Parents Report Positive Changes in Parental Feeding Practices 12 Months After Intervention.

OBJECTIVE: Determine self-reported parental feeding behavior changes and perspectives on parental feeding intervention at 12-month follow-up. METHODS: Telephone focus groups using a 2 × 2 design (English/Spanish × in-class or online) with Expanded Food and Nutrition Education Program participants (n = 37) with children 2-8 years and high exposure to the Food, Feeding, and Your Family intervention (7 lessons). Researchers (n = 3) independently identified themes. RESULTS: Parental behavior changes that (1) positively influenced children's diets, (2) involved children in food-related activities, (3) eased stressful situations around food, (4) led to healthier food choices, and (5) saved money when food shopping. Commonly implemented practices included establishing structured mealtime routines, introducing new foods multiple times, and encouraging children's eating competence. Online participants noted materials were easily accessible via text messages. CONCLUSIONS AND IMPLICATIONS: Incorporating parental feeding content (in-class or online) into nutrition education interventions, such as the Expanded Food and Nutrition Education Program, supports developing positive parental feeding behaviors in families with low income.

Using Mobile Technology for Family-Based Prevention in Families with Low Incomes: Lessons from a Randomized Controlled Trial of a Childhood Obesity Prevention Program.

Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart · Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.ClinicalTrials.gov Identifier: NCT03170700; Registration Date: March 08, 2017.

"I enjoy the good foods, all of which are not good for me." The categorization and moralization of food.

Intuitive eating emphasizes eating in response to physiological cues of hunger and satiety and is associated with multiple positive health outcomes. Unconditional permission to eat (UPE), a domain of intuitive eating, encourages removing food classifications and permission to eat all foods. However, the categorization of food is described as a method to simplify decision making and moralization of foods can help prioritize food items in consumption. Thus, we were interested in understanding how foods are labeled and applied, the moralization of foods, and how individuals with low UPE labeled and moralize foods. Using Prolific Academic, we recruited 49 adults 18 years and older living in the United States to complete an online survey and interview. The survey assessed intuitive eating (IES-2) and the interview explored what and how participants eat and their thoughts and feelings about their body. Participants frequently used multiple labels when talking about foods. Healthy and unhealthy were common and offered a rationale for consumption, emotions were used to label foods, and taste and cost were important to food choice. Participants frequently moralized foods, although three participants explicitly stated they choose not to moralize foods. Individuals reporting low UPE described the importance of restriction and were following strict dietary recommendations. While labeling foods has been proposed to simplify decision-making, the use of labels is highly nuanced and thus understanding the connections between how foods are labeled and behaviors may be highly complex. We suggest future research explore how the categorization and moralization of food are associated with health behaviors and outcomes, how differing definitions of "healthy/unhealthy" foods are associated with behaviors, and the impacts of food insecurity and chronic disease management on food categorization and moralization.

Perceived Changes in Social Connectedness Across the Life Course: A Mixed Method Approach.

Social connection is important across the life course, but overall levels have been declining. The COVID-19 pandemic presented a unique context to examine social connectedness and adaptive capacity in times of social adversity. We used a parallel mixed method design to collect online survey data from a representative U.S. sample (N = 359). Applying an exploratory sequential approach, we used a general linear model multivariate approach to repeated measures to test for differences in participants' perceptions of social connectedness by time and age category and qualitative analysis to gain insights about disrupted social contexts. Results indicated that social connectedness decreased after mitigation restrictions for all age groups, but individuals in emerging and late adulthood felt the greatest impact. Two themes emerged: differing emotional responses to altered communication and intentionality of maintaining and/or creating social connections. Experiences of social connectedness need to be understood as a function of life stage and developmental timing.

Short-Term Efficacy of a Childhood Obesity Prevention Program Designed to Pair Feeding Content With Nutrition Education.

Background: Family-based programs show considerable promise in preventing overweight and obesity in young children. However, dissemination is difficult because significant participant and staff involvement is required. This study examined the short-term efficacy of adding parental feeding content to a widely-used nutrition education curriculum for families in low-resourced communities comparing the influence of two delivery methods (in-class and online) on parents' feeding knowledge, practices, and styles. Methods: In this cluster randomized controlled trial, parents of 2- to 8-year-old children enrolled in the EFNEP (Expanded Food and Nutrition Education Program) in Colorado and Washington were randomly assigned to: in-class nutrition education only, in-class nutrition education with in-class feeding content, or in-class nutrition education with online feeding content. Data from the 382 participants who completed both pretest and posttest assessments are reported in this study. Results: Multilevel analyses showed empirical support for the influence of the program on parents' feeding knowledge, practices, and styles. Online and in-class methods were equally effective in delivering feeding content in low-resourced communities. Consistent effects were seen across the two delivery methods for encouraging children to try new foods (p < 0.05), use of child-centered feeding practices (i.e., greater responsiveness, p < 0.05), child involvement in food preparation (p < 0.05), and understanding the number of presentations often necessary for child acceptance of a new food (p < 0.001). Location and language differences were seen across some constructs. Conclusions: This study demonstrates the efficacy of in-class and online approaches to feeding highlighting the program's positive effects on promoting healthy feeding behaviors for parents of children in low-resourced families. ClinicalTrials.gov Identifier: NCT03170700.

Body image and eating behaviors: A latent profile analysis.

Body image is multidimensional and less is known about how the combination of positive and negative body image relates to eating behaviors. We used a person-centered approach to identify profiles of body image and explore the relationship between profile membership, sex, age, race, and current marital status, and eating behaviors in a community sample of adults. We recruited 288 adults 18 and older living in the United States using Prolific Academic. Participants completed an online survey assessing body appreciation, functionality appreciation, body dissatisfaction, weight bias internalization, and adaptive and maladaptive eating behaviors. We used latent profile analysis to identify four distinct body image profiles: appreciation & mild dissatisfaction, functional appreciation & moderate dissatisfaction, strong dissatisfaction, and strong appreciation. Profile membership differed by sex with more women and younger adults in profiles higher in negative body image. The relationships between profiles and eating behaviors differed; the three profiles including negative body image had the lowest adaptive and highest maladaptive eating behaviors. The identification of clinically relevant profiles: (1) confirm positive and negative body image coexist, (2) identify high- and low-risk profiles of body image and eating behavior, and (3) offer preliminary suggestions for screening and tailoring preventive interventions.

Communication About Food and Nutrition in the Parent Child Dyad.

PURPOSE: Developmentally appropriate messaging interventions may be an effective way to promote healthy behaviors in young children. However, there is a gap in the literature describing communication about food and nutrition within the parent-child dyad. Thus, we explored the content, frequency, context, and purpose of parental conversations about food and nutrition. DESIGN: Using a semi-structured interview guide, 20 in-person interviews were conducted with parents of 3 to 9 year old children living in Washington and Oregon at the location of their choice. METHODS: Qualitative data was analyzed using open coding and grounded theory. RESULTS: Three categories described communication within the dyad: purpose, content, and the bidirectional interaction between the parent and the child. Purpose included three themes: consumption, variety, and balance. Content included three themes: food-related content, body-related content, and utilizing connections. Subthemes within food-related content included properties, production, and preparation. Body-related content subthemes were utilization of food in the body and interoceptive awareness. Parents highlighted connections between the food and body-related content. Lastly, parent-child conversations about food and nutrition were dynamic and bidirectional with parents adapting to child factors. CONCLUSION: Our findings provide a description of parent communication about food and nutrition and suggest investigation of the purpose and content of communication and how parents tailor messages to their child.

Associations between body image, eating behavior, and diet quality.

Background: Weight-neutral interventions that promote adaptive eating behaviors are becoming a growing area of practice. Understanding whether adaptive eating behaviors are associated with improved diet quality is essential. Body image may be an important factor in this relationship given its close connection to eating behaviors. Aim: The purpose of this study was to develop an understanding of the relationships between positive and negative body image, adaptive and maladaptive eating behaviors, and diet quality. Methods: We recruited 288 adults 18 years and older who were living in the US using Prolific Academic. Participants completed an online survey including measures of positive and negative body image, adaptive and maladaptive eating behaviors, and a dietary screener questionnaire (DSQ). We ran a hierarchical linear regression and tested whether body image and diet quality were mediated by eating behavior. Results: Body image and maladaptive eating behaviors were not associated with diet quality. Body-food choice congruence (B-FCC), an adaptive eating behavior, was associated with diet quality. B-FCC mediated the relationship of positive and negative body image to diet quality. Conclusions: Our findings provide additional support for weight-neutral or adaptive eating interventions as a mechanism to promote diet quality. Additional research may benefit from exploring indirect effects of body image on diet intake, the relationship between eating behavior and diet quality using qualitative data, and the comparison of weight-neutral or non-diet interventions with traditional behavior change interventions.

Intuitive eating and dietary intake.

Intuitive eating has been associated with positive health benefits, yet the research investigating intuitive eating with dietary intake is minimal, inconsistent, and may differ by sex and food security status. The purpose of this study is to identify relationships between intuitive eating and dietary intake in adults living in the US and explore differences by sex and food insecurity status. We recruited 308 adults 18 years and older living in the US to complete an online survey including demographic data, intuitive eating, a diet screener questionnaire, and food insecurity status. We used structural equation modeling to analyze relationships between intuitive eating subscales, calcium, whole grains, added sugars, vegetables, and fruits. Then, we explored differences by sex and food security status. Unconditional permission to eat was associated with a higher intake of added sugar, while body-food choice congruence was associated with a lower intake of added sugar and calcium, and a higher intake of vegetables and whole grains. Eating for physical rather than emotional reasons was associated with a higher intake of calcium and vegetables. Intuitive eating differed by sex and food security status. While intuitive eating is not consistently related to the intake of more nutritious foods, eating for physical rather than emotional reasons and body-food choice congruence may promote diet quality in a community sample. Men and food secure adults scored higher in intuitive eating suggesting tailored intuitive eating interventions may be essential to increase effectiveness.

A lifespan perspective of structural and perceived social relationships, food insecurity, and dietary behaviors during the COVID-19 pandemic.

Physical distancing and economic impacts of the COVID-19 pandemic may influence dietary behaviors. Using a parallel mixed method design, we examined the relationships between structural and perceived social relationships on dietary behaviors across the adult lifespan and by food security status. A representative sample of 360 adults (18-78 years old) living in the United States were recruited through Prolific Academic to complete an online cross-sectional survey. Participants provided data about demographics, food insecurity, structural and perceived social relationships, diet quality, and unhealthy snacking at the onset of the pandemic. Participants responded to open-ended questions about perceived changes in social connections and dietary behavior since COVID-19. Quantitative findings indicated food insecure emerging and older adults were at highest risk for low diet quality and frequent unhealthy snacking. Friend support was associated with higher diet quality. Qualitative findings suggested overall decreases in social connection and changes in dietary behavior, with food insecure adults describing decreases in diet quality. Participants who reported increases in emotional eating also reported decreases in social connection. Findings suggest the pandemic may exacerbate inequalities, particularly among food insecure emerging and older adults. Scaling up preventive interventions to increase social connection and reduce food insecurity during unprecedented challenges may promote healthier dietary behaviors now and in the long-term.

Changes in Social, Economic, and Health Risk Factors Across the Lifespan during the COVID-19 Pandemic: A Latent Transition Analysis.

The COVID-19 pandemic led to unique, pervasive, and changing global impacts. It is imperative to characterize groups of individuals based on modifiable factors, and to describe how groups have been impacted by the continuing pandemic in the United States to promote health and well-being and to inform preventive interventions. We used latent transition analysis to identify subgroups of modifiable psychosocial, economic, and health risk factors; to explore subgroup shifts across time; and to assess the prevalence of non-modifiable factors associated with subgroup membership. We recruited 450 participants 18 years and older living in the United States to complete a longitudinal survey exploring health during the pandemic. Participants completed three waves of data collection from April to November 2020. We used latent transition analysis to identify statuses, shifts in prevalence over three waves, and the relationships of non-modifiable covariates with each status. Five statuses were identified: high risk together, low risk together, high risk alone, low risk alone, and financial risk together. Statuses were relatively stable over time; the majority (60%-66%) of participants were in statuses categorized by multiple indicators of high modifiable risk, and the largest transitions were to lower risk subgroups. Increasing age, being male, and living in an urban area were the only non-modifiable covariates associated with status membership. It is imperative to continue to scale up targeted interventions aimed at promoting resilience, well-being, financial well-being, delays in healthcare use, food insecurity, and depression among individuals in higher-risk subgroups to promote health and well-being.

Implementation Science Strategies Promote Fidelity in the Food, Feeding, and Your Family Study.

OBJECTIVE: Use of implementation science strategies to promote fidelity in the Food, Feeding, and Your Family study. DESIGN: Cluster randomized controlled trial with 3 conditions: control, in-class, or online, delivered in English or Spanish. Observations of 20% of classes. SETTING: Expanded Food and Nutrition Education Program (EFNEP) in 2 states. PARTICIPANTS: EFNEP peer educators (n = 11). INTERVENTION: Parental feeding content incorporated into EFNEP lessons (in-class) or through text with links to videos/activities (online). Extensive educator training, scripted curriculum, frequent feedback. ANALYSIS: Assessment of fidelity compliance. Qualitative analysis of verbatim educator interviews and classroom observer comments. RESULTS: During 128 class observations (40-45 per condition), peer educators followed scripted lesson plan 78% to 89% of the time. There was no evidence of cross-contamination of parental feeding content in control and only minor sharing in online conditions. Variations with fidelity were primarily tied to the EFNEP curriculum, not the parent feeding content. Educators (n = 7) expressed favorable opinions about the Food, Feeding, and Your Family study, thought it provided valuable information, and appreciated support from EFNEP leadership. CONCLUSIONS AND IMPLICATIONS: Incorporating implementation science strategies can help ensure successful adherence to research protocols. With proper training and support, EFNEP peer educators can deliver an evidence-based curriculum as part of a complex research study.

Twelve-Month Efficacy of an Obesity Prevention Program Targeting Hispanic Families With Preschoolers From Low-Income Backgrounds.

OBJECTIVE: Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children. DESIGN: Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks. SETTING: Families recruited from Head Start across 2 sites. PARTICIPANTS: Two hundred fifty-five families randomized into prevention (n = 136) or control (n = 119). INTERVENTION: Prevention received curriculum; control received no curriculum. MAIN OUTCOME MEASURE(S): Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child). ANALYSIS: Multilevel analyses for nested data (time points within families; families within waves) and multinomial regression. RESULTS: Program increased mothers' repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Program effects emphasize the importance of feeding approaches in reducing childhood obesity.

Differing Experiences of Boredom During the Pandemic and Associations With Dietary Behaviors.

OBJECTIVE: To examine how changes in feeling bored and eating because of boredom during the coronavirus disease 2019 (COVID-19) pandemic relate to intuitive eating, diet quality, and snacking. METHODS: A representative sample of 360 US adults completed an online survey including changes in feeling bored and eating because of boredom since the COVID-19 pandemic. An ANCOVA and multivariate analysis of covariance were used to examine relationships between intuitive eating, diet quality, and snacking in individuals who experienced: (1) increases in feeling bored and eating because of boredom, (2) eating because of boredom only, (3) increases in feeling bored only, and (4) no change/decreases in feeling bored and eating because of boredom. RESULTS: Individuals who increased feeling bored and eating because of boredom and increased eating because of boredom only snacked more and scored lower in intuitive eating. Diet quality did not differ across groups. CONCLUSIONS AND IMPLICATIONS: Although diet quality did not differ, eating because of boredom is potentially a negative impact on diet quality. Programs enhancing intuitive eating may be helpful.

Health Behaviors at the Onset of the COVID-19 Pandemic.

Objectives: We examined perceived behavior change since implementation of physical distancing restrictions and identified modifiable (self-rated health, resilience, depressive symptoms, social support and subjective wellbeing) and non-modifiable (demographics) risk/protective factors. Methods: A representative US sample (N = 362) completed an online survey about potential risk/protective factors and health behaviors prior to the pandemic and after implemented/recommended restrictions. We assessed change in perceived health behaviors prior to and following introduction of COVID-19. We conducted hierarchical linear regression to explore and identify risk/protective factors related to physical activity, diet quality, and social isolation. Results: There have been substantial decreases in physical activity and increases in sedentary behavior and social isolation, but no changes in diet quality since COVID-19. We identified modifiable and non-modifiable factors associated with each health behavior. Conclusions: Negative effects indicate the need for universal intervention to promote health behaviors. Inequalities in health behaviors among vulnerable populations may be exacerbated since COVID-19, suggesting need for targeted invention. Social support may be a mechanism to promote health behaviors. We suggest scaling out effective health behavior interventions with the same intensity in which physical distancing recommendations were implemented.

Applying Principles from Prevention and Implementation Sciences to Optimize the Dissemination of Family Feeding Interventions.

Because families are the primary food socialization agent for children, they are a key target for nutrition interventions promoting healthy eating development. Although researchers and clinicians have developed and tested successful family nutrition interventions, few have gained widespread dissemination. Prevention and implementation science disciplines can inform the design, testing, and dissemination of feeding interventions to advance the goals of widespread adoption and population health impact. We review concepts and frameworks from prevention science and dissemination and implementation (D&I) research that are useful to consider in designing, implementing, and evaluating feeding interventions. Risk and protective factor frameworks, types of translation processes, and implementation dimensions are explained. Specifically, we address how research-practice partnerships can reduce time to dissemination, how designing for modularity can allow for contextual adaptation, how articulating core components can strengthen fidelity and guide adaptation, and how establishing technical assistance infrastructure supports these processes. Finally, we review strategies for building capacity in D&I research and practice for nutrition professionals. In sum, the research and knowledge bases from prevention and implementation sciences offer guidance on designing and delivering family interventions in ways that maximize the potential for their broad dissemination, reducing time to translation and optimizing interventions for real-world settings.

Short-Term Effects of an Obesity Prevention Program Among Low-Income Hispanic Families With Preschoolers.

OBJECTIVE: To assess the short-term effects of an obesity prevention program promoting eating self-regulation and healthy food preferences in low-income Hispanic children. DESIGN: Randomized controlled trial with pretest, posttest, and 6- and 12-month assessments. SETTING AND PARTICIPANTS: Head Start and similar early learning institutions in Houston, TX, and Pasco, WA. A total of 255 families with preschoolers randomized into prevention (n = 136) and control (n = 119) groups. INTERVENTION: Multicomponent family-based prevention program. Fourteen waves lasted 7 weeks each with 8-10 mother-child dyads in each group. MAIN OUTCOME MEASURES: Parent assessments included feeding practices, styles, and knowledge. Child assessments included child eating self-regulation, willingness to try new foods, and parent report of child fruit and vegetable preferences. Parent and child heights and weights were measured. ANALYSIS: Multilevel analyses were employed to consider the nested nature of the data: time points within families within waves. RESULTS: The program had predicted effects on parental feeding practices, styles, and knowledge in the pre- to post-comparisons. Effects on child eating behavior were minimal; only the number of different vegetables tried showed significant pre-post differences. CONCLUSIONS AND IMPLICATIONS: Short-term effects of this prevention program highlight the importance of family-focused feeding approaches to combating child overweight and obesity.

Pairing Feeding Content With a Nutrition Education Curriculum: A Comparison of Online and In-Class Delivery.

OBJECTIVE: To develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model. DESIGN: A randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program. SETTING: Study will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State. PARTICIPANTS: Parents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states. INTERVENTIONS: FFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum. MAIN OUTCOME MEASURES: Parents will report on feeding practices, child eating behaviors, feeding styles, and acculturation. ANALYSIS: Because of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.

Child-Centered Nutrition Phrases Plus Repeated Exposure Increase Preschoolers' Consumption of Healthful Foods, but Not Liking or Willingness to Try.

OBJECTIVE: To determine whether the use of child-centered nutrition phrases (CCNP) with repeated exposure (RE) improved willingness to try, liking, and consumption of healthful foods compared with RE alone. DESIGN: The researchers used a 2 × 2 × 4 fractionated within-subjects experimental design in the study: phrase condition (RE vs CCNP + RE) by time of measurement (preintervention, postintervention, and 1-month follow-up), by type of food (tomatoes, bell peppers, lentils, and quinoa). SETTING: Children were recruited from 2 early education centers; 89% participated. PARTICIPANTS: Children aged 3-6 years old (n = 87) who were predominantly white (67%) and from middle-income homes and had parents with some higher education. INTERVENTION: Adult delivery of CCNP + RE weekly for 6 weeks. MAIN OUTCOME MEASURE(S): Willingness to try, change in liking, and change in consumption. ANALYSIS: Two-level random-effects models were used to account for repeated measurements of willingness to try, liking, and consumption nested within participants. RESULTS: Children exhibited greater consumption of CCNP foods at follow-up assessment compared with RE foods (b = -16.28, SE = 5.41, t(528) = 3.01; P = .003). CONCLUSIONS AND IMPLICATIONS: Use of CCNP combined with RE may encourage healthy eating, especially for novel foods that children may typically refuse.

Food parenting practices in rural poverty context.

Little is known about how low-income, rural mothers shape child eating behaviors. Descriptive and qualitative analysis of 55 mothers' surveys and in-depth interviews with 17 mothers in Washington state revealed a lack of alignment between mothers' intent to promote healthy child eating habits and counterproductive food parenting behaviors. Individual, family and community ecologies contributing to the divide included mothers' current nutrition knowledge, their childhood experiences, family food insecurity, housing issues preventing recommended practices, and a lack of public transportation or access to affordable grocery stores. The study highlights the need for educational programming that addresses contextual challenges and rural mothers' existing knowledge system to improve the family feeding environment.