Development and Psychometric Validation of the Athletes' Perceived Body Pressures from Coaches Questionnaire (APBPCQ).

This study aimed to develop a questionnaire to assess male and female athletes' perceived weight and shape pressure from coaches and establish its psychometric properties. Exploratory factor analysis (N = 412 in each female sample 1 and 2) provided evidence for 4 scales for female athletes and 3 scales for male athletes which were confirmed in confirmatory factor analysis (N = 260 in each male sample 1 and 2). For both females and males, KMO testing and Bartlett's test of sphericity indicated that the sampling was adequate and survey items were appropriate for factor analysis. Additionally, all scales for both sexes had strong factor loadings (≥0.65), good Cronbach alpha coefficients (>0.70), and made contextual sense. The magnitude of difference results were indicative of a stable factor structure. Goodness-of-fit indicators were all in the expected direction. Good convergent validity was demonstrated. The questionnaire's excellent psychometric properties and novelty make it a valuable tool for researchers and practitioners. This questionnaire has the potential to identify training needs in coaching staff, as well as to identify athletes who may benefit from support and guidance for effectively coping with pressure from coaches.

Body Dissatisfaction, Eating Styles, Weight-Related Behaviors, and Health among Young Women in the United States.

Body dissatisfaction is a common condition that poses health behavior risks, such as the use of maladaptive eating styles instead of adaptive eating styles. Few studies have simultaneously examined both adaptive and maladaptive eating styles and their association with body dissatisfaction in a comprehensive manner. To address this gap, this study examined how body dissatisfaction is related to an array of adaptive and maladaptive eating styles, weight-related behaviors, and health status as well as the associations of health status, BMI, and weight-related behaviors with body dissatisfaction in 261 young adult women. Maladaptive eating styles, such as emotional eating, tended to rise in tandem with body dissatisfaction, differing significantly among body-dissatisfaction levels with medium to large effect sizes. For adaptive eating styles, as body dissatisfaction increased, compensatory restraint increased, intuitive eating declined, and mindful eating did not differ. Weight-related dietary, physical activity, and sleep behaviors did not differ by body dissatisfaction level. BMI increased and health status decreased as body dissatisfaction increased. Binary logistic regression revealed those who were body-dissatisfied had significantly lower health status, higher BMIs, and did not differ on weight-related behaviors. Study findings suggest strategies to improve health-promotion interventions aiming to increase body satisfaction.

HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood.

BACKGROUND: Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood. METHODS: The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022. DISCUSSION: This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses. TRIAL REGISTRATION: ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.

Disordered eating concerns, behaviors, and severity in young adults clustered by anxiety and depression.

OBJECTIVES: Little is known about how anxiety and depression in combination relate to eating disorder concerns (eating, shape, and weight concern) and behaviors (restraint eating, binge eating, and purging) indicative of eating disorder symptom severity. This study examined links among disordered eating concerns, behaviors, and severity clustered by depression and anxiety. METHODS: College students (n = 1792) completed a survey comprised of the Generalized Anxiety Disorder Scale (GAD-7), 2-item Patient Health Questionnaire (PHQ-2) assessing Major Depressive Disorder (MDD), and Eating Disorder Exam Questionnaire (EDE-Q) assessing concerns and behaviors indicative of disordered eating. RESULTS: Cluster analysis yielded four groups: not depressed or anxious to subclinical, moderate, and high depression and anxiety. Analysis of variance (ANOVA) indicated overall eating disorder severity scores increased significantly as GAD and MDD increased, suggesting that as anxiety and depression rise in tandem, disturbed eating severity rises. Results revealed that even at subclinical levels, disordered eating concerns, behaviors, and overall severity scores increase. DISCUSSION: Future interventions aiming to reduce disordered eating in young adults may be strengthened by incorporating depression and anxiety management strategies. A screening for subclinical anxiety and depression (Mixed Anxiety and Depression Disorder [MADD]) may be helpful in providing early intervention to resolve disordered eating behaviors before they become entrenched.

Assessment of Sport Nutrition Knowledge, Dietary Practices, and Sources of Nutrition Information in NCAA Division III Collegiate Athletes.

Nutrition knowledge is a critical component of meeting sport nutrition guidelines. The present study aimed to evaluate the sport nutrition knowledge of National Collegiate Athletic Association (NCAA) Division III (DIII) athletes using a validated questionnaire, and to assess the dietary practices and sources of nutrition information in this population. A total of 331 student-athletes (n = 149 males, n = 181 females, n = 1 no sex indicated) completed the questionnaire. The mean score for total sport nutrition knowledge was 6.49 ± 8.9 (range -49 to 49) with a mean percent (%) correct score of 36.9 ± 19.1%. Athletes who had a previous college-level nutrition course (n = 62) had significantly higher (p < 0.05) total sport nutrition, carbohydrate, and hydration knowledge compared to those who did not (n = 268). Individual sport athletes (n = 90) scored significantly higher (p < 0.05) on hydration and micronutrients knowledge than team sport athletes (n = 237), while females scored higher than males for hydration knowledge (p < 0.05). The majority of athletes reported sensible dietary habits, such as not frequently skipping meals and eating carbohydrate and protein foods peri-workout. Athletes also reported their primary sources of nutrition information, the top three sources being social media, coaches, and athletic trainers, despite most frequently rating registered dietitians/nutritionists as "extremely knowledgeable". Despite low sport nutrition knowledge, NCAA DIII collegiate athletes practiced seemingly prudent dietary habits but lacked exposure to high-quality sources of nutrition information.

Food Choice Decisions of Collegiate Division I Athletes: A Qualitative Exploratory Study.

Limited research has examined athletes' food and health beliefs and decisions and the congruence of these decisions with recommendations from nutrition professionals. This study aimed to improve understanding of athletes' food-related beliefs and practices to enable nutrition professionals to more effectively enhance performance while protecting athletes' health. Division I college athletes (n = 14, 64% female) from a variety of sports were recruited to participate in 20-min semi-structured phone interviews about food and nutrition-related behaviors and cognitions. Data were content analyzed to identify themes and trends. Prominent factors influencing athletes' food choices were potential benefits to health and performance, availability of foods, and recommendations from sports dietitians. Foods commonly consumed by athletes, including fruits, vegetables, and lean protein, were generally healthy and aligned with sports nutrition recommendations. Athletes avoided energy-dense nutrient-poor foods, such as fast food and fried foods, with the goal of improving performance. Some athletes took supplements (i.e., multivitamin, iron, protein) on the premise that they would improve health and enhance performance or recovery. While athletes' nutrition behaviors are generally congruent with current recommendations, findings highlighted misconceptions held by athletes related to the benefits of some supplements and the belief that packaged/processed foods were inherently less healthy than other options. Nutrition misconceptions held by athletes and incongruities between athletes' nutrition knowledge and behaviors suggest that dietitians should aim to dispel misconceptions held by athletes and provide additional guidance and information to support athletes' current healthful behaviors to ensure these behaviors extend beyond their college athletic career.

Hassle Exposure and Reactivity Links with Obesogenic Health Behaviors.

Objectives: In this study, we explored associations between daily "hassles" (irritating inconveniences) and obesogenic health behaviors of college students. Methods: Students (N = 406, 62% female) completed a survey including the 5-point Brief College Student Hassle Scale which quantifies hassles experienced in the last month in 9 domains (eg, preparing meals, exercising, adequate sleep) and hassle reactivity (ie, upset from hassles), with scores categorized as low (< 2.5), moderate (≥ 2.5 to ≤ 3.5), or high (> 3.5). Results: Females had significantly (p < .05) greater hassles in all domains than males, except for work, personal relationships, and living environment. ANOVA revealed both sexes in the high hassle exposure groups tended to have poorer eating behaviors than the low hassle exposure group. Additionally, high hassle exposure females and males slept less, and had poorer sleep quality, satisfaction with life, and physical and mental health than lower hassle exposure groups. Multiple linear regression analyses examining associations of hassle exposures and hassle reactivity with each health behavior, adjusted for sex and body mass index, revealed all models were statistically significant, except fruit and vegetable intake. Conclusions: Lower hassle during college is associated with healthier weight-related behaviors and better health status. Future nutrition interventions targeting college students may be strengthened by incorporating strategies for effectively coping with daily hassles.

Relationships among Executive Function, Cognitive Load, and Weight-related Behaviors in University Students.

Objectives: College students have high risk of anxiety and weight gain. Understanding how executive function traits, especially with trait anxiety, associates with weight-related behaviors could indicate strategies for improving obesity prevention programs. In this study, we examined links between weight-related behaviors of undergraduate students and executive function traits with and without high cognitive loads in the form of trait anxiety. Methods: Participants (N = 406) completed an online survey assessing health, weight-related behaviors, executive function traits (cognitive self-control, concentration, and flexibility), and cognitive load (trait anxiety). Results: K-means cluster analysis of executive function trait scales yielded 3 homogenous groups distinctly different from each other: Cluster 1 had the lowest cognitive self-control and flexibility and moderate concentration traits, Cluster 2 had the lowest concentration and moderate self-control and flexibility traits, and Cluster 3 had the highest executive function traits. Clusters did not differ on BMI or physical health. Cluster 3 had better mental health, physical activity, sleep quality, and eating behaviors. Across clusters, those with high cognitive loads, as indicated by trait anxiety, had poorer mental health than those with low loads. High cognitive load in Clusters 2 and 3 adversely affected eating behaviors requiring cognitive concentration and self-control. Conclusions: Future research should explore the feasibility of delivering executive control improvement activities and health education simultaneously.

Maternal Sleep Quality is Associated with Personal and Parenting Weight-Related Behaviors.

Mothers of young children tend to report poor-quality sleep, yet little is known about links between maternal sleep quality and weight-related behaviors and parenting practices. Thus, mothers of preschoolers completed an online cross-sectional survey assessing their sleep, physical activity, dietary behaviors, eating styles, child feeding practices, family meal behaviors, and health parameters. Comparisons by sleep quality using the Pittsburgh Sleep Quality Index item (i.e., very bad/bad, n = 87; fair, n = 255; and good/very good, n = 193) revealed mothers with poor-quality sleep had weight-related behaviors associated with higher Body Mass Index (BMI) (lower physical activity, fewer fruits/vegetables, more emotional and disinhibited eating). Poor-quality sleepers also engaged in parenting practices contrary to recommendations, such as less frequent modeling of healthy eating and physical activity, more control of child feeding, and fewer family meals. Mothers reporting poor-quality sleep tended to have lower parenting self-efficacy, poorer overall health status, more days of poor mental and physical health, greater depression, more stress, and higher BMIs. Future nutrition research should establish the directionality between sleep quality and health behaviors. Future interventions should help mothers develop strategies for improving sleep quality, such as increased physical activity and fruit and vegetable intake, and helping mothers realize how their sleep quality may affect parenting practices.

Parenting Advice School-Age Kids Offer to Parents to Promote Healthier Child Weight-Related Behaviors.

OBJECTIVE: To explore parenting advice children would provide to help parents encourage positive health-related behaviors by children. DESIGN: Focus group discussions were conducted, and children shared the advice they would provide parents to help them encourage healthy weight-related behaviors (ie, diet, physical activity, and sleep) for children. SETTING: Focus groups (n = 65) were conducted in 3 states (Florida, New Jersey, and West Virginia). PARTICIPANTS: School-age children (n = 194) between the ages of 6 and 11 years old. PHENOMENON OF INTEREST: What parenting practices are recommended by children, and are they in line with best-practice guidelines? ANALYSIS: Focus group data were analyzed to identify themes and trends. RESULTS: Children's recommendations were congruent with authoritative parenting styles (ie, high levels of warmth and control). Most of the advice shared by children aligned with recommended parent practices (ie, responsive feeding, facilitation, environmental restructuring, parent modeling, and encouragement). However, not all of the children's advice aligned with best practices guidelines (ie, use of food rewards and deception). CONCLUSIONS AND IMPLICATIONS: Future nutrition education programs may be strengthened by helping parents adopt best practices for promoting healthy child behaviors. Furthermore, teaching children about recommended child feeding parenting practices may help protect future generations by preparing children to care for younger siblings or raise their children using best parenting practices.

Stability of Differences in Weight-Related Characteristics of Mothers across Economic, Cultural, Social, and Environmental-Health Indicators of Socioeconomic Status.

This study explored the differences in weight-related characteristics when socioeconomic status (SES) was assessed by economic, cultural, social, and environmental-health capital individually and as a composite with the goal of determining the stability of differences across types of capital and to ascertain whether single or a combination of capital indicators of SES should be used in nutrition and public health studies. Mothers (n = 557) of young children completed a survey assessing capital and weight-related characteristics. Mothers with higher economic, cultural, and social capital and composite SES had fewer sugar-sweetened beverage servings, fewer meals in front of the TV, more food security, and greater neighborhood space/supports for physical activity than comparators. Few differences occurred among environmental-health capital groups. Composite SES performed similarly to individual economic, cultural, and social capital measures. Findings suggest single SES indicators may be sufficiently stable to capture differences in weight-related characteristics. Each capital type captures a unique aspect of SES; thus, assessing an array of capital types could advance understanding of SES aspects on weight-related characteristics.

The "Motor of the Day": Parent and School-Age Children's Cognitions, Barriers, and Supports for Breakfast.

Despite the many benefits of regular breakfast consumption few parents and children consume this meal every day and research examining the determinants of breakfast consumption is limited. Thus, the purpose of this study was to examine breakfast-related cognitions (i.e., beliefs, attitudes, facilitators, barriers) of parents and school-age children (ages 6-11 years) using the constructs of Social Cognitive Theory as a guide. Parents (n = 37) and children (n = 41) participated in focus group discussions held in community settings in 3 states (FL, NJ, WV). Data were qualitatively content analyzed to detect trends. Parents felt breakfast was important for numerous reasons. Parents expressed concern about the healthfulness of some traditional breakfast options, preferring breakfasts containing mostly fruits, vegetables, and protein and fewer carbohydrates. Parents identified lack of time as the greatest barrier to breakfast consumption. To overcome this barrier, they utilized grab-and-go foods, prepared breakfast ahead of time, and got up earlier. Utilizing the school breakfast program was another strategy mentioned, however some were concerned about the nutritional quality of this option. Children recognized the importance of breakfast and cited several benefits. The greatest barrier to breakfast identified by children was feeling rushed in the morning. To overcome barriers, children suggested having a morning routine, selecting or preparing breakfast foods ahead, and relying on parents to encourage breakfast consumption. The effectiveness of interventions aiming to improve breakfast intake may be improved by addressing parent and child breakfast-related cognitions and tailoring interventions to address their needs.

"My stuffed animals help me": the importance, barriers, and strategies for adequate sleep behaviors of school-age children and parents.

STUDY OBJECTIVES: To describe parents' and school-age children's sleep-related cognitions and behaviors. METHODS: Parents (n = 36) and school-age children (n = 40; 6-11 years old) from New Jersey, Florida, and West Virginia participated in focus groups lasting ~60 minutes for parents and ~30 minutes for children. Trained researchers led the focus groups designed using Social Cognitive Theory constructs. Standard content analysis procedures were used independently by 3 trained researchers to analyze focus group data. RESULTS: A consistent finding across focus groups was that a set bedtime was a typical behavior. Both parents and children recognized the importance of sleep for health and academic success. Technology was highlighted by both groups as a barrier to adequate sleep. The children discussed postbedtime activities of their parents as barriers to sleep. Physical activity along with several healthy sleep practices was identified as strategies to improve sleep. Parents and children stressed the role of parents in promoting healthy sleep behaviors and sleep-conducive environment. Participants did not mention some well-established links between sleep duration and health as well as sleep-promoting behaviors. Several unique factors, not yet reported in the literature, were discussed by the parents and children including the use of stuffed animals for comfort and disruptive behaviors of others in the household. CONCLUSIONS: Many of the cognitions of parents and children coincide with evidence from scientific literature surrounding sleep and sleep hygiene but also demonstrated sleep hygiene knowledge gaps. Study findings can be applied to future sleep education materials targeting parents and school-age children.

"If my family is happy, then I am happy": Quality-of-life determinants of parents of school-age children.

OBJECTIVE: Obesity is a public health concern for children and adults and effective obesity prevention programming is needed urgently. The effectiveness of health-related messaging and interventions is influenced by the way content is framed. HomeStyles is an obesity prevention program, which aims to promote health through the frame of improved quality of life. METHODS: Thus, focus groups were conducted with English- and Spanish-speaking parents of school-aged children (ages 6-11) to identify key quality-of-life determinants as described by parents. RESULTS: Parents (n = 158) reported that their quality of life was influenced by family happiness and parent and child health (e.g. adequate sleep, exercise, healthy diet). Many parents expressed that their busy schedules and lack of family time were detrimental to their quality of life. Work-life balance and financial stability were other factors commonly noted to impact quality of life. Spanish-speaking parents also reported being undocumented and feeling a lack of a sense of community negatively influenced their quality of life. CONCLUSION: Considering parent-defined quality-of-life determinants when framing health-related messaging and developing interventions may increase participant interest and ultimately improve health-related behaviors. Next steps in the HomeStyles project include using parent-reported quality-of-life determinants to guide the development of intervention materials.

"Your Body Feels Better When You Drink Water": Parent and School-Age Children's Sugar-Sweetened Beverage Cognitions.

Sugar-sweetened beverages (SSBs) are a leading source of added sugar in the American diet. Further, ingestion of added sugars from SSBs exceeds recommendations. Thus, interventions that effectively reduce SSB consumption are needed. Focus group discussions with parents (n = 37) and school-aged children between the ages of 6 and 11 years (n = 41) from Florida, New Jersey, and West Virginia were led by trained moderators using Social Cognitive Theory as a guide. Trends and themes that emerged from the content analysis of the focus group data indicated that both parents and children felt that limiting SSBs was important to health and weight control. However, parents and children reported consuming an average of 1.85 ± 2.38 SD and 2.13 ± 2.52 SD SSB servings/week, respectively. Parents and children were aware that parent behaviors influenced kids, but parents reported modeling healthy SSB behaviors was difficult. Busy schedules, including more frequent parties and events as children get older, were another barrier to limiting SSBs. Parents were most successful at limiting SSBs when they were not in the house. This qualitative research provides novel insights into parents' and children's cognitions (e.g., beliefs, attitudes), barriers, and facilitators related to SSB ingestion. Consideration of these insights during nutrition intervention development has the potential to improve intervention effectiveness in reducing SSB intake.

"My Tummy Tells Me" Cognitions, Barriers and Supports of Parents and School-Age Children for Appropriate Portion Sizes.

Larger portion sizes have increased in tandem with the rise in obesity. Elucidation of the cognitions of children and parents related to portion size is needed to inform the development of effective obesity prevention programs. This study examined cognitions of parents (n = 36) and their school-age children (6 to 11 years; n = 35) related to portion sizes via focus group discussions. Parents and children believed controlling portion sizes promoted health and weight control. Some parents felt controlling portions was unnecessary, particularly if kids were a healthy weight because kids can self-regulate intake. Barriers to serving appropriate portions identified by parents focused largely on kids getting enough, rather than too much, to eat. Parents also identified lack of knowledge of age-appropriate portions as a barrier. Facilitators of portion control cited by parents included purchasing pre-portioned products and using small containers to serve food. Children relied on cues from parents (e.g., amount of food parent served them) and internal hunger/satiety cues to regulate intake but found it difficult to avoid overeating highly palatable foods, at restaurants, and when others were overeating. Results suggest obesity prevention interventions should aim to improve portion sizes cognitions, barrier management, and use of facilitators, in families with school-age children.