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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

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.

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.

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.

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.

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.

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.

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.

Objective: Although stressful life events (SLEs) have been suggested to be associated with child well-being, few studies have examined SLEs with child and family behavioral and emotional well-being, especially within diverse populations. The current study examined the associations between SLEs and child behavioral and emotional outcomes, in addition to family-level measures of well-being. Method: Children 5-7 years old and their families (n = 150) from 6 racial and ethnic groups (n = 25 each for African American, Hispanic, Hmong, Native American, Somali, White families) participated in this mixed-methods study. Participants were recruited through primary care clinics. Results: Results showed that all racially and ethnically diverse immigrant and refugee families were experiencing SLEs. The majority of diverse children were experiencing emotional and behavioral problems (i.e., hyperactivity, emotional) in the face of SLEs (i.e., combined SLE score, health-related events), with Somali children being at highest risk. Additionally, the majority of diverse families did not experience lower family functioning in response the SLEs, except regarding certain SLEs (i.e., health-related, legal). However, specific families (i.e., Somali) experienced lower family functioning in the face of multiple SLEs. Discussion: Health care practitioners should consider screening and providing extra resources for reducing stress in children, given all children in the study had some emotional and behavioral problems in the face of SLEs. Additionally, it would be important for practitioners to know which families are at greatest risk for experiencing SLEs (i.e., African American, Native American, Somali families) to ensure they are provided with the resources necessary to mitigate the impact of SLEs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Given the high prevalence of overweight/obesity and the low prevalence of engaging in physical activity in children, it is important to identify barriers that impede child physical activity. One potential barrier is parental stress. The current study examined the association between parental stress levels and girls’ and boys’ moderate to vigorous physical activity. Children aged 5–7 years and their families (n = 150) from 6 racial/ethnic groups (n = 25 each Black, Hispanic, Hmong, Native American, Somali, and White families) were recruited for the Family Matters mixed-methods study in 2015 through primary care clinics in Minneapolis and St Paul, MN. Two in-home visits were carried out with families 10 days apart for data collection, with an 8-day observational period in between when children wore accelerometers. Higher parental stress levels were associated with fewer minutes of moderate to vigorous physical activity in girls (P

Objectives To examine how exposure to controlling parental feeding practices during adolescence is associated with disordered eating behaviors in emerging adulthood. Methods Data were analyzed from 543 males and 769 females (Mage at baseline = 14.5 years, Mage at follow-up = 22.7 years) and their parents who participated in the population-based EAT 2010-2018 and Project F-EAT studies. Parental food restriction and pressure-to-eat practices were assessed with items from the Child Feeding Questionnaire. Regression models predicted chronic dieting, unhealthy weight control behaviors, and binge eating, adjusted for demographic covariates, adiposity, and outcome at baseline. Results Overall, exposure to controlling parental feeding practices during adolescence was not associated with disordered eating behaviors at eight-year follow-up, with one exception. Among males, maternal pressure-to-eat was associated with greater risk of chronic dieting in emerging adulthood. Conclusions By emerging adulthood, other factors may be more salient with regard to disordered eating outcomes than parental feeding practices during adolescence.

BACKGROUND: Current measures of parent feeding practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations in these behaviors across time and context. The current study uses ecological momentary assessment to examine variability of, and predictors of parent feeding practices within a low-income, racially/ethnically diverse, and immigrant sample. METHODS: Children ages 5–7 years old and their parents (n=150 dyads) from six racial/ethnic groups (n=25 from each; Black/African American, Hispanic, Hmong, Native American, Somali, White) were recruited for this mixed-methods study through primary care clinics. RESULTS: Among parents who used restriction (49%) and pressure-to-eat (69%) feeding practices, these feeding practices were utilized about every other day. Contextual factors at the meal associated with parent feeding practices included: number of people at the meal, who prepared the meal, types of food served at meals (e.g., pre-prepared, homemade, fast food), meal setting (e.g., kitchen table, front room), and meal emotional atmosphere (p

In response to the limitations of siloed weight-related intervention approaches, scholars have called for greater integration that is intentional, strategic, and thoughtful between researchers, health care clinicians, community members, and policy makers as a way to more effectively address weight and weight-related (e.g., obesity, diabetes, cardiovascular disease, cancer) public health problems. The Mastery Matrix for Integration Praxis was developed by the Healthy Eating and Activity across the Lifespan (HEAL) team in 2017 to advance the science and praxis of integration across the domains of research, clinical practice, community, and policy to address weight-related public health problems. Integrator functions were identified and developmental stages were created to generate a rubric for measuring mastery of integration. Creating a means to systematically define and evaluate integration praxis and expertise will allow for more individuals and teams to master integration in order to work towards promoting a culture of health.

Childhood maltreatment is consistently associated with adult obesity, leading to calls for tailored weight interventions for people with maltreatment histories. However, it is possible that the maltreatment–obesity association is spurious and driven by unmeasured confounding, in which case such interventions would be misplaced. The home food environment in childhood is a potential confounder, but its role in the association of maltreatment with obesity has not been examined. We used a longitudinal dataset (Project EAT) to examine the association of adult retrospective reports of maltreatment history in childhood (1+ types of maltreatment before age 18 years) with previously-collected prospective childhood reports of home food environment characteristics (availability of healthy foods, availability of sweet/salty snack food, family meal frequency, and food insufficiency). We then estimated the association between maltreatment and adult body mass index (BMI, kg/m(2)) with and without adjustment for these home food environment factors. After adjustment for sociodemographics, maltreatment was only associated with the frequency of family meals. Those with maltreatment had a 0.84 kg/m(2) (95% CI: 0.28, 1.41) higher BMI at age 24–39 years, compared to those with no maltreatment, after adjustment for sociodemographics, parenting style, and BMI in childhood. Additional adjustment for home food environment factors had little effect on this association (β=0.78 kg/m(2); 95% CI: 0.21,1.35), suggesting limited confounding influence of the home food environment factors. Findings provide additional robust evidence that childhood maltreatment is a risk factor for obesity that may warrant tailored interventions.

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

There are disparities in the prevalence of childhood obesity for children from low-income and minority households. Mixed-methods studies that examine home environments in an in-depth manner are needed to identify potential mechanisms driving childhood obesity disparities that have not been examined in prior research. The Family Matters study aims to identify risk and protective factors for childhood obesity in low-income and minority households through a two-phased incremental, mixed-methods, and longitudinal approach. Individual, dyadic (i.e., parent/child; siblings), and familial factors that are associated with, or moderate associations with childhood obesity will be examined. Phase I includes in-home observations of diverse families (n=150; 25 each of African American, American Indian, Hispanic/Latino, Hmong, Somali, and White families). In-home observations include: (1) an interactive observational family task; (2) ecological momentary assessment of parent stress, mood, and parenting practices; (3) child and parent accelerometry; (4) three 24-hour child dietary recalls; (5) home food inventory; (6) built environment audit; (7) anthropometry on all family members; (8) an online survey; and (9) a parent interview. Phase I data will be used for analyses and to inform development of a culturally appropriate survey for Phase II. The survey will be administered at two time points to diverse parents (n=1200) of children ages 5-9. The main aim of the current paper is to describe the Family Matters complex study design and protocol and to report Phase I feasibility data for participant recruitment and study completion. Results from this comprehensive study will inform the development of culturally-tailored interventions to reduce childhood obesity disparities.

Despite intense nationwide efforts to improve healthy eating and physical activity across the lifespan, progress has plateaued. Moreover, health inequities remain. Frameworks that integrate research, clinical practice, policy, and community resources to address weight-related behaviors are needed. Implementation and evaluation of integration efforts also remain a challenge. The purpose of this paper is to: (1) Describe the planning and development process of an integrator entity, HEAL (Healthy Eating and Activity across the Lifespan); (2) present outcomes of the HEAL development process including the HEAL vision, mission, and values statements; (3) define the planned integrator functions of HEAL; and (4) describe the ongoing evaluation of the integration process. HEAL team members used a theoretically-driven, evidence-based, systemic, twelve-month planning process to guide the development of HEAL and to lay the foundation for short- and long-term integration initiatives. Key development activities included a review of the literature and case studies, identifying guiding principles and infrastructure needs, conducting stakeholder/key informant interviews, and continuous capacity building among team members. Outcomes/deliverables of the first year of HEAL included a mission, vision, and values statements; definitions of integration and integrator functions and roles; a set of long-range plans; and an integration evaluation plan. Application of the HEAL integration model is currently underway through community solicited initiatives. Overall, HEAL aims to lead real world integrative work that coalesce across research, clinical practice, and policy with community resources to inspire a culture of health equity aimed at improving healthy eating and physical activity across the lifespan.

Background Despite research linking family meals to healthier diets, some families are unable to have regular meals together. These families need guidance about other ways to promote healthy eating among adolescents. Objective Our aim was to examine the association between various parenting practices and adolescent fruit and vegetable (F/V) intake at different levels of family meal frequency. Design We conducted a cross-sectional, population-based survey of influences on adolescent weight-related behaviors using Project EAT (Eating and Activity in Teens) 2010. Participants/setting Participants were 2,491 adolescents recruited from middle/high schools in Minneapolis/St Paul, MN. Measures Adolescent F/V intake was ascertained with a food frequency questionnaire. Survey items assessed frequency of family meals and F/V parenting practices (availability, accessibility, parent modeling, parent encouragement, and family communication). Statistical analyses Linear regression models were used to examine associations with and interactions among family meals and parenting practices. Models were adjusted for age, sex, socioeconomic status, race/ethnicity, and energy intake (kilocalories per day). Results Family meals, F/V availability, F/V accessibility, F/V modeling, and encouragement to eat healthy foods were independently associated with higher F/V intake. Of the 949 (34%) adolescents who reported infrequent family meals (≤2 days/wk), mean F/V intake was 3.6 servings/day for those with high home F/V availability vs 3.0 servings/day for those with low home F/V availability. Similar differences in mean F/V intake (0.3 to 0.6 servings/day) were found for high vs low F/V accessibility, parental modeling, and parent encouragement for healthy eating. Frequent family meals in addition to more favorable parenting practices were associated with the highest F/V intakes. Conclusions Food parenting practices and family meals are associated with greater adolescent F/V intake. Longitudinal and intervention studies are needed to determine which combination of parenting practices will lead to improvements in adolescent diets.

Background Research on family meals has demonstrated that family meals are protective for many aspects of child and adolescent health. It is unclear whether distractions at family meals, such as watching TV, are associated with child weight and weight-related behaviors, the emotional atmosphere at the meal, or family meal healthfulness. Methods Direct observational and objective data were collected on primarily low-income and minority families (n = 120) with 6–12 year old children. Data were collected during home visits and included 24-hr dietary recalls, anthropometry, and video-recorded family meals. Video-recorded family meals were coded to assess the presence of TV, whether the family was paying attention to the TV, family group enjoyment and the dietary healthfulness of the foods served at family meals. Results The presence of TV was negatively associated with the dietary healthfulness and emotional atmosphere of the meal and the child's overall dietary quality. It was positively associated with serving fast food for family meals. Those families who were paying attention to the TV had significantly worse meal dietary healthfulness and were more likely to have fast food at family meals compared to those who were not paying attention. No significant findings were found between the presence of TV at family meals and child overweight status. Conclusions Study results show that TV is frequently present at family meals. Even if families are not paying attention to the TV, it appears that simply having the TV on as background noise is associated with deleterious outcomes. In addition to increasing family meals, families should be given guidance on turning off the TV and making the family meal a time to connect with one another.

Background Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. Objective This study aimed to examine the associations between the parent’s EMA report of their child’s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous–intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. Methods A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. Results The parent’s EMA report of their child’s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent’s EMA report of their child’s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P.31). Conclusions When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child’s PA and SB, the parent’s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA’s strong associations with accelerometer-measured PA and ST.

Objective:To describe snacking characteristics and patterns in children and examine associations with diet quality and BMI.Design:Children’s weight and height were measured. Participants/adult proxies completed multiple 24 h dietary recalls. Snack occasions were self-identified. Snack patterns were derived for each sample using exploratory factor analysis. Associations of snacking characteristics and patterns with Healthy Eating Index-2010 (HEI-2010) score and BMI were examined using multivariable linear regression models.Setting:Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, USA: NET-Works, GROW, GOALS and IMPACT studies.Participants:Predominantly low-income, racial/ethnic minorities: NET-Works (n534, 2–4-year-olds); GROW (n610, 3–5-year-olds); GOALS (n241, 7–11-year-olds); IMPACT (n360, 10–13-year-olds).Results:Two snack patterns were derived for three studies: a meal-like pattern and a beverage pattern. The IMPACT study had a similar meal-like pattern and a dairy/grains pattern. A positive association was observed between meal-like pattern adherence and HEI-2010 score (Pfor trend < 0⋅01) and snack occasion frequency and HEI-2010 score (βcoefficient (95 % CI): NET-Works, 0⋅14 (0⋅04, 0⋅23); GROW, 0⋅12 (0⋅02, 0⋅21)) among younger children. A preference for snacking while using a screen was inversely associated with HEI-2010 score in all studies except IMPACT (βcoefficient (95 % CI): NET-Works, −3⋅15 (−5⋅37, −0⋅92); GROW, −2⋅44 (−4⋅27, −0⋅61); GOALS, −5⋅80 (−8⋅74, −2⋅86)). Associations with BMI were almost all null.Conclusions:Meal-like and beverage patterns described most children’s snack intake, although patterns for non-Hispanic Blacks or adolescents may differ. Diets of 2–5-year-olds may benefit from frequent meal-like pattern snack consumption and diets of all children may benefit from decreasing screen use during eating occasions.

The purpose of this study is to examine the associations between family functioning and youth overweight and obesity in a sample of primary care paediatric patients. Specially, we hypothesize that caregivers of youth with an overweight/obese weight status will report more impaired family functioning. A cross-sectional descriptive study was conducted with 329 caregivers of youth ages 2 to 18 seen in paediatric primary care. Caregivers completed the Family Assessment Device General Functioning Scale and clinical demographics, including parent-reported youth height and weight to calculate body mass index (BMI). Family functioning was used as a continuous total variable, and as a dichotomous variable based on clinically impaired or healthy family functioning. Analyses included descriptive statistics, Pearson's correlations, and independent t tests. Caregivers who reported impaired family functioning based on the clinical cutoff score were more likely to report that their youth had a higher BMI and BMI z-score. Caregivers with impaired family functioning and who identified as being in two-parent families, with at least a Bachelor's degree, and a moderate to high family income were more likely to report their youth was a higher weight status. Further screening and assessment of family functioning in combination with youth weight status among a larger diverse sample of primary care paediatric patients over time will provide insight into what aspects of family functioning may contribute to maintaining a healthy lifestyle or adopting new health behaviours to prevent and/or treat obesity in youth.

Little is known about the association between parental perception of their child's weight as well as parent's current and future concerns regarding their child's weight and a broad range of food-related parenting practices. This study used the first wave of cross-sectional data from the longitudinal Family Matters study to examine the relationships between parental perception of child weight status, parent concern for child's current and future weight and parent use of different types of food-related practices. Parent/child dyads (n = 150) were recruited from primary care clinics. Multiple regression models were fit to examine cross-sectional relationships between parental perception and concern for their child's weight and food-related parenting practices (food restriction, pressure-to-eat, food control, food monitoring, nutrition education, and parent modeling). Parents who perceived their child to be underweight had lower scores for food restriction than parents who perceived their child to be overweight. Parents who reported concern about their child's current weight reported higher scores for food restriction and monitoring than parents who were not currently concerned. Parents who reported concern about their child's future weight status reported higher scores for pressure-to-eat and monitoring than parents who were not at all concerned about their child's future weight status. The relationship between parental perception of child's current weight status and parent use of food restriction, pressure-to-eat, and overall food control was modified by child sex. Overall, results suggest that parent's perceptions of and concerns about their child's current and future weight status were correlated with their feeding approaches. Health care providers may want to consider providing anticipatory guidance for parents that have concerns about their child's weight by teaching them about positive, evidence-based ways they can engage in healthy food-related parenting practices.

Objectives To prospectively evaluate parent supportive behaviors (PSB) for child physical activity (PA) and neighborhood environment variables on changes in child PA over 3 years. Study design Secondary data analysis of the Now Everybody Together for Amazing and Healthful Kids-Works study with 534 parent-child (age 2-4 years) dyads randomized to a community-based pediatric obesity prevention intervention for 3 years (92% retention). PSB and neighborhood environmental variables were examined in relation to changes in child moderate-to-vigorous PA (MVPA), light and sedentary activity, and screen time. Child and parent accelerometry data were collected at visit 0, 12, 24, and 36 months. Mixed multivariate models were used to examine independent and interactive effects of parent-level and neighborhood-level variables on changes in child PA outcomes. Results PSB significantly interacted with visit on change in child MVPA (β = 0.12) and sedentary behaviors (β = -0.18). Over 3 years, a 1-unit increase in PSB was associated with an average increase of 4.3 minutes/day of MVPA and an average decrease of 6.5 minutes/day of sedentary time. Significant main effects were observed for PSB and 3-year change in child screen time (β = -0.05). The children of parents with higher PSB at baseline watched an average of 1.8 fewer minutes/day of screen time compared with parents with lower baseline PSB. Neighborhood-level variables were not significantly associated with changes in child PA outcomes. Conclusions Parents who increase their supportive behaviors for their child's PA have children who are more physically active and less sedentary over time. Interventions to increase preschool-age children's PA may enhance their effectiveness by targeting parents' supportive behaviors for their child's PA.

Summary Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double-coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter-coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p

Few studies have examined concordance/discordance between caregivers to identify whether caregivers see familial and parental factors in the home environment similarly or differently and whether the agreement or disagreement is related to adolescent obesity risk. Answers to these questions are important and may inform whether family-based childhood obesity interventions need to target both parents.The main objective of the study was to examine whether and how parental concordance/discordance on factors in the home environment (eg, importance of family meals, parent feeding practices, encouraging child physical activity, and limit setting on child screen time) are associated with adolescent health behaviors and weight status.Data from two linked population-based studies were used in cross-sectional analyses. Linear regression models examined associations between parental concordance/discordance on home environment factors and adolescents' health behaviors and weight status.Racially/ethnically and socioeconomically diverse adolescents (n=1,052; 54% girls; mean age=14.3 years) and their parents (n=2,104; 52% women; mean age=41.0 years) from Minneapolis and St Paul, MN, participated in the study. Anthropometric assessments and surveys were completed at school by adolescents and surveys were completed at home by parents.Parental concordance on home environment factors was high for some factors (eg, 68% concordance on not pressuring adolescent to eat) and low for other factors (eg, 2% concordance on parent engaging in physically activity with child 4+ hours per week). Parental concordance on positive home environment factors (eg, frequency of family meals) was associated with more adolescent healthful eating patterns and hours of physical activity (P0.05), but not consistently. When parents were discordant, adolescents had higher consumption of fast food and more unhealthy weight control behaviors (P0.05), but not consistently.Results suggest there is some degree of parental concordance on home environment factors; however, the results were inconsistent and approximately one-third of parents were discordant on these factors. Future research is needed to further examine the role of parental concordance/discordance on adolescent health behaviors and weight status.

Food insecurity is becoming increasingly prevalent, especially for children from diverse households. Food insecurity presents a potentially different context in which parents engage in food-related parenting practices and children engage in eating behaviors. Parents may also experience higher levels of stress and depressed mood in the context of food insecurity. This study aims to examine associations between momentary parental stress and depressed mood, food-related parenting practices, and child eating behaviors within food secure and insecure households. Children ages 5–7 and their families (n = 150) from six racial/ethnic groups (n = 25 each African American, Hispanic, Hmong, Native American, Somali, White) were recruited for this mixed-methods study through primary care clinics in Minneapolis/St. Paul, MN in 2015–2016. High levels of parental stress and depressed mood experienced earlier in the day within food insecure households was associated with using restrictive feeding practices and serving more pre-prepared foods at the evening meal the same night. Parents from food secure households who experienced high levels of stress earlier in the day were more likely to engage in pressure-to-eat feeding practices, serve more fast food, and to have children who engaged in picky eating behaviors at the evening meal the same night. Health care clinicians may want to consider, or continue to, screen parents for food insecurity, stress, and depressed mood during well child visits and discuss the influence these factors may have on every day food-related parenting practices. Additionally, future research should consider using real-time interventions to reduce parental stress to promote healthy food-related parenting practices within food insecure and secure households.

OBJECTIVE: To prospectively examine the bidirectional relationship between parental feeding practices (eg, instrumental feeding, encouragement to eat) and child eating behaviors (eg, food responsiveness, emotional eating) in low-income, ethnically diverse preschool children over a 3-year period. STUDY DESIGN: Parent/child (age 2–4 years at baseline) pairs (n = 222 non-Hispanics; n = 312 Hispanics) participated in NET-Works (Now Everybody Together for Amazing and Healthful Kids), a randomized controlled trial carried out in community and in-home settings in urban areas of Minnesota. Data were collected at baseline and 12, 24, and 36 months. The present study is a secondary data analysis using cross-lagged models to identify bidirectional associations between parental feeding practices and child eating behaviors. RESULTS: Three models showed significant cross-lagged effects (P < .05): model 1, parental instrumental feeding influencing later child food responsiveness; model 2, parental emotional feeding influencing later child food responsiveness; and model 3, parental emotional feeding influencing later child eating satiety. Model 1 showed significant bidirectional temporal paths, whereas models 2 and 3 showed significant unidirectional temporal paths from parental feeding practices to child eating behaviors. CONCLUSIONS: Parental instrumental and emotional feeding practices prospectively influence child food responsiveness and satiety. This study demonstrates causal temporality between parental feeding practices and child eating behaviors. Heath care providers may want to use findings regarding parent feeding practices as part of their anticipatory guidance during well-child visits with parents of preschoolers.

The primary objective of this study was to describe parents’ preference for how physicians should approach diet and weight-related advice for their child. Semi-structured interviews were conducted with parents (n = 40) of preschoolers, transcribed verbatim, and double-coded using an inductive thematic analysis approach. Parents identified recommendations for how physicians should approach conversations about weight. Themes included (1) Tone and Approach are Important, (2) Avoid Judgment, (3) Have Regard for Parental Expertise, (4) Consider the Timing of the Discussion with Parents, and (5) Equip Parents with Concrete and Individualized Recommendations. Future research should focus on developing brief, effective communication tools to guide discussions with parents about child nutrition and weight. Opportunities to learn about and practice the use of these brief interventions should be incorporated into medical education with the goal of providing clinicians the learning opportunities, skills/tools, and resources needed to adequately and respectfully discuss weight and diet with parents and children.

OBJECTIVE Prospective associations between obesity in adolescence and adult socioeconomic outcomes, and potential mediators, were examined in a contemporary cohort. METHODS Longitudinal data collected in 1998 to 1999 (Project EAT-I) and 2015 to 2016 (EAT-IV) were analyzed for 1,796 participants who provided data at both time points. Adolescents (mean age = 14.8 years) self-reported demographic and psychosocial variables (EAT-I) and follow-up outcomes (EAT-IV). Body weight and height were directly measured. Bachelor's degree or more education, income ≥ US $50,000, and partnered status at follow-up were examined by baseline obesity (>95th BMI percentile) using logistic regression. Self-esteem, depression, and weight-related teasing were examined as mediators using multivariate probit regressions. All analyses were adjusted for race, baseline age, and parent socioeconomic status. RESULTS Girls with obesity were significantly less likely to have achieved a bachelor's degree (OR 0.32, 95% CI [0.18, 0.58]; P < 0.001), earn ≥ $50,000 annually (OR 0.57, 95% CI [0.33, 0.99]; P < 0.04), or be partnered (OR 0.45, 95% CI [0.27, 0.75]; P < 0.002) in adulthood. No associations were observed among boys. Among girls, depression mediated 8.5% and 23.6% of the association between adolescent obesity and adult education and income, respectively. CONCLUSIONS Adolescent girls with obesity have lower educational attainment and income and are less likely to be partnered in later adulthood. Depression may partly mediate the associations.

BACKGROUND: Although previous cross-sectional research has revealed potential harmful outcomes associated with parent encouragement to diet, it is unclear whether these effects are long lasting and whether they are transmitted to the next generation. The main aim of the current study was to examine longitudinal associations between exposure to parent encouragement to diet in adolescence and weight-related and emotional health outcomes in adulthood and to examine whether intergenerational transmission of encouragement to diet occurs. METHODS: This is a longitudinal, population-based study (ie, Project Eating and Activity in Teens and Young Adults) of socioeconomically and racially and/or ethnically diverse adolescents managed into adulthood and/or parenthood (n = 556; mean age = 31.4; 64.6% female). Surveys and anthropometrics were completed at school by adolescents in 1998–1999 and surveys were completed online in 2015–2016 by young adults. RESULTS: Experiencing parent encouragement to diet as an adolescent was significantly associated with a higher risk of overweight or obesity, dieting, binge eating, engaging in unhealthy weight control behaviors, and lower body satisfaction 15 years later as a parent, after adjusting for sociodemographics and baseline measures of the outcomes (P < .05). Additionally, intergenerational transmission of encouragement to diet occurred and resulted in parents being more likely to report other weight-focused communication in the home environment. CONCLUSIONS: Exposure to parent encouragement to diet as an adolescent had long-term harmful associations with weight-related and emotional health outcomes in parenthood and was transmitted to the next generation. It may be important for health care providers to educate parents about the potential harmful and long-lasting consequences of engaging in encouragement to diet with their children.

A growing body of research suggests that children and adolescents who share frequent meals with their families report better nutrition indicators, family relationships and mental health. Yet, little research has examined whether parents who share meals with their families report the same indicators of wellbeing. The current paper addresses this question using population-based survey data and a sample of parents in the United States (n = 889, mean age 31 years) that responded to the fourth wave of the Project EAT study in 2015-16. Multiple regression models were used to examine associations between frequency of family meals and indicators of nutritional, social and emotional wellbeing, controlling for demographic and household characteristics. Analyses also examined if associations were moderated by sex, as mothers tend to be more responsible for household and childcare tasks. Results suggested that parent report of frequent family meals was associated with higher levels of family functioning, greater self-esteem, and lower levels of depressive symptoms and stress (p-value for all0.001). Frequency of family meals was also related to greater fruit and vegetable consumption (both p 0.05), but was unrelated to other indicators of parent body size and nutritional wellbeing. Associations between frequency of family meals and parent wellbeing were similar for both mothers and fathers. Findings from the current study suggest that frequent family meals may contribute to the social and emotional wellbeing of parents. Future strategies to promote family meals should consider the potential impacts on the health and wellbeing of the whole family.

Introduction Black men are diagnosed with prostate cancer at nearly twice the rate of white men and are underrepresented in prostate cancer research, including validation studies of new clinical tools (e.g., genomic testing). Because healthcare system mistrust has contributed to these disparities for centuries, black men may be less inclined to pursue novel testing, and identification of facilitators to their participation in prostate cancer research studies remains warranted. Methods A community-engaged approach involving a partnership with a community organization was used to conduct seven focus groups in Minnesota, Alabama, and California to explore black men's attitudes toward prostate cancer research participation and genomic testing for prostate cancer. Data were collected and analyzed from April 2015 to April 2017. Results Identified genomic testing barriers included a lack of terminology understanding, healthcare system mistrust, reluctance to seek medical care, and unfavorable attitudes toward research. Facilitators included family history, value of prevention, and the desire for health education. Lack of prostate cancer knowledge, prostate-specific antigen testing confusion, healthcare system distrust, and misuse of personal health information were barriers to research study participation. Some black men were motivated to participate in research if it was seen as constructive and transparent. Conclusions Disparities for black men can both motivate and disincentivize participation depending upon a positive or negative view of research. Confusion over prostate cancer clinical care has fueled some mistrust among black men affecting both clinical care and research participation. With increased education, health literacy, and assurances of research integrity and transparency, black men may be more willing to participate in prostate cancer testing and research. Supplement information This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

“Community engagement” has been defined in a variety of ways over the years, ranging from petition and protests by disenfranchised groups against powerful others (e.g., businesses, governments) who have hurt or neglected them to purposeful partnerships advanced by lay community members and professional organizations. In healthcare, we have seen community engagement evolve from early efforts in peer support that do not directly involve professionals (e.g., Alcoholics Anonymous, Al-Anon) to those that are positioned within communities—but are professionally led (e.g., community-oriented primary care). Today, cutting-edge efforts in community engagement are gaining ground through community-based participatory research (CBPR); this manner of partnering communities and professionals is driven by the wisdom that everyone involved—patients, family members, community leaders, healthcare providers, administrators, etc.—has something to contribute. Collectively, this mosaic of expertise and energy is far more powerful than the sum of its parts.

Pediatric medicine—or “pediatrics” as an umbrella term—promotes the physical, mental, and social well-being of infants, children, adolescents, and young adults (American Academy of Pediatrics, 2011). Pediatric practices are generally situated within primary and specialty care/tertiary care settings. Primary care settings—also called pediatric patient-centered medical homes (PPMH; Ader et al., 2015)—include those where annual well-baby and well-child visits, sick visits, and routine physical exams take place. They are usually led by generalist pediatricians. Specialty/tertiary care settings require additional training tailored to a specific content areas, such as pediatric endocrinology and/or obesity, pediatric pulmonary, pediatric oncology, pediatric hematology, pediatric orthopedics, pediatric intensive care, neonatology, neonatal intensive care, pediatric palliative care, pediatric nephrology, pediatric audiology and speech pathology, pediatric rheumatology, pediatric urology, pediatric gastroenterology, and other health conditions/presentations (see glossary for term definitions). Healthcare providers—and the roles that they serve—in pediatric specialty care teams are tailored to the specialty itself (e.g., a registered dietician in a pediatric endocrinology and obesity clinic).

BACKGROUND: Previous studies have examined the independent influence of mother’s weight status or child’s weight status on parents’ use of specific feeding practices (ie, food restriction, pressure-to-eat). However, studies have not examined the mutual influence of parents’ and adolescents’ weight status on parents’ feeding practices. This study examines the relationship between parent and adolescent weight status concordance and discordance and parent feeding practices. METHODS: Data from 2 linked population-based studies, Eating and Activity in Teens (EAT) 2010 and Families and Eating and Activity in Teens (F-EAT), were used for cross-sectional analysis. Parents (n = 3252; 63% female; mean age 42.6 years) and adolescents (n = 2153; 54% female; mean age 14.4 years) were socioeconomically and racially/ethnically diverse. Anthropometric assessments and surveys were completed at school by adolescents, and surveys were completed at home by parents. RESULTS: Parents used the highest levels of pressure-to-eat feeding practices when parents and adolescents were both nonoverweight compared with all other combinations of concordant and discordant parent/adolescent weight status categories. Additionally, parents used the highest levels of food restriction when parents and adolescents were both overweight/obese compared with all other combinations of concordant and discordant parent/adolescent weight status categories. Sensitivity analyses with 2-parent households revealed similar patterns. CONCLUSIONS: Results suggest that parents use feeding practices in response to both their adolescents’ and their own weight status. Results may inform health care providers and public health interventionists about which parent/adolescent dyads are at highest risk for experiencing food restriction or pressure-to-eat parent feeding practices in the home environment and whom to target in interventions.

Objective To examine whether having family meals as an adolescent protects against becoming overweight or obese 10 years later as a young adult. Study design Data from Project Eating and Activity in Teens -III, a longitudinal cohort study with emerging young adults, were used. At baseline (1998-1999), adolescents completed surveys in middle or high schools, and at 10-year follow-up (2008-2009) surveys were completed online or via mailed surveys. Young adult participants (n = 2117) were racially/ethnically and socioeconomically diverse (52% minority; 38% low income) between the ages of 19 and 31 years (mean age = 25.3; 55% female). Logistic regression was used to associate weight status at follow-up with family meal frequency 10 years earlier during adolescence, controlling and testing for interactions with demographic characteristics. Results All levels of baseline family meal frequency (ie, 1-2, 3-4, ≥5 family meals/wk) during adolescence were significantly associated with reduced odds of overweight or obesity 10 years later in young adulthood compared with never having family meals as an adolescent. Interactions by race indicated that family meals had a stronger protective effect for obesity in black vs white young adults. Conclusions Family meals during adolescence were protective against the development of overweight and obesity in young adulthood. Professionals who work with adolescents and parents may want to strategize with them how to successfully carry out at least 1 to 2 family meals per week in order to protect adolescents from overweight or obesity in young adulthood.

Background A better understanding of the optimal “dose” of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development. Methods A systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2–18 years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score). Results Of the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (# sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size. Conclusions This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose. Trial registrations The protocol was registered on PROSPERO (Registration #CRD42016036124). Electronic supplementary material The online version of this article (10.1186/s12966-017-0615-7) contains supplementary material, which is available to authorized users.

Introduction Decision aids for prostate cancer screening can increase knowledge and shared decision making, but remain underused due to cost and time constraints that disrupt clinic flow. We examined the impact of a simple prostate specific antigen screening decision aid distribution strategy on clinic flow as well as shared decision making in a diverse, urban primary care clinic. Methods Men 50 to 75 years old viewed the decision aid while waiting for physicians. Participants and physicians completed questionnaires evaluating the shared decision making process. Focus groups were conducted with clinic staff and physicians to evaluate the impact on clinic operations. Results Overall 50% of men discussed prostate specific antigen screening and 85% reported the decision aid made decision making easier. Participants reported an average of 12.9 minutes reading the decision aid, with high decision satisfaction and low decisional conflict. Physicians reported an average of 5.2 minutes discussing prostate specific antigen screening. Clinic staff reported increased enthusiasm for the process after adjustments were made in response to concerns including time, as well as lack of knowledge about the decision aid subject matter and involvement in the process. Physician reported barriers included ambivalence about prostate specific antigen screening. Conclusions A prostate specific antigen screening decision aid, requiring few resources, can be implemented with broad involvement of clinic staff and minimal disruption to clinic flow in an urban primary care clinic, and may facilitate shared decision making.

ObjectiveHaving frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children’s overall diet quality (HEI-2010) and BMI percentile.DesignCross-sectional baseline data (2012–2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.SettingStudies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.SubjectsParent–child (ages 2–5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.ResultsOver 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (PConclusionsBreakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile.

BACKGROUND: Research suggests that stress and depressed mood are associated with food-related parenting practices (ie, parent feeding practices, types of food served at meals). However, current measures of parental stress, depressed mood, and food-related parenting practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations across time and context. Identifying momentary factors that influence parent food-related parenting practices will facilitate the development of effective interventions aimed at promoting healthy food-related parenting practices. In this study, we used ecological momentary assessment to examine the association between momentary factors (eg, stress, depressed mood) occurring early in the day and food-related parenting practices at the evening meal. METHODS: Children aged 5 to 7 years and their families (N = 150) from 6 racial and/or ethnic groups (n = 25 each African American, Hispanic/Latino, Hmong, American Indian, Somali, and white families) were recruited for this mixed-methods study through primary care clinics. RESULTS: Higher stress and depressed mood earlier in the day predicted pressure-to-eat feeding practices and fewer homemade foods served at meals the same night. Effect modification was found for certain racial and/or ethnic groups with regard to engaging in pressure-to-eat feeding practices (ie, America Indian, Somali) or serving fewer homemade meals (ie, African American, Hispanic/Latino) in the face of high stress or depressed mood. CONCLUSIONS: Clinicians may want to consider discussing with parents the influence stress and depressed mood can have on everyday food-related parenting practices. Additionally, future researchers should consider using real-time interventions to reduce parental stress and depressed mood to promote healthy parent food-related parenting practices.

Having frequent family meals has consistently been associated with better health outcomes in children/adolescents. It is important to identify how intergenerational transmission of family meal practices occurs to help families benefit from the protective nature of family meals. Limited studies exist that explore the intergenerational transmission of family meal practices, particularly among racially/ethnically diverse and immigrant populations. This study explores how parents describe differences and similarities between meals “then” and “now”, lessons they learned as children about family meals, lessons they passed onto their children, the challenges of carrying out family meals, and how families handle the barriers/challenges to intergenerational transmission of family meal practices. The study was conducted with a sample of African American, Native American, Latino, Hmong, Somali, and White families (25/category). Qualitative themes were explored with the overall sample, by race/ethnicity, immigrant status, and by time in the United States (US) as an immigrant. Parents overwhelmingly reported learning as children that family meals were important and conveying this message to their own children. Differences existed among racial/ethnic groups and time in the US as an immigrant. For example, Somali parents frequently endorsed having no challenges with intergenerational transmission of family meal practices. Immigrant parents in the US for a longer period of time were more likely to endorse learning/teaching about family meal importance, that the food eaten now is different than growing up, that a chaotic environment is a challenge to having family meals, and that they accommodate family member's schedules when planning family meals. Results demonstrate that exploring a parent's early family meal experiences may be important when intervening with parents from diverse racial/ethnic and immigrant populations when trying to improve or increase family meal practices.