Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment.

BACKGROUND: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. OBJECTIVE: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. METHODS: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question "Overall, how difficult was it for you to fill out the surveys today?" on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. RESULTS: The burden was low at 1.2 (SD 1.14) indicating "a little" burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English-speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (ß=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. CONCLUSIONS: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives.

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

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

Helicopter Parenting Among Socio-Economically and Ethnically/Racially Diverse Emerging Adults: Associations with Weight-Related Behaviors.

Helicopter parenting, a parenting style defined by over-involvement, may lead to poor health outcomes. However, research has primarily focused on children and adolescents from White, high socio-economic families, with little research examining weight-related health or with emerging adult children. The current study examined associations with emerging adult diet, physical activity, and body mass index (BMI) among a diverse population-based sample of parent and emerging adult dyads (n = 919). Helicopter parenting was highest among lower socioeconomic households and those identifying as Black, Indigenous, or people of color. Helicopter parenting was associated with both healthy and less healthy dietary behaviors across ethnic/racial groups, but was not associated with physical activity or BMI. Greater consideration of the cultural context related to helicopter parenting is needed before making conclusions about its benefits or harms.

A Mixed-Methods Description of the Home Physical Activity Environments of Racially/Ethnically Diverse and Immigrant/Refugee Children.

Disparities in childhood obesity prevalence by race/ethnicity remain high. Physical activity is an important factor to consider, however little is known about how physical activity resources in the home environment and neighborhood differ by race/ethnicity. This study examines the physical activity environments in the homes and neighborhoods of diverse households using both quantitative and qualitative data. Home visits were conducted with 150 families, and accelerometry data was collected for both parents and children (5-7 years old). Qualitative interviews were also conducted with parents, which provided context to quantitative data. Racial/ethnic differences were found for physical activity, sedentary behavior, and family-level resources for physical activity (P < .05). There were also differences by race/ethnicity in neighborhood physical activity promoters and perceived lack of neighborhood safety (P < .05). This study is important in informing providers and future interventions of the varying promoters and barriers to optimal physical activity that exist across race/ethnicity.

Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families.

OBJECTIVE: To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families. DESIGN: This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups. SETTING: The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019. PARTICIPANTS: The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White). RESULTS: Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups. CONCLUSIONS: Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.

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

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

Exploring associations between social determinants of health and mental health outcomes in families from socioeconomically and racially and ethnically diverse households.

This cross-sectional study investigated the associations between Social Determinants of Health (SDOH) and mental health outcomes of parents and children (n = 1307) from the Latinx, Native American, Somali/Ethiopian, White, Hmong, and African American communities. Logistic regression models were used to estimate the adjusted associations between five parent and child mental health measures and 25 measures of SDOH. False discovery rate q-values were computed to account for multiple comparisons. Families of color reported 5.3-7.8 SDOH barriers while White families reported 1.7 SDOH barriers on average. Adjusted analyses indicated that low family functioning and high perceived discrimination were associated with low resiliency among parents and increased behavioral difficulties among children. Other SDOH that were adversely associated with parent or child mental health included lack of social support, recent stressful life events, and adverse childhood experiences among parents. SDOH in the social and community context were most likely to be associated with mental health problems. Community-engaged evidence-based interventions are needed to improve population mental health.

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

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

Using a Community-Based Participatory Approach to Address Gender Equity in Academic Medicine: The Center for Women in Medicine and Science at the University of Minnesota.

Many medical schools are instituting gender equity initiatives to address long-standing inequities (e.g., salary, leadership positions, resource distribution) between women and men in academic medicine. However, few theory-driven models exist with built-in metrics to assess the impact of gender equity initiatives. The authors describe the theory- and metric-driven process used to create the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota (UMN) Medical School. An innovative theory-driven approach using community-based participatory research (CBPR) was used to create and organize CWIMS. CBPR acknowledges community members (e.g., faculty members, staff), academic organizational representatives (e.g., department heads, center directors), and administrative leaders (e.g., deans) as equal contributors in carrying out all aspects of gender equity work. CBPR values collaborative approaches that empower faculty, promote co-learning and co-creation of initiatives among all university partners, and build upon already existing community strengths and resources. Four CWIMS action groups were created using CBPR principles. The action groups are retention and recruitment; mentoring; salary, resource, and leadership equity; and strategic communications and collaborations. Faculty members across all medical school departments joined these 4 action groups to co-create and carry out all CWIMS gender equity initiatives. The process of developing the CWIMS center and action groups, the CBPR theoretical model guiding the approach, the initiatives developed by the action groups and metrics created, and the outcomes achieved to date are described. In addition, 4 lessons learned from the development of the CWIMS-use of theoretically driven and evidence-based models is key to building a sustainable organization; bottom-up and top-down engagement of partners is crucial for sustainability; passion and innovation are critical for long-term momentum; and not all faculty members and leaders will be enthusiastic about gender equity issues-are shared for the benefit of other medical schools wanting to develop similar centers.

Framework for advancing equity in academic medicine and science: Perspectives from early career female faculty during the COVID-19 pandemic.

Early-career female faculty, both physician scientists and basic researchers, have disproportionately experienced negative professional, financial, and personal consequences associated with the novel coronavirus disease 2019 (COVID-19) pandemic. This career phase represents a critical time for establishing a network of mentors and collaborators, demonstrating professional independence, and balancing new teaching, research, and service duties while simultaneously navigating personal and familial responsibilities. Persistent gender inequality perpetuated by adherence to traditional gender roles place early-career women faculty at a further disadvantage. Women in academic medicine and research do not attain promotion, leadership positions, and other established markers of success at the same rate as their male counterparts. This disparity was the impetus for the creation of a Recruitment and Retention action group within the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota Medical School (UMN). This perspective piece is written from the viewpoint of a group of female-identifying early-career faculty participating in a career development program for early-stage and newly appointed faculty at UMN, sponsored by the Recruitment and Retention CWIMS action group and our Office of Faculty Affairs. We describe areas of stress exacerbated by the COVID-19 pandemic: work, financial, and work-life well-being, and propose an adapted diversity, equity and inclusion (DEI) model to guide the response to future challenges within a faculty competency framework. We offer recommendations based on the DEI-competency framework, including opportunities for lasting positive change that can emerge from this challenging moment of our collective history.

Expanding Family Medicine Scholarship to All Faculty: The Minnesota Model for Harmonizing Clinical Care, Education, and Research Missions.

BACKGROUND: The Department of Family Medicine and Community Health at the University of Minnesota engaged in a 5-year transformation to expand research and scholarship opportunities to all faculty. A harmonization framework was used to integrate the 3 missions of clinical care, education, and research to ensure that research and scholarship were an ongoing focus of the department. METHODS: The key elements of our transformation included as follows: (1) a general culture of inquiry, (2) harmonized leadership, (3) training and mentoring, and (4) infrastructure and resources. Components of each of these elements were intentionally instituted simultaneously and iteratively across the 5 years to provide robust and sustainable research and scholarship opportunities for all faculty. RESULTS: Outputs and outcomes of the harmonized transformation indicated that clinical and research faculty publications increased, and the percentage of clinical faculty trained in research and scholarship skills increased across the 5 years. CONCLUSIONS: Important lessons learned during the harmonized transformation included the following: (1) key elements of the transformation need to be balanced as an ensemble, (2) cultural and organizational shifts take concerted effort and time, (3) embrace iteration: allow "bumps in the road" to propel the work forward, (4) transformation is financially feasible, (5) career research faculty can mutually benefit from clinical faculty engaging in scholarship, and (6) honor skepticism or disinterest and let people cultivate enthusiasm for research and scholarship rather than being forced.

The Collaborative Scholarship Intensive: A Research-Intensive Course to Improve Faculty Scholarship.

BACKGROUND AND OBJECTIVES: Learning to balance the clinical, educational, and scholarly elements of an academic career is challenging for faculty. To increase research output amongst family medicine faculty with limited to no publications, we developed the Collaborative Scholarship Intensive (CSI) to provide participants with intensive instruction in research methodology coupled with structured writing support and protected time for writing. METHODS: The CSI was developed by the University of Minnesota Department of Family Medicine and Community Health as a six-session faculty development program that enrolled 23 participants in its first three classes. RESULTS: Findings reveal that faculty participants significantly improved their pre- to postcourse self-ratings of 12 research competencies, and significantly increased their scholarly output. CONCLUSIONS: Our CSI faculty development program successfully engaged clinical faculty in a collaborative research program. Our results suggest that a program focused on intensive instruction in research methodology coupled with structured writing support and protected writing time may be a model for faculty development in other academic departments.

Concordance of children's intake of selected food groups as reported by parents via 24-h dietary recall and ecological momentary assessment.

OBJECTIVE: To understand how dietary intake data collected via a brief ecological momentary assessment (EMA) measure compares to that of data collected via interviewer-administered 24-h dietary recalls, and explore differences in level of concordance between these two assessment types by individual- and meal-level characteristics. DESIGN: Parents completed three 24-h dietary recalls and 8 d of brief EMA surveys on behalf of their child; in total, there were 185 d where dietary intake data from both EMA and 24-h recall were available. The EMA measure asked parents to indicate whether (yes/no) their child had consumed any of the nine total food items (e.g. fruit, vegetable, etc.) at eating occasions where both the child and parent were present. SETTING: Twenty-four-hour dietary recalls were completed in person in the study participant's home; participants completed EMA surveys using a study provided in iPad or their personal cell phone. PARTICIPANTS: A diverse, population-based sample of parent-child dyads (n 150). RESULTS: Among meals reported in both the EMA and dietary recalls, concordance of reporting of specific types of food ranged from moderate agreement for meat (kappa = 0·55); fair agreement for sweets (kappa = 0·38), beans/nuts (kappa = 0·37), dairy (kappa = 0·31), fruit (kappa = 0·31) and vegetables (kappa = 0·27); and little to no agreement for refined grains, whole grains and sweetened beverages (73 % overall agreement; kappa = 0·14). Concordance of reporting was highest for breakfast and snacks, as compared with other eating occasions. Higher concordance was observed between the two measures if the meal occurred at home. CONCLUSIONS: Data suggest that among meals reported in both the EMA and dietary recalls, concordance in reporting was reasonably good for some types of food but only fair or poor for others.

Stressed Out! Examining family meal decisions in response to daily stressors via ecological momentary assessment in a racially/ethnically diverse population.

The impact various sources of stress have on family meal decisions and child health-related behaviors is an understudied area. For this study, 128 racially/ethnically diverse parent/child dyads were recruited from primary care clinics in the Twin Cities, Minnesota between 2015 and 2016. Parent participants completed eight days of ecological momentary assessment, which included end-of-day surveys where the parent reported on (1) sources of daily stress (e.g., family demands, work/school demands) and related family meal choices (e.g., fixed quick meal, skipped meal), (2) meal planning, and (3) parent and child health-related behaviors (e.g., watched TV, ate unhealthy snack). Adjusted generalized estimating equations were used to estimate marginal probabilities and 95% confidence intervals of outcomes by race/ethnicity. Results indicated that common meal-related choices as a result of being stressed varied from fixing a quick/easy meal, buying fast food, everyone fixing their own meal or skipping a meal, or none of the above. When parents reported family demands as the source of stress, children were three times more likely to eat an unhealthy snack. Additionally, children were more likely to eat an unhealthy snack with higher levels of parental stress or if families have not planned the meal the night before. Interventions to lower parental stress and support family meal planning may increase the healthfulness of the home food environment during moments of elevated stress.

Associations between parent and child physical activity and eating behaviours in a diverse sample: an ecological momentary assessment study.

OBJECTIVE: This study is a secondary data analysis that examines the association between parent modelling of dietary intake and physical activity and the same child behaviours among different races/ethnicities using innovative, rigorous and objective measures. DESIGN: Ecological momentary assessment surveys were sent to parents to assess whether their child had seen them exercise or consume food. Dietary recall data and accelerometry were used to determine dietary intake and physical activity behaviours of children. SETTING: Participants were randomly selected from primary care clinics, serving low-income and racially/ethnically diverse families in Minnesota, USA. PARTICIPANTS: Participants were families with children aged 5-7 years old who lived with parents 50 % of the time and shared at least one meal together. RESULTS: A 10 percentage point higher prevalence in parent modelling of fruit and vegetable intake was associated with 0·12 higher serving intake of those same foods in children. The prevalence of parent modelling of eating energy dense foods (10 % prevalence units) was associated with 0·09 higher serving intake of sugar-sweetened beverages. Furthermore, accelerometry-measured parent sedentary hours was strongly correlated with child sedentary time (0·37 child sedentary hours per parent sedentary hours). An exploratory interaction analysis did not reveal any statistical evidence that these relationships depended on the child's race/ethnic background. CONCLUSIONS: Interventions that increase parent modelling of healthy eating and minimise modelling of energy dense foods may have favourable effects on child dietary quality. Additionally, future research is needed to clarify the associations of parent modelling of physical activity and children's physical activity levels.

Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study.

BACKGROUND: Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. OBJECTIVE: This study aimed to examine the associations between the parent's EMA report of their child's PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous-intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. METHODS: A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. RESULTS: The parent's EMA report of their child's PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent's EMA report of their child's PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P<.001). For the parent's EMA report of their child's SB, strong associations were observed with accelerometer-measured ST (P<.001), LPA (P=.005), and MVPA (P=.008). The findings related to sex-interaction terms indicated that the association between the parent-reported child's PA via EMA and the accelerometer-measured MVPA was stronger for boys than girls (P=.02). The association between the parent's EMA report of their child's PA and SB and accelerometer-measured ST and PA was similar across seasons in this sample (all P values >.31). CONCLUSIONS: When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child's PA and SB, the parent's EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA's strong associations with accelerometer-measured PA and ST.

Ecological momentary assessment of the snacking environments of children from racially/ethnically diverse households.

Children consume nearly one-third of their daily energy intake as snacks (i.e., eating occasions that occur between meals); thus there is a growing interest in understanding what snacking occasions look like in the homes of young children. This study makes use of ecological momentary assessment (EMA) to 1) examine differences in the contextual factors, including location, food preparation style, people present, presence of media devices, and overall atmosphere, between meal and snack occasions; and 2) explore differences in the context of snacking occasions across children's gender and weight status. Data for the current study came from the Family Matters Study, which included 150 families with children aged 5-7 years old (n = 25 from each of the following groups: Black/African American, Hispanic, Hmong, Native American, Somali, White). Parents completed an 8-day EMA observation period, during which they were surveyed after each eating occasion with the study child; questions explored contextual factors including location, food preparation style, people present, presence of media devices, and the overall atmosphere of each eating occasion. Differences between meals and snacks were observed; a smaller percentage of snacks (compared to meals) were prepared by the parent, consisted of only homemade food, and were planned ahead of time, as opposed to being served in response to a child's request. Snacks were more likely than other meals to be eaten on the couch and in the presence of a screen. Furthermore, important differences in snacking context were observed by child gender and weight status. Findings illuminate opportunities to improve children's overall dietary intake via interventions focused on improving the quality of foods served during snacks, as well as the contextual environment in which snacks are eaten.

Ecological Momentary Assessment of the Breakfast, Lunch, and Dinner Family Meal Environment in Racially/Ethnically Diverse and Immigrant Households.

OBJECTIVE: To describe meal characteristics across breakfast, lunch, and dinner family meals in racially/ethnically diverse and immigrant/refugee households via ecological momentary assessment; identify real-time meal characteristics associated with family meal frequency; and identify qualitative themes regarding parents' perspectives about meal characteristics and meal types that influence family meal frequency. DESIGN: Cross-sectional study. SETTING: In-home visits. PARTICIPANTS: Children aged 5-7 years (n = 150) and their families from diverse and low-income households. MAIN OUTCOME MEASURE(S): Mixed methods. ANALYSIS: Multiple linear regression and hybrid deductive and inductive content analysis. RESULTS: Quantitative results indicated several similar meal characteristics occurring across weekdays and weekend days and by meal type (eg, parent prepared the meal, food mostly homemade, meal eaten at table) and some significant negative associations (P < .05) between meal characteristics and family meal frequency (eg, fast food for family meals). Eight main qualitative themes with several subthemes supported and expanded the quantitative findings and added depth to interpretation of the findings. CONCLUSIONS AND IMPLICATIONS: Results identified specific meal characteristics both quantitatively and qualitatively that may inform the development of interventions to increase the frequency of family meals so that more families can benefit from the protective nature of family meals.

Who is meeting the Healthy People 2020 objectives?: Comparisons between racially/ethnically diverse and immigrant children and adults.

INTRODUCTION: To determine the prevalence of reaching multiple Healthy People 2020 (HP 2020) objectives including nutrition and weight status, sleep health, physical activity, health-related quality of life, social determinants of health, and education among low-income, diverse children and adults. METHODS: Children ages 5- to 7-years-old (n = 150; 47% female) and their parents (mean age = 35; 91% mothers) from 6 racial/ethnic and immigrant/refugee groups (n = 25 from each; African American, Native American, Hispanic, Hmong, Somali, White) participated in this cross-sectional mixed-methods study. RESULTS: Overall, the majority of HP 2020 objectives were not being met across this low-income, racially/ethnically diverse, and immigrant/refugee sample of children and adults. In particular, African American children and parents consistently fell below the majority of the HP 2020 targets, with only 5 of the 24 HP 2020 objectives being met. Additionally, immigrant children and parents met less than 2/3 of the HP 2020 objectives. DISCUSSION: Concerted public health efforts are needed to address the disparities in reaching the HP 2020 objectives and informing the development of the future HP 2030 objectives among low-income, racially/ethnically diverse, and immigrant children and parents. In order to achieve and assess the current and future HP objectives in these diverse populations, changes may be needed in both interventions and assessment tools. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Examining variability in parent feeding practices within a low-income, racially/ethnically diverse, and immigrant population using ecological momentary assessment.

BACKGROUND: Current measures of parent feeding practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations in these behaviors across time and context. The current study uses ecological momentary assessment to examine variability of, and predictors of, parent feeding practices within a low-income, racially/ethnically diverse, and immigrant sample. METHODS: Children ages 5-7 years old and their parents (n = 150 dyads) from six racial/ethnic groups (n = 25 from each; Black/African American, Hispanic, Hmong, Native American, Somali, White) were recruited for this mixed-methods study through primary care clinics. RESULTS: Among parents who used restriction (49%) and pressure-to-eat (69%) feeding practices, these feeding practices were utilized about every other day. Contextual factors at the meal associated with parent feeding practices included: number of people at the meal, who prepared the meal, types of food served at meals (e.g., pre-prepared, homemade, fast food), meal setting (e.g., kitchen table, front room), and meal emotional atmosphere (p < 0.05). Parents tended to restrict desserts, dairy, and vegetables and pressure children to eat fruits, vegetables, meat proteins, and refined grains (p < 0.05). There were some differences by race/ethnicity across findings (p < 0.01), with Hmong parents engaging in the highest levels of pressure-to-eat feeding practices. CONCLUSIONS: Parent feeding practices varied across the week, indicating feeding practices are more likely to be context-specific, or state-like than trait-like. There were some meal characteristics more strongly associated with engaging in restriction and pressure-to-eat feeding practices. Given that parent feeding practices appear to be state-like, future interventions and health care providers who work with parents and children may want to address contextual factors associated with parent feeding practices to decrease restriction and pressure-to-eat parent feeding practices.