Virtual fitness buddy ecosystem: a mixed reality precision health physical activity intervention for children.

6-11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact.

Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment.

BACKGROUND: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. OBJECTIVE: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. METHODS: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question "Overall, how difficult was it for you to fill out the surveys today?" on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. RESULTS: The burden was low at 1.2 (SD 1.14) indicating "a little" burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English-speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (ß=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. CONCLUSIONS: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives.

Spillover from parent stress to family meals among diverse families: An ecological momentary assessment study.

Family meals are beneficial for youth healthy development. However, parents' experiences of daily stressors may hinder their capacity to facilitate family meals, serve healthful foods, and have implications for the family meal atmosphere. Using data from ecological momentary assessment, we examined whether family meals are less likely to occur, meals are less healthful, and meal atmosphere is less positive on days when parents experience higher-than-usual stress and whether coparenting support buffers these associations. We also explored the role of family stressors in these links. Participants were 497 parents (Mage = 35.86 years; 91% female) of 5- to 9-year-old children who identified as Asian (15%), Black (17%), Hispanic (10%), Native American (10%), Native Hawaiian (< 1%), White (38%), multiracial (8%), or other (< 1%). Results from multilevel models indicated that daily deviations in parents' stress levels were not correlated with family meal occurrence, healthfulness, or positive atmosphere. However, on days when the source of parents' stress was family related (e.g., family demands), odds of a positive meal atmosphere were significantly lower (OR = 0.92, 95% CI [0.88, 0.96]), adjusting for other sources of stress. Coparenting relationship quality was positively associated with family meal occurrence (OR = 1.34, 95% CI [1.01, 1.79]) and healthfulness (γ = 0.20, p < .001), however, it did not moderate links between stress and family meal occurrence, healthfulness, or atmosphere. Findings suggest that day-to-day fluctuations in parents' stress levels may not disrupt whether a family meal occurs, the healthfulness of foods served, or the atmosphere of family meals. However, family stressors and coparenting relationship quality merit investigation as potential intervention targets. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interpersonal Discrimination, Neighborhood Inequities, and Children's Body Mass Index: A Descriptive, Cross-Sectional Analysis.

Psychosocial stressors have been implicated in childhood obesity, but the role of racism-related stressors is less clear. This study explored associations between neighborhood inequities, discrimination/harassment, and child body mass index (BMI). Parents of children aged 5-9 years from diverse racial/ethnic backgrounds (n = 1307), completed surveys of their child's exposure to discrimination/harassment. Census tract data derived from addresses were used to construct an index of concentration at the extremes, a measure of neighborhood social polarization. Child's height and weight were obtained from medical records. Multiple regression and hierarchical models examined child's BMI and racism at the individual and census tract levels. Children residing in the most Black-homogenous census tracts had 8.2 percentage units higher BMI percentile (95% confidence interval, 1.5-14.9) compared with white-homogenous tracts (P = .03). Household income and home values were lower, poverty rates higher, and single parent households more common among Black-homogeneous census tracts. Almost 30% of children experienced discrimination/harassment in the past year, which was associated with a 5.28-unit higher BMI percentile (95% confidence interval, 1.72-8.84; P = .004). Discrimination and racial/economic segregation were correlated with higher child BMI. Longitudinal studies are needed to understand whether these factors may be related to weight gain trajectories and future health.

Complex Posttraumatic Stress Disorder Links Trauma Exposure and Suicidal Behaviors Among Sexual Minority Populations: A New Target in Suicide Prevention?

Exposure to potentially traumatic events and posttraumatic stress are known risk factors for suicidal thoughts and behaviors (STB). Research suggests that sexual minorities are disproportionately exposed to traumatic events and experience greater STB than their heterosexual peers, although few studies have explored connections between these parallel disparities. Further, existing literature may implicate complex posttraumatic stress disorder (CPTSD) as a potential mechanism in the trauma-suicide connection among sexual minorities. This study uses a sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 1351) to test structural equation models for associations between trauma exposure, heterosexist discrimination, and CPTSD with suicide attempt status. We found CPTSD mediated associations between exposure to traumatic events and presence of a lifetime suicide attempt among sexual minority male and female samples. Discrimination demonstrated a synergistic effect on the association between trauma exposure and CPTSD, but, among males, CPTSD did not fully explain associations between discrimination and suicide attempts. Our findings suggest that CPTSD should be considered an important mechanism in the trauma-suicide connection for sexual minorities and may be a potentially important target for suicide prevention and that interventions should address the influence of discrimination on traumatic stress in this high-risk population.

Is Trauma Exposure More Harmful for Sexual Minority Youth? Differences in Trauma-Suicide Associations in a Nationally Representative Sample of U.S. Youth and Implications for Suicide Prevention.

Purpose: Lesbian, gay, and bisexual (LGB) youth experience disproportionately high rates of suicidality and exposure to traumatic events, such as sexual violence and teen dating violence. Rates of suicidality and exposure to traumatic events also vary by sexual minority subgroup. The purpose of this study was to: (1) explore the impact of LGB identity on the relationship between violence exposure and suicide; and (2) to examine variations by sexual identity. Method: A subsample of respondents who reported on their sexual identity in the Youth Risk Behavior Survey (n = 14,690) was used to examine if the associations between sexual and dating violence with suicide outcomes (suicidal ideation, planning, and suicide attempt) depended on the sexual identity of the respondent. Logistic regression models were fitted with an interaction effect to quantify heterogeneity of associations across identity strata. Results: Overall interaction tests mostly indicated heterogeneity of associations between sexual violence and physical dating violence. Several contrast of strata associations suggested substantive probability differences between sexual minority respondents and their heterosexual peers. Conclusion: While exposure to violence was broadly associated with increased probability of experiencing any type of suicidality, LGB and questioning youth were significantly more likely to experience suicidality compared to their heterosexual peers. Gay and lesbian youth demonstrated the strongest probability of experiencing suicidal thoughts and behaviors among survivors of sexual violence, while bisexual youth may be more at risk following dating violence. Implications for future research and suicide prevention are discussed.

Associations Between Adverse Childhood Experiences and Stressful Life Events and Health Outcomes in Pregnant and Breastfeeding Women from Diverse Racial and Ethnic Groups.

Background: This study sought to understand the characteristics of racially/ethnically diverse pregnant and breastfeeding women who have experienced adverse childhood experiences (ACEs) and stressful life events (SLEs) and the relationship among ACEs, SLEs, and health outcomes in this population. Materials and Methods: This was a secondary analysis of cross-sectional data from the Family Matters study. The participants in this study were families with children ages 5-9 (N = 1,307) recruited from Minneapolis-St. Paul primary care clinics representing six racial/ethnic backgrounds (White, Black, Native American, Hmong, Somali, Latino). Primary caregivers completed surveys about personal health, parenting styles, resilience, ACEs, and SLEs. Linear and logistic regression models were used to examine the associations between ACEs and SLEs with health outcomes of pregnant and breastfeeding women at the individual level. Results: A total of 123 racially/ethnically diverse women in this study reported being pregnant or currently breastfeeding. Eighty-eight (72%) reported a history of ACEs or SLEs. Those with both ACEs/SLEs reported more depression, economic strain, and a shorter duration of living in the United States. An increase in one reported ACE or SLE was positively associated with self-reported stress, number of reported medical conditions, substance use, self-efficacy, and permissive parenting (all ß coefficients p < 0.05). SLEs independently demonstrated increased predictive probability of severe mental health distress (6.7 percentage points, confidence interval [95% CI: 0.02-0.11; p < 0.01]) and moderate or severe anxiety (7.5 percentage points [95% CI: 0.04-0.11; p < 0.001]). Conclusion: Exposure to ACEs and SLEs appear to have significant impacts on physical health, mental health, and substance use in pregnant racially/ethnically diverse women.

A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design.

BACKGROUND: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. METHODS/DESIGN: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. DISCUSSION: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. TRIAL REGISTRATION: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

A Three-Arm Randomized Controlled Trial Using Ecological Momentary Intervention, Community Health Workers, and Video Feedback at Family Meals to Improve Child Cardiovascular Health: The Family Matters Study Design.

Background: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. Methods/design: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI+Virtual Home Visiting with CHW+Video Feedback; and (3) EMI+Hybrid Home Visiting with CHW+Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n=525) with increased risk for cardiovascular disease (i.e., BMI ≥75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. Discussion: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary assessment, intervention, video feedback and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. Trial Registration: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals.

OBJECTIVE: To examine parent-reported key family meal characteristics to advance the conceptualization of how parents perceive family meals to inform public health interventions and clinical practice. DESIGN: Cross-sectional study design using ecological momentary assessment (EMA) and online survey data from a racially and ethnically diverse population. PARTICIPANTS: Parent/child dyads (N = 631) with children ages 5-9 years old from diverse, low-income households. ANALYSIS: Multi-level logistic regression, conditional fixed effects estimators and multi-level logistic models with inverse probability weights. RESULTS: Characteristics of meals that parents considered family meals (N = 3328) included: homemade, prepared by the caregivers, eaten at home (table/counter), most of the nuclear family gathered, having a conversation and an enjoyable atmosphere (p < 0.001). Characteristics of meals that parents deemed as non-family meals (N = 562) included: watching TV/tablets, non-family members joining, chaotic/rushed atmosphere (p < 0.001). CONCLUSIONS AND IMPLICATIONS: Parents consider family meals to be meals that take place at home around a table/counter, with homemade food prepared by the caregivers, and most family members gathered enjoying a conversation without other distractions. Study findings indicated that parents endorse specific characteristics as key for defining what "counts" as a family meal. These findings can be used by clinicians as recommendations for improving one's family meal experience and by future research as the basis for intervening on family meal characteristics and standardization of a definition of family meals.

Associations Between Weight Talk and Biopsychosocial Outcomes in Children from Racially/Ethnically Diverse Households.

Weight talk in the home-parents talking to their children about their weight, shape or size-has been associated with many negative health outcomes in children and adolescents, although the majority of research has been with adolescents. This study explored associations between weight talk in the home and a broad range of child biopsychosocial outcomes (e.g., weight status, diet quality, psychological well-being, peer problems), in addition to child sex and race/ethnicity. Parents of 5-7 year old children from six racial/ethnic groups (White, African American, Hmong, Latino, Native American, Somali) (n=150) completed an online survey and completed 24-hour dietary recalls on the child. Additionally, anthropometric measurements were taken on the 5-7 year old child and parent. Over one-third of parents reported engaging in weight talk with their child. Overall, weight talk was associated with child weight status, but not with child diet quality. The presence of weight talk differed by race/ethnicity and child weight status. Most psychological (e.g., emotional problems) and social (e.g., peer problems) outcomes differed significantly by race/ethnicity with the following pattern: (1) no significant associations between weight talk and biopsychosocial outcomes were found for Hmong and Latino children; (2) a negative association (e.g., less healthy functioning) was found for African American and Somali children; (3) a positive association (e.g., healthier functioning) was found for Native American children. Future research should investigate why psychological and social outcomes differ by race/ethnicity in children experiencing weight talk. This study confirms the need to develop best practices for helping parents concerned about their child's weight to talk to children in a healthful way.

Intergenerational Pathways Between Parental Experiences of Adverse Childhood Experiences (ACEs) and Child Weight: Implications for Intervention.

BACKGROUND/OBJECTIVE: Prior research suggests an association between parental experiencing of 1 or more adverse childhood experiences (ACEs) and increased risk for overweight/obesity in children. However, the pathways through which parental experiences of ACEs lead to child weight are unclear. METHODS: Participants were parent and child dyads from racially/ethnically diverse and low-income households in Minneapolis and St. Paul, Minnesota, in 2015. Parents completed an online survey regarding their own adverse experiences in childhood, their height and weight, parenting practices, and mental health. Child height and weight were obtained from electronic medical records. Structural equation modeling was used to examine the extent to which parent mental health and parenting practices mediate associations between parental ACEs and child body mass index (BMI) percentile. RESULTS: The parent mental health pathway was statistically significant in explaining the intergenerational transmission of parental ACEs to child weight. Parent ACEs were positively associated with low parent mental health, parent low mental health was correlated with higher parent BMI > 25, and parent overweight was positively related to higher child BMI percentile. CONCLUSIONS: Study findings suggest that intervening on parent low mental health may be a key factor in reducing the intergenerational transmission between parental ACEs and child weight.

Potential Points of Intervention to Minimize the Impact of Parents' Adverse Childhood Experiences on Child Mental Health.

OBJECTIVE: Children of parents who experienced adverse childhood experiences (ACEs) are at elevated risk for mental health (MH) issues. The goal of this study was to explore the relationships between parent ACEs and child MH and to identify potential mediators and points of psychosocial intervention. METHODS: Participants were 1307 children aged 5 to 9 years from diverse backgrounds and their primary caregivers. Using cross-sectional questionnaire data, we used structural equation modeling to examine the research questions. RESULTS: Parent ACEs were directly related to child MH issues (ß = 0.189, p < 0.001). This relationship was fully mediated by parent MH (ß = 0.374, p < 0.001; ß = 0.246, p < 0.001) and positive parenting behaviors (ß = -0.237, p < 0.001; ß = -0.556, p < 0.001). High parent ACEs were negatively associated with parent MH (ß = 0.374, p < 0.001), which was then negatively associated with parenting behaviors (ß = -0.500, p < 0.001), which was then negatively associated with child MH (ß = -0.600, p < 0.001). Parent MH maintained a significant, though attenuated, direct relationship with child MH (ß = 0.102, p < 0.05). CONCLUSION: Parents with high ACEs but who have good mental health and positive parenting behaviors demonstrated no impact of their ACEs on their children's mental health. Providing MH care to parents and parenting programs may be strategies for improving children's MH. Parenting behavior assessment is recommended for clinicians when pediatric patients present with MH concerns.

A Mixed-Methods Description of the Home Physical Activity Environments of Racially/Ethnically Diverse and Immigrant/Refugee Children.

Disparities in childhood obesity prevalence by race/ethnicity remain high. Physical activity is an important factor to consider, however little is known about how physical activity resources in the home environment and neighborhood differ by race/ethnicity. This study examines the physical activity environments in the homes and neighborhoods of diverse households using both quantitative and qualitative data. Home visits were conducted with 150 families, and accelerometry data was collected for both parents and children (5-7 years old). Qualitative interviews were also conducted with parents, which provided context to quantitative data. Racial/ethnic differences were found for physical activity, sedentary behavior, and family-level resources for physical activity (P < .05). There were also differences by race/ethnicity in neighborhood physical activity promoters and perceived lack of neighborhood safety (P < .05). This study is important in informing providers and future interventions of the varying promoters and barriers to optimal physical activity that exist across race/ethnicity.

Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families.

OBJECTIVE: To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families. DESIGN: This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups. SETTING: The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019. PARTICIPANTS: The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White). RESULTS: Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups. CONCLUSIONS: Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.

Participant characteristics and dietary correlates of SNAP and other assistance programs among families with children from racially and ethnically diverse households.

The objective of this study was to describe food purchasing behaviors and the home food environment across families simultaneously receiving SNAP (Supplemental Nutrition Assistance Program) and other cash and food assistance benefits, and assess how child dietary intake varied across three distinct categories of assistance (i.e., SNAP and other assistance programs, assistance programs other than SNAP, and not enrolled in any assistance program). This cross-sectional study was conducted with parents of children aged 5-9 years (N = 1033) from low-income and racially and ethnically diverse households, living in Minneapolis and Saint Paul, Minnesota, metropolitan areas. In an online survey, parents reported enrollment in seven assistance programs (SNAP, WIC [Special Supplemental Nutrition Program for Women, Infants and Children Program], free or reduced-cost school breakfast, free or reduced-cost school lunch, SSI [Supplemental Security Income Program], MFIP [Minnesota Family Investment Program], daycare assistance), food purchasing behaviors, the home food environment, and child dietary and fast-food intake. Descriptive statistics were computed to describe food purchasing behaviors and the home food environment. Multivariable linear regressions were used to evaluate the association between assistance categories and child dietary intake factors. Models were adjusted for child age, parent and child sex, race and ethnicity, household income, primary caregiver's educational attainment, employment status, and place of birth. Relative to families participating in assistance programs other than SNAP and not enrolled in any assistance program, families participating in SNAP and other assistance programs had less reliable modes of transportation to go food shopping (use 'my own car or vehicle' 57% vs. 90% and 83%, respectively), shopped less frequently during the month ('1 big trip a month and small trips in between' 35% vs. 19% and 24%, respectively], had a somewhat higher presence of energy-dense (e.g., 'French fries' 60% vs. 35% and 25%, respectively) and high-sodium food items in the home (e.g., 'canned pasta' meals 48% vs. 35% and 20%, respectively), and some aspects of children's dietary intake that were not congruent with current dietary recommendations (e.g., consumption of 'fried vegetables' 3.9 times/week [95% CI 3.4, 4.4] vs. 2.9 [2.3, 3.5] and 2.8 [2.1, 3.6], respectively). Findings could inform targeted strategies to maximize the impact of simultaneous programs' benefits on improving child dietary intake and reaching eligible households not enrolled in assistance programs.

Health Inequity in Georgia During the COVID-19 Pandemic: An Ecological Analysis Assessing the Relationship Between County-Level Racial/Ethnic and Economic Polarization Using the ICE and SARS-CoV-2 Cases, Hospitalizations, and Deaths in Georgia as of October 2020.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic disproportionately burdens communities of color in the United States. The prevalence of preexisting conditions in these populations has not accounted for the observed health inequities. A growing body of research indicates a significant role of racialized residential segregation and income inequality on health outcomes. The Index of Concentration at the Extremes (ICE) is a metric which captures socio-spatial and economic polarization that has proven to be a valuable predictor of a large variety of health outcomes. Objectives: The primary objective of this ecologic study was to determine the impact of socio-spatial and economic segregation on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) morbidity and mortality in Georgia. Methods: The ICE scores for racial/ethnic, economic, and racialized economic segregation for each county in Georgia (n=159) were calculated and investigated as predictors of increased SARS-CoV-2 positivity rate, case-hospitalization rate, and case-mortality rate after controlling for the prevalence of preexisting conditions (diabetes, obesity, and smoking) and potential barriers to care (uninsured rate). Results: Counties with the largest income disparity had 1.57 times the case rate (p<0.0001) and 1.7 times (p<0.01) the case-mortality rate compared to the most privileged counties. Cases in counties with the largest racialized economic segregation were 1.8 times more likely to be hospitalized (p<0.0001). Conclusion: Racialized economic segregation is a strong correlate of pandemic health inequities in Georgia and highlights the need for structural interventions to address barriers to minority and vulnerable population health. Increased focus and efforts to address the structural and systematic barriers faced by communities of color is necessary to address health inequities.

Kitchen Adequacy and Child Diet Quality in a Racially/Ethnically Diverse Sample.

This study examined kitchen adequacy in a racially/ethnically diverse low-income sample and associations with child diet quality. Families with children age five to seven years old (n = 150) from non-Hispanic white, non-Hispanic Black, Hispanic, Native American, Hmong, and Somali families were recruited through primary care clinics. More than 85% of families had 15 of the 20 kitchen items queried, indicating that the sample had adequate kitchen facilities. Only one item (a kitchen table) was associated with higher overall diet quality of children. In contrast, children living in households with can openers and measuring spoons consumed more sodium and added sugars, respectively.

Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study.

BACKGROUND: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. OBJECTIVE: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. METHODS: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent's stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child's day). RESULTS: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants' time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. CONCLUSIONS: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30525.

CHAOS in the Home Environment and Child Weight-Related Outcomes.

INTRODUCTION: Biopsychosocial approaches to health care are critical to addressing childhood obesity. This study aimed to examine how multiple indicators of the home environment related to child weight-related outcomes. We hypothesized that families with home environments of higher chaos and stress, and lower quality parent-child interactions, would have children with a higher body mass index (BMI), less healthy dietary intake, and less healthy eating behaviors. METHODS: Data were drawn from the cross-sectional Phase I of the Family Matters study. Participants were 150 racially/ethnically diverse families with a child between 5 to 7 (mean, 6.4) years old. We used a latent profile analysis approach. A 4-class solution fit the data well, and we used predicted class posterior probabilities to assign families to classes. We then regressed the results onto the distal outcomes of child BMI, healthy dietary intake, and healthy eating behaviors. RESULTS: Families were classified as Collaborative-Chill (n = 38), Busy Bees (n = 37), Engaged (n = 61), and Inconsistent-Distant (n = 14). Collaborative-Chill was used as the reference class. Inconsistent-Distant families had children with higher BMI (P < .001) that were more food responsive (P < .001). Busy Bees families had children who were more food responsive (P = .04) and more satiety responsive (P = .02). Engaged families had children who were marginally more food responsive (P = .06). CONCLUSION: Household chaos, parent stress, and parent-child interactions are important components of the home environment implicated in children's weight-related outcomes. Health care providers should consider these indicators with child patients who struggle with obesity.