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This study was designed to examine (1) the types of technologies or other applications (apps) emerging adults use to track their eating, physical activity, or weight; (2) who uses these apps and (3) whether eating and weight-related concerns during adolescence predict app use in emerging adulthood.Longitudinal survey data were obtained from EAT 2010-2018 (Eating and Activity over Time study, N = 1428), a population-based sample of ethnically/racially and socioeconomically diverse adolescents (mean age: 14.5 ± 2.0 years), who were followed into emerging adulthood (mean age: 22.0 ± 2.0 years). Data were used to examine sociodemographic correlates of physical activity- and dietary-focused app use. Adjusted, gender-stratified logistic regressions were used to investigate longitudinal relationships between eating and weight-related concerns in adolescence and app use in emerging adulthood.Compared to men, women were more likely to use physical activity- (23.2 versus 12.5%, p 0.001) and dietary-focused apps (16.1 versus 5.5%, p 0.001). Among women, eating and weight-related concerns in adolescence, particularly unhealthy muscle-building behaviors (OR = 1.73, 95% CI 1.03-2.92), were associated with later dietary-focused app use. Among men, use of other muscle-building behaviors and body dissatisfaction in adolescence predicted use of physical activity- (OREating and weight-related concerns may predict later use of physical activity- and dietary-focused apps; future research is needed to understand whether use of such apps further increases eating and weight-related concerns.III, well-designed longitudinal cohort study.

BACKGROUND: Despite the increased availability of vaccines, masking and social distancing remain important strategies to mitigate COVID-19 transmission. This qualitative study aimed to better understand experiences navigating public health recommendations to slow the spread of COVID-19 among economically and ethnically diverse mothers with young children. METHODS: Mothers of preschoolers (n=25) were recruited from Project EAT 2010–2018 (Eating and Activity over Time) longitudinal cohort. Participants completed a virtual semi-structured interview about their experiences during COVID-19. Interview transcripts were coded using deductive and inductive content analysis and analyzed using thematic analysis to identify themes. RESULTS: The first identified theme, “Selective adherence to recommendations” included subthemes highlighting how social distancing was more challenging than mask wearing, family and children were primary reasons for reduced adherence, and concern for the wellbeing of others influenced adherence. The second theme, “Personal experiences and relationships were important determinants of perceived severity of the virus and critical aspects of desired support,” included subthemes on feelings of uncertainty, personal experiences with the virus, and desired community supports. Participants felt stressed and confused about what information to trust. Personal experiences with COVID-19 influenced perceptions of its seriousness, and mothers were more confident about following recommendations when they them from trusted medical professionals and desired for communities to work together. CONCLUSIONS: How findings among this diverse population of mothers can help inform future public health messaging and policies throughout the remainder of this pandemic, its aftermath, and future public health emergencies, in which masking and social distancing will be needed, are discussed.

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.

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.

Using the positive deviance approach, the purpose of this study was to identify parent feeding practices that might be protective against early childhood obesity among children with lower weight status (BMI percentile ≥5th-85th) relative to higher weight status (BMI percentile ≥85th). Qualitative interviews were conducted with 71 parents of children aged 2-5 years old (48% girls) enrolled in the Minnesota Special Supplemental Nutrition Program for Women Infants and Children (WIC). Children were identified as having lower weight status (defined as 'positive deviants') (n = 36) or 'higher weight status' (n = 35), and were African American [n = 22], Hispanic [n = 23], or Hmong [n = 26]). Parents were asked about approaches to child feeding and health- and weight-related practices. Findings indicated that relative to caregivers of children with higher weight status, parents of children identified as positive deviant were more likely to report having a consistent routine for providing meals, using a guided choices approach, serving small portions of food during mealtimes, and trusting their child hunger and satiety cues. Moreover, parents of children identified as positive deviant were more likely to promote healthful eating and physical activity engagement and implement clear rules and limits for screen time than parents of children with higher weight status. Results suggest specific parent feeding behaviors and health-related practices that may influence child weight status among children living in low-income and racialized households. The findings of this study also provide research evidence and support the tenets of the Satter Division of Responsibility in Feeding framework. Parenting practices and strategies among parents of children identified as positive deviant are expected to be feasible and should be explored and communicated in future interventions to support age- and sex-recommended weight and health-related outcomes among young children to promote health equity.

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.

Cardiovascular risk is common among resettled refugees from Southeast Asia, but the association with refugee status is unclear. This study investigated the lipid levels of Burmese refugees as compared to the general population of Burma. This observational study included adult refugees from Burma undergoing domestic medical examination at a clinic in Minnesota (n = 127). The cholesterol levels of the refugee cohort were compared to a survey of Burmese residents sampled by the World Health Organization (WHO). The primary variable of interest, mean LDL, was 118.9 mg/dL in the refugee cohort. Adjusting for sex and age-group, this was 18.5 mg/dL higher than the WHO cohort (95% CI 10.0–27.1 mg/dL, p

Background Primary care physicians (PCPs) are in a critical position for identifying, preventing and treating childhood obesity. However, a one-size-fits-all approach does not exist for having conversations about weight with families. A better understanding of how PCPs can address paediatric patients’ weight concerns is needed in order to develop effective guidelines and trainings. Objective To describe PCPs preferences and behaviours regarding weight-related conversations with paediatric patients’ and their families. Methods Twenty PCPs affiliated with the University of Minnesota, USA, were recruited to participate in semi-structured interviews. Transcripts were analysed using inductive thematic analysis. Results PCP’s identified well-child visits as the most appropriate time for weight-related discussions with families. Physicians described what approaches/elements they perceived to work best during conversations: collaboration, empathy, health-focused and objective measures. Conclusions Overall, PCPs were more comfortable with weight-related discussions during annual well-child visits and rarely initiated them during an acute visit or the first encounter with a patient. Objective measures, such as growth charts, were often utilized to start discussions. Considering a large proportion of well-child visits are missed, alternative opportunities to have discussions about healthy lifestyle behaviours should be explored. The integral role PCPs play in paediatric obesity warrants further research.

This mixed-methods study endeavored to expand the current understanding of how early pandemic related disruptions impacted the home food environment and parent feeding practices of families with young children. Data for this study are taken from the Kids EAT! Study, a racially/ethnically diverse cohort of families with 2-5 year old children. Individual interviews were conducted by phone and video conference with mothers (n = 25) during August/September of 2020 and were coded using a hybrid deductive/inductive analysis approach. Parents also reported on their family's food insecurity status enabling qualitative findings to be stratified by family-level food security status. Two overarching themes were identified related to how families in this sample describe the COVID-19 pandemic's impact on their home food environment. Themes included 1) Impacts on obtaining food for one's family, and 2) Specific changes in parent feeding practices. Findings indicated variation within each theme by family food security status. Overall, families experiencing food insecurity more frequently discussed using various coping strategies, including stocking up, rationing food, and use of supplemental food resources, to overcome challenges associated with obtaining food brought on by COVID-19. Families with food insecurity also reported having more time for home cooked meals and more frequently discussed enforcing less structure (timing of meal, place) related to meals/snacks consumed at home during the pandemic. The impacts of the COVID-19 persist, ranging from ongoing economic challenges, inconsistent access to childcare for families, and the emergence of new, more contagious, variants. With this, interventions to address food insecurity amongst families with young children should consider how to optimize the home food environment and promote healthful parent feeding practices within the families they serve in the face of an evolving public health crisis.

Introduction: Substantial cross-sectional evidence exists supporting an association between high body mass index (BMI) during childhood and increased cardiometabolic risk factors. However, less is known about longitudinal associations of child BMI trajectories with biomarkers of cardiometabolic risk. The objective of this study was to (1) identify distinct BMI trajectories during childhood from ages 2-11 years and (2) evaluate the association of these BMI trajectories with biomarkers of cardiometabolic risk at ages 7-11 years. Methods: The analytic sample included 338 children living in low-income and racially/ethnically diverse households who participated in the NET-Works randomized intervention trial and the NET-Works 2 prospective follow-up study. BMI was measured at baseline (when children were 2-4 years of age) and again at 1-, 2-, 3- and 5-year follow-up visits. Percent of the 95 th percentile of BMI (%BMIp95) was the BMI metric calculated at each time point. At the 5-year follow-up visit, children (aged 7 to 11 years) completed assessments for carotid to anterior tibial artery pulse wave velocity (PWV), C-reactive protein (CRP), leptin, adiponectin, and oxidized low-density lipoprotein (oxLDL). Group-based trajectory modeling was used to identify child %BMIp95 trajectory groups. Adjusted linear regressions evaluated the associations between %BMIp95 trajectory groups and PWV, CRP, leptin, adiponectin, and oxLDL. Results: We identified two trajectory groups: (1) 75% of children had a moderate-decreasing trajectory (baseline BMI was below the 95th percentile of BMI and followed a moderate-decreasing trajectory over time), and (2) 25% had a marked-increasing trajectory (baseline BMI was above the 95th percentile of BMI and followed a steep increase over time). Relative to children in the moderate-decrease trajectory group, children in the marked-increase trajectory group had higher mean adjusted CRP (3.3 mg/L, 95% CI [1.6, 4.9]) and leptin (62.5 ng/mL, 95% CI [44.0, 80.9]), and lower levels of adiponectin (-1.4 μg/mL, 95% CI [-2.5, -0.1]). Differences in PWV and oxLDL were small and not statistically significant. Conclusions: Two unique BMI trajectories were observed among children living in low-income and racially/ethnically diverse households. Compared to children with steady BMI decrease over time, those with steady BMI increase over time had a higher baseline BMI and adverse inflammatory and adipokine profiles later in childhood. However, we found no evidence of differences in arterial stiffness, which could develop later in adolescence or adulthood. This study provides additional objective evidence supporting the importance of early-life tracking of BMI using the %BMIp95 metric and lifestyle interventions to reduce the risk of obesity and emerging cardiometabolic risk during childhood.

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.

Use of weight-related self-monitoring (WRSM) apps is common among emerging adults, as are weight and shape concerns. The present study aimed to examine (1) whether emerging adult use of dietary-focused (e.g., MyFitnessPal) and physical activity-focused (e.g., Fitbit) WRSM apps was associated with weight-control and muscle-building behaviors, including commonly recommended/conventional behaviors and disordered behaviors and (2) whether prior use of weight-control and muscle-building behaviors in adolescence might explain such relationships. Data were collected as part of the EAT (Eating and Activity over Time) 2010–2018 study (n=1,446) and analyzed using gender-stratified logistic regression models adjusted for demographic characteristics and body mass index. Among women and men, physical activity- and dietary-focused app use were associated with greater adjusted prevalence of disordered weight-control behaviors (e.g., fasting, purging), and disordered muscle-building behaviors (e.g., using steroids). Physical activity- and dietary-focused app use were also associated with a higher adjusted prevalence of commonly recommended weight-control and conventional muscle-building behaviors (e.g., exercising, changing eating habits), but only among those who were also engaging in disordered behaviors. The observed associations remained statistically significant in models that further adjusted for adolescent use of the respective behaviors. Findings suggest that emerging adults who use physical activity- and dietary-focused WRSM apps are more likely to engage in disordered weight-control and muscle-building behaviors and that these associations are not explained by engagement in these behaviors during adolescence. Future research is needed to examine if there are aspects of WRSM apps that could be modified to reduce potential harm.

Food insecurity (FI) may increase risk for binge eating through a "feast-or-famine" cycle, where fluctuations in food availability correspond to alternating periods of food restriction and opportunities for binge eating, but research on this topic is limited. To clarify the relationship between food availability and binge eating in the context of FI, this study examined the association between momentary food security level and subsequent binge-eating symptoms among individuals in food-insecure households and investigated how this association differs by factors that may modify the extent to which food availability fluctuates. Ecological momentary assessment data were collected in 2020-2021 from 75 young adults (M

Although primary care is an ideal setting in which to address behavioral influences on health, clinicians spend little time discussing preventive care, including lifestyle counseling. There is a dearth of comprehensive training and evidence-based resources to educate clinicians in how to effectively engage with patients about these topics. This study describes and evaluates the acceptability of Change that Matters: Promoting Healthy Behaviors, a ten-module curriculum to train clinicians in brief, evidence-based interventions. Each module includes three parts: interactive patient handouts, didactic training, and electronic health record templates to guide the discussion and after visit summary. A two-part, mixed-methods pilot study was used to evaluate the acceptability of the curriculum in a family medicine residency clinic. In Study 1, external family medicine faculty experts (N = 11) provided written feedback on the patient handouts. In Study 2, 20 residents and 20 patients completed qualitative interviews regarding their experience with curricular materials. Content analysis was used to extract qualitative themes. Experts rated the patient handouts as highly understandable and actionable. Resident themes indicated that the curriculum provided concrete tools to address health behavior change, helped structure patient discussions, and increased confidence. Patients felt empowered to make behavior changes. This new curriculum addresses a gap in existing resources, and is available for free download online which can facilitate dissemination ( https://changethatmatters.umn.edu/ ). Research has found the curriculum to be acceptable to experts, residents, and patients. Future studies need to explore its impact on the behavior of both clinicians and patients.

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. 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

Background Self-weighing is widespread among young adults and is sometimes recommended by healthcare providers for weight management. The present study aims to deepen our understanding of who is frequently self-weighing among young adults, and to examine for whom self-weighing impacts mood based on weighing frequency and other eating and weight-related characteristics. Methods Survey data were collected from a large population-based sample of young adults (31.1 ± 1.6y) participating in Project EAT-IV (n = 1719). Cross-sectional data were stratified across sex and analyzed with chi-square, t-tests, and linear and logistic regressions controlling for age, ethnicity/race, education level, and income. Results Self-weighing frequency was higher among male and female young adults with a current eating disorder, those trying to lose weight or who endorsed any disordered eating behaviors or cognition, and females with higher BMI. Young adult females were significantly more likely than males to report that self-weighing impacted their mood (53% vs 27%, p Conclusion Findings suggest that for many young adults, particularly females and those with weight-related concerns, self-weighing is a behavior that comes with emotional valence. The emotional consequences of self-weighing should be considered when making public health and clinical recommendations regarding the usefulness of self-weighing.

Objective Sociocultural theories hold that family and peer weight-related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross-sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and family teasing (occurrence and perceived impact) in early adolescence, body satisfaction in late adolescence, and UWCBs in young adulthood among a racially/ethnically and socioeconomically diverse population. Method Data were drawn from three waves of Project EAT over a 15-year period (Eating and Activity in Teens and Young Adults), and included responses from 1,902 young adults (57% female). Results Among female participants, a mediated indirect pathway emerged with family weight-related teasing predicting increased engagement in UWCBs in early adulthood via poorer body image in late adolescence. In contrast, peer teasing did not predict body image or UWCBs. Among boys, the mediated indirect pathways were not significant. However, poor body image in late adolescent males predicted higher likelihood of engaging in UCWBs in early adulthood. Discussion These findings support the long-term impact of family weight-related teasing on greater risk for UWCBs among girls and young women, and poor body image as a mechanism accounting for this relationship. Moreover, the results highlight the poor body image among adolescent boys as a factor for increased risk of engaging in UWCBs in early adulthood. Pending replication in current cohorts, health promotion and prevention involving family members of early adolescents that address family weight teasing and body image are needed.

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.

Purpose of Review This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice. Recent Findings Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date. Summary Emerging evidence consistently indicates that food insecurity is cross-sectionally associated with bulimic-spectrum ED pathology among adults. Findings emphasize the need for ED research to include marginalized populations who have historically been overlooked in the ED field. Much more research is needed to better understand the relationship between food insecurity and ED pathology and to determine effective ways to intervene.

BACKGROUND: Parents have a role in shaping the eating behaviors of young children and the intergenerational transmission of eating attitudes. However, little is known regarding how parental intuitive eating practices are related to characteristics of home food and meal environments. OBJECTIVE: To investigate the relationship between parental intuitive eating and the home food and meal environment. DESIGN: Cross-sectional analysis of survey data collected online and by mail in 2015–2016 as part of the Project EAT cohort study. PARTICIPANTS AND SETTING: Participants from 750 unique households (470 mothers, 280 fathers) were surveyed in young adulthood (Mean [M] age = 31.4 years, Standard Deviation [SD] = 1.5). Baseline enrollment of participants in the population-based Project EAT study was conducted in Minneapolis-St. Paul, Minnesota, schools. MAIN OUTCOME MEASURES: Intuitive eating was assessed via self-report. STATISTICAL ANALYSES: Modified Poisson regression models were conducted, adjusting for age, race/ethnicity, and socioeconomic status. RESULTS: Among mothers, higher intuitive eating scores were associated with greater likelihood of usually having fruits and vegetables in the home (prevalence ratio [PR] = 1.03) and with lower likelihood of usually having salty snacks and soda pop in the home (PR = 0.91). Higher intuitive eating scores were also associated with greater likelihood of usually serving fruits and vegetables at dinner among mothers (PR = 1.07). Among both mothers (PR = 1.08) and fathers (PR = 1.07), higher intuitive eating scores were associated with greater likelihood of usually having enough time and energy to prepare meals. CONCLUSIONS: Intuitive eating practices in parents are associated with specific home food environment characteristics. Extending the understanding of these relationships in longitudinal data has the potential to inform the directionality of influences and may help to identify targets for intervention.

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.

Lack of food preparation knowledge, time to prepare meals and concerns about fruit and vegetable spoilage before consumption are the potential barriers to home cooking. These barriers may be addressed by meal kits (bundles of recipes and ingredients). We described home cooking barriers and evaluated acceptability of meal kits, using semi-structured focus groups with caregivers and adolescent patients of an outpatient paediatric weight management clinic. One meal kit per family, containing non-perishable food, a $20 gift card to a grocery store and recipes designed by clinic dietician for two meals, were given at clinic appointments. Two in-person semi-structured focus groups were conducted within 2 weeks of meal kit receipt. Four adolescent participants (75% female; 12.7 ± 0.9 years) and eight caregivers (88% female) participated in the focus groups. Four barriers to home cooking were identified: (a) healthy food cost, (b) preparation time, (c) food preparation knowledge and (d) picky eaters. Participants felt the meal kits addressed the time and lack of food preparation knowledge barriers to home cooking. A clinical meal kit programme was acceptable to a treatment-seeking adolescent population with obesity and their caregivers.

The COVID-19 pandemic brought about many changes that potentially altered the home food environment, which has been associated with child health outcomes, such as dietary intake and weight status. There is also some evidence that changes due to the COVID-19 pandemic are associated with health behaviors in children, such as an increased intake of high-calorie snack food. The current study aimed to more deeply understand how the COVID-19 pandemic affected the home food environment of meal and snack time routines and patterns within families of young children. Data for this study are taken from the Kids EAT! Study, a racially/ethnically diverse cohort of families with 2-5 year old children. Qualitative interviews were conducted by phone and video conference with mothers (n = 25) during August/September 2020 and were coded using a hybrid deductive/inductive analysis approach. This allowed coders to identify themes using the interview questions as an organizational template (deductive) while also allowing unique themes to emerge from the qualitative data (inductive). Four overarching themes emerged with multiple sub-themes: 1) Mothers were more directive in the types of food and amounts of food eaten by children; 2) Mothers had less rules around mealtimes; 3) Mothers had increased meal responsibilities; 4) Changes to child snacking. When faced with a change in a structured schedule and increased stress-such as occurred with the COVID-19 pandemic, parents may benefit from advice on how to manage parent feeding practices, including tips on appropriate limit setting, establishing a schedule and routines, and improving accessibility of healthful snacks. Lessons learned during the COVID-19 pandemic may have relevance to other time periods when families face disruptions to routine and during other times of transition.

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

Objective To explore the extent to which parents divide responsibilities of feeding (what, when, where, how much, and whether) with their children and the factors that influence parents' approach to feeding. Design Individual interviews. Participants Parents (n = 40) of preschoolers. Phenomenon of Interest Division of feeding responsibilities; motivation for feeding approach; challenges to feeding. Analysis Audio-recorded interviews were transcribed verbatim and coded using deductive and inductive content analysis. Results Parent's approaches to feeding varied widely. A few parents followed the Division of Responsibility approach closely. Instead, many parents gave their child more than the recommended amount of influence over what foods were served and offered children less than the recommended amount of autonomy over the whether and how much of eating. Meals and snacks were approached differently; parents exhibited less control over the timing of snacks as well as the types and amounts of foods eaten during snacks, compared with the control exhibited during meals. Conclusions and Implications These data support future research to understand the impact of this framework on child health outcomes when it is adhered to on all eating occasions, including snacks. Collaboration by researchers and clinicians to explore alternative frameworks that encourage parents to provide the structure and autonomy support may enhance positive outcomes in children.

Objective. Childhood obesity experts have identified licensed child care providers as a focus for prevention efforts. Since 2011, local public health agencies in Minnesota have provided training and support to child care providers to assist in implementation of weight-related policies and practices as part of Minnesota’s Statewide Health Improvement Partnership (SHIP). Method. A representative sample of licensed child care centers and family home providers in Minnesota participated in a 2016 survey of policies and practices on child nutrition, infant feeding, and physical activity ( n = 618, response rate = 38.5%). Results. In adjusted analyses, SHIP-participating providers were significantly more likely to implement child nutrition (prevalence ratio = 1.46, 95% confidence interval [CI] 1.14, 1.88]) and physical activity (PR = 1.64, 95% CI [1.26, 2.14]) policies and implemented approximately one additional best practice in child nutrition and infant feeding, respectively. SHIP participation was associated with best practices and policies among home-based providers and policies among centers. Conclusions. Child care providers who participated in SHIP implemented more best practices and policies on weight-related topics than providers who did not participate. Findings suggest that efforts by local public health agencies to support child care providers can be effective at increasing adherence to practices and policies that are likely to influence child behavior and weight.

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.

The goal of the ‘Healthy Start, Healthy State’ study was to describe changes in the implementation of healthy nutrition and physical activity (PA) best practices in early child care and education (ECE) settings from 2010 to 2016. A cohort of 215 Minnesota licensed center- and family/home-based providers completed a survey describing 15 nutrition and 8 PA best practices that they “already do” in 2010 and again in 2016 were analyzed in 2016. There was a significant net implementation rate increase for 15 best practices (10 nutrition, 5 PA) in centers and 12 best practices (8 nutrition, 4 PA) in family/home-based programs. The 2010 nutrition and PA scores were negatively associated with mean change in 2016 indicating the decreased potential for improvement among sites with more best practices already implemented in 2010. Adjusted for 2010 nutrition score and other factors, centers implemented, on average, 1.45 more nutrition best practices from 2010 to 2016 than family/home based programs, and CACFP participating programs implemented, on average, 1.7 more nutrition best practices from 2010 to 2016 than non-CACFP participants. Urbanicity, provider education, and provider years of experience were not significantly associated with 2010–2016 change in nutrition score. The mean PA score change had a small but significant increase for each additional year of provider ECE experience after adjusting for the 2010 score. State-level surveillance of implemented best practices in ECE settings is useful. Findings identify opportunities for stakeholders to respond with targeted technical support and training and to consider potential future policy levers., Highlights • From 2010 to 2016, centers had implementation rate increases for 15 best practices. • Family/home ECE programs had implementation rate increases for 12 best practices. • Coordinated federal, state, and local initiatives are credited with improvements. • State-wide monitoring of implemented best practices in ECE settings is useful.

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

INTRODUCTION This large mixed-method study examines the prevalence of reported positive and negative weight-related comments from significant others and ways in which they are associated with weight-control and muscle-enhancing behaviors and emotional well-being in young adults. METHOD As part of Project EAT (Eating and Activity in Teens and Young Adults)-IV, survey data were provided by 1,436 young adult men and women with a significant other in 2015-2016 (mean age = 31.1 years; 58.6% women). Independent variables included the reported frequency of receiving positive or negative comments about body shape or size; written examples of positive comments were qualitatively coded for subtypes. Analysis of covariance, adjusting for body mass index, tested associations between comments and weight-control behaviors, muscle-enhancing behaviors, and various measures of emotional well-being (i.e., body satisfaction, self-esteem, and depressive symptoms). RESULTS About twice as many participants received positive comments from their significant others compared to negative comments (75% vs. 36%). Receiving positive and/or negative comments was related to body satisfaction, self-esteem, and depressive symptoms but was largely unrelated to weight-control and muscle-enhancing behaviors. In almost all cases, receiving no comments was associated with significantly better well-being than was receiving only negative comments. There were few differences in weight-control or muscle-enhancing behaviors or emotional well-being across subtypes of positive comments. DISCUSSION Reporting the receipt of negative comments from significant others was associated with poorer emotional well-being than was receiving positive comments or no weight-related comments at all. Therapists and other health professionals working with couples should consider advising young adults on the apparent advantages of providing positive feedback regarding weight and shape or abstaining from commenting altogether. (PsycINFO Database Record

Purpose Body dissatisfaction and disordered eating are linked to adverse health consequences. Research describing socioeconomic patterns in the prevalence of these problems is important for informing the design of health services and efforts to improve health equity. Methods Population-based cohort study (EAT 2010–2018: Eating and Activity over Time) of socioeconomically and ethnically/racially diverse U.S. young people who completed surveys as adolescents in 2009–2010 (mean age = 14.5 years) and as emerging adults in 2018 (mean age = 22.0 years). Participants were recruited from 20 schools in Minneapolis-St. Paul, Minnesota. Household socioeconomic status was determined using adolescent report of parental education, employment, and public assistance benefits. Analyses were conducted using data from 1531 participants and regression models that accounted for repeated measures within individuals. Results Among females, high body dissatisfaction and unhealthy weight control behaviors (e.g., skipping meals) were more prevalent and regular use of lifestyle weight management behaviors (e.g., exercise) was less prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Among males, thinness-oriented dieting, unhealthy weight control behaviors, and extreme weight control behaviors (e.g., taking diet pills) were all more prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Few differences were observed across SES groups in models that adjusted for ethnic/racial identity and body mass index. Conclusions There is a need for greater attention to the reach and relevance of efforts to prevent disordered eating and improve body satisfaction to ensure efforts benefit young people across SES groups.

ObjectiveThe present study examined longitudinal associations between four family meal patterns (i.e. never had regular family meals, started having regular family meals, stopped having regular family meals, maintained having regular family meals) and young adult parents’ dietary intake, weight-related behaviours and psychosocial well-being. In addition, family meal patterns of parents were compared with those of non-parents.DesignAnalysis of data from the longitudinal Project EAT (Eating and Activity in Adolescents and Young Adults) study. Linear and logistic regressions were used to examine the associations between family meal patterns and parents’ dietary intake, weight-related behaviours and psychosocial well-being.SettingSchool and in-home settings.SubjectsAt baseline (1998; EAT-I), adolescents (n 4746) from socio-economically and racially/ethnically diverse households completed a survey and anthropometric measurements at school. At follow-up (2015; EAT-IV), participants who were parents (n 726) and who were non-parents with significant others (n 618) completed an online survey.ResultsYoung adult parents who reported having regular family meals as an adolescent and as a parent (‘maintainers’), or who started having regular family meals with their own families (‘starters’), reported more healthful dietary, weight-related and psychosocial outcomes compared with young adults who never reported having regular family meals (‘nevers’; PConclusionsResults suggest that mental and physical health benefits of having regular family meals may be realized as a parent whether the routine of regular family meals is carried forward from adolescence into parenthood, or if the routine is started in parenthood.

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.

Using a community adolescent sample, we aimed to (a) empirically derive eating disorder (ED) symptom groups, (b) examine the longitudinal stability of those groups over 10 years, and (c) identify risk factors associated with ED group stability and transition through young adulthood. Young people (N = 2,287) from the Project EAT cohort participated at baseline (1998-1999) and at 10-year follow-up (2008-2009). Participants completed anthropometric measures at baseline and self-report surveys on disordered eating symptoms and risk factors at both time points. Latent transition modeling was used to test the first two aims and multinomial logistic regression was used for the third aim. Three groups emerged and were labeled as: (a) asymptomatic, (b) dieting, (c) disordered eating (e.g., binge eating, compensatory behaviors). Stability of group membership over 10 years was highest for those in the asymptomatic group, while those in the dieting group showed equal likelihood of transitioning to any group. There was a 75% chance that those in the disordered eating group would continue to belong to a symptomatic group 10 years later. We found that these transitions could be predicted by baseline risk factors. For example, adolescents with one standard deviation higher depressive symptoms than their peers had 53% higher odds (OR = 1.53, 95% CI 1.09-2.16) of transitioning from the asymptomatic group to the disordered eating group. Transition among ED groups is relatively common during adolescence and early adulthood. By targeting risk factors such as self-esteem and familial factors in early adolescence, prevention efforts may be improved.