Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician's Delivery of Smoking Interventions within Behavioral Health Treatment Clinics.

BACKGROUND: Smoking is elevated amongst individuals with behavioral health disorders, but not commonly addressed. Taking Texas Tobacco Free is an evidence-based, tobacco-free workplace program that addresses this, in-part, by providing clinician training to treat tobacco use in local mental health authorities (LMHAs). This study examined organizational moderators of change in intervention delivery from pre- to post-program implementation. METHODS: LMHA leaders completed the Organizational Readiness for Implementing Change (ORIC) and provided organization demographics pre-implementation. Clinicians (N = 1237) were anonymously surveyed about their consistent use of the 5As (Asking about smoking; Advising clientele to quit; Assessing willingness to quit; Assisting them to quit; Arranging follow-up) pre- and post-program implementation. Adjusted generalized linear mixed models were used for analyses (responses nested within LMHAs), with interaction terms used to assess moderation effects. RESULTS: Clinician delivery of 5As increased pre- to post-implementation (p < .001). LMHAs with fewer employees (ref = ≤300) demonstrated greater increases in Asking, Assessing, and Assisting over time. LMHAs with fewer patients (ref = ≤10 000) evinced greater changes in Asking over time. Less initial ORIC Change Efficacy, Change Commitment, and Task Knowledge were each associated with greater pre- to post-implementation changes in Asking. Less initial Task Knowledge was associated with greater increases in Advising, Assessing, and Assisting. Finally, less initial Resource Availability was associated with greater increases in Assisting (all moderation term ps < .025). CONCLUSION: The smallest and least ready LMHAs showed the largest gains in tobacco cessation intervention delivery; thus, low initial readiness was not a barrier for program implementation, particularly when efficacy-building training and resources are provided. IMPLICATIONS: This study examined organizational moderators of increases in tobacco cessation treatment delivery over time following the implementation of a comprehensive tobacco-free workplace program within 20 of 39 LMHAs across Texas (hundreds of clinics; servicing >50% of the state) from 2013 to 2018. Overall, LMHAs with fewer employees and patients, and that demonstrated the least initial readiness for change, evinced greater gains in intervention delivery. Findings add to dissemination and implementation science by supporting that low initial readiness was not a barrier for this aspect of tobacco-free workplace program implementation when resources and clinician training sessions were provided.

Biomarkers of Dietary Omega-6 Fatty Acids and Incident Cardiovascular Disease and Mortality.

BACKGROUND: Global dietary recommendations for and cardiovascular effects of linoleic acid, the major dietary omega-6 fatty acid, and its major metabolite, arachidonic acid, remain controversial. To address this uncertainty and inform international recommendations, we evaluated how in vivo circulating and tissue levels of linoleic acid (LA) and arachidonic acid (AA) relate to incident cardiovascular disease (CVD) across multiple international studies. METHODS: We performed harmonized, de novo, individual-level analyses in a global consortium of 30 prospective observational studies from 13 countries. Multivariable-adjusted associations of circulating and adipose tissue LA and AA biomarkers with incident total CVD and subtypes (coronary heart disease, ischemic stroke, cardiovascular mortality) were investigated according to a prespecified analytic plan. Levels of LA and AA, measured as the percentage of total fatty acids, were evaluated linearly according to their interquintile range (ie, the range between the midpoint of the first and fifth quintiles), and categorically by quintiles. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Heterogeneity was explored by age, sex, race, diabetes mellitus, statin use, aspirin use, omega-3 levels, and fatty acid desaturase 1 genotype (when available). RESULTS: In 30 prospective studies with medians of follow-up ranging 2.5 to 31.9 years, 15 198 incident cardiovascular events occurred among 68 659 participants. Higher levels of LA were significantly associated with lower risks of total CVD, cardiovascular mortality, and ischemic stroke, with hazard ratios per interquintile range of 0.93 (95% CI, 0.88-0.99), 0.78 (0.70-0.85), and 0.88 (0.79-0.98), respectively, and nonsignificantly with lower coronary heart disease risk (0.94; 0.88-1.00). Relationships were similar for LA evaluated across quintiles. AA levels were not associated with higher risk of cardiovascular outcomes; in a comparison of extreme quintiles, higher levels were associated with lower risk of total CVD (0.92; 0.86-0.99). No consistent heterogeneity by population subgroups was identified in the observed relationships. CONCLUSIONS: In pooled global analyses, higher in vivo circulating and tissue levels of LA and possibly AA were associated with lower risk of major cardiovascular events. These results support a favorable role for LA in CVD prevention.

Fatty acids in the de novo lipogenesis pathway and incidence of type 2 diabetes: A pooled analysis of prospective cohort studies.

BACKGROUND: De novo lipogenesis (DNL) is the primary metabolic pathway synthesizing fatty acids from carbohydrates, protein, or alcohol. Our aim was to examine associations of in vivo levels of selected fatty acids (16:0, 16:1n7, 18:0, 18:1n9) in DNL with incidence of type 2 diabetes (T2D). METHODS AND FINDINGS: Seventeen cohorts from 12 countries (7 from Europe, 7 from the United States, 1 from Australia, 1 from Taiwan; baseline years = 1970-1973 to 2006-2010) conducted harmonized individual-level analyses of associations of DNL-related fatty acids with incident T2D. In total, we evaluated 65,225 participants (mean ages = 52.3-75.5 years; % women = 20.4%-62.3% in 12 cohorts recruiting both sexes) and 15,383 incident cases of T2D over the 9-year follow-up on average. Cohort-specific association of each of 16:0, 16:1n7, 18:0, and 18:1n9 with incident T2D was estimated, adjusted for demographic factors, socioeconomic characteristics, alcohol, smoking, physical activity, dyslipidemia, hypertension, menopausal status, and adiposity. Cohort-specific associations were meta-analyzed with an inverse-variance-weighted approach. Each of the 4 fatty acids positively related to incident T2D. Relative risks (RRs) per cohort-specific range between midpoints of the top and bottom quintiles of fatty acid concentrations were 1.53 (1.41-1.66; p < 0.001) for 16:0, 1.40 (1.33-1.48; p < 0.001) for 16:1n-7, 1.14 (1.05-1.22; p = 0.001) for 18:0, and 1.16 (1.07-1.25; p < 0.001) for 18:1n9. Heterogeneity was seen across cohorts (I2 = 51.1%-73.1% for each fatty acid) but not explained by lipid fractions and global geographical regions. Further adjusted for triglycerides (and 16:0 when appropriate) to evaluate associations independent of overall DNL, the associations remained significant for 16:0, 16:1n7, and 18:0 but were attenuated for 18:1n9 (RR = 1.03, 95% confidence interval (CI) = 0.94-1.13). These findings had limitations in potential reverse causation and residual confounding by imprecisely measured or unmeasured factors. CONCLUSIONS: Concentrations of fatty acids in the DNL were positively associated with T2D incidence. Our findings support further work to investigate a possible role of DNL and individual fatty acids in the development of T2D.

Levels of adherence needed to achieve significant weight loss.

BACKGROUND/OBJECTIVES: Positive associations have been found between adherence and weight loss in behavioral weight-management interventions. However, less attention has been given to the level of adherence needed to reach clinically significant weight loss. This study examined the levels of adherence associated with a ≥ 5% - < 10% or ≥ 10% weight loss in a community-based, intensive behavioral weight management program, Weight Watchers® (WW), which included three modes of access: (1) 24-weekly WW meetings over 6 months, (2) the WW member website, and (3) the WW mobile application. METHODS: A total of 292 participants were randomized to a WW (n = 147) or a self-help (SH) (n = 145) condition. To assess the impact of adherence, only participants in the WW condition were included in analyses (n = 147). Adherence was defined as use of the three modes of access. Measured heights and weights were obtained at baseline and 6 months. Receiver-operating characteristic curve analyses were conducted to determine the minimal level of adherence associated with clinically significant weight loss. RESULTS: In a 6-month period, increased likelihood of achieving a weight loss ≥ 5% - < 10% was associated with attending approximately one-third (35.4%) of weekly meetings, use of the member website about 25% of days, and use of the mobile application 16.1% of days. Attendance at approximately two-thirds (64.5%) of meetings, use of the member website 41.6% of days, and use of the mobile application 14.7% of days were associated with a clinically significant weight loss of ≥ 10%. Meeting attendance was the strongest predictor of weight loss at 6 months. CONCLUSIONS: Although adherence to a behavioral weight management program was an important predictor of weight loss, extremely high levels were not needed to achieve clinically significant weight loss. These results are important to help patients and treatment providers understand realistic goals for weight management.

Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children.

The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important measure to assess parent feeding practices as it encompasses a broad range of feeding behaviors, not just behaviors negatively associated with child weight outcomes. However, parent feeding practices have been shown to differ across ethnicities and the CFPQ has not been tested among low-income, Hispanic-American parents with preschool-aged children, a group at elevated risk for developing obesity. A confirmatory factor analysis was performed with the present Hispanic-American sample of Head Start mothers with preschoolers to confirm the original 12-factor, 49-item structure of the CFPQ. Because the original factor structure was not confirmed in the present Hispanic-American sample, an exploratory factor analysis was conducted to examine the psychometric properties of the CFPQ in this sample (n = 187). Among this sample, a five-factor model with 34 items was found to more appropriately assess parent feeding practices than the original 12-factor, 49-item CFPQ. This study provides preliminary validation of the CFPQ for use among low income, Hispanic-American families. Although future research is needed to replicate findings among a larger sample, this study takes an important first step toward more accurately assessing parent feeding practices among this high-risk population to inform tailored interventions that aim to reduce economic and ethnic disparities in child obesity.

Sugar-sweetened beverage intake associations with fasting glucose and insulin concentrations are not modified by selected genetic variants in a ChREBP-FGF21 pathway: a meta-analysis.

AIMS/HYPOTHESIS: Sugar-sweetened beverages (SSBs) are a major dietary contributor to fructose intake. A molecular pathway involving the carbohydrate responsive element-binding protein (ChREBP) and the metabolic hormone fibroblast growth factor 21 (FGF21) may influence sugar metabolism and, thereby, contribute to fructose-induced metabolic disease. We hypothesise that common variants in 11 genes involved in fructose metabolism and the ChREBP-FGF21 pathway may interact with SSB intake to exacerbate positive associations between higher SSB intake and glycaemic traits. METHODS: Data from 11 cohorts (six discovery and five replication) in the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium provided association and interaction results from 34,748 adults of European descent. SSB intake (soft drinks, fruit punches, lemonades or other fruit drinks) was derived from food-frequency questionnaires and food diaries. In fixed-effects meta-analyses, we quantified: (1) the associations between SSBs and glycaemic traits (fasting glucose and fasting insulin); and (2) the interactions between SSBs and 18 independent SNPs related to the ChREBP-FGF21 pathway. RESULTS: In our combined meta-analyses of discovery and replication cohorts, after adjustment for age, sex, energy intake, BMI and other dietary covariates, each additional serving of SSB intake was associated with higher fasting glucose (ß ± SE 0.014 ± 0.004 [mmol/l], p = 1.5 × 10-3) and higher fasting insulin (0.030 ± 0.005 [log e pmol/l], p = 2.0 × 10-10). No significant interactions on glycaemic traits were observed between SSB intake and selected SNPs. While a suggestive interaction was observed in the discovery cohorts with a SNP (rs1542423) in the ß-Klotho (KLB) locus on fasting insulin (0.030 ± 0.011 log e pmol/l, uncorrected p = 0.006), results in the replication cohorts and combined meta-analyses were non-significant. CONCLUSIONS/INTERPRETATION: In this large meta-analysis, we observed that SSB intake was associated with higher fasting glucose and insulin. Although a suggestive interaction with a genetic variant in the ChREBP-FGF21 pathway was observed in the discovery cohorts, this observation was not confirmed in the replication analysis. TRIAL REGISTRATION: Trials related to this study were registered at clinicaltrials.gov as NCT00005131 (Atherosclerosis Risk in Communities), NCT00005133 (Cardiovascular Health Study), NCT00005121 (Framingham Offspring Study), NCT00005487 (Multi-Ethnic Study of Atherosclerosis) and NCT00005152 (Nurses' Health Study).

Fatty acid biomarkers of dairy fat consumption and incidence of type 2 diabetes: A pooled analysis of prospective cohort studies.

BACKGROUND: We aimed to investigate prospective associations of circulating or adipose tissue odd-chain fatty acids 15:0 and 17:0 and trans-palmitoleic acid, t16:1n-7, as potential biomarkers of dairy fat intake, with incident type 2 diabetes (T2D). METHODS AND FINDINGS: Sixteen prospective cohorts from 12 countries (7 from the United States, 7 from Europe, 1 from Australia, 1 from Taiwan) performed new harmonised individual-level analysis for the prospective associations according to a standardised plan. In total, 63,682 participants with a broad range of baseline ages and BMIs and 15,180 incident cases of T2D over the average of 9 years of follow-up were evaluated. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Prespecified interactions by age, sex, BMI, and race/ethnicity were explored in each cohort and were meta-analysed. Potential heterogeneity by cohort-specific characteristics (regions, lipid compartments used for fatty acid assays) was assessed with metaregression. After adjustment for potential confounders, including measures of adiposity (BMI, waist circumference) and lipogenesis (levels of palmitate, triglycerides), higher levels of 15:0, 17:0, and t16:1n-7 were associated with lower incidence of T2D. In the most adjusted model, the hazard ratio (95% CI) for incident T2D per cohort-specific 10th to 90th percentile range of 15:0 was 0.80 (0.73-0.87); of 17:0, 0.65 (0.59-0.72); of t16:1n7, 0.82 (0.70-0.96); and of their sum, 0.71 (0.63-0.79). In exploratory analyses, similar associations for 15:0, 17:0, and the sum of all three fatty acids were present in both genders but stronger in women than in men (pinteraction < 0.001). Whereas studying associations with biomarkers has several advantages, as limitations, the biomarkers do not distinguish between different food sources of dairy fat (e.g., cheese, yogurt, milk), and residual confounding by unmeasured or imprecisely measured confounders may exist. CONCLUSIONS: In a large meta-analysis that pooled the findings from 16 prospective cohort studies, higher levels of 15:0, 17:0, and t16:1n-7 were associated with a lower risk of T2D.

Item response modeling: a psychometric assessment of the children's fruit, vegetable, water, and physical activity self-efficacy scales among Chinese children.

BACKGROUND: This study aimed to evaluate the psychometric properties of four self-efficacy scales (i.e., self-efficacy for fruit (FSE), vegetable (VSE), and water (WSE) intakes, and physical activity (PASE)) and to investigate their differences in item functioning across sex, age, and body weight status groups using item response modeling (IRM) and differential item functioning (DIF). METHODS: Four self-efficacy scales were administrated to 763 Hong Kong Chinese children (55.2% boys) aged 8-13 years. Classical test theory (CTT) was used to examine the reliability and factorial validity of scales. IRM was conducted and DIF analyses were performed to assess the characteristics of item parameter estimates on the basis of children's sex, age and body weight status. RESULTS: All self-efficacy scales demonstrated adequate to excellent internal consistency reliability (Cronbach's α: 0.79-0.91). One FSE misfit item and one PASE misfit item were detected. Small DIF were found for all the scale items across children's age groups. Items with medium to large DIF were detected in different sex and body weight status groups, which will require modification. A Wright map revealed that items covered the range of the distribution of participants' self-efficacy for each scale except VSE. CONCLUSIONS: Several self-efficacy scales' items functioned differently by children's sex and body weight status. Additional research is required to modify the four self-efficacy scales to minimize these moderating influences for application.

Impact of blood products on platelet function in patients with traumatic injuries: a translational study.

BACKGROUND: Reductions in platelet (PLT) count and function are associated with poor outcomes in trauma patients. We proposed to determine if patients expected to receive blood products have a decrease in PLT function higher than expected based on the reduction in PLT count, and if the reduction in function could be associated with the donor plasma/supernatant received. METHODS: PLT count and function were measured on admission to the emergency department and intensive care unit in severely injured patients expected to receive a transfusion. PLT function was measured by Multiplate aggregometry in response to five agonists. Function was corrected for alterations in count. In vitro studies were conducted in the blood of normal subjects to assess the effect of dilutions with AB donor plasma on PLT function. RESULTS: Forty-six patients were enrolled, with 87% requiring a transfusion. Median Injury Severity Score was 23 (13, 29) and mortality 15%. PLT count and function were decreased from emergency department to intensive care unit admission by 25% and 58%, respectively. Decreases in function persisted after adjustment for count. Patients requiring large volumes of blood products had reductions in function that were disproportionately greater. Reductions in PLT function were greatest after transfusion of PLTs. In in vitro studies with a 30% dilution by autologous plasma caused a relational reduction in function, whereas allogenic plasma resulted in greater decreases that were highly variable between donors. CONCLUSIONS: Within hours of injury a decrease in both PLT count and function occurs, that is aggravated with the administration of blood products, with transfusion of PLTs showing the greatest effect. The effect on PLT function of allogenic transfused plasma appears to be highly donor related.

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

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

Obesity status trajectory groups among elementary school children.

BACKGROUND: Little is known about patterns in the transition from healthy weight to overweight or obesity during the elementary school years. This study examined whether there were distinct body mass index (BMI) trajectory groups among elementary school children, and predictors of trajectory group membership. METHODS: This is a secondary analysis of 1651 elementary school children with complete biannual longitudinal data from kindergarten to the beginning of 5(th) grade. Heights and weights were measured by trained school nurses using standard procedures at the beginning and end of each school year for 11 consecutive assessments. Group-based trajectory clustering and multinomial logit modeling were conducted. RESULTS: When using BMIz score, six trajectory groups were identified revealing substantial consistency in BMIz score across time. When using a categorical variable separating overweight/obese children (BMI ≥ 85%ile) from the rest, five developmental trajectories (persistently non-overweight/obese weight: 51.1 %; early-onset overweight/obese: 9.2 %; late-onset overweight/obese: 9.7 %; becoming healthy weight: 8.2 %; and chronically overweight/obese: 21.8 %) were identified. When using a categorical variable separating obese children (BMI ≥ 95%ile) from the rest, three trajectories (persistently non-obese: 74.1 %, becoming obese: 12.8 %; and chronically obese: 13.2 %) were identified. For both cutoffs (≥ BMI percentile 85 % or 95 %), girls were more likely than boys to be classified in the persistently non-overweight and/or obese group (odds ratios (OR) ranged from 0.53 to 0.67); and Hispanic children and non-Hispanic Black children were more likely to be chronically overweight and/or obese than non-Hispanic White children (OR ranged from 1.57 to 2.44). Hispanic children were also more likely to become obese (OR: 1.84) than non-Hispanic White children when ≥ BMI percentile 95 % was used. CONCLUSIONS: Boys, Hispanic and non-Hispanic Black children were at higher risk of being overweight or obese throughout their elementary school years, supporting the need for obesity treatment. Post kindergarten and post second grade summer months were times when some children transitioned into overweight/obesity. It will be important to identify which behavioral factors (e.g., diet, physical activity, sedentary behaviors, and/or sleep) predisposed children to becoming overweight/obese, and whether these factors differ by time (Kindergarten versus second grade). If behavioral predisposing factors could be identified early, targeted obesity prevention should be offered.

The Narrative Impact of Active Video Games on Physical Activity Among Children: A Feasibility Study.

BACKGROUND: Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children's AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors. OBJECTIVE: The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG, Nintendo Wii Sports Resort: Swordplay Showdown. METHODS: A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it. RESULTS: Children in the narrative group had significantly (P<.05) more steps per 10-second period (mean 3.2, SD 0.7) and overall (mean 523, SD 203) during game play compared with the nonnarrative group (10-second period: mean 2.7, SD 0.7; overall: mean 366, SD 172). CONCLUSIONS: The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.

Validation of the Physical Activity Questionnaire for Older Children (PAQ-C) among Chinese Children.

OBJECTIVE: This study initially validates the Chinese version of the Physical Activity Questionnaire for Older Children (PAQ-C), which has been identified as a potentially valid instrument to assess moderate-to-vigorous physical activity (MVPA) in children among diverse racial groups. METHODS: The psychometric properties of the PAQ-C with 742 Hong Kong Chinese children were assessed with the scale's internal consistency, reliability, test-retest reliability, confirmatory factory analysis (CFA) in the overall sample, and multistep invariance tests across gender groups as well as convergent validity with body mass index (BMI), and an accelerometry-based MVPA. RESULTS: The Cronbach alpha coefficient (α=0.79), composite reliability value (ρ=0.81), and the intraclass correlation coefficient (α=0.82) indicate the satisfactory reliability of the PAQ-C score. The CFA indicated data fit a single factor model, suggesting that the PAQ-C measures only one construct, on MVPA over the previous 7 days. The multiple-group CFAs suggested that the factor loadings and variances and covariances of the PAQ-C measurement model were invariant across gender groups. The PAQ-C score was related to accelerometry-based MVPA (r=0.33) and inversely related to BMI (r=-0.18). CONCLUSION: This study demonstrates the reliability and validity of the PAQ-C in Chinese children.

The association of parent's outcome expectations for child TV viewing with parenting practices and child TV viewing: an examination using path analysis.

BACKGROUND: Television (TV) viewing has been associated with many undesirable outcomes for children, such as increased risk of obesity, but TV viewing can also have benefits. Although restrictive parenting practices are effective in reducing children's TV viewing, not all parents use them and it is currently unclear why. The current study examined parenting practices related to TV viewing in the context of social- cognitive theory. Specifically, we hypothesized that positive and negative Parental Outcome Expectations for child's TV Viewing (POETV) would be associated with social co-viewing and restrictive parenting practices, and that POETV and parenting practices influence the amount of TV viewed by child. METHOD: Data were collected from an internet survey of 287 multi-ethnic parents and their 6-12 year old children on participants' sociodemographic information, parenting practices related to TV use, POETV, and parent and child TV viewing. Path analysis was used to examine the relationship amongst variables in separate models for weekday and weekend TV viewing. controlling for child age, household education, and parental TV viewing. RESULTS: The results provided partial support for the hypotheses, with notable differences between weekday and weekend viewing. The models explained 13.6% and 23.4% of the variance in children's TV viewing on weekdays and weekends respectively. Neither positive nor negative POETV were associated with restrictive TV parenting in either model. One subscale each from positive and negative POETV were associated with social co-viewing parenting on both weekends and weekdays in the expected direction. Restrictive parenting practices were directly negatively associated with children's TV viewing on weekdays, but not weekends. Social co-viewing parenting was directly positively associated with children's TV viewing on weekends, but not weekdays. The strongest influence on children's TV viewing was having a TV in the child's bedroom. Negative POETV was weakly associated with having a TV in the child's room. CONCLUSIONS: These findings suggest that POETV and parenting may have a greater impact on weekend TV viewing, when children tend to watch more TV, than weekday. The models suggest that POETV, parenting and especially removing the TV from children's rooms may be promising targets for interventions.

Predicting use of effective vegetable parenting practices with the Model of Goal Directed Behavior.

OBJECTIVE: To model effective vegetable parenting practices using the Model of Goal Directed Vegetable Parenting Practices construct scales. DESIGN: An Internet survey was conducted with parents of pre-school children to assess their agreement with effective vegetable parenting practices and Model of Goal Directed Vegetable Parenting Practices items. Block regression modelling was conducted using the composite score of effective vegetable parenting practices scales as the outcome variable and the Model of Goal Directed Vegetable Parenting Practices constructs as predictors in separate and sequential blocks: demographics, intention, desire (intrinsic motivation), perceived barriers, autonomy, relatedness, self-efficacy, habit, anticipated emotions, perceived behavioural control, attitudes and lastly norms. Backward deletion was employed at the end for any variable not significant at P<0·05. SETTING: Houston, TX, USA. SUBJECTS: Three hundred and seven parents (mostly mothers) of pre-school children. RESULTS: Significant predictors in the final model in order of relationship strength included habit of active child involvement in vegetable selection, habit of positive vegetable communications, respondent not liking vegetables, habit of keeping a positive vegetable environment and perceived behavioural control of having a positive influence on child's vegetable consumption. The final model's adjusted R 2 was 0·486. CONCLUSIONS: This was the first study to test scales from a behavioural model to predict effective vegetable parenting practices. Further research needs to assess these Model of Goal Directed Vegetable Parenting Practices scales for their (i) predictiveness of child consumption of vegetables in longitudinal samples and (ii) utility in guiding design of vegetable parenting practices interventions.

Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior.

OBJECTIVE: Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. DESIGN: A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices. SETTING: The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion. SUBJECTS: Parents of 307 pre-school children (3-5 years old). RESULTS: Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized ß=0·349, P<0·0001) and desire (standardized ß=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized ß=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized ß=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized ß=-0·133, P=0·009), autonomy (standardized ß=-0·118, P=0.014), attitude about negative effects of vegetables (standardized ß=-0·118, P=0·015) and descriptive norms (standardized ß=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices. CONCLUSIONS: The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.

Confirmatory factor analysis of the Feeding Emotions Scale. A measure of parent emotions in the context of feeding.

Assessing parent affect is important because studies examining the parent-child dyad have shown that parent affect has a profound impact on parent-child interactions and related outcomes. Although some measures that assess general affect during daily lives exist, to date there are only few tools that assess parent affect in the context of feeding. The aim of this study was to develop an instrument to measure parent affect specific to the feeding context and determine its validity and reliability. A brief instrument consisting of 20 items was developed that specifically asks how parents feel during the feeding process. This brief instrument draws on the structure of a well-validated general affect measure. A total of 296 Hispanic and Black Head Start parents of preschoolers completed the Feeding Emotions Scale along with other parent-report measures as part of a larger study designed to better understand feeding interactions during the dinner meal. Confirmatory factor analysis supported a two-factor model with independent subscales of positive affect and negative affect (Cronbach's alphas of 0.85 and 0.84, respectively). Concurrent and convergent construct validity was evaluated by correlating the subscales of the Feeding Emotions Scale with positive emotionality and negative emotionality from the Differential Emotions Scale - a measure of general adult emotions. Concurrent and convergent criterion validity was evaluated by testing mean differences in affect across parent feeding styles using ANOVA. A significant difference was found across maternal weight status for positive feeding affect. The resulting validated measure can be used to assess parent affect in studies of feeding to better understand how interactions during feeding may impact the development of child eating behaviors and possibly weight status.

Vegetable parenting practices scale. Item response modeling analyses.

OBJECTIVE: To evaluate the psychometric properties of a vegetable parenting practices scale using multidimensional polytomous item response modeling which enables assessing item fit to latent variables and the distributional characteristics of the items in comparison to the respondents. We also tested for differences in the ways item function (called differential item functioning) across child's gender, ethnicity, age, and household income groups. METHOD: Parents of 3-5 year old children completed a self-reported vegetable parenting practices scale online. Vegetable parenting practices consisted of 14 effective vegetable parenting practices and 12 ineffective vegetable parenting practices items, each with three subscales (responsiveness, structure, and control). Multidimensional polytomous item response modeling was conducted separately on effective vegetable parenting practices and ineffective vegetable parenting practices. RESULTS: One effective vegetable parenting practice item did not fit the model well in the full sample or across demographic groups, and another was a misfit in differential item functioning analyses across child's gender. Significant differential item functioning was detected across children's age and ethnicity groups, and more among effective vegetable parenting practices than ineffective vegetable parenting practices items. Wright maps showed items only covered parts of the latent trait distribution. The harder- and easier-to-respond ends of the construct were not covered by items for effective vegetable parenting practices and ineffective vegetable parenting practices, respectively. CONCLUSIONS: Several effective vegetable parenting practices and ineffective vegetable parenting practices scale items functioned differently on the basis of child's demographic characteristics; therefore, researchers should use these vegetable parenting practices scales with caution. Item response modeling should be incorporated in analyses of parenting practice questionnaires to better assess differences across demographic characteristics.

Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines.

OBJECTIVE: Low-income Hispanic women are at greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program participation and dietary intake among 661 Hispanic women aged 26-44 years living in Texas. METHODS: Cross-sectional data was collected using standard methods. Analysis of variance and logistic regression examined the influence of Supplemental Nutrition Assistance Program on diet after adjusting for household characteristics, body mass index, and food security status. RESULTS: Most women did not meet recommended dietary guidelines. Supplemental Nutrition Assistance Program participants consumed higher amounts of total sugars, sweets-desserts, and sugar-sweetened beverages than Supplemental Nutrition Assistance Program nonparticipants. High sodium intakes and low dairy consumption were observed in both groups. Only 27% of low-income eligible women received Supplemental Nutrition Assistance Program benefits. DISCUSSION: Low-income Hispanic women participating in Supplemental Nutrition Assistance Program reported less healthful dietary patterns than nonparticipants. This may contribute to the increased obesity prevalence and related comorbidities observed in this population. CONCLUSION: Supplemental Nutrition Assistance Program should play an important role in enhancing the overall dietary quality of low-income households. Policy initiatives such as limiting the purchase of sugar-sweetened beverages and education to enable women to reduce consumption of high sodium processed foods deserve consideration as means to improve the dietary quality of Supplemental Nutrition Assistance Program participants. Effective measures are needed to increase Supplemental Nutrition Assistance Program participation rates among Hispanics.

Psychometric validity of the parent's outcome expectations for children's television viewing (POETV) scale.

BACKGROUND: TV and other screen use are common among elementary school aged children with both potential benefits and harms. It is not clear why some parents restrict their children's screen use and others do not. Parent's outcome expectations for allowing their child to watch TV and other screen media, i.e. the perceived 'costs' and 'benefits,' may be influential. Our objective was to develop a measure of Parent's Outcome Expectations for Children's TV Viewing (POETV) and test the psychometrics of the resulting instrument among parents with children 6-12 years old. METHODS: An ethnically diverse sample (n = 311) of parents from Harris County, Texas completed measures for POETV, demographics, and parent and child TV viewing and other screen media use via an internet survey. The sample was randomly split and an exploratory factor analysis (EFA) was conducted among the first half of the sample separately for Positive and Negative POETV. A confirmatory factor analysis (CFA) assessed the fit of the resulting factors with the data in the second half of the sample. Internal reliabilities and Spearman partial correlations (controlling for confounders) of children's TV and other screen use with the resulting POETV factors were calculated for the full sample. RESULTS: EFA identified two factors for Positive POETV (Parent Centered; Child Centered) and two factors for Negative POETV (TV & Content Exposure; Prevent Other Activities). Follow up CFA confirmed moderate to good psychometric properties for both factor structures with the addition of four correlated errors in the Positive POETV model. Internal reliabilities were appropriate (Cronbach's alpha >0.7). Parent Centered Positive POETV and Child Centered Positive POETV were correlated with children's TV viewing on weekdays (0.14, p < 0.05) and weekends (0.17, p < 0.01) respectively. Both also correlated with other screen media use on weekends (0.20 and 0.21, p < 0.001). Prevent Other Activities Negative POETV was negatively correlated with children's TV viewing on weekdays (-0.16, p < 0.01), weekends (-0.14, p < 0.05) and other screen media on weekends (-0.14, p < 0.05). CONCLUSIONS: The Positive and Negative POETV scales offer a new tool to better define predictors of screen media parenting practices and child screen media use behaviors.