Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study.

INTRODUCTION: Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS: Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS: Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION: Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.

A qualitative study of providers' perceptions of parental feeding practices of infants and toddlers to prevent childhood obesity.

BACKGROUND: With a recent focus on establishing US Dietary Guidance for children ages 0 to 2 years old, the objective of this qualitative study was to determine misconceptions and barriers that prevent parents from implementing early childhood feeding and obesity prevention practices as reported by healthcare, community-based, and education providers. METHODS: Trained researchers conducted one-on-one qualitative phone interviews, using a semi-structured script, with early childhood health and education providers working with families of young children. Interviews were audiotaped, transcribed verbatim, and analyzed using the classic analysis approach. Transcripts were coded by researchers and analyzed for themes. RESULTS: Providers (n = 21) reported commonly observed obesogenic practices including overfeeding tendencies, early initiation of solids or less optimal feeding practices, lack of autonomy and self-regulation by child, and suboptimal dietary patterns. Sources of parental misconceptions about feeding were often related to cultural, familial, and media influences, or lack of knowledge about optimal feeding practices for infants or toddlers. CONCLUSIONS: Providers indicated a need for engaging and consistent child feeding and obesity prevention education materials appropriate for diverse cultural and literacy levels of parents, with detailed information on transitioning to solid foods. Early education and community-based providers reported limited access to evidence-based educational materials more so than healthcare providers. It is an opportune time to develop reputable and evidence-based child feeding guidance that is readily available and accessible for parents of infants and toddlers to prevent early childhood obesity.

Interpretation and Understanding of the Dietary Guidelines for Americans Consumer Messages Among Low-Income Adults.

Objective: The objective of this study was to determine the interpretation, understanding, and implementation of the Dietary Guidelines for Americans (DGA) consumer messages among low-income adults and compare findings to perceptions of the messages for consumers by community nutrition educators.Methods: In this mixed methods, cross-sectional study, a convenience sample of low-income adults (n = 98) with a child between the ages of 3 and 10 years old and nutrition educators (n = 9) were interviewed individually about the DGA messages, food-related behaviors, and barriers related to consuming fruits, vegetables, and whole grains. Interviews were audio-taped, transcribed verbatim, and analyzed using the inductive approach. Interpretation and ranking of the clarity and ease of the DGA messages by low-income adults and nutrition educators and perceptions about the messages were assessed. Descriptive statistics were conducted for demographic data and Fisher's exact tests were used to examine differences regarding the clarity and ease of the messages among low-income adults and nutrition educators.Results: According to the interview results, messages that tended to be misinterpreted most frequently were on topics such as sodium, fruit and vegetables, portions, and whole grain intake. Low-income adults and nutrition educators also differed in perceptions for the message clarity addressing whole grain servings (p = .001), avoiding oversized portions (p = .002), and comparing sodium (p < .001).Conclusions: Improvements in the DGA consumer messages are warranted to improve clarity and feasibility for low-income adults through new communication tools or strategies that complement the DGA.

Ripple Effects of the Communities Preventing Childhood Obesity Project.

This research examines the practice of community coaching within coalitions in the Communities Preventing Childhood Obesity project. A quasi-experimental design was used in seven Midwestern states. Each state selected two rural, low-income communities with functioning health coalitions. Coalitions were randomly assigned to be intervention or comparison communities. After 4 years of the coaching intervention, ripple effect mapping served as one method for examining the coalitions' work that may affect children's weight status. A research team from each state conducted ripple effect mapping with their two coalitions, resulting in 14 ripple maps. Community capitals framework and the social-ecological model were used for coding the items identified within the ripple maps. A quantitative scoring analysis determined if differences existed between the intervention and comparison coalitions in terms of the activities, programs, funding, and partnerships for social-ecological model score (e.g., individual, community, policy levels), community capitals score, and ripples score (e.g., number of branches formed within the maps). All scores were higher in intervention communities; however, the differences were not statistically significant (p > .05). Assessing community assets, such as availability of a community coach, is necessary in order to decide whether to deploy certain resources when designing health promotion strategies.

A qualitative investigation of body weight and weight loss-related attitudes of mothers and fathers in the context of food insecurity.

PURPOSE: To examine attitudes about body weight and weight loss among low-income parents of young children experiencing household food insecurity. METHODS: One-on-one interviews were conducted with 25 dyads of cohabitating low-income mothers and fathers who lived with their child aged 2.5-10 years old. Basic inductive analysis was conducted using NVivo to identify emerging themes related to body weight. RESULTS: Three main themes emerged including (1) weight loss as a "Blessing in Disguise," (2) trouble with losing weight, and (3) the impact of compromised diet quality. Some differences existed in themes between mothers and fathers, but both placed value on weight loss resulting from food insecurity. CONCLUSION: This research underscores the importance of sufficient nutrition assistance for limited resource families. A lack of money for food was a barrier towards maintaining a healthy weight but the value our culture places on weight loss even in times of despair was undeniably present. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Instruments assessing parental responsive feeding in children ages birth to 5 years: A systematic review.

Responsive feeding of young children has been identified as a protective factor against the development of childhood obesity. Instruments developed to assess responsive feeding by parents of children birth to 5 years of age over the past 17 years were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Four electronic databases (PubMed, CINAHL, PsycINFO, and Scopus) were used to search for relevant articles to include at least one parental responsive feeding category (Food Rewards, Pressure to Eat, Parental Control of Intake, Emotional Feeding, or Responsiveness to Cues/Child Autonomy), development, validation, or reliability of the instrument, and evaluated in at least one child between ages birth to 5 years old. The final review included 33 individual responsive feeding related instruments. Risk of bias for each article was assessed using the Risk of Bias in Non-randomized Studies (ROBINS-I) assessment tool. Of the 15 instruments intended for birth to 2-year-olds and the 28 intended for 3- to 5-year-olds, only three instruments showed rigorous validation and reliability testing (Feeding Practices and Structure Questionnaire, Comprehensive Feeding Practices Questionnaire, and Family Food Behavior Survey). The most commonly reported psychometric testing was construct validity and internal reliability. There were limited instruments intended for young children (birth to 2 years), low-income, diverse racial and ethnic groups (Hispanic and non-Hispanic black), and fathers or other caregivers. The most frequently assessed feeding practices included Pressure to Eat, Parental Control, and Food Rewards, but none of the instruments assessed all aspects of responsive feeding. This review identified the need for more comprehensive instruments that measure all aspects of responsive feeding, the need for further testing in diverse populations, and further validity and reliability testing.

Project TEAMS (Talking about Eating, Activity, and Mutual Support): a randomized controlled trial of a theory-based weight loss program for couples.

BACKGROUND: Obesity risk is shared between spouses, yet existing weight loss programs focus on individuals and not the marital dyad. Given the interdependence of weight in couples, weight management outcomes might be improved by targeting joint weight loss and the creation of an interpersonal milieu that supports long-term behavior change. According to Self-Determination Theory (SDT), greater autonomous self-regulation of behaviors, and subsequently better treatment outcomes, are observed in needs supportive environments in which personally meaningful choice is supported and criticism and control are minimized. Correlational analyses confirm these pathways in weight management, with needs support from one's spouse or partner emerging as a distinct predictor of weight loss success. Research is now needed to establish causal links and to develop and test weight loss interventions designed to facilitate the needs supportive behavior of spouses. METHODS: Project TEAMS (Talking about Eating, Activity, and Mutual Support) is a randomized controlled trial testing a couples-based intervention, grounded in SDT, designed to change the social context of weight loss by training spouses to provide needs support for each other's eating and physical activity behavior. Sixty-four couples will be randomized to either 6 months of behavioral weight loss treatment informed by SDT (SDT-WL) or to 6 months of standard behavioral weight loss treatment (BWL). Couples will attend weekly sessions for 6 months and will be assessed at 0, 3, 6, and 12 months. By bolstering needs support, SDT-WL is predicted to increase autonomous self-regulation and perceived competence and produce greater weight loss and maintenance than standard behavioral treatment. Exploratory analyses will examine the SDT process model prediction that the influence of needs support on treatment outcomes will be mediated by autonomous self-regulation and perceived competence. DISCUSSION: This study addresses the fundamental importance of interpersonal support in weight management by focusing on couples rather than individuals and using a rich theoretical framework to train spouses in supportive behaviors. TRIAL REGISTRATION: Clinicaltrials.gov ; NCT02570009 .

The impact of environmental, parental and child factors on health-related behaviors among low-income children.

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S. SAMPLE: This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (ß: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (ß: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (ß: -0.19, 95% CI: -0.29; -0.10). More parental covert control (ß: 0.44, 95% CI: 0.35; 0.54), more parental overt control (ß: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (ß: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Comparing Low-income Mothers' and Fathers' Concern for Young Children's Weight.

PURPOSE: The objectives of this study were to compare the relationship of mother and father (1) perceived child weight and child body mass index (BMI) z-score, (2) concern for child's current weight and child BMI z-score, and (3) concern for child's future weight and child BMI z-score. DESIGN AND METHODS: This cross-sectional study included low-income mothers (n=30) and fathers (n=30) with a young child (3 to 10years old) from the same household. Each parent completed select items from the Child Feeding Questionnaire (CFQ) with a trained interviewer. Child BMI z-score was calculated. RESULTS: There was a significant, positive relationship between fathers' perceived child weight and child BMI z-score (p=0.006) and between fathers' concern for a child's future weight and child BMI z-score (p=0.001) but not among mothers. CONCLUSIONS: Cohabitating low-income parents of young children may have conflicting appraisals of their child's BMI z-score and concerns for their child's future weight, and low-income fathers may be more accurate and concerned about their children's weight. PRACTICE IMPLICATIONS: Based on findings from this study, healthcare providers including physicians and nurses should attempt to include fathers in discussions regarding their child's weight for obesity prevention, especially in low-income families.

How Are Fathers' Demographic Characteristics Related to Preschool-Age Children's Weight and Obesity Risk Factors?

Fathers (n = 149) of preschool children were interviewed using the Child Feeding, Role of the Father (ROF), and ROF at Mealtimes (ROFM) questionnaires to determine whether fathers' demographic characteristics are associated with child overweight. Low-income was associated with higher pressure to eat (p = .006) and perceived their child as higher weight (p = .001). Higher education level was associated with lower ROF (p = .018) and ROFM (p = .002) and higher child diet quality (p = .002). Father's BMI was positively associated with ROFM (p = .008). Certain fathers may be important targets in childhood obesity prevention programs.

A quasi-experimental study to mobilize rural low-income communities to assess and improve the ecological environment to prevent childhood obesity.

BACKGROUND: The Ecological Model of Childhood Overweight focuses on characteristics that could affect a child's weight status in relation to the multiple environments surrounding that child. A community coaching approach allows community groups to identify their own strengths, priorities and identity. Little to no research currently exists related to community-based efforts inclusive of community coaching in creating environmental change to prevent childhood obesity particularly in rural communities. METHODS: A quasi-experimental study will be conducted with low-income, rural communities (n = 14) in the North Central region of the United States to mobilize capacity in communities to create and sustain an environment of healthy eating and physical activity to prevent childhood obesity. Two rural communities within seven Midwestern states (IN, KS, MI, OH, ND, SD, WI) will be randomly assigned to serve as an intervention or comparison community. Coalitions will complete assessments of their communities, choose from evidence-based approaches, and implement nutrition and physical activity interventions each year to prevent childhood obesity with emphasis on policy, system or environmental changes over four years. Only intervention coalitions will receive community coaching from a trained coach. Outcomes will be assessed at baseline, annually and project end using previously validated instruments and include coalition self-assessments, parental perceptions regarding the built environment, community, neighborhood, and early childhood environments, self-reflections from coaches and project staff, ripple effect mapping with coalitions and, final interviews of key stakeholders and coaches. A mixed-methods analysis approach will be used to evaluate if Community Coaching enhances community capacity to create and sustain an environment to support healthy eating and physical activity for young children. ANOVA or corresponding non-parametric tests will be used to analyze quantitative data relating to environmental change with significance set at P < .05. Dominant emergent themes from the qualitative data will be weaved together with quantitative data to develop a theoretical model representing how communities were impacted by the project. DISCUSSION: This project will yield data and best practices that could become a model for community development based approaches to preventing childhood obesity in rural communities.

Association of fathers' feeding practices and feeding style on preschool age children's diet quality, eating behavior and body mass index.

The associations of parental feeding practices and feeding style with childhood obesity have gained more attention in the literature recently; however, fathers are rarely included within these studies. The aim of this research was to determine the relationship of paternal feeding practices on child diet quality, weight status, and eating behavior, and the moderating effect of paternal feeding style on these relationships in preschool age children. This study included a one-time, one-on-one interview with biological fathers of preschoolers (n = 150) to assess feeding practices (Child Feeding Questionnaire), feeding style (Caregiver Feeding Style Questionnaire), child eating behaviors (Child Eating Behavior Questionnaire), and diet quality (24 hour recall, Healthy Eating Index). Height and weight for each father and child were also measured and Body Mass Index (BMI) or BMI z-score calculated. Linear regression was used to test the relationship between paternal feeding practices, style and child diet quality and/or body weight. Overall, the findings revealed that a father's feeding practices and feeding style are not associated with children's diet quality or weight status. However, child eating behaviors are associated with child BMI z-score and these relationships are moderated by paternal feeding practices. For example, child satiety responsiveness is inversely (ß = -.421, p = 0.031) associated with child BMI z-score only if paternal restriction scores are high. This relationship is not significant when paternal restriction scores are low (ß = -.200, p = 0.448). These results suggest that some child appetitive traits may be related to child weight status when exposed to certain paternal feeding practices. Future studies should consider the inclusion of fathers as their feeding practices and feeding style may be related to a child's eating behavior.

The future of recommendations on grain foods in dietary guidance.

Grain foods serve as an important source of energy, essential nutrients, and sometimes fiber. Recognizing that fiber continues to be identified as a nutrient of public health priority, there is an urgent need to address the ongoing fiber intake deficit. The focus in dietary guidance on whole grains as a source of fiber from the grains food group has not improved levels of fiber consumption. Consumer confusion around whole grains and fiber, combined with the wide range of fiber amounts found in whole-grain-labeled products, suggests that the current recommendation to "make half your grains whole" may be oversimplified in its intent to support increased fiber intakes. Nutrition educators and policy makers need to bring the conversation back to balancing all grain food choices, including enriched grains, whole grains, bran-based grain foods, and other grain-based foods with fiber, with greater emphasis on differentiating grain foods by the fiber they deliver. Changes in labeling, policy recommendations, and consumer messages are needed to help make this happen.

Parenting styles, feeding styles, and their influence on child obesogenic behaviors and body weight. A review.

With recommendations to include parents as targets for childhood obesity interventions, there is a need to review the relationship of general parenting influences on childhood obesity. Therefore, the aim of this review is to examine the existing literature regarding the influence of parenting style and/or feeding styles on childhood obesogenic behaviors and body weight. Research articles related to parenting style (n=40) and parental feeding style (n=11) were identified and reviewed. An authoritative style appears to be the most protective parenting and feeding style while the indulgent feeding style is consistently associated with negative health outcomes. Overall, results for parenting style studies are inconsistent due to differences in conceptualization and measurement, while the results for feeding styles are much more cohesive. The literature is lacking in the ability to describe the interplay between parenting and feeding styles and child obesity risk. Recommendations for future research and interventions are discussed in regards to feeding style and influences on childhood obesity.

Relation of parenting styles, feeding styles and feeding practices to child overweight and obesity. Direct and moderated effects.

The purpose of this study was to evaluate the direct and interacting relations of parenting styles, feeding styles, and feeding practices to child overweight and obesity. Participants were 144 mothers and children under 6 years of age. Mothers completed questionnaires about parenting and feeding styles and feeding practices. Researchers weighed and measured mothers and children or obtained measurements from a recent health report. Feeding practices were not directly related to child weight status. Compared to the uninvolved feeding style, authoritative and authoritarian feeding style categories were linked to lower odds of overweight. Feeding practices interacted with authoritative and authoritarian parenting styles to predict obesity: (1) healthful modeling was associated with 61% (OR = 0.39) reduced odds of obesity in children of authoritative mothers but with 55% (OR = 1.55) increased odds in children of non-authoritative mothers and (2) covert control was linked to 156% (OR = 2.56) increased odds of obesity in children of authoritarian mothers but with 51% (OR = 0.49) decreased odds in children of non-authoritarian mothers. Healthful modeling interacted with feeding style demandingness to predict overweight and with responsiveness to predict obesity. Findings suggest the need for research and interventions on mechanisms mediating between feeding practices and obesity in families characterized by non-authoritative parenting styles.

Feasibility, Acceptability, and Preliminary Outcomes of a Father-Focused Childhood Obesity Prevention Program for Low-Income Families with Preschool-Age Children.

Background: Few childhood obesity prevention interventions have focused exclusively on fathers, particularly in low-income families. The objectives of this study were to determine feasibility, acceptability, and preliminary outcomes of a father-focused childhood obesity prevention program for low-income families with preschool children (ages 3-5 years old). Methods: Father-child pairs (n = 45) enrolled in a community-based intervention in a Northeastern US state and were assigned within groups to intervention (n = 31) or a delayed comparison group (n = 14). The 8-week (2 h/week) program included nutrition, cooking, and parent education. Feasibility (enrollment, retention, and attendance) and acceptability (quality and value of program) of the program were assessed. Pre/Post measures included the Meals in our Household, Comprehensive Feeding Practices, Healthy Kids, and the Cooking Matters questionnaires. T-tests were conducted and Hedge's g was calculated to estimate effect sizes. Significance was set at p ≤ 0.10. Results: Results indicated feasibility and acceptability of the program for intervention fathers, but recruitment and retention of comparison fathers proved challenging. Small to medium effect sizes were detected for improvements in fathers' feeding pressure (g = 0.48, p = 0.005), confidence in cooking skills (g = 0.25, p = 0.09), ability to cook healthy foods on a budget (g = 0.33, p = 0.10), and frequency that fathers cooked dinner (g = 0.15, p = 0.06). There was a large effect size detected in the increase of green salad consumption (g = 0.75, p = 0.01) by fathers and a small effect size for frequency of children eating vegetables (g = 0.13, p = 0.07). Conclusions: While results are promising, further research should evaluate impact of a larger scale father-focused intervention on diet and obesity risk. The project was registered on ClinicalTrials.gov as NCT03071419.

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review.

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

A Qualitative Study to Compare Barriers to Improving Food Security among Households with Young Children in the U.S. as Perceived by Different Types of Stakeholders before and during COVID-19.

This qualitative study aimed to determine the perceived barriers of different community stakeholders' to providing resources for improving food security in households with young children in the U.S. Community stakeholders working with low-income families with children 0-3 years of age in Florida were recruited to represent healthcare (n = 7), community/policy development (n = 6), emergency food assistance (n = 6), early childhood education (n = 7), and nutrition education (n = 6) sectors. In 2020, one-on-one interviews were conducted with each stakeholder in via Zoom, using an interview script based on the PRECEDE-PROCEED model and questions to capture the impacts of COVID-19. The interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis was used to compare data across categories of stakeholders. Healthcare professionals and nutrition educators indicated stigma, community/policy development stakeholders indicated a lack of time, emergency food assistance personnel indicated a limited access to food, and early childhood professionals indicated a lack of transportation as the main barriers to food security prior to COVID-19. COVID-19 impacts included the fear of virus exposure, new restrictions, lack of volunteers, and a lack of interest in virtual programming as barriers to food security. As perceived barriers may vary with respect to providing resources to improve food security in families with young children and the COVID-19 impacts persist, coordinated policy, systems, and environmental changes are needed.

BabyByte: Qualitative Research to Inform the Development of an App to Improve Responsive Feeding Practices in Parents of Infants and Toddlers.

Responsive feeding is associated with a reduced risk of childhood obesity. The objective of this qualitative study was to determine parental preferences for mobile health (mHealth) app content and features designed to improve responsive feeding practices. Parents of 0-2-year-old children were interviewed individually. Interview questions were informed by the Technology Acceptance Model, and parents provided feedback on sample app content and features. Interviews were audio-recorded, transcribed verbatim, and coded by two researchers using thematic analysis; responses were compared by parent gender and income. Parents (n = 20 fathers, n = 20 mothers) were, on average, 33 years old, low-income (50%), identified as non-white (52.5%), and had a bachelor's degree or higher (62%). Overall, parents were most interested in feeding tips and recipe content, and app features that allowed tracking child growth and setting feeding goals. Fathers were most interested in content about first foods, choking hazards, and nutrition information, while mothers preferred content on breastfeeding, picky eating, and portion sizes. Parents with lower incomes were interested in nutrition guidelines, breastfeeding, and introducing solids. Non-low-income parents preferred information related to food allergies, portion sizes, and picky eating. The findings of this study provide considerations when developing mHealth apps to improve responsive feeding practices in parents.

Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program.

Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.