Relationships of family conflict, cohesion, and chaos in the home environment on maternal and child food-related behaviours.

This study examined how food-related behaviours differed in mothers and their preschool children by levels of family functioning (cohesion and conflict) and household disorganization (chaos). A nationally representative sample of mothers of preschoolers completed an online survey assessing food-related behaviours of themselves and their children. Maternal and child diet, eating behaviours, and health status; household availability of fruits/vegetables, salty/fatty snacks, and sugar-sweetened beverages; family mealtime atmosphere; and family conflict, cohesion, and household chaos were assessed with valid, reliable scales. Cluster analyses assigned families into low, middle, and high conflict, cohesion, and chaos groups. Participants (n = 550) were 72% White, and 82% had some post-secondary education. Regression analysis examining the association of cluster grouping levels on diet-related behaviour measures revealed that positive home environments (i.e., low family conflict, high family cohesion, and low household chaos) were associated with healthier food-related behaviours (e.g., increased fruits/vegetables intake), whereas negative home environments (i.e., high family conflict, low family cohesion, and high household chaos) were associated with unhealthy food-related behaviours (e.g., greater % total calories from fat) even after controlling for sociodemographic and related behavioural factors. Findings suggest family functioning and household chaos are associated with food-related behaviours. This frequently overlooked component of family interaction may affect intervention outcomes and objectives of educational and interventional initiatives.

Systematic review of control groups in nutrition education intervention research.

BACKGROUND: Well-designed research trials are critical for determining the efficacy and effectiveness of nutrition education interventions. To determine whether behavioral and/or cognition changes can be attributed to an intervention, the experimental design must include a control or comparison condition against which outcomes from the experimental group can be compared. Despite the impact different types of control groups can have on study outcomes, the treatment provided to participants in the control condition has received limited attention in the literature. METHODS: A systematic review of control groups in nutrition education interventions was conducted to better understand how control conditions are described in peer-reviewed journal articles compared with experimental conditions. To be included in the systematic review, articles had to be indexed in CINAHL, PubMed, PsycINFO, WoS, and/or ERIC and report primary research findings of controlled nutrition education intervention trials conducted in the United States with free-living consumer populations and published in English between January 2005 and December 2015. Key elements extracted during data collection included treatment provided to the experimental and control groups (e.g., overall intervention content, tailoring methods, delivery mode, format, duration, setting, and session descriptions, and procedures for standardizing, fidelity of implementation, and blinding); rationale for control group type selected; sample size and attrition; and theoretical foundation. RESULTS: The search yielded 43 publications; about one-third of these had an inactive control condition, which is considered a weak study design. Nearly two-thirds of reviewed studies had an active control condition considered a stronger research design; however, many failed to report one or more key elements of the intervention, especially for the control condition. None of the experimental and control group treatments were sufficiently detailed to permit replication of the nutrition education interventions studied. CONCLUSIONS: Findings advocate for improved intervention study design and more complete reporting of nutrition education interventions.

Validity and reliability of HOP-Up: a questionnaire to evaluate physical activity environments in homes with preschool-aged children.

BACKGROUND: Early identification of physical activity (PA) opportunities in the home and neighborhood environment may help obesity prevention efforts in households with young children. This cross-sectional study's purpose was to develop a brief, easy-to-use, self-report inventory called Home Opportunities for Physical activity check-Up (HOP-Up), to evaluate the availability and accessibility of PA space and equipment in and near homes with preschool children, and establish its validity and reliability. METHODS: The HOP-Up was field tested by two trained researchers and parents of preschool-aged children (n = 50; 71% white). To establish criterion validity, researchers were the 'gold standard' and visited participants' homes to assess their PA environments using the HOP-Up, while participants separately completed their HOP-Up. Two weeks later, parents completed the HOP-Up online for test-retest reliability. After minor survey refinements, exploratory and confirmatory factor analysis using a split-half cross validation procedure was conducted in a larger sample of participants (n = 655, 60% white) who completed the HOP-Up online to examine its factor structure. To establish convergent validity, correlations were conducted to compare HOP-Up scales from the factor solution generated with PA behavior and cognitions, and reported screen time. RESULTS: Intra-class correlations (ICCs) examining HOP-Up item agreement between researcher and parents revealed slight to substantial agreement (range 0.22 to 0.81) for all items. ICCs for all HOP-Up items ranged from fair to substantial agreement between parent responses at both time points (range 0.42 to 0.95). Exploratory factor analysis revealed a five factor solution (18 items), supported eigen values, scree plots, review for contextual sense, and confirmatory factor analysis. Additionally, there were significant (p < 0.05) positive correlations among nearly all five HOP-Up scales with parent and child physical activity levels (range 0.08 to 0.35), and values parents placed on PA for self and child (range 0.16 to 0.35), and negative correlations of Neighborhood Space & Supports for PA scale with parent and child reported screen time (r = -0.11, r = -0.13, respectively). CONCLUSIONS: Findings support the psychometric properties of this brief, easy-to-use, HOP-Up questionnaire, which may help parents, prevention researchers, residential planners, and practitioners increase their understanding of how the home environment-inside, outside, and the neighborhood- impacts preschool children's physical activity levels.

Reliability and criterion validity of self-measured waist, hip, and neck circumferences.

BACKGROUND: Waist, hip, and neck circumference measurements are cost-effective, non-invasive, useful markers for body fat distribution and disease risk. For epidemiology and intervention studies, including body circumference measurements in self-report surveys could be informative. However, few studies have assessed the test-retest reliability and criterion validity of a self-report tool feasible for use in large scale studies. METHODS: At home, mothers of young children viewed a brief, online instructional video on how to measure their waist, hip, and neck circumferences. Afterwards, they created a homemade paper measuring tape from a downloaded file with scissors and tape, took all measurements in duplicate, and entered them into an online survey. A few weeks later, participants visited an anthropometrics lab where they measured themselves again, and trained technicians (n = 9) measured participants in duplicate using standard equipment and procedures. To assess differences between self- and technician-measured circumferences, duplicate measurements for participant home self-measurements, participant lab self-measurements, and technician measurements each were averaged and Wilcoxon signed-rank tests conducted. Agreement between all possible pairs of measurements were examined using Intraclass Correlations (ICCs) and Bland-Altman plots. RESULTS: Participants (n = 41; aged 38.05 ± 3.54SD years; 71 % white) were all mothers that had at least one child under the age of 12 yrs. Technical error of measurements for self- and technician- duplicate measurements varied little (0.08 to 0.76 inches) and had very high reliability (≥0.90). Intraclass Correlations (ICC) comparing self vs technician were high (0.97, 0.96, and 0.84 for waist, hip, and neck). Comparison of self-measurements at home vs lab revealed high test-retest reliability (ICC ≥ 0.87). Differences between participant self- and technician measurements were small (i.e., mean difference ranged from -0.13 to 0.06 inches) with nearly all (≥93 %) differences within Bland-Altman limits of agreement and <10 % exceeding the a priori clinically meaningful difference criterion. CONCLUSIONS: This study has demonstrated a simple, inexpensive method for teaching novice mothers of young children to take their own body circumferences resulting in accurate, reliable data. Thus, collecting self-measured and self-reported circumference data in future studies may be a feasible approach in research protocols that has potential to expand our knowledge of body composition beyond that provided by self-reported body mass indexes.

Evaluation of a Childhood Obesity Prevention Online Training Certificate Program for Community Family Educators.

Community family educators have the opportunity to incorporate childhood obesity prevention concepts in their programming with families of young children, but often lack formal health and nutrition education. The purpose of this feasibility study was to create an online training certificate program for community family educators and assess the program's effectiveness at improving participant's knowledge, attitudes, and intended and actual behaviors related to healthy lifestyles. Community family educators (n = 68) completed an online pretest, viewed 13 brief videos (8-15 min) focused on childhood obesity related topics and took mini-knowledge self-checks after each video followed by an online posttest. At posttest, paired t tests showed participants' childhood obesity prevention related knowledge (i.e., nutrition, physical activity, screen time and sleep) improved significantly (p < 0.001). Participants' attitudes toward parenting behaviors related to feeding practices, family meals, physical activity, screen time control and parent modeling significantly (p < 0.05) improved. Improvements also were seen in participants' intentions to promote obesity prevention behaviors (i.e., age appropriate portions sizes, adequate physically active, and parental role modeling). Furthermore, changes in personal health behaviors at posttest revealed participants had significantly (p < 0.05) greater dietary restraint, improvements in sleep quality, and reductions of use of electronic devices during meals and snacks. Overall, participants were very satisfied with the training program, felt comfortable with skills acquired, and enjoyed the program. Findings suggest this online training program is a feasible and effective method for improving community family educators' knowledge, attitudes, and intentions for obesity-prevention related parenting practices.

Fruit-related terms and images on food packages and advertisements affect children's perceptions of foods' fruit content.

OBJECTIVE: To determine whether food label information and advertisements for foods containing no fruit cause children to have a false impression of the foods' fruit content. DESIGN: In the food label condition, a trained researcher showed each child sixteen different food label photographs depicting front-of-food label packages that varied with regard to fruit content (i.e. real fruit v. sham fruit) and label elements. In the food advertisement condition, children viewed sixteen, 30 s television food advertisements with similar fruit content and label elements as in the food label condition. After viewing each food label and advertisement, children responded to the question 'Did they use fruit to make this?' with responses of yes, no or don't know. SETTING: Schools, day-care centres, after-school programmes and other community groups. SUBJECTS: Children aged 4-7 years. RESULTS: In the food label condition, χ 2 analysis of within fruit content variation differences indicated children (n 58; mean age 4·2 years) were significantly more accurate in identifying real fruit foods as the label's informational load increased and were least accurate when neither a fruit name nor an image was on the label. Children (n 49; mean age 5·4 years) in the food advertisement condition were more likely to identify real fruit foods when advertisements had fruit images compared with when no image was included, while fruit images in advertisements for sham fruit foods significantly reduced accuracy of responses. CONCLUSIONS: Findings suggest that labels and advertisements for sham fruit foods mislead children with regard to the food's real fruit content.

Translating it into real life: a qualitative study of the cognitions, barriers and supports for key obesogenic behaviors of parents of preschoolers.

BACKGROUND: Little is known about preschool parents' cognitions, barriers, supports and modeling of key obesogenic behaviors, including breakfast, fruit and vegetable consumption, sugary beverage intake, feeding practices, portion sizes, active playtime, reduced screen-time, sleep and selection of child-care centers with characteristics that promote healthy behaviors. METHODS: Thus, the purpose of this study was to examine these factors via survey and focus groups among 139 parents of 2- to 5-year-old children. Standard content analysis procedures were used to identify trends and themes in the focus group data, and Analysis of Variance was used to test for differences between groups in the survey data. RESULTS: Results showed 80% of parents ate breakfast daily, consumed sugary beverages 2.7 ± 2.5SD days per week, and had at least two different vegetables and fruits an average of 5.2 ± 1.8SD and 4.6 ± 2.0SD days per week. Older parents and those with greater education drank significantly fewer sugary drinks. Parents played actively a mean 4.2 ± 2.2 hours/week with their preschoolers, who watched television a mean 2.4 ± 1.7 hours/day. Many parents reported having a bedtime routine for their preschooler and choosing childcare centers that replaced screen-time with active play and nutrition education. Common barriers to choosing healthful behaviors included lack of time; neighborhood safety; limited knowledge of portion size, cooking methods, and ways to prepare healthy foods or play active indoor games; the perceived cost of healthy options, and family members who were picky eaters. Supports for performing healthful behaviors included planning ahead, introducing new foods and behaviors often and in tandem with existing preferred foods and behaviors, and learning strategies from other parents. CONCLUSIONS: Future education programs with preschool parents should emphasize supports and encourage parents to share helpful strategies with each other.

Cover Lines Using Positive, Urgent, Unique Language Entice Moms to Read Health Communications.

Crafting messages that capture consumer interest is a frequent challenge of health communicators. A better understanding of the techniques magazine editors use to create cover lines may aid health communicators in their efforts to arouse interest in their communiqués. This study (a) content-analyzed magazine cover lines, (b) used content analysis findings to create health-related cover lines, and (c) assessed the degree to which the health-related cover lines fostered motivation to read the health communication. Cover lines (N = 867) from 11 magazines published in 2012 frequently read by mothers of young children used a variety of themes, with those focusing on informative/how-to, control/improve, and unique/special being most common. Health communication experts used key descriptor terms corresponding to each theme and wrote 310 cover lines for topics focusing on childhood obesity prevention strategies. Unpaired t tests revealed that mothers of young children (N = 77) reported they were significantly (p < .05) more motivated to read a short, health-related magazine article when cover lines had a happiness/fun, unique/special, or quick/urgency theme and were significantly less motivated to read when cover lines used a control/improve theme. Study findings may help health communicators create cover lines that better attract reader attention.

Accuracy and consistency of weights provided by home bathroom scales.

BACKGROUND: Self-reported body weight is often used for calculation of Body Mass Index because it is easy to collect. Little is known about sources of error introduced by using bathroom scales to measure weight at home. The objective of this study was to evaluate the accuracy and consistency of digital versus dial-type bathroom scales commonly used for self-reported weight. METHODS: Participants brought functioning bathroom scales (n=18 dial-type, n=43 digital-type) to a central location. Trained researchers assessed accuracy and consistency using certified calibration weights at 10 kg, 25 kg, 50 kg, 75 kg, 100 kg, and 110 kg. Data also were collected on frequency of calibration, age and floor surface beneath the scale. RESULTS: All participants reported using their scale on hard surface flooring. Before calibration, all digital scales displayed 0, but dial scales displayed a mean absolute initial weight of 0.95 (1.9 SD) kg. Digital scales accurately weighed test loads whereas dial-type scale weights differed significantly (p<0.05). Imprecision of dial scales was significantly greater than that of digital scales at all weights (p<0.05). Accuracy and precision did not vary by scale age. CONCLUSIONS: Digital home bathroom scales provide sufficiently accurate and consistent weights for public health research. Reminders to zero scales before each use may further improve accuracy of self-reported weight.

What foods are US supermarkets promoting? A content analysis of supermarket sales circulars.

This study compared the types of foods advertised in supermarket newspaper circulars across geographic region (US Census regions: northeast [n=9], midwest [n=15], south [n=14], and west [n=13]), obesity-rate region (i.e., states with CDC adult obesity rates of <25% [n=14], 25 to <30% [n=24], and ≥ 30% [n=13]), and with MyPlate recommendations. All food advertisements on the first page of each circular were measured (±0.12-in.) to determine the proportion of space occupied and categorized according to food group. Overall, ≥ 50% of the front page of supermarket sales circulars was devoted to protein foods and grains; fruits, vegetables, and dairy, combined, were allocated only about 25% of the front page. The southern geographic region and the highest obesity-rate region both devoted significantly more advertising space to sweets, particularly sugar-sweetened beverages. The lowest obesity-rate region and western geographic region allocated the most space to fruits. Vegetables were allocated the least space in the western geographic region. Grains were the only food group represented in ads in proportions approximately equal to amounts depicted in the MyPlate icon. Protein foods exceeded and fruits, dairy, and vegetables fell below comparable MyPlate proportional areas. Findings suggest supermarket ads do not consistently emphasize foods that support healthy weight and MyPlate recommendations. More research is needed to determine how supermarket newspaper circulars can be used to promote healthy dietary patterns.

Associations of Mother's Behaviors and Home/Neighborhood Environments with Preschool Children's Physical Activity Behaviors.

OBJECTIVE: Examining associations of mother's behaviors and home/neighborhood physical activity (PA) environments with preschoolers' PA and screen time. DESIGN: Cross-sectional online survey. SETTING: Mothers with a 2 to 5 years old preschooler were recruited from the US panel members of Survey Sampling International. PARTICIPANTS: Five hundred thirty-one mothers with a preschool child aged 2 to 5 years old. OUTCOME MEASURE: Child daily screen time and PA, mother-child inside- and outside-home co-PA. ANALYSIS: K-mean cluster analysis and Logit and negative binomial regressions. RESULTS: Mothers' healthy behaviors, such as decreased screen time, healthy eating habits, and increased PA, and perceived importance for PA were significantly (P < .05) associated with preschoolers' decreased screen time and increased PA. Available toys (P < .01) and maternal perceived neighborhood safety (P < .05) were negatively correlated with preschoolers' screen time, while available room space (P < .01) was positively correlated with preschoolers' PA. Variables positively correlated with mother-child co-PA included mothers' PA (P < .001) and healthy eating habits (P < .05), and home room space (P < .05) for inside-home, and yard space and quality (P < .05) for outside-home. CONCLUSIONS: Mother's role modeling and home PA environment were positively associated with preschoolers' PA behavior.

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

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

An Exploratory Study Examining Obesity Risk in Non-Obese Mothers of Young Children Using a Socioecological Approach.

This cross-sectional, exploratory study aimed to (1) develop an obesity risk score using a comprehensive set of variables assessing mothers’ intrapersonal weight-related characteristics and those of their homes’ interpersonal and physical environments, and (2) determine how weight-related characteristics differ by obesity risk level. U.S. mothers (N = 550) of preschool-aged children completed an online survey that assessed maternal self-report weight status, sociodemographics, health-related characteristics, and maternal intrapersonal and their homes’ interpersonal and physical environment weight-related characteristics. Binomial logistic regression analysis identified variables significantly associated with obesity. Scores for all obesity risk variables were summed to create a weighted obesity risk score for non-obese participants (n = 386). Analysis of variance and Tukey post-hoc tests determined how non-obese mothers’ sociodemographic, health-related, and intrapersonal and their homes’ interpersonal and physical environment characteristics differed among obesity risk score tertiles. Results revealed that eight variables explained 53 percent of maternal obesity risk, including African American race, lower education level, more children in household, poorer maternal health, higher weight teasing history, higher body dissatisfaction, primary relative with obesity, and greater concern about children’s overweight risk. Non-obese mothers in the highest obesity risk tertile had greater food insecurity risk, lower family affluence, worse sleep quality, less fruit/vegetable availability, and reported less frequent modeling of healthy behaviors and more family conflict. In conclusion, eight characteristics that explained more than half of the risk for obesity in non-obese mothers of young children, may help healthcare professionals identify mothers at increased risk of obesity and offer preventive care early.

Promoting healthy home environments and lifestyles in families with preschool children: HomeStyles, a randomized controlled trial.

The purpose of the HomeStyles randomized controlled trial was to determine the effect of participation in the HomeStyles intervention vs an attention control condition on the weight-related aspects of the home environment and lifestyle behavioral practices of families with preschool children. Parents of preschool children (n=489) were systematically randomized to experimental or attention control group after completing the baseline survey. Baseline and post surveys comprehensively assessed study outcomes using a socio-ecological approach incorporating valid, reliable intrapersonal (e.g., diet, activity), interpersonal (e.g., family meal frequency), and environmental measures (e.g., home media environment), and self-reported parent and child measured heights and weights. For all outcome measures, paired t-tests compared within group differences over time and ANCOVA, controlling for baseline scores and prognostic variables (e.g., parent sex), determined differences in post survey scores between groups. The final analytical sample (N=172; age 32.34±5.71SD; 58% White; 93% female) completed baseline and post surveys. The experimental group families had improved family meal and diet-related behaviors, and self-efficacy for food-related childhood obesity-protective practices. Household food supplies changed little, except for less availability of salty/fatty snacks. Within group effects indicated the control group also experienced some improvements, however these were few in number. ANCOVA revealed the experimental group parents had greater physical activity, reduced screentime, improved family mealtime behaviors, and increased self-efficacy for childhood obesity-protective behaviors and cognitions compared to the control group at post survey, though effect sizes were small. The HomeStyles program for families with preschool children promoted improvements in an array of obesity-preventive behaviors.

Long-term follow-up effects of the HomeStyles randomized controlled trial in families with preschool children on social cognitive theory constructs associated with physical activity cognitions and behaviors.

This study examined long-term follow-up effects of participation in the HomeStyles RCT, using Social Cognitive Theory constructs, on physical activity cognitions, home environment, and lifestyle behavioral practices of families with preschool children (ages 2 to 5 years). Parents were systematically randomized to experimental or attention control group at baseline. Those completing all surveys that comprised of valid, reliable measures were the analytic sample (n = 61 experimental, n = 63 control; mean age 32.8 ±â€¯5.9SD years). Repeated measures ANCOVA, controlling for prognostic variables (e.g., parent sex) revealed that variables assessing modeling of physical activity for children increased significantly (P ≤ .01) in both groups with no significant time by group effects. Paired t-tests indicated the experimental group's self-efficacy for keeping children's weight healthy and performing health promoting behaviors increased significantly over time whereas the control group did not but with no significant time by group effects. Self-regulation paired t-test findings indicated that total screentime the experimental group allowed children decreased significantly over time with no significant time by group effect. The value parents placed on physical activity for children increased over time in both groups with a significant time effect. The experimental group over time had significantly greater increases in the availability of physical activity space and supports inside the home than the control group. Improvements noted have the potential to help protect children and parents from excess weight gain, yet findings indicate considerable opportunity for continued improvement as well as elucidation of factors affecting concomitant changes in both study groups.

The marketing plan and outcome indicators for recruiting and retaining parents in the HomeStyles randomized controlled trial.

BACKGROUND: Despite the critical importance of successful recruitment and retention to study integrity, reporting of recruitment and retention strategies along with factors associated with successful recruitment and retention of participants in health-related interventions remain rare, especially for health and obesity prevention programs. Thus, the purpose of this article is to retrospectively examine the recruitment and retention marketing plan used in the online HomeStyles randomized controlled trial (RCT) and discuss outcomes associated with completion of the intervention. METHODS: The HomeStyles RCT is an online intervention developed to motivate parents of young children to gain the skills and self-confidence needed to shape home environments and lifestyles to be protective against childhood obesity. Using the seven Ps of services marketing (i.e., people, place, product, physical evidence, price, promotion, and process), a comprehensive and systematic plan for recruitment and retention was implemented and outcomes assessed. RESULTS: A total of 489 parents with a young child aged 2 to < 6 years were eligible to participate, a final capture rate of 33%. Only 23% of Hispanic participants chose to use the Spanish-language version of HomeStyles intervention materials, below the demand anticipated. However, Hispanic enrollment overall was substantially higher than the U.S. population proportion (i.e., 17%). The number of participants prematurely leaving the study was similar in both treatment groups, indicating attrition was not differential. Completers reported high satisfaction of HomeStyles, using a 1-5 scale (strongly disagree to strongly agree) on guide attractiveness, interestingness, and usefulness. Despite all the retention efforts, the average monthly recruitment accrual rate of ~ 33 eligible enrolled participants at baseline (i.e., 489 participants/15-month recruitment period), declined to ~ 18, 11, 9, and 8 remaining recruited participants/month at midpoint, post, follow-up, and long-term follow-up surveys, respectively. In general, survey completers were significantly more likely to be female and perceived their child's health status to be better, and they were significantly less likely to be restrictive of their child's food intake. CONCLUSIONS: The findings of the present study highlight the need for far-reaching, concentrated, and varied recruitment strategies; sufficient time in the research plan for recruitment and retention activities; and creative, tireless, flexible, persistent project staff for health-related interventions.

HomeStyles, A Web-Based Childhood Obesity Prevention Program for Families With Preschool Children: Protocol for a Randomized Controlled Trial.

BACKGROUND: The home environment is where young children spend most of their time, and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied, and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights. OBJECTIVE: The aim of the HomeStyles randomized controlled trial (RCT) is to determine whether the Web-based HomeStyles intervention enables and motivates parents to shape the weight-related aspects of their home environments and lifestyle behavioral practices (diet, exercise, and sleep) to be more supportive of their preschool children's optimal health and weight. METHODS: A rigorous RCT utilizing an experimental group and an attention control group, receiving a bona fide contemporaneous treatment equal in nonspecific treatment effects and differing only in subject matter content, will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework, and will assess: intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-preventive practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home. RESULTS: Enrollment for this study has been completed and statistical data analyses are currently underway. CONCLUSIONS: This paper describes the HomeStyles intervention with regards to: rationale, the intervention's logic model, sample eligibility criteria and recruitment, experimental group and attention control intervention content, study design, instruments, data management, and planned analyses.

A Socio-Ecological Examination of Weight-Related Characteristics of the Home Environment and Lifestyles of Households with Young Children.

Home environment and family lifestyle practices have an influence on child obesity risk, thereby making it critical to systematically examine these factors. Thus, parents (n = 489) of preschool children completed a cross-sectional online survey which was the baseline data collection conducted, before randomization, in the HomeStyles program. The survey comprehensively assessed these factors using a socio-ecological approach, incorporating intrapersonal, interpersonal and environmental measures. Healthy intrapersonal dietary behaviors identified were parent and child intakes of recommended amounts of 100% juice and low intakes of sugar-sweetened beverages. Unhealthy behaviors included low milk intake and high parent fat intake. The home environment's food supply was found to support healthy intakes of 100% juice and sugar-sweetened beverages, but provided too little milk and ample quantities of salty/fatty snacks. Physical activity levels, sedentary activity and the home's physical activity and media environment were found to be less than ideal. Environmental supports for active play inside homes were moderate and somewhat better in the area immediately outside homes and in the neighborhood. Family interpersonal interaction measures revealed several positive behaviors, including frequent family meals. Parents had considerable self-efficacy in their ability to perform food- and physical activity-related childhood obesity protective practices. This study identified lifestyle practices and home environment characteristics that health educators could target to help parents promote optimal child development and lower their children's risk for obesity.

Relationships of cognitive load on eating and weight-related behaviors of young adults.

Little is known about the relationship between weight-related behaviors and cognitive load (working memory available to complete mental activities like those required for planning meals, selecting foods, and other health-related decisions). Thus, the purpose of this study was to explore associations between cognitive load and eating behaviors, physical activity, body mass index (BMI), and waist circumference of college students. College students (n=1018) from 13 institutions completed an online survey assessing eating behaviors (e.g., routine and compensatory restraint, emotional eating, and fruit/vegetable intake), stress level, and physical activity level. BMI and waist circumference were measured by trained researchers. A cognitive load score was derived from stress level, time pressure/income needs, race and nationality. High cognitive load participants (n=425) were significantly (P<0.05) more likely to be female, older, and further along in school than those with low cognitive loads (n=593). Compared to low cognitive load participants, high cognitive load participants were significantly more likely to eat <5 cups of fruits/vegetables/day, have greater routine and compensatory restraint, and greater susceptibility to eating in response to external cues and emotional eating. Both males and females with high cognitive load scores had a non-significant trend toward higher BMIs, waist circumferences, and drinking more alcohol than low cognitive load counterparts. In conclusion, cognitive load may be an important contributor to health behaviors. Understanding how cognitive load may affect eating and other weight-related behaviors could potentially lead to improvements in the effectiveness of obesity prevention and intervention programs.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers.

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.