Remembered childhood mealtime experiences influence on early childcare and education staff.

Parent feeding styles, behaviors, beliefs, and practices are associated with developing children's eating behaviors. However, many children spend considerable time in childcare; thus, are exposed to child-feeding practices of other adults, e.g., early care and education (ECE) staff. Limited research exists on how and whether current classroom feeding practices of ECE staff associate with their own childhood experiences. The About Feeding Children survey, conducted in 2005, examined self-reported feeding practices and beliefs and personal characteristics of ECE staff in Western United States. An exploratory factor analysis of questions related to childhood experiences (N = 1189), revealed two Mealtime Factors: Remembered Adult Control and Remembered Child Autonomy Support. Structural equation modeling was conducted to examine the hypothesis that these remembered experiences would be associated with current feeding practices (Structural Mealtime Strategies, Verbal Mealtime Strategies, and Beliefs about Mealtimes). For each outcome, models had good to moderate fit. Across models, Remembered Autonomy Support was associated with less control, bribing, autonomy undermining, and concern-based control beliefs and greater support at meals and autonomy promoting beliefs in teachers' classroom feeding practices. More research is called for to consider whether reflection on remembered childhood experiences might be beneficial to consider during ECE staff training related to feeding young children.

Strengthening Nutrition Education and Behavior Research for Academicians and Practitioners.

Nutrition education and behavior research is essential for translating scientific nutrition-related evidence into actionable strategies at the individual, family, community, and policy levels. To enhance the impact of nutrition educators and researchers' efforts, there is a need for continued and directed support to sustain the rigor of research. It is the perspective of this paper that the field of nutrition education and behavior research address its inherent complexities to meet the diverse investigative strategies used by academicians as well as practitioners. Such strategies could ensure the role of nutrition education and behavior in ongoing nationwide efforts to address emerging and novel nutrition research.

Preschoolers Build Fundamental Motor Skills Critical to an Active Lifestyle: The All 4 Kids© Intervention Study.

This pragmatic, real world study examined the effects of the All 4 Kids© intervention on preschoolers' mastery of movement skills and determined whether the instruction had greater impact than natural development. Methods included a quasi-experimental intervention-comparison subsample of 379 children (COMPARISON) and a pretest-posttest design with convenience scale-up sampling of 2817 preschoolers (SCALE-UP). Children receiving education and dance instruction 3 times/week for 8 weeks were assessed using the Preschool Movement Assessment to evaluate skills pre and post intervention. Using repeated measures ANOVA, McNemar and Wilcoxon signed ranks tests, preschooler's participation in the intervention resulted in greater improvement in 12 movement skills (F = 83.451, df = 1, p < 0.001, η p 2 = 0.555), balance (p = 0.028), hopping (t = -3.545, df = 112, p = 0.001) and crossing the midline (p < 0.001) than natural development (COMPARISON). In the SCALE-UP study, children significantly improved in all measures based on post-intervention scores. Significant differences were observed between Hispanic and non-Hispanic children for the 12-skills (b = -0.758, se = 0.161, p < 0.001) using hierarchical linear models; boys' and girls' scores were not differentially impacted by the intervention. Therefore, implementation of interventions focused on fundamental movement skill development have the potential to remediate secular motor skill decline in young children.

Workplace Lactation Support: Using Implementation Climate to Inform a New Model.

Introduction: Breastfeeding (BF) duration remains problematic, especially among women returning to work. Given that use of workplace lactation support programs has not gained traction in improving BF duration, there appears to be elements missing from lactation support initiatives that need further exploration. The field of Implementation Science, in explaining organizational behavior, provides an opportunity to inform a better model for workplace BF support. Materials and Methods: To inform a new model for workplace lactation support, data from the Breastfeeding and Employment Study (BESt) were combined with Implementation Climate theory. BESt surveyed companies on their BF supports, and used hierarchical linear modeling to determine the association of those supports with company employee perceptions of and manager attitudes toward BF supports. Results: Employee scores were not associated with any company scores. Total company scores were associated with more positive manager attitudes (p < 0.01), due to structural supports, or those supports most visible to managers. Considering these results along with other studies, it is proposed that employees and managers are influenced by tangible (physical) as well as intangible (people) workplace lactation supports. Furthermore, strategies are needed to design and implement approaches to these components to increase workplace lactation support and improve BF durations. Conclusions: Implementation strategies will vary with the diversity of workplaces and how they function. A better understanding of the application of implementation climate for workplace lactation support will help tailor programs and their implementation to improve BF duration in employed women.

Interrater Reliability of a Field-Based Preschool Movement Skills Assessment.

OBJECTIVE: To determine the interrater reliability of the Preschool Movement Assessment (PMA), a unique field-based assessment tool for use by early childhood professionals in preschool settings. METHODS: A total of 123 preschool children, aged 3-5years, were assessed by 6 trained raters using the PMA tool in an intervention. Interrater agreement on individual items of the PMA was determined using the kappa (κ) and intraclass correlation coefficient statistics. RESULTS: Weighted κ values were 0.82-0.96, indicating excellent agreement for all constructs of the PMA. The 95% confidence intervals indicated that all weighted κ's were statistically significant. The intraclass correlation coefficient for the PMA total score was 0.97. CONCLUSIONS AND IMPLICATIONS: After additional developmental research, the tool might serve to establish and support a minimum level of functional movements that should be attained before a child enters grade school.

About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers.

BACKGROUND: Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children. METHODS: Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted. RESULTS: Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60). CONCLUSIONS: The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.

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.

Potential Use of Food/Activity, Parenting Style, and Caregiver Feeding Style Measurement Tools with American Indian Families: A Brief Report.

Objective To provide preliminary descriptive data on caregiver and child weight status, parenting styles, feeding styles, and feeding practices of a small American Indian sample. Methods Participants included a subsample of American Indian caregivers (n = 23) identified from a larger study that was conducted in five states. Using previously validated instruments, means, standard deviations, and ranges for general parenting styles, feeding styles, and feeding practices were explored. Results In general, most caregivers reported healthy feeding practices. Most caregivers scored higher on responsive compared to restrictive or permissive in general parenting. Of the sample, 12 caregivers (52.2 %) were classified in the indulgent feeding style category, 5 caregivers (21.7 %) were classified as authoritative, 5 (21.7 %) uninvolved, and 1 (4.3 %) authoritarian. Conclusions More investigations are needed to explore questions raised by this study about using common tools that measure childhood obesity with American Indian families.

Is family sense of coherence a protective factor against the obesogenic environment?

Despite greater risk for poor nutrition, inactivity, and overweight, some low-income children are able to maintain a healthy weight. We explore if a strong family sense of coherence (FSOC) acts as a protective factor against childhood obesity for low-income preschool children. Families with a strong FSOC view challenges as predictable, understandable, worthy of engaging, and surmountable. Data were collected from 321 low-income mothers and their preschool children in five states between March 2011 and May 2013. FSOC was assessed using the Family Sense of Coherence Scale. A 16-item checklist was used to assess practicing healthy child behaviors (fruit and vegetable consumption and availability, physical activity, and family meals) and limiting unhealthy child behaviors (sweetened beverage and fast food consumption, energy dense snack availability, and screen time). Child body mass index (BMI) z-scores were calculated from measured height and weight. FSOC was significantly associated with practicing healthy child behaviors (ß = 0.32, p < .001). We did not find a statistically significant association between FSOC and limiting unhealthy child behaviors or child BMI z-scores in fully adjusted models. Our results suggest the importance of family functioning in predicting health behaviors around food consumption and availability, physical activity, and family meals.

Breastfeeding Knowledge and Attitudes of Nevada Health Care Professionals Remain Virtually Unchanged over 10 Years.

BACKGROUND: It is prudent that health care professionals remain cognizant of breastfeeding-related issues to support nursing mothers. In 1995, Freed and colleagues noted deficits in breastfeeding knowledge among family medicine, pediatric, and obstetrics/gynecology residents and practitioners. Others reported similar findings despite calls to action and reports of successful breastfeeding interventions. OBJECTIVE: This retrospective study compared baseline breastfeeding knowledge and attitude scores from Nevada health care professionals from 2004 through 2013. METHODS: In-training and practicing professionals (pediatric/family practice/obstetric residents and attending physicians; hospital nursing staff; nursing and medical students) attended a 90-minute workshop at their sites. Following each session, attendees voluntarily completed a survey consisting of 2 knowledge and 2 attitudinal questions, using the post:pre-evaluation method, which diminishes overinflation of pretest scores as respondents can more accurately reflect their baseline levels. A Kruskal-Wallis test evaluated differences in baseline knowledge and attitude scores among 3 professional groups and for physicians over the 10-year period using Bonferroni post-hoc analyses. RESULTS: A total of 889 professionals participated, with only physicians represented yearly. Except for knowledge of milk production, physician median baseline scores did not differ significantly over time. Overall, hospital nurses had significantly higher median baseline knowledge scores about initiation and frequent feeding than physicians and students. Nurses also had higher median attitude scores (likelihood of and confidence in talking with parents about breastfeeding) than physicians who had higher scores than students. CONCLUSION: Despite growing societal enthusiasm and support, the baseline knowledge of and attitudes toward breastfeeding showed minimal change over 10 years.

Family Resiliency: A Neglected Perspective in Addressing Obesity in Young Children.

BACKGROUND: Traditional research primarily details child obesity from a risk perspective. Risk factors are disproportionately higher in children raised in poverty, thus negatively influencing the weight status of low-income children. Borrowing from the field of family studies, the concept of family resiliency might provide a unique perspective for discussions regarding childhood obesity, by helping to identify mediating or moderating protective mechanisms that are present within the family context. METHODS: A thorough literature review focusing on (1) components of family resiliency that could be related to childhood obesity and (2) factors implicated in childhood obesity beyond those related to energy balance was conducted. We then conceptualized our perspective that understanding resiliency within an obesogenic environment is warranted. RESULTS: Both family resiliency and childhood obesity prevention rely on the assumptions that (1) no one single answer can address the multifactorial nature involved with adopting healthy lifestyle behaviors and (2) the pieces in this complex puzzle will differ between families. Yet, there are limited holistic studies connecting family resiliency measures and childhood obesity prevention. Combining mixed methodology using traditional measures (such as general parenting styles, feeding styles, and parent feeding behaviors) with potential family resiliency measures (such as family routines, family stress, family functioning, and family structure) might serve to broaden understanding of protective strategies. CONCLUSIONS: The key to future success in child obesity prevention and treatment may be found in the application of the resiliency framework to the exploration of childhood obesity from a protective perspective focusing on the family context.

Preschoolers can distinguish between healthy and unhealthy foods: the all 4 kids study.

OBJECTIVE: To determine changes in preschoolers' ability to distinguish between healthy and unhealthy foods and stated food preferences after participation in a nutrition education program. DESIGN: Pre-post comparison/intervention study with sites clustered based on center size and language. SETTING: Preschool classrooms. PARTICIPANTS: A total of 191 preschoolers from Nevada and 128 from Connecticut, New Jersey, and Oklahoma. INTERVENTION: All 4 Kids, a 24-lesson program taught by trained instructors. MAIN OUTCOME MEASURES: Pre- and post-assessment sum scores for identifying 18 foods; stated preference for, and distinguishing between, healthy vs unhealthy choice from 9 food pairs using a newly designed tool. ANALYSIS: t tests; multiple linear and logistic regression models. RESULTS: There was a statistically significant improvement in identification scores from pre- to post-study for both groups from Nevada (P < .001). For preference and distinguishing between healthy and unhealthy foods, no differences were noted at pretest. At posttest, significantly more intervention than comparison preschoolers indicated a preference for healthier foods (P < .006) and an ability to distinguish them (P < .03). Outcome comparison between Nevada and 3 states demonstrated generalizability of the study tool. CONCLUSIONS AND IMPLICATIONS: Participation in All 4 Kids resulted in preschoolers' increased understanding of healthy foods and changed their stated food preferences.

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.

The use of low-calorie sweeteners by adults: impact on weight management.

The application of low-calorie sweeteners (LCS) in foods and beverages has increased over the past 35 y. At the same time, many characteristics of the American diet have changed, including variations in fat and carbohydrate content and composition, increased nutrient additions, and new dietary patterns due to changing lifestyles and attitudes toward food and the changing cost of food. During this same time period, the prevalence of overweight and obesity has increased from ~30 to 70% of adults in the United States. Clearly, these trends lead to a variety of hypotheses and efforts to explain the role of LCS in this association. The aim of this review is to gain clarity on the role of LCS in weight management and their impact on diet quality. In addition, because the majority of studies aimed at identifying associations between LCS and these outcomes are based on observational data, the pitfalls in designing and evaluating data from observational studies are also discussed. We conclude that there is no evidence that LCS can be claimed to be a cause of higher body weights in adults. Similarly, evidence supporting a role for LCS in weight management is lacking. Due to the confounders in most observational studies, randomized controlled trials are needed to advance understanding.

Child care provider training and a supportive feeding environment in child care settings in 4 states, 2003.

INTRODUCTION: Strategies to prevent adult chronic diseases, including obesity, must start in childhood. Because many preschool-aged children spend mealtimes in child care facilities, staff should be taught supportive feeding practices for childhood obesity prevention. Higher obesity rates among low-income children suggest that centers providing care to these children require special attention. We compared self-reported feeding practices at child care centers serving low-income children on the basis of whether they received funding and support from the Child and Adult Care Food Program (CACFP), which suggests supportive feeding practices. We also assessed training factors that could account for differences among centers. METHODS: Eligible licensed child care centers (n = 1600) from California, Colorado, Idaho, and Nevada received surveys. Of the 568 responding centers, 203 enrolled low-income families and served meals. We analyzed the responses of 93 directors and 278 staff for CACFP-funded centers and 110 directors and 289 staff from nonfunded centers. Chi square analyses, pairwise comparisons, t tests, and multiple linear regressions were used to compare CACFP-funded and nonfunded centers. RESULTS: Significant differences were noted in 10 of 26 feeding practices between CACFP-funded and nonfunded centers. In each case, CACFP-funded centers reported practices more consistent with a supportive feeding environment. Forty-one percent of the variance could be explained by training factors, including who was trained, the credentials of those providing training, and the type of training. CONCLUSION: Our findings suggest that when trained by nutrition professionals, child care staff learn, adopt, and operationalize childhood obesity prevention feeding guidelines, thereby creating a supportive mealtime feeding environment.