Leveraging ecological momentary assessment to understand variability in food parenting practices within a low-income racially/ethnically diverse sample of parents of preschoolers.

Children's eating behaviors are shaped significantly by their home food environment, including exposure to food parenting practices. The current study leveraged ecological momentary assessment (EMA) to describe how food parenting practices used to feed preschoolers (n = 116) differed across contextual factors around eating, including type of eating occasion (i.e., meals vs. snacks), day of the week (i.e., weekend vs. weekday), who initiated the meal (parent vs. child), emotional climate of the eating occasion. Parent perceptions of how well the eating occasion went, including how well the child ate and whether the food parenting practices worked as intended were also explored. Parent use of specific food parenting practices, situated within four higher-order domains (i.e., structure, autonomy support, coercive control, indulgent), was found to differ by type of eating occasion; parents engaged in a higher proportion of structure practices at meals than at snacks. Use of specific food parenting practices differed by mealtime emotional climate; parent use of structure and autonomy support was associated with eating occasions described as relaxed, enjoyable, neutral, and fun. Finally, parent perception of how well the child ate differed by use of specific food parenting practices; during eating occasions when parent's felt their child ate "not enough", they used less autonomy support and more coercive control compared to eating occasions where the child ate "enough and a good balance." Leveraging EMA allowed for increased understanding of the variability in food parenting practices and contextual factors. Findings may be utilized to inform the development of larger-scale studies seeking to understand why parents choose specific approaches to feeding their children, as well as the impact of various approaches to child feeding on child health outcomes.

Parents of preschoolers use multiple strategies to feed their children: Findings from an observational video pilot study.

The current study leveraged observational data collection methods to fill gaps in our understanding of parent approach to feeding as well as child responses to various parental approaches. Specifically, the study aimed to: 1) characterize the broad range of food parenting practices used by parents of preschoolers during shared mealtimes at home, including differences by child gender, and 2) describe child responses to specific parent feeding practices. Forty parent-child dyads participated by recording two in-home shared meals. Meals were coded using a behavioral coding scheme that coded the occurrence of 11 distinct food parenting practices (e.g. indirect and direct commands, praise, bribes) and eight child responses (e.g., eat, refuse, cry/whine) to food parenting practices. Results revealed that parents engaged in a broad range of food parenting practices at meals. On average, parents in our sample used 10.51 (SD 7.83; Range 0-30) total food parenting practices per mealtime with a mean use of 3.38 (SD 1.67; Range 0-8) unique food parenting practices per mealtime. Use of indirect and direct commands to eat were most common; direct and indirect commands were used by 97.5% (n = 39) and 87.5% (n = 35) of parents at meals, respectively. No statistically significant differences were observed by child gender. No one specific feeding practice consistently yielded compliance or refusal to eat from the child, instead child responses were often mixed (e.g., compliance followed by refusal and/or refusal followed by compliance). However, use of praise to prompt eating was the practice that most often resulted in child compliance; 80.8% of children complied following parent's use of praise as a prompt to eat. Findings deepen our understanding of the types and frequency of food parenting practices used by parents of preschoolers during meals eaten at home and illuminate child responses to specific food parenting practices.

Directive and non-directive food-related parenting practices: Associations between an expanded conceptualization of food-related parenting practices and child dietary intake and weight outcomes.

This study examines associations between an expanded conceptualization of food-related parenting practices, specifically, directive and non-directive control, and child weight (BMI z-score) and dietary outcomes [Healthy Eating Index (HEI) 2010, daily servings fruits/vegetables] within a sample of parent-child dyads (8-12 years old; n = 160). Baseline data from the Healthy Home Offerings via the Mealtime Environment (HOME Plus) randomized controlled trial was used to test associations between directive and non-directive control and child dietary outcomes and weight using multiple regression analyses adjusted for parental education. Overall variance explained by directive and non-directive control constructs was also calculated. Markers of directive control included pressure-to-eat and food restriction, assessed using subscales from the Child Feeding Questionnaire; markers of non-directive control were assessed with a parental role modeling scale and a home food availability inventory in which an obesogenic home food environment score was assigned based on the types and number of unhealthful foods available within the child's home food environment. DIRECTIVE CONTROL: Food restriction and pressure-to-eat were positively and negatively associated with BMI z-scores, respectively, but not with dietary outcomes. NON-DIRECTIVE CONTROL: An obesogenic home food environment was inversely associated with both dietary outcomes; parental role modeling of healthful eating was positively associated with both dietary outcomes. Neither non-directive behavioral construct was significantly associated with BMI z-scores. TOTAL VARIANCE: Greater total variance in BMI-z was explained by directive control; greater total variance in dietary outcomes was explained by non-directive control. Including a construct of food-related parenting practices with separate markers for directive and non-directive control should be considered for future research. These concepts address different forms of parental control and, in the present study, yielded unique associations with child dietary and weight outcomes.

Food-related parenting practices and child and adolescent weight and weight-related behaviors.

The prevalence of overweight and obesity in children has reached a concerning plateau in the past three decades, with overweight or obesity impacting approximately one-third of youth. Unhealthy weight-related behaviors, including dieting, unhealthy weight control practices and binge eating, are also a great public health concern for young people given both their high prevalence and harmful consequences. Food-related parenting practices, including food restriction and pressure-to-eat, have been associated with higher weight status, as well as the use of unhealthy weight-related behaviors, in children and adolescents. Physicians and other health care providers who work with families should discourage parents from using food restriction and pressure-to-eat parenting practices with their child or adolescent. Alternatively, parents should be empowered to promote healthy eating by focusing on making nutritious food items readily available within their home and modeling healthy food choices for their child or adolescent.

Relationships between the family environment and school-based obesity prevention efforts: can school programs help adolescents who are most in need?

Identifying factors that contribute to students' behavior and weight improvements during school-based obesity prevention interventions is critical for the development of effective programs. The current study aims to determine whether the support and resources that adolescent girls received from their families were associated with improvements in physical activity (PA), television use, dietary intake, body mass index (BMI) and body composition during participation in New Moves, a school-based intervention to prevent obesity and other weight-related problems. Adolescent girls in the intervention condition of New Moves (n = 135), and one parent of each girl, were included in the current analysis. At baseline, parents completed surveys assessing the family environment. At baseline and follow-up, 9-12 months later, girls' behaviors were self-reported, height and weight were measured by study staff and body fat was assessed using dual-energy X-ray absorptiometry. Results showed few associations between family environment factors and girls' likelihood of improving behavior, BMI or body composition. These findings suggest that in general, school-based interventions offer similar opportunities for adolescent girls to improve their PA, dietary intake, and weight, regardless of family support.

Weight-related attitudes and behaviors of adolescent boys and girls who are encouraged to diet by their mothers.

OBJECTIVE: To assess the relationships between mothers' reports of dieting and encouraging adolescents to diet and adolescents' reports of their own dieting practices and weight-related concerns. DESIGN: Cross-sectional study of parent interviews and adolescent surveys in an ethnically-diverse sample. SUBJECTS: A total of 810 adolescents (n=381 boys and n=429 girls) and their mothers. RESULTS: Mothers' dieting was associated with their adolescent girls' weight-related concerns and behaviors, but these associations were not significant after adjusting for girls' body mass index (BMI). In contrast, mothers' encouragement for sons to diet was associated with sons' binge eating, dieting and other weight-control behaviors, even after controlling for sons' BMI. Compared with mothers who did not encourage their child to diet, mothers who encouraged their child to diet were significantly heavier women and were more likely to view their child as overweight. Forty-three percent of boys and 46% of girls who were encouraged by their mothers to diet were classified as nonoverweight by federal guidelines. CONCLUSIONS: Boys who are encouraged by their mothers to diet may be at risk for health-compromising eating and dieting behaviors, particularly binge-eating, fasting, eating a little bit of food and skipping meals. Parents who are concerned about their children's weight should be educated to encourage healthy eating habits and physical activity to promote their children's health, including healthy weight control.

Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables.

OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 4746 adolescent students. DESIGN: A survey was administered to students in classrooms at 31 secondary schools in a large metropolitan area in Minnesota, United States. Height and body weight were measured. SUBJECTS: Students in grades 7-12 who were enrolled in participating schools, had parental consent and were in attendance on the day of data collection. MEASUREMENTS: Frequency of fast food restaurant use (FFFRU), dietary intake, and demographic and behavioral measures were self-reported. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Height and body weight were directly measured. RESULTS: FFFRU was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and was inversely associated with daily servings of fruit, vegetables and milk. FFFRU was positively associated with student employment, television viewing, home availability of unhealthy foods, and perceived barriers to healthy eating, and was inversely associated with students' own and perceived maternal and peer concerns about healthy eating. FFFRU was not associated with overweight status. CONCLUSIONS: FFFRU is associated with higher energy and fat intake among adolescents. Interventions to reduce reliance on fast food restaurants may need to address perceived importance of healthy eating as well as time and convenience barriers.

The relative importance of social versus commercial sources in youth access to tobacco, alcohol, and other drugs.

BACKGROUND: Youth substance use began to increase in 1992 following a decade-long decline, leading to increased interest in controlling access to tobacco, alcohol, and other drugs. METHODS: The anonymous and voluntary Minnesota Student Survey was administered to 133,794 public school students in grades 6, 9, and 12. Questions addressed current frequency of use of tobacco, alcohol, and other drugs and how students obtained these substances. Data were analyzed to determine the relationship between grade level, gender, race/ethnicity, use frequency, and access to substances through social and commercial sources. (Tobacco analyses were limited to students under age 18 years.) RESULTS: Social sources (especially friends) predominate across all age groups and substances. Students are much more likely to obtain tobacco than alcohol from commercial sources but few rely exclusively on commercial sources for either. Females and infrequent users are more likely to depend on social sources exclusively while males and frequent users are more likely to use commercial sources. CONCLUSIONS: Because substances are easily accessible through social sources, prevention policies directed at retail outlets may not have the desired effect on reducing teen smoking and drinking. Greater attention to reducing access to all substances from social sources is needed.

Commitment to treatment goals in prediction of group cognitive-behavioral therapy treatment outcome for women with bulimia nervosa.

The purpose of this study was to investigate potential client variables that predict favorable response to group cognitive-behavioral therapy in a sample of women (N = 143) seeking treatment for bulimia nervosa. Similar to findings of previous studies, bulimic symptom remission at end of treatment was predicted by baseline degree of bulimic symptom severity but not by depressive symptomatology or perfectionism. After these variables were controlled for, both pretreatment ratings of desire to discontinue bulimic behaviors and expected success significantly added to prediction of treatment outcome. The primary variable found to predict longer term outcome was symptom remission at the end of treatment and at the 1-month follow-up.

Increasing weight-bearing physical activity and calcium intake for bone mass growth in children and adolescents: a review of intervention trials.

OBJECTIVE: The purpose of this review is to evaluate the current state-of-the-science for interventions to increase bone mass gains in children and adolescents using weight-bearing physical activity or calcium supplementation. METHODS: Studies were located using computerized and manual searches of the empirical literature. Inclusion criteria were: (a) intervention study targeting weight-bearing physical activity or calcium intake; (b) inclusion of a control group; (c) subject age range under 18 years; and (d) outcome measured bone mineral density or bone mineral content. RESULTS: Weight-bearing physical activity and calcium supplement intervention studies both consistently show positive effects on bone mass gains in children and adolescents. The most consistent findings for both weight-bearing physical activity and calcium were for lumbar spine and total body bone sites. Only weight-bearing physical activity interventions had significant effects on the femoral neck sites. Low power may have contributed to the lack of statistically significant findings in several studies and also prevented proper evaluation of potential interactions between pubertal status and interventions on bone mass gains. CONCLUSIONS: Increases in weight-bearing physical activity or calcium intake have positive effects on bone mass gains in children and adolescents. Further research is needed to evaluate: (a) the long-term durability of these effects; (b) specific dose-response associations; (c) interactions between weight-bearing physical activity and calcium intake; and (d) interactions between pubertal development and weight-bearing physical activity or calcium intake on bone mass outcomes.

DSM-IV substance abuse and dependence: are there really two dimensions of substance use disorders in adolescents?

AIM: To examine the distinctness of the DSM-IV substance abuse and dependence constructs in a large, general adolescent population. DESIGN: Data were collected using the 1995 Minnesota Student Survey. Survey items were designed to correspond to DSM-IV diagnostic criteria for substance abuse and dependence. SETTINGS: Public schools, alternative schools and area learning centers. PARTICIPANTS: Of the 78,800 students between the ages of 14 and 18 years who completed the survey, 18,803 reported substance use and at least one substance use disorder diagnostic criterion during the previous 12 months and were used for the analyses. The sample was divided randomly into two groups in order to conduct data analyses on one group (n = 9490) and confirm the findings in the other group (n = 9313). MEASUREMENTS: Confirmatory factor analyses were conducted to test three competing factor structure models consisting of a single factor model, a two-factor model of distinct dimensions and a two-factor model with interrelated dimensions. FINDINGS: The single factor and correlated two-factor models had similar parameter estimates and fit the data better than the competing two-factor model with distinct dimensions. Findings were confirmed in a second sample. CONCLUSIONS: The study findings indicate that DSM-IV substance abuse and dependence criteria may be more optimally structured as a unidimensional construct rather than as bidimensional constructs for adolescents.

Eating-disordered behaviors and personality characteristics of high school athletes and nonathletes.

OBJECTIVE: To assess whether high school athletes are at risk for an eating disorder, whether personality characteristics differentiate athletes from nonathletes, and whether high levels of perfectionism put athletes at risk. METHOD: 318 high school athletes were randomly matched to 360 nonathletes. Comparisons were made by means of the Eating Disorders Inventory (EDI), Restraint Scale, Risk Symptom Checklist, Multidimensional Personality Questionnaire (MPQ), and body mass index (BMI). RESULTS: Athletes did not have higher levels of disordered eating behaviors and attitudes than their nonathletic counterparts. Athletes had less negative views of life than nonathletes. However, perfectionistic tendencies may put some athletes at risk. DISCUSSION: High school athletes are not at greater risk for the development of an eating disorder than other students. Athlete's positive outlook on life and high self-efficacy may serve as protective factors. Alternatively, athletes may not be at risk until they train for one particular sport in a highly competitive environment.

DSM-IV substance use disorder criteria for adolescents: a critical examination based on a statewide school survey.

OBJECTIVE: The DSM-IV criteria for substance use disorders were incorporated into the 1995 Minnesota Student Survey in order to estimate the need for alcohol/drug treatment among adolescents in the state. This study used data from the survey to examine the utility of individual diagnostic criterion items, diagnostic categories, and diagnostic thresholds in a general adolescent population. METHOD: The survey was administered to ninth- and 12th-grade public school students. Participation was voluntary, and survey questionnaires were anonymous. The survey included questions about the use of substances during the past year and the presence of DSM-IV criterion symptoms for substance abuse and dependence. This study was based on responses from 74,008 students who answered these questions. RESULTS: Of the students who reported any substance use in the past 12 months, 13.8% of the ninth graders and 22.7% of the 12th graders met the criteria for a substance abuse diagnosis, and 8.2% of the ninth graders and 10.5% of the 12th graders met the criteria for dependence. The presence of multiple criterion symptoms was strongly associated with the use of multiple drugs. Analyses of positive and negative predictive value, sensitivity, and specificity did not support the diagnostic distinction between dependence criteria and abuse criteria. CONCLUSIONS: A combined set of criteria, with empirically derived diagnostic threshold categories based on total number of symptoms, may be more suitable for estimates of substance use disorders and need for treatment among adolescents.

Disordered eating in adolescent males from a school-based sample.

OBJECTIVE: The authors sought to describe a sample of adolescent males who reported disordered eating, to explore whether males with disordered eating are overweight or obese, and to determine if patterns displayed by females would be replicated with a male sample. METHOD: Three school-based adolescent samples were selected. (1) 27 males reporting disordered eating (2) 27 physically matched controls, and (3) 27 randomly selected controls. RESULTS: Findings indicated that boys reporting disordered eating expressed greater body dissatisfaction, depression, restraint, and poorer interoceptive awareness compared to matched and randomly selected controls. Negative Emotionality and poor Interoceptive Awareness scores showed the strongest associations with eating pathology. Body mass index and Negative Emotionality scores showed the strongest relationships to restrained eating. DISCUSSION: Previous results for female adolescents were replicated, suggesting that findings for females can be generalized to males. Disordered eating appears to exist in the absence of significant weight problems in adolescent males.

Multiple substance use among adolescent physical and sexual abuse victims.

OBJECTIVE: This study was conducted to examine the relationship between substance use patterns among adolescents and their histories of physical and/or sexual abuse. METHOD: The Minnesota Student Survey was administered in 1995 to 122,824 public school students in Grades 6, 9, and 12. Substance user groups were created based on frequency of use and the number of substances used. Use of individual substances, use of multiple substances, age of first use, and reasons for use were examined with respect to histories of physical and/or sexual abuse. RESULTS: Physical and sexual abuse were associated with an increased likelihood of the use of alcohol, marijuana, and almost all other drugs for both males and females in the three grades surveyed. Use of multiple substances was highly elevated among victims of abuse, with the highest rates seen among students who reported both physical and sexual abuse. Abuse victims also reported initiating substance use earlier than their nonabused peers and gave more reasons for using, including use to cope with painful emotions and to escape from problems. CONCLUSION: Because of their increased vulnerability, young victims of physical and sexual abuse need improved prevention, early intervention, and treatment services related to substance use.

The future of risk factor research in understanding the etiology of eating disorders.

This article explores whether particular risk factors are best seen as precursors or as symptoms. Psychological, cultural, family, developmental, and biological risk domains that may be important in the etiology of eating disorders are briefly reviewed. We describe a 4-year prospective study assessing a wide range of risk factors for development of eating disorders in a large school-based sample of adolescents. For subjects who were relatively asymptomatic, a personality or temperamental characteristic of negative affect/esteem measured at study entrance was the only significant predictor of later risk score for both girls and boys. The significant comorbidity demonstrated in a separate group that had high risk for eating disorders suggests that negative affectivity may be a vulnerability factor for overall psychopathology rather than a predisposition specifically for eating disorders. Following subjects through the young-adult years and later may further clarify the range of influences affecting disordered eating. Primary prevention and early intervention programs in the schools are also recommended.

The development of patient profiles for Minnesota's treatment outcomes monitoring system.

Minnesota's treatment outcomes monitoring system is a cooperative effort between the State alcohol and drug abuse agency and 366 licensed treatment providers. A minimum dataset is required on all treatment admissions to provide a state-wide system profile. In addition, data are being collected on a sample of 30 patients from each program to measure patient characteristics and severity of problems, patient perceptions of needed assistance, actual nature and amount of services received, patient satisfaction and patient functioning 6 months following discharge from treatment. The dimensions measured include alcohol and other drug use, physical health, psychological well-being, employment and financial status, family and social relationships and criminality. The aggregated data will be analysed to determine what types of services are associated with more favorable outcomes for different types of patients. The findings will be used to develop standards for treatment placement and service delivery based on individual patient profiles. This report provides an overview of the plan and an illustration of how patient profiles can be developed for purposes of treatment service matching and outcomes monitoring.

Self-esteem and change in body mass index over 3 years in a cohort of adolescents.

Self-esteem has been hypothesized to be lower in obese adolescents relative to their normal weight peers and to be an important factor in preventing or reversing obesity. The present study examined the relationship between obesity and self-esteem cross-sectionally and prospectively over three years in a cohort of 1278 adolescents in grades 7 to 9 at baseline. Cross-sectional analyses revealed an inverse association between physical appearance self-esteem and body mass index in both males and females. In females, body mass index was inversely associated with global self-esteem, close friendship, and behavioral conduct self-esteem. In males, body mass index was inversely associated with athletic and romantic appeal self-esteem. Prospectively, in females, physical appearance and social acceptance self-esteem at baseline were inversely related to body mass index three years later. Baseline self-esteem was unrelated prospectively to change in body mass index in males. All associations were modest in magnitude. These results suggest that in a middle class white sample of adolescents, self-esteem specific to physical appearance is modestly associated with body mass index. Low self-esteem does not appear to predict the development of obesity over time.

Dieting behaviors and weight change history in female adolescents.

The prevalence of dieting, weight change history, and specific weight loss behaviors was examined in a population-based sample of 1,015 female 9th-12th graders. Healthy weight loss behaviors were reported much more frequently than unhealthy weight loss behaviors (e.g., healthy behaviors: exercise = 32.4%, decrease fat intake = 26.0%, reduce snacks = 25.0%, reduce kilocalorie intake = 22.4%; unhealthy behaviors: fasting = 8.1%, diet pills = 5.4%, vomiting = 4.4%). Obesity status and restrained eating scores were positively related to greater history of weight loss episodes, pounds lost, and weight fluctuations and to greater use of healthy weight loss methods and weight loss programs. Implications for public health recommendations regarding dieting and its associated behaviors in female adolescents are discussed.

Changes in psychological variables and health behaviors by dieting status over a three-year period in a cohort of adolescent females.

PURPOSE: Psychologic and behavioral changes associated with frequent dieting were examined. Compared to nondieters, frequent dieters were hypothesized to show more adverse psychologic changes and increased use of unhealthy weight control behaviors, but possibly healthier eating and exercise behavior changes, over the three-year period of observation. METHODS: A prospective study of female students, in grades 7-10 at baseline completed a health behavior survey in school once a year for a total of three years. RESULTS: Restrained eating, body dissatisfaction and drive for thinness, self-induced vomiting, laxative use, diet pill use, and alcohol use, significantly increased, and physical appearance and self-concept significantly decreased among frequent dieters, compared to non-dieters. Changes in scores on five EDI subscales, eight self-esteem subscales, weight fluctuations, dietary intake, and physical activity patterns did not significantly differ over time by dieting status. CONCLUSION: Dieting may reflect a general pattern of unhealthy behaviors adopted in adolescence, rather than act as a causal factor in promoting psychologic distress.