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Research addressing the impact of the COVID-19 pandemic on psychosocial well-being and health behavior is accumulating; however, implications for emerging adult populations are underexplored. This manuscript synthesizes findings from a mixed-methods study of well-being, eating and activity behaviors, and food insecurity among a diverse, longitudinal cohort of emerging adults. The review includes findings from 11 original studies that involved collecting online surveys from 720 emerging adults and in-depth, virtual interviews with 33 respondents who were food insecure. Findings indicated the pandemic had widespread impacts on well-being. Population groups at greatest risk for poor outcomes included women; those who identified as Black, Indigenous, or a Person of Color; persons in households of low socioeconomic status; parents of young children; and persons who previously experienced mental health challenges or weight stigma. Further research will be needed to evaluate efforts to improve the well-being of emerging adults in the aftermath of the pandemic.

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.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.Parent ACEs were directly related to child MH issues (β = 0.189, p0.001). This relationship was fully mediated by parent MH (β = 0.374, p0.001; β = 0.246, p0.001) and positive parenting behaviors (β = -0.237, p0.001; β = -0.556, p0.001). High parent ACEs were negatively associated with parent MH (β = 0.374, p0.001), which was then negatively associated with parenting behaviors (β = -0.500, p0.001), which was then negatively associated with child MH (β = -0.600, p0.001). Parent MH maintained a significant, though attenuated, direct relationship with child MH (β = 0.102, p0.05).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.

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.

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.

Many medical schools are instituting gender equity initiatives to address long-standing inequities (e.g., salary, leadership positions, resource distribution) between women and men in academic medicine. However, few theory-driven models exist with built-in metrics to assess the impact of gender equity initiatives. The authors describe the theory- and metric-driven process utilized to create the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota Medical School (UMN). An innovative theory-driven approach using community-based participatory research (CBPR) was used to create and organize CWIMS. CBPR acknowledges community members (e.g., faculty members, staff), academic organizational representatives (e.g., department heads, center directors), and administrative leaders (e.g., deans) as equal contributors in carrying out all aspects of gender equity work. CBPR values collaborative approaches that empower faculty, promote co-learning and co-creation of initiatives among all university partners, and build upon already-existing community strengths and resources. Four CWIMS action groups were created utilizing CBPR principles. The action groups are retention and recruitment; mentoring; salary, resource, and leadership equity; and strategic communications and collaborations. Faculty members across all medical school departments joined these 4 action groups to co-create and carry out all CWIMS gender equity initiatives. The process of developing the CWIMS center and action groups, the CBPR theoretical model guiding the approach, the initiatives developed by the action groups and metrics created, and the outcomes achieved to date are described. In addition, 4 lessons learned from the development of the CWIMS-use of theoretically driven and evidence-based models is key to building a sustainable organization; bottom-up and top-down engagement of partners is crucial for sustainability; passion and innovation are critical for long-term momentum; and not all faculty members and leaders will be enthusiastic about gender equity issues-are shared for the benefit of other medical schools wanting to develop similar centers.

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.

Junia N de Brito,1 Jessica K Friedman,1 Rebecca L Emery,2 Dianne Neumark-Sztainer,1 Jerica M Berge,3 Susan M Mason1 1Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA; 2Department of Family Medicine and Biobehavioral Health, University of Minnesota, Duluth, MN, USA; 3Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USACorrespondence: Junia N de BritoDivision of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55455, USATel +1 612-624-1818Email nogue013@umn.eduBackground: The coronavirus disease 2019 (COVID-19) pandemic increased mothers’ caregiving demands, potentially placing them at increased risk for reduced engagement in healthful behaviors and high psychological distress.Purpose: The purpose of this study was to describe perceived changes in moderate-vigorous physical activity (MVPA) and sedentary behaviors and the prevalence of different measures of psychological distress (depressive and anxiety symptoms, perceived stress, and positive and negative affect) among mothers. We also evaluated the associations of perceived change in MVPA and sedentary behaviors with measures of psychological distress.Methods: We conducted a cross-sectional survey with 317 mothers living with children (0– 20 years old) at home. Mothers self-reported perceived changes in MVPA and sedentary behaviors from before the pandemic to during COVID-19 stay-at-home orders and early reopening, and levels of depression and anxiety symptomatology, perceived stress, and positive and negative affect during the pandemic.Results: Compared to pre-pandemic levels, 39% of mothers reported engaging less in MVPA, and 63% reported engaging in more sedentary activities. One-quarter and 31% of mothers reported moderate/severe depressive and anxiety symptoms, respectively, and 78% medium/high levels of perceived stress. Adjusted linear regression analyses revealed that reduced MVPA and increased sedentary behaviors were associated with high average scores of depressive and anxiety symptoms, perceived stress, negative affect, and low scores of positive affect.Conclusion: A large proportion of mothers reported being less physically active and more engaged in sedentary behaviors, which were associated with increases in psychological distress. Clinical and public health intervention efforts should consider how to improve mothers’ physical and mental health as the country emerges from this crisis.Keywords: COVID-19, mothers, physical activity, stress, depression, anxiety

The aim of this study is to identify the prevalence, predictors, and psychosocial well-being (depressive symptoms, stress) and weight-related behavior (eating behaviors, physical activity, and sedentary behavior) correlates of social distancing during COVID-19 among emerging adults. A rapid-response survey was sent to participants ( n=720; mean age=24.7 ± 2.0 years, 62% female) in a population-based cohort study in Minnesota during April–October 2020. Half of emerging adults reported fully social distancing. Emerging adults from White backgrounds were least likely to social distance while those from Asian backgrounds were most likely to social distance, in addition to those living with a parent. Females who partially/did not social distance reported less healthy eating behaviors, while males and “essential workers” reported higher levels of psychosocial distress. Public health messaging and practical supports for social distancing may need to be made more relevant to emerging adults during public health crises. Resources may need to differ depending on sex of emerging adult.

Primary care has increasingly adopted integrated behavioral health (IBH) practices to enhance overall care. The IBH Cross-Model Framework clarifies the core processes and structures of IBH, but little is known about how practices vary in the implementation of these processes and structures. This study aimed to describe clusters of clinics using the IBH Cross-Model Framework for a large sample of primary care clinics, as well as contextual variables associated with differences in implementation. Primary care clinics (N = 102) in Minnesota reported their level of implementation across 18 different components of IBH via the site self-assessment (SSA). The components were mapped to all five principles and four of the nine structures of the IBH Cross-Model Framework. latent class analysis was used to identify unique clusters of IBH components from the SSA across the IBH Cross-Model Framework's processes and structures. Latent classes were then regressed onto context variables. A four-class model was determined to be the best fit: Low IBH (39.6%), Structural IBH (7.9%), Partial IBH (29.4%), and Strong IBH (23.1%). Partial IBH clinics were more urban than the other three classes, lower in SES risk than Structural IBH clinics, and located in smaller organizations than Strong IBH clinics. There were no differences between classes in race/ethnicity of the clinic area or practice size. Four groups of IBH implementation were identified representing unique profiles of integration. These clusters may represent patterns of community-based implementation of IBH that indicate easier and more challenging aspects of IBH implementation.

Background: The Department of Family Medicine and Community Health at the University of Minnesota engaged in a 5-year transformation to expand research and scholarship opportunities to all faculty. A harmonization framework was used to integrate the 3 missions of clinical care, education, and research to ensure that research and scholarship were an ongoing focus of the department. Methods: The key elements of our transformation included as follows: (1) a general culture of inquiry, (2) harmonized leadership, (3) training and mentoring, and (4) infrastructure and resources. Components of each of these elements were intentionally instituted simultaneously and iteratively across the 5 years to provide robust and sustainable research and scholarship opportunities for all faculty. Results: Outputs and outcomes of the harmonized transformation indicated that clinical and research faculty publications increased, and the percentage of clinical faculty trained in research and scholarship skills increased across the 5 years. Conclusions: Important lessons learned during the harmonized transformation included the following: (1) key elements of the transformation need to be balanced as an ensemble, (2) cultural and organizational shifts take concerted effort and time, (3) embrace iteration: allow “bumps in the road” to propel the work forward, (4) transformation is financially feasible, (5) career research faculty can mutually benefit from clinical faculty engaging in scholarship, and (6) honor skepticism or disinterest and let people cultivate enthusiasm for research and scholarship rather than being forced.

Purpose: This study aimed to identify the associations between social isolation, social contextual factors, and behavioral and psychological health during emerging adulthood. Methods: Participants (n = 1,568) were drawn from EAT 2018 (mean age = 22.1 ± 2.0). Logistic regressions tested the associations between social isolation, contextual factors, and behavioral and psychological health. Results: Approximately 16% of the sample reported social isolation. Emerging adults with socially marginalized identities (e.g., racial/ethnic, socioeconomic), who were unemployed, and/or lived alone had higher odds of experiencing social isolation. Social isolation was associated with more risky health behaviors and lower self-esteem. Discussion: Emerging adults who were socially disadvantaged (e.g., unemployed) had greater risk of social isolation. Findings suggest that social isolation is more strongly linked with behavioral health than psychological health. Generally, findings suggest that access to community resources and areas wherein social connections can be formed may to be important for behavioral health in emerging adulthood.

Background and Objectives: Learning to balance the clinical, educational, and scholarly elements of an academic career is challenging for faculty. To increase research output amongst family medicine faculty with limited to no publications, we developed the Collaborative Scholarship Intensive (CSI) to provide participants with intensive instruction in research methodology coupled with structured writing support and protected time for writing. Methods: The CSI was developed by the University of Minnesota Department of Family Medicine and Community Health as a six-session faculty development program that enrolled 23 participants in its first three classes. Results: Findings reveal that faculty participants significantly improved their pre- to postcourse self-ratings of 12 research competencies, and significantly increased their scholarly output. Conclusions: Our CSI faculty development program successfully engaged clinical faculty in a collaborative research program. Our results suggest that a program focused on intensive instruction in research methodology coupled with structured writing support and protected writing time may be a model for faculty development in other academic departments.

Native scholars are advocating for decolonized research that integrates western methods with Indigenous worldviews and epistemologies. The study presented here was conducted in the Midwestern USA with six graduate students, four recent alumni, and three community Elders with experience in health research. Our goal was to learn from their experiences in scholarship so as to inform future teachers and trainees. An iterative thematic analysis revealed participants’ unanimous emphasis on processes in trust-building. Said processes include gaining insights about personal biases, seeking preparatory and ongoing guidance from Elders and other experienced personnel, educating oneself about Native histories, and functioning as a humble learner. Learning about and enacting these behaviors and strategies can facilitate authentic collaborations. Lessons, suggestions, and resources shared by participants are informative toward creating guidelines for current and future educators in research methods, alongside the new students and professionals that they engage in instruction for such scholarship.

Helicopter parenting, a parenting style defined by over-involvement, may lead to poor health outcomes. However, research has primarily focused on children and adolescents from White, high socio-economic families, with little research examining weight-related health or with emerging adult children. The current study examined associations with emerging adult diet, physical activity, and body mass index (BMI) among a diverse population-based sample of parent and emerging adult dyads ( n = 919). Helicopter parenting was highest among lower socioeconomic households and those identifying as Black, Indigenous, or people of color. Helicopter parenting was associated with both healthy and less healthy dietary behaviors across ethnic/racial groups, but was not associated with physical activity or BMI. Greater consideration of the cultural context related to helicopter parenting is needed before making conclusions about its benefits or harms.

biBackground:/i/bMentored research career development programs are excellent training opportunities for junior faculty/early-stage investigators to transition into independent research careers. However, there is limited evidence that provides guidance on best practices for measuring the impact and reach of these programs, both for individual Scholars and the program as a whole. This article evaluates both the individual and overall impact of the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) National Institutes of Health research career development award at the University of Minnesota.biMaterials and Methods:/i/bBIRCWH Scholars (in/i = 16) and a comparison group (in/i = 17) were evaluated on traditional metrics (ie.g./i, publications, grant funding) in addition to bibliometrics (ie.g./i, network growth, interdisciplinary collaborations, international reach, policy impact).biResults:/i/bTraditional metric findings showed that BIRCWH Scholars had significantly more publications from pre- to post-BIRCWH experience than the comparison group and more grant funding. Bibliometric findings showed exponential network growth, interdisciplinary collaborations, international citations, and policy impact from pre- to post-BIRCWH Scholar experience.biConclusion:/i/bFindings from this evaluation have potential important implications. At the Scholar level, the results can be used to provide evidence of research impact in materials developed for merit review and promotion as well as in job and research grant applications. At the program level, the results can be used at the institutional level to gain broad administrative support and leverage additional funds for program activities and for evidence of program success for continuation funding from federal agencies.

In recognition of the family as central to health, the concept of family, rather than individual, health has been an important area of research and, increasingly, clinical practice. There is a need to leverage existing theories of family health to align with our evolving understanding of Life Course Health Development, including the opportunities and constraints of the family context for promoting lifelong individual and population health. The purpose of this article is to propose an integrative model of family health development within a Life Course Health Development lens to facilitate conceptualization, research, and clinical practice. This model provides an organizing heuristic model for understanding the dynamic interactions between family structures, processes, cognitions, and behaviors across development. Potential applications of this model are discussed.

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.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.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.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.

Objective:To examine how food insecurity is related to emerging adults’ food behaviours and experiences of neighbourhood safety and discrimination and to identify resources needed to support their health during the COVID-19 outbreak.Design:Rapid response online survey. Participants completed the six-item US Household Food Security Survey Module, a brief measure of food insufficiency, and measures of food behaviours, neighbourhood safety and discrimination. Open-ended questions were used to assess changes in eating behaviours during COVID-19 and needed resources.Setting:C-EAT (COVID-19 Eating and Activity over Time) study invitations were sent by email and text message to a longitudinal cohort.Participants:A total of 218 emerging adults (mean age = 24·6 (sd 2·0) years, 70·2 % female) completed a survey in April–May 2020 during a stay-at-home order in Minnesota.Results:The past year prevalence of food insecurity was 28·4 %. Among food-insecure respondents, 41·0 % reported both eating less and experiencing hunger due to lack of money in the past month. Food-insecure respondents were less likely than those who were food secure to have fruits/vegetables at home and more likely to have frequent fast-food restaurant meals, feel unsafe in their neighbourhood and experience discrimination during the stay-at-home order. Food-insecure adults reported changes including eating more food prepared at home, eating more take-out restaurant meals and purchasing more energy-dense snacks as a result of events related to COVID-19. Resources most needed to support their health included eligibility for more food assistance and relief funds.Conclusions:Food-insecure emerging adults experience many barriers to maintaining healthful eating patterns during COVID-19.

Objective:To understand how dietary intake data collected via a brief ecological momentary assessment (EMA) measure compares to that of data collected via interviewer-administered 24-h dietary recalls, and explore differences in level of concordance between these two assessment types by individual- and meal-level characteristics.Design:Parents completed three 24-h dietary recalls and 8 d of brief EMA surveys on behalf of their child; in total, there were 185 d where dietary intake data from both EMA and 24-h recall were available. The EMA measure asked parents to indicate whether (yes/no) their child had consumed any of the nine total food items (e.g. fruit, vegetable, etc.) at eating occasions where both the child and parent were present.Setting:Twenty-four-hour dietary recalls were completed in person in the study participant’s home; participants completed EMA surveys using a study provided in iPad or their personal cell phone.Participants:A diverse, population-based sample of parent–child dyads (n 150).Results:Among meals reported in both the EMA and dietary recalls, concordance of reporting of specific types of food ranged from moderate agreement for meat (kappa = 0·55); fair agreement for sweets (kappa = 0·38), beans/nuts (kappa = 0·37), dairy (kappa = 0·31), fruit (kappa = 0·31) and vegetables (kappa = 0·27); and little to no agreement for refined grains, whole grains and sweetened beverages (73 % overall agreement; kappa = 0·14). Concordance of reporting was highest for breakfast and snacks, as compared with other eating occasions. Higher concordance was observed between the two measures if the meal occurred at home.Conclusions:Data suggest that among meals reported in both the EMA and dietary recalls, concordance in reporting was reasonably good for some types of food but only fair or poor for others.

Objective:This study is a secondary data analysis that examines the association between parent modelling of dietary intake and physical activity and the same child behaviours among different races/ethnicities using innovative, rigorous and objective measures.Design:Ecological momentary assessment surveys were sent to parents to assess whether their child had seen them exercise or consume food. Dietary recall data and accelerometry were used to determine dietary intake and physical activity behaviours of children.Setting:Participants were randomly selected from primary care clinics, serving low-income and racially/ethnically diverse families in Minnesota, USA.Participants:Participants were families with children aged 5–7 years old who lived with parents 50 % of the time and shared at least one meal together.Results:A 10 percentage point higher prevalence in parent modelling of fruit and vegetable intake was associated with 0·12 higher serving intake of those same foods in children. The prevalence of parent modelling of eating energy dense foods (10 % prevalence units) was associated with 0·09 higher serving intake of sugar-sweetened beverages. Furthermore, accelerometry-measured parent sedentary hours was strongly correlated with child sedentary time (0·37 child sedentary hours per parent sedentary hours). An exploratory interaction analysis did not reveal any statistical evidence that these relationships depended on the child’s race/ethnic background.Conclusions:Interventions that increase parent modelling of healthy eating and minimise modelling of energy dense foods may have favourable effects on child dietary quality. Additionally, future research is needed to clarify the associations of parent modelling of physical activity and children’s physical activity levels.

Background Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood. Objective The current study examined associations between snacking and children's diet quality along with differences across ethnicity or race, sex, and weight status. Design Cross-sectional data came from Phase I of the Family Matters Study, an observational study. Participants/setting This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis–Saint Paul, MN in 2017-2018. Main outcome measures Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls. Statistical analyses performed Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only. Results Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children's consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds. Conclusions Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children's food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.

Household food insecurity (FI) is a pressing social, economic and public health issue. However, little is known regarding the effect of FI exposure during the first few years of life, the most active postnatal time for neurobiological and physiological development, on patterns of weight gain during early childhood. It is also unknown whether dietary quality would serve as a pathway through which FI affects children's weight development.This was a secondary data analysis from a three-year randomized clinical trial with five hundred and thirty-four parent/child dyads. Household FI in the past year was reported by parents at baseline when children were 2-4 years of age using the USDA Household Food Security Survey Module-Six Item Short Form. Children's dietary quality at baseline was measured by the US Department of Agriculture Healthy Eating Index (HEI). Child body mass index (BMI) was measured following standardized protocols at baseline and 12-, 24-, and 36-month follow-up. A latent growth curve model was used to examine 1) the association between baseline FI and sex-and-age-adjusted BMI z-scores in children and 2) the HEI pathway between the FI- BMI association.FI early in life was associated with higher baseline BMI z-scores. Children who had higher BMI at baseline maintained their higher BMI status over the next three years. Children's dietary intake quality did not explain the association between baseline FI and BMI z-scores.Early exposure to FI was associated with higher BMI in children as early as two years of age, setting them up for an increased likelihood of persistently high BMI-for-age in later childhood. These data suggest that the first few years may be a critical time for developing obesity risk, calling for policy and practices designed for early intervention of food insecurity.

Several studies have documented a link between maternal employment and childhood obesity, but the mechanisms are not clear. This study investigated the association of maternal employment with children's weight status and detailed weight-related behaviors using data from Phase I of Family Matters, a cross-sectional, observational study of 150 children aged 5-8 from six racial/ethnic groups (White, Black, Latinx, Native American, Hmong, and Somali) and their families from the Minneapolis/St. Paul, MN metropolitan area recruited in 2015-2016. Weight status (objectively measured), child dietary intake (three 24-h dietary recalls), physical activity (eight days of hip-mounted accelerometer data on children), and sleep (eight daily parent reports on children's sleep hours) were examined across four categories of maternal employment status: stay-at-home caregivers, working part-time, working full-time, and unemployed/unable to work. This study found that children's weight status and physical activity levels were similar across all categories of maternal employment. However, there were significant differences in aspects of children's diets by maternal employment status and, compared to children with stay-at-home mothers, children's sleep was significantly lower if their mother worked full-time. These findings highlight that dietary and sleep interventions tailored to the mother's employment status may be fruitful.

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.

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

OBJECTIVES: Ecological momentary assessment (EMA) is an innovative tool being used in the obesity field to capture real-time information about people's health. A recent systematic review regarding the use of EMA to assess dietary intake and physical activity in youth found the need for standardized reporting of EMA measures and methods. This presentation will discuss EMA methods used in the NIH-funded Family Matters study, including survey design, registration/technology, EMA protocols, implementation, and lessons learned for future EMA studies. METHODS: Family Matters is an incremental, two-phased (Phase I = 150 participants; Phase II = 627 participants), mixed-methods study conducted with a racially/ethnically diverse and immigrant/refugee sample from largely low-income households. Across two phases, the Family Matters research team designed and administered EMA surveys to parents of 5–9 year olds to measure momentary factors of importance to child weight and weight-related behaviors including parent feeding practices, child eating behaviors, meal preparation, and foods served at family meals. RESULTS: EMA data allowed for many cutting-edge research questions to be addressed, innovative analyses to be run, and methodological approaches to be advanced. Many diet-related topics were investigated, including 1) the investigation of both within-and across-day relationships between transient and chronic stress and parent feeding practices; 2) parental stress and mood earlier in the day and its association with parent feeding practices later in the day; and 3) family meal characteristics by meal type and day of the week. Additionally, concordance between diet-related EMA measures and objectively collected 24-hour dietary recalls was examined. Family Matters EMA diet-related measures will be presented and related results discussed. CONCLUSIONS: This presentation will be valuable for researchers interested in using EMA for collecting obesity-related measures, such as dietary intake, physical activity, parent feeding practices, and stress/mood. FUNDING SOURCES: Research is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge).

OBJECTIVES: Childhood obesity is a critical public health issue with short and long-term health and financial burdens. Studies show that childhood obesity is higher among children of immigrant/refugee households compared to children whose parents were born in the United States. Poor child dietary intake is a critical risk factor for elevated obesity prevalence. Nonetheless, parents feeding practices are known to be associated with child dietary intake. Thus, this study aimed to examine the associations between length of residence time in the US of migrants/refugees, parents feeding practices, and child diet quality while also taking into consideration race/ethnicity. METHODS: Data are from baseline measures of a longitudinal cohort study called Family Matters. The sample includes 1307 children ages 5–9 and their families from six racial/ethnic backgrounds. RESULTS: Results showed that feeding practices of immigrant/refugee parents changed in relation to their length of residency in the US, in particular, with regard to using directive (e.g., restriction), non-directive (e.g., modeling), and emotional feeding practices. Additionally, race/ethnicity was found to influence the relation between time length in the US and parents feeding practices. Moreover, the diet quality score changed in relation to parents' length of time in the US. For example, Hmong children had the poorest diet quality compared to African American, Native American, Hispanic, Somali, and White children. CONCLUSIONS: Future research should consider studying more in-depth why parent feeding practices may change when parents move to the US and explore whether there is a combination of parent feeding practices that are most useful in promoting healthful child diet quality. It is also important to further examine why child diet quality declines (e.g., Hmong children) with parents' time living in the US as a migrant/refugee. FUNDING SOURCES: Research is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge). Content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute of the National Institutes of Health.

PURPOSE: To identify whether parent encouragement to diet as an adolescent predicts subsequent encouragement to diet from significant others/romantic partners as an adult and to examine longitudinal associations between cumulative encouragement to diet from close relationships (i.e., parent, significant other) and later weight, weight-related, and psychosocial well-being outcomes in adulthood. METHODS: Data from Project EAT I-IV, a 15-year longitudinal population-based study of socio-economically and racially/ethnically diverse adolescents followed into adulthood (n =1116; mean age=31.1; 61% female), were used for this study. Surveys and anthropometric measures were completed at school by adolescents in 1998–1999 and follow-up mailed and online surveys were completed at approximately 5-year intervals between 2003–2016. RESULTS: Adolescents who experienced encouragement to diet from their parents were more likely to have a significant other as an adult who also encouraged them to diet. In addition, there was a significant (p

BACKGROUND. There has been interest in initiatives that promote home cooking, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families. OBJECTIVE. The current study examined data on multiple meals per family in diverse households to determine whether home-cooked meals are more likely to contain nutritious ingredients compared to pre-prepared meals. DESIGN. Data for the study came from the National Institutes of Health-funded Family Matters Study. As part of this study, between 2015 and 2016, 150 families provided ecological momentary assessment data on 3,935 meals over an eight-day observation window. PARTICIPANTS/SETTING. The study followed 150 families with children aged five to seven years old from six racial/ethnic groups (n=25 each non-Hispanic white, non-Hispanic Black, Hispanic, Native American, Hmong, and Somali families). Recruitment occurred through primary care clinics serving low-income populations in Minnesota. MAIN OUTCOME MEASURES. The main outcomes were participants’ self-reports of whether they served fruits, vegetables and whole grains at a meal, reported within hours of the meal. STATISTICAL ANALYSES PERFORMED. Within-group estimator methods were used to estimate the associations between meal preparation and types of food served. These models held constant time-invariant characteristics of families and adjusted for whether the meal was breakfast, lunch, dinner or a snack, and whether it was a weekend meal. RESULTS. For all racial/ethnic and poverty status groups, meals that were fully or partly home-cooked were more likely to contain fruits and vegetables than pre-prepared meals (p

This cross-sectional study investigated the associations between Social Determinants of Health (SDOH) and mental health outcomes of parents and children (n = 1307) from the Latinx, Native American, Somali/Ethiopian, White, Hmong, and African American communities. Logistic regression models were used to estimate the adjusted associations between five parent and child mental health measures and 25 measures of SDOH. False discovery rate q-values were computed to account for multiple comparisons. Families of color reported 5.3-7.8 SDOH barriers while White families reported 1.7 SDOH barriers on average. Adjusted analyses indicated that low family functioning and high perceived discrimination were associated with low resiliency among parents and increased behavioral difficulties among children. Other SDOH that were adversely associated with parent or child mental health included lack of social support, recent stressful life events, and adverse childhood experiences among parents. SDOH in the social and community context were most likely to be associated with mental health problems. Community-engaged evidence-based interventions are needed to improve population mental health.

Background This study examined who is engaging in family/shared meals and associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being among young adults during the COVID-19 pandemic. Methods A rapid-response online survey was sent to participants in a ten-year longitudinal study (Eating and Activity over Time: EAT 2010-2018). A total of 585 young adults (mean age = 24.7 ± 2.0 years, 63.3% female) living with at least one family member completed the COVID-EAT (C-EAT) survey during the U.S. outbreak of COVID-19. Items assessed changes in family/shared meal frequency, eating behaviors, and emotional well-being. Regression models adjusting for sociodemographic characteristics examined associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being. Results Participants reported an average of 4.6 ± 3.4 family/shared meals per week during COVID-19, a 0.5 meal/week increase from prior to the pandemic (p = .002). Family/shared meal frequency during COVID-19 differed by race/ethnicity, with Asian American participants being most likely to report only 1-2 family/shared meals per week. Family/shared meals during COVID-19 were associated with higher vegetable intake, greater availability of fruits, vegetables, and whole wheat bread in the home, lower levels of depressive symptoms and perceived stress, and greater perceived ability to manage stress in young adults. Conclusions Results suggest that engaging in a regular routine, such as family/shared meals, during COVID-19 may have protective associations with dietary health and emotional well-being for young adults. Results may inform practices/routines to offer protective benefits during public health crises such as the current pandemic.

Early-career female faculty, both physician scientists and basic researchers, have disproportionately experienced negative professional, financial, and personal consequences associated with the novel coronavirus disease 2019 (COVID-19) pandemic. This career phase represents a critical time for establishing a network of mentors and collaborators, demonstrating professional independence, and balancing new teaching, research, and service duties while simultaneously navigating personal and familial responsibilities. Persistent gender inequality perpetuated by adherence to traditional gender roles place early-career women faculty at a further disadvantage. Women in academic medicine and research do not attain promotion, leadership positions, and other established markers of success at the same rate as their male counterparts. This disparity was the impetus for the creation of a Recruitment and Retention action group within the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota Medical School (UMN). This perspective piece is written from the viewpoint of a group of female-identifying early-career faculty participating in a career development program for early-stage and newly appointed faculty at UMN, sponsored by the Recruitment and Retention CWIMS action group and our Office of Faculty Affairs. We describe areas of stress exacerbated by the COVID-19 pandemic: work, financial, and work-life well-being, and propose an adapted diversity, equity and inclusion (DEI) model to guide the response to future challenges within a faculty competency framework. We offer recommendations based on the DEI-competency framework, including opportunities for lasting positive change that can emerge from this challenging moment of our collective history.

Background Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods Families were recruited between 2012-2013 from primary care clinics in the Minneapolis–St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P Conclusions Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment.

Summary The environments of children influence their risk for childhood obesity through, among other factors, a child's weight‐related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio‐ecologic lens, we present evidence from cross‐sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio‐ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio‐ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

El entorno en el que viven los niños influye en su riesgo de sufrir obesidad debido, entre otros factores, a los comportamientos relacionados con el peso (es decir, a la dieta y la actividad física). En este artículo presentaremos evidencia sobre los factores socioambientales asociados a la dieta y la actividad física de los niños y, de forma más general, a la prevención y el control de la obesidad infantil entre los niños hispanos y latinos de Estados Unidos y los países latinoamericanos. Utilizando un enfoque socioecológico, presentaremos evidencia procedente de varios estudios transversales y longitudinales realizados en Estados Unidos con niños hispanos y latinos, así como de otros estudios realizados en Latinoamérica en los que también participaron niños. Nos hemos centrado especialmente en los estudios que analizan los factores relacionados con la crianza en el entorno doméstico (p. ej., estrategias de crianza) y, aunque en menor medida, también en los factores socioambientales relacionados con otros contextos de la vida (p. ej., la escuela). La influencia de la aculturación sobre las relaciones sociales transciende los límites del marco conceptual socioecológico. La investigación sobre intervenciones permitió identificar estrategias y brechas de investigación para intervenir los factores sociales que promueven comportamientos saludables y reducen el riesgo de obesidad infantil. Los trabajadores de salud comunitaria y otras formas de apoyo de los pares fueron identificados como elementos relevantes en múltiples niveles del marco socioecológico. Este artículo concluye brindando algunas líneas de trabajo para que futuras investigaciones comprendan mejor el entorno social usando las nuevas tecnologías de información y comunicación.

Background A steep rise in food insecurity is among the most pressing US public health problems that has resulted from the COVID-19 pandemic. Objective This study aimed to (1) describe how food-insecure emerging adults are adapting their eating and child-feeding behaviors during COVID-19 and (2) identify barriers and opportunities to improve local food access and access to food assistance. Design The COVID-19 Eating and Activity Over Time study collected survey data from emerging adults during April to October 2020 and completed interviews with a diverse subset of food-insecure respondents. Participants/setting A total of 720 emerging adults (mean age: 24.7 ± 2.0 years; 62% female; 90% living in Minnesota) completed an online survey, and a predominately female subsample (n = 33) completed an interview by telephone or videoconference. Main outcome measures Survey measures included the short-form of the US Household Food Security Survey Module and 2 items to assess food insufficiency. Interviews assessed eating and feeding behaviors along with barriers to healthy food access. Analyses performed Descriptive statistics and a hybrid deductive and inductive content analysis. Results Nearly one-third of survey respondents had experienced food insecurity in the past year. Interviews with food-insecure participants identified 6 themes with regard to changes in eating and feeding behavior (eg, more processed food, sporadic eating), 5 themes regarding local food access barriers (eg, limited enforcement of COVID-19 safety practices, experiencing discrimination), and 4 themes regarding barriers to accessing food assistance (eg, lack of eligibility, difficulty in locating pantries). Identified recommendations include (1) expanding the distribution of information about food pantries and meal distribution sites, and (2) increasing fresh fruit and vegetable offerings at these sites. Conclusions Interventions of specific relevance to COVID-19 (eg, stronger implementation of safety practices) and expanded food assistance services are needed to improve the accessibility of healthy food for emerging adults.

Given the known health risks, societal burden, and healthcare costs associated with childhood obesity, addressing child weight and weight-related behaviors is critical. The home environment is one key domain to examine when trying to understand risk and protective factors for childhood obesity. This chapter presents innovative mixed-methods approaches to measuring key parental and familial factors linked to child weight and weight-related behaviors. The importance of including multiple family members when measuring the influence of the home environment on child weight and weight-related behaviors is discussed. Selected findings from three NIH-funded mixed-methods studies related to parent and familial factors of importance to child weight and weight-related behaviors are reported, and implications for future intervention research are presented.

Childhood obesity prevalence is high among children from immigrant/refugee households who live in high-income countries. Poor child dietary intake is a critical risk factor for elevated obesity prevalence and food parenting practices have been found to be associated with child dietary intake and eating behaviors. The main aim of this study was to examine the associations between migrants’/refugees’ food parenting practices, the length of residence time in the US, race/ethnicity, and child diet quality. The current study included 577 families from three racial/ethnic groups that include mostly foreign-born parents (Latino, Hmong, and Somali/Ethiopian), and a comparison group of 239 non-Hispanic White families. Results showed that for Latino and Hmong parents, some food parenting practices varied by how long they had lived in the US. For example, more recently moved parents engaged in more non-directive (e.g., avoid buying sweets) practices compared with US-born parents. In contrast, Somali/Ethiopian parents engaged in different food parenting practices than White parents, regardless of time in the US. Results also showed that diet quality among Hmong children was lower if their parents were US-born compared to foreign-born. Future researchers may want to consider studying why some food parenting practices change when parents move to the US and explore whether there is a combination of food parenting practices that are most useful in promoting a healthful child’s diet and weight among immigrant and refugee families.

Rationale There is a need to understand how the ongoing COVID-19 pandemic has affected the mental and behavioral health of young adults in the U.S. Objective This study used quantitative and qualitative survey data to identify young adults at highest risk for psychological distress during the U.S. outbreak of COVID-19 and to further understand how the pandemic has impacted their stress, mood, and substance use. Methods Participants were 670 young adult cohort members (ages 21–29) of the population-based longitudinal study EAT 2010–2018 who participated in the C-EAT study (COVID-19 Eating and Activity over Time). Results Among the sample, 84% (n = 561) reported pandemic-related changes to their mood or stress and 33% (n = 221) reported changes to their substance use. Linear regression analyses identified several meaningful risk factors for higher psychological distress during the pandemic, including female gender, White race, higher pre-pandemic depressive symptoms and perceived stress, and lower pre-pandemic stress management ability. A thematic analysis further identified five major themes related to changes in stress and mood following the COVID-19 outbreak describing specific emotional reactions, stress related to the direct impact of the pandemic as well as interpersonal connectedness and economic factors, and strategies for managing stress. In addition, two major themes were identified related to substance use during the pandemic detailing specific changes in and motivations for substance use. Conclusions These findings underscore the need to develop effective, scalable, and rapidly deployable public health resources that target the stressors commonly experienced among young adults to improve their psychological wellbeing during this pandemic.