and safety were described as major barriers for students to be physically active during physical education class, on sports teams, and before and after school. The quality of the food served, easy access to nonnutritious snacks, limited time for lunch period, and weight concerns emerged as significant reasons why students do not eat nutritious meals in school. When developing programs and policies to improve the health of students, environmental influences that undermine efforts to improve student health behaviors must be addressed.