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1.  What’s for dinner? Types of food served at family dinner differ across parent and family characteristics 
Public health nutrition  2012;17(1):145-155.
Objective
To examine the types of food served at family dinner in the homes of adolescents and correlations with parent and family sociodemographic characteristics, psychosocial factors, and meal-specific variables.
Design
A cross-sectional population-based survey completed by mail or telephone by parents participating in Project F-EAT (Families and Eating and Activity in Teens) in 2009–2010.
Setting
Homes of families with adolescents in Minneapolis/St Paul urban area.
Subjects
Participants included 1,923 parents/guardians (90.8% female; 68.5% from ethnic/racial minorities) of adolescents who participated in EAT 2010.
Results
Less than a third (28%) of parents reported serving a green salad at family dinner on a regular basis, but 70% reported regularly serving vegetables (other than potatoes). About one-fifth (21%) of families had fast food at family dinners two or more times a week. Variables from within the sociodemographic domain (low educational attainment); psychosocial domain (high work-life stress, depressive symptoms, low family functioning); and meal-specific domain (low value of family meals, low enjoyment of cooking, low meal planning, high food purchasing barriers, and fewer hours in food preparation) were associated with lower healthfulness of foods served at family dinners, in analyses adjusted for sociodemographic characteristics.
Conclusions
There is a need for interventions to improve the healthfulness of food served at family meals. Interventions need to be suitable for parents with low levels of education; take parent and family psychosocial factors into account; promote more positive attitudes toward family meals; and provide skills to make it easier to plan and prepare healthful family meals.
doi:10.1017/S1368980012004594
PMCID: PMC3815492  PMID: 23083836
Family meals; parents; adolescents; home food availability
2.  Eating breakfast and dinner together as a family: Associations with sociodemographic characteristics and implications for diet quality and weight status 
Journal of the Academy of Nutrition and Dietetics  2013;113(12):10.1016/j.jand.2013.08.011.
Background
Research has shown that adolescents who frequently share evening meals with their families experience more positive health outcomes, including diets of higher nutritional quality. However, little is known about families eating together at breakfast.
Objectives
This study examined sociodemographic differences in family meal frequencies in a population-based adolescent sample. Additionally, this study examined associations of family breakfast meal frequency with dietary quality and weight status.
Design
Cross-sectional data from EAT 2010 (Eating and Activity in Teens) included anthropometric assessments and classroom-administered surveys completed in 2009-2010.
Participants/setting
Participants included 2,793 middle and high school students (53.2% girls, mean age=14.4 years) from Minneapolis/St. Paul, MN, public schools.
Main outcome measures
Usual dietary intake was self-reported on a food frequency questionnaire. Height and weight were measured.
Statistical analyses performed
Regression models adjusted for sociodemographic characteristics, family dinner frequency, family functioning, and family cohesion were used to examine associations of family breakfast frequency with dietary quality and weight status.
Results
On average, adolescents reported having family breakfast meals 1.5 times (SD=2.1) and family dinner meals 4.1 times (SD=2.6) in the past week. There were racial/ethnic differences in family breakfast frequency, with the highest frequencies reported by adolescents of Black, Hispanic, Native American, and mixed race/ethnicity. Family breakfast frequency was also positively associated with male sex; younger age; and living in a two-parent household. Family breakfast frequency was associated with several markers of better diet quality (such as higher intake of fruit, whole grains, and fiber) and lower risk for overweight/obesity. For example, adolescents who reported seven family breakfasts in the past week consumed an average of 0.37 additional daily fruit servings compared to adolescents who never had a family breakfast meal.
Conclusions
Results suggest that eating breakfast together as a family may have benefits for adolescents’ dietary intake and weight status.
doi:10.1016/j.jand.2013.08.011
PMCID: PMC3833880  PMID: 24139290
Adolescents; Family meals; Breakfast; Dietary intake; Overweight
3.  Intervention effects on kindergarten and 1st grade teachers’ classroom food practices and food-related beliefs in American Indian reservation schools 
Journal of the Academy of Nutrition and Dietetics  2013;113(8):10.1016/j.jand.2013.04.019.
Prevalence of obesity among American Indian (AI) children is higher than the general US population. The school environment and teachers play important roles in helping students develop healthy eating habits. The aim of this prospective study was to examine teachers’ classroom and school food practices and beliefs and the effect of teacher training on these practices and beliefs. Data were used from the Bright Start study, a group-randomized, school-based trial on the Pine Ridge AI reservation (Fall 2005 to Spring 2008). Kindergarten and first grade teachers (n=75) from 14 schools completed a survey at the beginning and end of the school year. Thirty-seven survey items were evaluated using mixed-model analysis of variance to examine the intervention effect for each teacher-practice and belief item (adjusting for teacher type and school as random effect). At baseline, some teachers reported classroom and school food practices and beliefs that supported health and some that did not.
The intervention was significantly associated with lower classroom use of candy as a treat (p=0.0005) and fast food rewards (p=0.008); more intervention teachers disagreed that fast food should be offered as school lunch alternatives (p=0.019), that it would be acceptable to sell unhealthy foods as part of school fund-raising (p=0.006), and that it would not make sense to limit students’ food choices in school (p=0.035). School-based interventions involving teacher training can result in positive changes in teachers’ classroom food practices and beliefs about the influence of the school food environment in schools serving AI children on reservations.
doi:10.1016/j.jand.2013.04.019
PMCID: PMC3828676  PMID: 23885704
American Indian; school food environment; child weight; teacher classroom practices; kindergarten; child obesity
5.  Shared meals among young adults are associated with better diet quality and predicted by family meal patterns during adolescence 
Public health nutrition  2012;16(5):883-893.
Objective
To describe shared meal patterns and examine associations with dietary intake among young adults.
Design
Population-based, longitudinal cohort study (Project EAT: Eating and Activity in Teens and Young Adults).
Setting
Participants completed surveys and food frequency questionnaires in Minneapolis/St. Paul, Minnesota high school classrooms in 1998–1999 (mean age=15.0, “adolescence”) and follow-up measures online or by mail in 2008–2009 (mean age=25.3, “young adulthood”).
Subjects
There were 2,052 participants who responded to the 10-year follow-up survey and reported on frequency of having shared meals.
Results
Among young adults, the frequency of shared meals during the past week was as follows: never (9.9%), one or two times (24.7%), three to six times (39.1%), and seven or more times (26.3%). Having more frequent family meals during adolescence predicted a higher frequency of shared meals in young adulthood above and beyond other relevant sociodemographic factors such as household composition and parental status. Compared to young adults who never had family meals during adolescence, those young adults who reported seven or more family meals per week during adolescence had an average of one additional shared meal per week. Having more frequent shared meals in young adulthood was associated with greater intake of fruit among males and females, and with higher intakes of vegetables, milk products, and some key nutrients among females.
Conclusions
Nutrition professionals should encourage families of adolescents to share meals often and establish the tradition of eating together, and work with young adults to ensure that healthy food and beverage choices are offered at mealtimes.
doi:10.1017/S1368980012003539
PMCID: PMC3624057  PMID: 22857517
family meals; longitudinal; young adulthood; adolescence
6.  Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study 
Pediatrics  2013;131(5):e1443-e1450.
OBJECTIVE:
To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs.
METHODS:
Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone.
RESULTS:
Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status.
CONCLUSIONS:
Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children’s ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.
doi:10.1542/peds.2012-3073
PMCID: PMC3639463  PMID: 23610202
parenting; feeding; adolescent obesity; weight status
7.  Food Responsiveness, Parental Food Control and Anthropometric Outcomes among Young American Indian Children: Cross-sectional and Prospective Findings 
Ethnicity & disease  2013;23(2):136-142.
Objective
Assess cross-sectional and prospective associations between food responsiveness and parental food control and anthropometric outcomes among American Indian children.
Design
Parents/caregivers completed psychosocial surveys and trained staff measured children’s anthropometry at baseline (kindergarten) and at follow-up (1st grade) as part of a school-based obesity prevention trial (Bright Start).
Setting
On/near the Pine Ridge Indian reservation.
Participants
422 child (51% female, mean age = 5.8 years, 30% overweight/obese) and parent/caregiver (89% mothers) dyads.
Main Outcome Measures
Two independent variables (child’s Food Responsiveness and Parental Control scales) and six child anthropometric dependent variables (overweight status, body mass index z-score, % body fat, waist circumference, triceps skinfold, subscapular skinfold). Linear regression analyses, stratified by sex and adjusted for age and treatment condition.
Results
Baseline Food Responsiveness scale scores were positively associated with all six baseline anthropometric outcomes among boys (P’s all <.01), but not girls. Parental Control scale scores were not significantly associated with outcomes and no prospective associations were statistically significant.
Conclusions
Responsiveness to food may be associated with excess adiposity in young American Indian boys, however, the effects are not detectable over time. Obesity prevention programs for American Indian children may benefit by addressing eating without hunger among boys.
PMCID: PMC3883505  PMID: 23530292
Food Responsiveness; Parental Food Control; BMI; Anthropometry; Obesity; American Indian; Children
8.  Changes in the frequency of family meals from 1999-2010 in the homes of adolescents: Trends by sociodemographic characteristics 
Objective
To examine secular trends from 1999 to 2010 in family meal frequency in a population-based sample of adolescents across sociodemographic characteristics.
Methods
A repeated cross-sectional design was used. Participants were from Minneapolis/St. Paul middle schools and high schools and included 3,072 adolescents in 1999 (mean age=14.6±1.8) and 2,793 adolescents in 2010 (mean age=14.4±2.0) from diverse ethnic/racial and socioeconomic backgrounds. Trends in family meal frequency were examined using inverse probability weighting to control for changes in sociodemographic characteristics over time.
Results
Family meal frequency remained fairly constant from 1999 to 2010 in the overall sample, but decreases were found in population subgroups including girls, middle school students (grade 6-8), Asians, and youth from low socioeconomic backgrounds. Among youth from the lowest socioeconomic backgrounds, the mean number of family meals in the past week decreased from 4.0 in 1999 to 3.6 in 2010 (p=.003). Furthermore, the percentage of youth from low socioeconomic backgrounds eating five or more meals in the past week decreased from 46.9% in 1999 to 38.8% in 2010 (p<.001). In contrast, family meal frequency tended to increase over time among youth from higher socioeconomic backgrounds.
Conclusions
The widening gap in family meal frequency between youth from low and high socioeconomic backgrounds is concerning, particularly given the greater risk for poor health outcomes among low-income youth. Given findings from other studies suggesting multiple benefits of family meals, interventions to increase family meal frequency are needed that target adolescents and their families from the most vulnerable segments of the population.
doi:10.1016/j.jadohealth.2012.06.004
PMCID: PMC3552297  PMID: 23332485
9.  Eat this, not that! Parental demographic correlates of food-related parenting practices 
Appetite  2012;60(1):140-147.
To understand how parents of adolescents attempt to regulate their children’s eating behaviors, the prevalence of specific food-related parenting practices (restriction, pressure-to-eat) by sociodemographic characteristics (parent gender, race/ethnicity, education level, employment status, and household income) were examined within a population-based sample of parents (n=3709) of adolescents. Linear regression models were fit to estimate the association between parent sociodemographic characteristics and parental report of food restriction and pressure-toeat. Overall, findings suggest that use of controlling food-related parenting practices , such as pressuring children to eat and restricting children’s intake, is common among parents of adolescents, particularly among parents in racial/ethnic minority subgroups, parents with less than a high school education, and parents with a low household income. Results indicate that that social or cultural traditions, as well as parental access to economic resources, may contribute to a parent’s decision to utilize specific food-related parenting practices. Given that previous research has found that restriction and pressure-to-eat food-related parenting practices can negatively impact children’s current and future dietary intake, differences in use of these practices by sociodemographic characteristics may contribute, in part, to the disparities that exist in the prevalence of overweight and obesity among adolescents by their race/ethnicity and socioeconomic status.
doi:10.1016/j.appet.2012.09.019
PMCID: PMC3889702  PMID: 23022556
Parenting practices; feeding practices; feeding strategies; parents; adolescents; restriction; pressure-to-eat; socio-demographics; cross-sectional study
10.  Sociodemographic Differences in Selected Eating Practices Among Alternative High School Students 
Journal of the American Dietetic Association  2009;109(5):10.1016/j.jada.2009.02.001.
Background
Students attending alternative high schools are an at-risk group of youth for poor health behaviors and obesity, however little is known about their dietary practices.
Objective
To examine associations between gender, race/ethnicity and socioeconomic status and selected dietary practices, that included consumption of sweetened beverages, high fat foods, and fruits and vegetables and fast food restaurant use among students attending alternative high schools (AHS).
Design
Population-based, cross-sectional study.
Subjects/setting
A convenience sample of adolescents (n=145; gender: 52% male; age: 63% <18 years; race/ethnicity: 39% white, 32% black, and 29% other/multiracial) attending six alternative high schools in the St. Paul/Minneapolis metropolitan area completed a survey. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial.
Statistical analyses performed
Descriptive statistics were used to describe dietary practices. Mixed model multivariate analyses were used to assess differences in dietary practices by gender, race/ethnicity and socioeconomic status.
Results
Regular soda was consumed ≥ 5-6 times per week by more than half of students. One-half of the students reported eating or drinking something from a fast food restaurant at least 3-4 times a week. Black students had the highest consumption of sweetened beverages (p=0.025), high fat foods (p=0.002) and highest frequency of fast food restaurants (p<0.025). Mean fruit/vegetable intake was 3.6 servings/day; there were no sociodemographic differences in fruit/vegetable consumption. Higher socioeconomic status was associated with a higher consumption of regular soda (p=0.027).
Conclusion
Racial/ethnic and gender differences in the consumption of regular soda, high fat foods, and fast food restaurant use among AHS students underscores the importance of implementing health promotion programs in alternative high schools.
doi:10.1016/j.jada.2009.02.001
PMCID: PMC3873095  PMID: 19394468
Sociodemographic; Diet; Alternative High School
11.  Associations between hurtful weight-related comments by family and significant other and the development of disordered eating behaviors in young adults 
Journal of behavioral medicine  2011;35(5):500-508.
Background
Research has found that weight-teasing is associated with disordered eating in adolescents. This study expands on the existing research by examining associations between hurtful weight comments by family and a significant other and disordered eating in young adults.
Methods
Data come from 1,902 young adults (mean age 25) who completed surveys in 1998, 2003 and 2009. Correlations were examined between receiving hurtful comments from family and significant others, and four disordered eating behaviors in young adulthood, adjusting for prior disordered eating and prior teasing.
Results
Disordered eating behaviors were common in young adulthood, and were associated with hearing hurtful weight-related comments from family members and a significant other, for both females and males.
Conclusion
Disordered eating prevention activities, which include messages about the potential harm associated with hurtful weight-related comments, should be expanded to address young adults, and programs may want to target relationship partners.
doi:10.1007/s10865-011-9378-9
PMCID: PMC3337892  PMID: 21898148
young adults; disordered eating; teasing; weight comments
12.  Stressed out and overcommitted! The relationships between time demands and family rules and parents’ and their child’s weight status 
Objective
To determine the relationship between parent time demands and presence and enforcement of family rules and parent/child dyad weight status.
Methods
Dyads of one child/parent per family (n=681dyads), Twin Cities, Minnesota, 2007–2008 had measured height/weight and a survey of demographics, time demands and family rules-related questions. Parent/child dyads were classified into four healthy weight/overweight categories. Multivariate linear associations were analyzed with SAS, testing for interaction by work status and family composition (p<0.10).
Results
In adjusted models, lack of family rules and difficulty with rule enforcement were statistically lower in dyads in which the parent/child was healthy weight compared to dyads in which the parent/child was both overweight (Difference in family rules scores=0.49, p=0.03; difference in rule enforcement scores=1.09, p=<0.01). Of parents who worked full-time, healthy weight dyads reported lower time demands than other dyads (Difference in time demands scores=1.44, p=0.01).
Conclusions
Family experiences of time demands and use of family rules are related to the weight status of parents and children within families.
doi:10.1177/1090198111426453
PMCID: PMC3587053  PMID: 22228775
adult; child; weight status; time demands; family rules
13.  Family Meals: Associations with Weight and Eating Behaviors Among Mothers and Fathers 
Appetite  2012;58(3):1128-1135.
Few studies have looked at the relationship between family meals and adult weight and health behaviors. The current study investigates the association between frequency of family meals and mothers’ and fathers’ body mass index (BMI), dietary intake, dieting behaviors and binge eating. Data from Project F-EAT (Families and Eating and Activity in Teens) were used for the current analysis. Socio-economically and racially/ethnically diverse mothers and fathers (n = 3,488) of adolescents participating in a multi-level population-based study (EAT 2010) completed surveys mailed to their homes. Predicted means or probabilities were calculated for each outcome variable at each level of family meal frequency. Interactions between race/ethnicity and marital status with family meals were evaluated in all models. Overall, results indicated that having more frequent family meals was associated with increased consumption of fruits and vegetables for mothers and fathers, after adjusting for age, educational attainment, marital status and race/ethnicity. Other findings including less fast food intake for fathers and fewer dieting and binge eating behaviors for mothers were significantly associated with family meal frequency, but not consistently across all family meal categories or with BMI. Interactions by race/ethnicity and marital status were non-significant, indicating that family meals may be important for more healthful dietary intake across race and marital status. Future research should confirm findings in longitudinal analyses to identify temporality and strength of associations.
doi:10.1016/j.appet.2012.03.008
PMCID: PMC3340527  PMID: 22425759
Family Meals; Parents; Weight; Dietary Intake; Dieting; Binge Eating
14.  Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children 
Obesity (Silver Spring, Md.)  2012;20(11):2241-2249.
The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. While the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, while the control children experienced a corresponding incidence of 24.8%; a difference of −11.4% (p=0.033). The intervention significantly reduced parent reported mean child intakes of sugar-sweetened beverages, whole milk and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.
doi:10.1038/oby.2012.89
PMCID: PMC3407274  PMID: 22513491
15.  Examining the Relationships Between Family Meal Practices, Family Stressors, and the Weight of Youth in the Family 
Background
Research is limited on how the social environment of the home is related to childhood obesity.
Purpose
The purpose of this research was to examine the relationships between positive family meal practices, family stressors, and the weight of youth and to examine parental weight status as a moderator of these relationships.
Methods
The study enrolled 368 parent/child dyads from a Minnesota sample. We used mediation analysis to examine the associations
Results
Families represented by an overweight parent reported fewer positive family meal practices (p<0.001), higher levels of depression (p=0.01), and fewer family rules (p=0.02) as compared to families represented by a healthy weight parent. For overweight parents, positive family meal practices mediated the relationship between some family stressors and child weight.
Conclusions
This research suggests that the home environment may affect the weight of children in the family, and the effect is more pronounced in families with at least one overweight parent.
doi:10.1007/s12160-010-9243-z
PMCID: PMC3617927  PMID: 21136225
Family meal practices; Family stressors; Youth weight
16.  Secular trends in weight status and weight-related attitudes and behaviors in adolescents from 1999 to 2010 
Preventive Medicine  2011;54(1):77-81.
Objective
To examine secular trends from 1999 to 2010 in weight status and weight-related attitudes and behaviors among adolescents.
Methods
A repeated cross-sectional design was used. Participants were from Minneapolis/St. Paul middle schools and high schools and included 3,072 adolescents in 1999 (mean age14.6±1.8) and 2,793 adolescents in 2010 (mean age14.4±2.0). Trends in weight-related variables were examined using inverse probability weighting to control for changes in sociodemographics over time.
Results
The prevalence of obesity among boys increased by 7.8% from 1999 to 2010, with large ethnic/racial disparities. In black boys the prevalence of obesity increased from 14.4% to 21.5% and among Hispanic boys, obesity prevalence increased from 19.7% to 33.6% Trends were more positive among girls: weight status did not significantly increase, perceptions of overweight status were more accurate, the use of healthy weight control behaviors remained high, dieting decreased by 6.7%, unhealthy weight control behaviors decreased by 8.2% and extreme weight control behaviors decreased by 4.5%.
Conclusions
Trends indicate a need to intensify efforts to prevent obesity and other weight-related problems, particularly for boys from ethnic/racial minorities. The decreases in unhealthy weight control behaviors among girls are encouraging.
doi:10.1016/j.ypmed.2011.10.003
PMCID: PMC3266744  PMID: 22024221
Obesity; Adolescents; Dieting; Weight control; Secular trends; Racial disparities
17.  Situational characteristics of young adults' eating occasions: a real-time data collection using Personal Digital Assistants 
Public health nutrition  2010;14(3):472-479.
Objective
To examine: (a) situational characteristics of young adult eating occasions, including away-from-home eating, social influences, and multitasking, and (b) how these characteristics are associated with specific foods/beverages consumed.
Design
Participants logged numerous characteristics of eating occasions (n=1237) in real-time over 7 days.
Setting
Minneapolis/St. Paul metropolitan area (Minnesota, USA)
Subjects
Forty-eight participants, ages 18–3 years
Results
Half of all eating occasions (46%) occurred alone, 26% occurred while watching television and 36% involved other multitasking. Most participants (63%) did not think about their food choices in advance of eating occasions. Eating that occurred in the absence of television viewing and/or other multi-tasking was less likely to include sweetened beverages, and more likely to include items like water, fruit, vegetables, cereal, grains and entrées. Eating occasions occurring and/or those occurring at home, were more likely to include snack foods that required little preparation (e.g., cookies, baked goods), and less likely to include more traditional meal items (e.g., fruits, vegetables, entrée items).
Conclusion
Overall, a large proportion of young adult eating occasions occurred alone, while engaging in other activities and with little advanced planning. Although many young adult eating occasions consist of a wide range of highly processed, energy-dense, convenience products, more traditional meal settings (i.e., eating at home with others in the absence of multi-tasking) may result in more structured mealtimes and better food choices, such as more fruits and vegetables. Effective behavioral strategies promoting positive eating patterns, including home meal preparation, among young adults are urgently needed.
doi:10.1017/S1368980010003186
PMCID: PMC3516625  PMID: 21138611
Dietary intake; meal patterns; young adults; emerging adults
18.  Away-from-home family dinner sources and associations with weight status, body composition and related biomarkers of chronic disease among adolescents and their parents 
Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietitians. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and take-out foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006–2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly versus none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z-score (MRC), cholesterol, HDL-C, LDL, triglycerides, fasting glucose, insulin and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency and demographic characteristics. The odds of overweight/obesity were significantly greater when families reported at least one away-from-home dinner purchase in the past week (OR=1.2–2.6). Mean percent body fat, MRC z-scores and insulin levels were significantly greater with weekly purchases of family dinner from fast food restaurants (p’s < .05). Mean percent body fat, MRC z-scores and HDL levels were significantly higher for families who purchased weekly family dinner from take-out sources (p’s < .05). Although frequent family dinners may be beneficial for adolescents, the source of dinners is likely as important in maintaining a healthy weight. Interventions should focus on encouragement of healthful family meals.
doi:10.1016/j.jada.2011.09.035
PMCID: PMC3230299  PMID: 22117665
family dinner; overweight; obesity; away-from-home; adolescents
19.  Longitudinal and secular trends in parental encouragement for healthful eating, physical activity, and dieting throughout the adolescent years 
The Journal of Adolescent Health  2011;49(3):306-311.
Purpose
Parental encouragement of healthful eating and physical activity has been found to be associated with adolescents’ long-term healthful habits, while parental encouragement to diet has been associated with disordered eating behaviors among adolescents. However, little is known about how parental encouragement changes as adolescents grow older (longitudinal trends), or how parental encouragement has changed over time (secular trends). This study examined 5-year longitudinal and secular trends in adolescents’ report of their parents’ encouragement to eat healthfully, be physically active, and diet.
Methods
Project EAT surveyed a cohort of Minnesota adolescents (n=2516) in 1999 and 2004. Mixed-model regressions were used to assess changes in adolescents’ report of parental encouragement from early to middle adolescence (middle school to high school) and from middle to late adolescence (high school to post-high school), and secular changes in parental encouragement among middle adolescents between 1999 and 2004.
Results
There were significant decreases in parental encouragement to eat healthfully, be active, and diet between early and middle adolescence. Between middle and late adolescence, among males parental encouragement for all behaviors decreased while among females parental encouragement to diet increased. Few secular changes in parental encouragement were observed between 1999 and 2004.
Conclusions
Given the importance of parental support for healthful eating and physical activity, efforts should be made to help parents maintain a high level of encouragement for their children's healthful behavior throughout adolescence. Parents of late-adolescent females should aim to decrease the pressure on their daughters to diet during these critical developmental years.
doi:10.1016/j.jadohealth.2010.12.023
PMCID: PMC3401949  PMID: 21856524
Adolescence; parenting; nutrition; physical activity; dieting; encouragement
21.  Development and validation of a screening instrument to assess the types and quality of foods served at home meals 
Background
Although there is growing interest in assessing the home food environment, no easy-to-use, low cost tools exist to assess the foods served at home meals, making it difficult to assess the meal component of the food environment. The aim of this study was to develop and validate a user-friendly screener to assess the types of foods served at home meals.
Methods
Primary food preparing adults (n = 51) participated in a validation study in their own homes. Staff and participants independently completed a screener as participants cooked dinner. The screener assessed the types of foods offered, method(s) of preparation, and use of added fats. Two scale scores were created: 1) to assess offerings of foods in five food groups (meat and other protein, milk, vegetables, fruit, grains), 2) to assess the relative healthfulness of foods based on types offered, preparation method, and added fats. Criterion validity was assessed comparing staff and participant reports of individual foods (kappa (k)) and scale scores (Spearman correlations).
Results
Criterion validity was high between participants' and staffs' record of whether major food categories (meat and other protein, bread and cereal, salad, vegetables, fruits, dessert) were served (k = 0.79-1.0), moderate for reports of other starches (e.g., rice) being served (k = 0.52), and high for the Five Food Group and Healthfulness scale scores (r = 0.75-0.85, p < .001).
Conclusions
This new meal screening tool has high validity and can be used to assess the types of foods served at home meals allowing a more comprehensive assessment of the home food environment.
doi:10.1186/1479-5868-9-10
PMCID: PMC3298474  PMID: 22313614
Validation; Meal screener; Dinner; Home; Families; Food
22.  Weight Comments by Family and Significant Others in Young Adulthood 
Body image  2010;8(1):12-19.
Weight teasing is common among adolescents, but less is known about the continuation of this experience during young adulthood. The present study uses survey data from a diverse sample of 2,287 young adults, who participated in a 10-year longitudinal study of weight-related issues to examine hurtful weight comments by family members or a significant other. Among young adults, 35.9% of females and 22.8% of males reported receiving hurtful weight-related comments by family members, and 21.2% of females and 23.8% of males with a significant other had received hurtful weight-related comments from this source. Hispanic and Asian young adults and overweight/obese young adults were more likely to report receiving comments than those in other groups. Weight teasing during adolescence predicted hurtful weight-related comments in young adulthood, with some differences by gender. Findings suggest that hurtful weight talk continues into young adulthood and is predicted by earlier weight teasing experiences.
doi:10.1016/j.bodyim.2010.11.002
PMCID: PMC3101896  PMID: 21163716
Weight teasing; romantic relationships; emerging adults; young adults
23.  American Indian Parents’ Assessment of and Concern About Their Kindergarten Child’s Weight Status, South Dakota, 2005-2006 
Introduction
Obesity is highly prevalent among American Indians, and effective prevention efforts require caregiver involvement. We examined American Indian (AI) parents' assessment of and level of concern about their kindergarten child's weight status.
Methods
We collected baseline data (fall of 2005 and fall of 2006) on children and their parents or caregivers for a school-based obesity prevention trial (Bright Start) on an AI reservation in South Dakota. The current study uses 413 parent-child pairs. Age- and sex-adjusted body mass index percentiles were categorized as very underweight (<5th percentile), slightly underweight (5th to <15th percentile), normal weight (15th to <85th percentile), overweight (85th to <95th percentile), and obese (≥95th percentile). Parents or caregivers reported their assessment of and concerns about their child's weight status as well as sociodemographic characteristics. We used mixed-model multivariable analysis to examine associations between sociodemographic characteristics and the probability of parents underclassifying or overclassifying their child's weight status; analyses were adjusted for school as a random effect.
Results
Children were evenly divided by sex and had a mean age of 5.8 years. Twenty-nine percent of children and 86% of parents were overweight or obese. Approximately 33% (n = 138) of parents underclassified and 7% (n = 29) of parents overclassified their child's weight status. Higher parental weight status and higher concern about their child's weight status increased the probability of underclassification (P for trend = .02 for both).
Conclusion
In this sample of at-risk children, one-third of parents underclassified their child's weight status. Childhood obesity prevention programs need to increase awareness and recognition of childhood obesity and address parental weight issues.
PMCID: PMC3359100  PMID: 22338596
24.  Are there nutritional and other benefits associated with family meals among at-risk youth? 
Purpose
The literature suggests positive associations between family dinner frequency and dietary practices and psychosocial well-being, and inverse associations between family dinner frequency and overweight status among general adolescent populations. The present study aims to examine these associations among a population of adolescents at-risk of academic failure.
Methods
A racially-diverse sample of adolescents (n=145, 52% male, 61% nonwhite) from six alternative high schools (AHS) completed surveys and had their heights and weights measured by trained research staff. Mixed model logistic regression analyses assessed associations between family dinner frequency and overweight status, healthy and unhealthy weight management, and food insecurity, while mixed linear models assessed associations with breakfast consumption, fruit and vegetable consumption, high fat food intake, fast food intake, substance use, and depressive symptoms. Analyses adjusted for race/ethnicity, age, gender, socioeconomic status, and the random effect of school.
Results
Family dinner frequency was positively associated with breakfast consumption and fruit intake (p<.01 and p<.05, respectively), and inversely associated with depressive symptoms (p<.05). Adolescents who reported never eating family dinner were significantly more likely to be overweight (Odds ratio (OR) = 2.8, Confidence Interval (CI) = 1.1–6.9) and food insecure (OR=6.0, CI=2.2–16.4) than adolescents who reported 5–7 family meals per week.
Conclusions
In this at-risk sample of youth, some, but not all of the benefits of family meals found in other studies were apparent. Intervention programs to increase the availability and affordability of healthful foods and promote family meals for families of AHS students may be beneficial.
doi:10.1016/j.jadohealth.2009.02.011
PMCID: PMC3246800  PMID: 19766944
alternative high schools; family meals; family dinner; overweight; diversity; psychosocial well-being; at-risk; nutrition; obesity prevention
25.  Associations of American Indian Children’s Screen-Time Behavior With Parental Television Behavior, Parental Perceptions of Children’s Screen Time, and Media-Related Resources in the Home 
Preventing Chronic Disease  2011;8(5):A105.
Introduction
American Indian children have high rates of overweight and obesity, which may be partially attributable to screen-time behavior. Young children's screen-time behavior is strongly influenced by their environment and their parents' behavior. We explored whether parental television watching time, parental perceptions of children's screen time, and media-related resources in the home are related to screen time (ie, television, DVD/video, video game, and computer use) among Oglala Lakota youth residing on or near the Pine Ridge Reservation in South Dakota.
Methods
We collected baseline data from 431 child and parent/caregiver pairs who participated in Bright Start, a group-randomized, controlled, school-based obesity prevention trial to reduce excess weight gain. Controlling for demographic characteristics, we used linear regression analysis to assess associations between children's screen time and parental television watching time, parental perceptions of children's screen time, and availability of media-related household resources.
Results
The most parsimonious model for explaining child screen time included the children's sex, parental body mass index, parental television watching time, how often the child watched television after school or in the evening, parental perception that the child spent too much time playing video games, how often the parent limited the child's television time, and the presence of a VCR/DVD player or video game player in the home (F7,367 = 14.67; P < .001; adjusted R 2 = .37). The presence of a television in the bedroom did not contribute significantly to the model.
Conclusion
Changes in parental television watching time, parental influence over children's screen-time behavior, and availability of media-related resources in the home could decrease screen time and may be used as a strategy for reducing overweight and obesity in American Indian children.
PMCID: PMC3181178  PMID: 21843408

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