Invalidating childhood environments in anorexia and bulimia nervosa

OBJECTIVE: This study examined the relationship between an invalidating childhood environment and eating pathology, including diagnoses, eating attitudes and eating behaviours. METHOD: Fifty-eight eating-disordered patients completed a measure of invalidating childhood environments, and a standardised measure of eating pathology. RESULTS: Patients with bulimia nervosa scored higher on levels of paternal invalidation than those with anorexia nervosa. There were no associations at the attitudinal level, but some behaviours were related to perceived parental style. Self-induced vomiting was associated with paternal invalidation, while those who experienced an invalidating mother were less likely to report binge-eating. Those who exercised excessively were more likely to have experienced a family style in which the focus is on remaining in control of one's emotions, success and achievement. DISCUSSION: Invalidating childhood environment was related to eating psychopathology in a clinical population - particularly the presence or absence of some behaviours. Implications for treatment are considered.     

Parental employment and work-family stress: associations with family food environments

Parental employment provides many benefits to children's health. However, an increasing number of studies have observed associations between mothers' full-time employment and less healthful family food environments. Few studies have examined other ways in which parental employment may be associated with the family food environment, including the role of fathers' employment and parents' stress balancing work and home obligations. This study utilized data from Project F-EAT, a population-based study of a socio-demographically diverse sample of 3709 parents of adolescents living in a metropolitan area in the Midwestern United States, to examine cross-sectional associations between mothers' and fathers' employment status and parents' work-life stress with multiple aspects of the family food environment. Among parents participating in Project F-EAT, 64% of fathers and 46% of mothers were full-time employed, while 25% of fathers and 37% of mothers were not employed. Results showed that full-time employed mothers reported fewer family meals, less frequent encouragement of their adolescents' healthful eating, lower fruit and vegetable intake, and less time spent on food preparation, compared to part-time and not-employed mothers, after adjusting for socio-demographics. Full-time employed fathers reported significantly fewer hours of food preparation; no other associations were seen between fathers' employment status and characteristics of the family food environment. In contrast, higher work-life stress among both parents was associated with less healthful family food environment characteristics including less frequent family meals and more frequent sugar-sweetened beverage and fast food consumption by parents. Among dual-parent families, taking into account the employment characteristics of the other parent did not substantially alter the relationships between work-life stress and family food environment characteristics. While parental employment is beneficial for many families, identifying policy and programmatic strategies to reduce parents' work-life stress may have positive implications for the family food environment and for the eating patterns and related health outcomes of children and parents.     

Food Availability/Convenience and Obesity

Neighborhood environments have received considerable attention in recent local, state, and national obesity prevention initiatives, with a particular focus on food deserts, or areas with poor access to healthy foods. Yet, there are inconsistencies in the evidence base, suggesting a nuanced association between neighborhood environment, food availability, diet behaviors, and obesity. There is heterogeneity in associations between environmental exposures and health outcomes across race/ethnicity, gender, region, and urbanicity, which results in complexity in the interpretation of findings. There are several limitations in the literature, including a predominance of cross-sectional studies, reliance on commercial business listings, lack of attention to the process by which diet resources are established and expanded within neighborhoods and the potential for individuals to selectively migrate to locate near such facilities, a predominant focus on residential neighborhoods, and lack of information about the decision-making process underlying purchasing patterns. More research is needed to address the complexity of individual-level residential decision making as well as the purposeful placement of food environment resources across social and geographic space using longitudinal data and complex statistical approaches. In addition, improvements in data quality and depth related to food access and availability are needed, including behavioral data on purchase patterns and interactions with the food environment, and greater attention to heterogeneity across subpopulations. As policy changes to the food environment move forward, it is critical that there is rigorous and scientific evaluation of environmental changes and their impact on individual-level diet choices and behaviors, and their further influence on body weight.     

Determinants of healthy eating in Canada: an overview and synthesis

This article uses a population health perspective to examine the complex set of interactions among the determinants of healthy eating. An overview of current knowledge on determinants of healthy eating was organized as follows: 1) individual determinants of personal food choices and 2) collective determinants, including a) environmental determinants as the context for eating behaviours and b) public policies as creating supportive environments for healthy eating. A conceptual synthesis of the literature revealed that individual determinants of personal food choice (physiological state, food preferences, nutritional knowledge, perceptions of healthy eating and psychological factors) are necessary, but not sufficient, to explain eating behaviour, which is highly contextual. Collective determinants of eating behaviour include a wide range of contextual factors, such as the interpersonal environment created by family and peers, the physical environment, which determines food availability and accessibility, the economic environment, in which food is a commodity to be marketed for profit, and the social environment, in which social status (income, education and gender) and cultural milieu are determinants of healthy eating that may be working "invisibly" to structure food choice. Policy is a powerful means of mediating multiple environments. There are gaps in our understanding of the process of intervening in macro-level environments and the impact of such interventions on the promotion of healthy eating. Collective determinants of food choice and policy contexts for promoting healthy eating, therefore, require investment in research. Applying a population health promotion lens to understanding the multiple contexts influencing healthy eating provides insight into prioritizing research and action strategies for the promotion of healthy eating.     

An activity space approach to understanding how food access is associated with dietary intake and BMI among urban,low-income African American women

Inconclusive evidence for how food environments affect health may result from an emphasis on residential neighborhood-based measures of exposure. We used an activity space approach to examine whether 1) measures of food access and 2) associations with diet and BMI differ between residential and activity space food environments among low-income African American women in Atlanta, Georgia (n = 199). Although residential and activity space environments differed across all dimensions of food access, being located farther away from ‘unhealthy’ outlets was associated with lower BMI in both environments. Future research should move beyond asking whether residential and activity space environments differ, toward examining if, how, and under what conditions these differences impact the estimation of health effects.     

Workplace smoking policies in Taiwan and their association with employees' smoking behaviours

BACKGROUND: The implementation of worksite smoking policies has shown significant effects on reducing employees' smoking consumption and protecting non-smoking workers. However, there are no data about workplace smoking policies in Taiwan. The purpose of this study was to document the status of worksite smoking policies in Taiwan and its potential impact on employees' smoking behaviours. METHODS: A two-stage investigation was conducted. The first stage was to examine the current status of workplace smoking policies and the second was to evaluate the relationship between workplace smoking policies and employees' smoking behaviours. After two follow-ups in each stage, 264 companies and 1141 employees returned their questionnaires. RESULTS: Workplace smoking policies were associated with types of businesses and size of workplaces. Only approximately half of manufacturing and service companies have implemented a prohibitive smoking policy. Large facilities (>750 employees) were more likely to implement a prohibitive policy (57%). Employees in workplaces with a prohibitive policy had lower prevalence of smoking and cigarette consumption, and less exposure to passive smoking. Although most smokers agreed with banning smoking in their work environment, no difference in interest in participating in cessation programs was found. CONCLUSIONS: Significant associations were found between workplace smoking policies and employees' smoking behaviours. Results of the study provide basic information for designing more refined smoking policies in the workplace in Taiwan.     

Initial investigation of associations between feeding practices,eating behaviours,and weight status in Vietnamese children using modified questionnaires

AimsThis cross-sectional study aims to extend the preliminary validation of the Feeding Practices and Structure Questionnaire (FPSQ) and Children’s Eating Behaviour Questionnaire (CEBQ) in the Vietnamese context by examining associations between maternal feeding practices, child eating behaviours, and child weight status.MethodsModified versions of the FPSQ and CEBQ were used to measure maternal feeding practices and child eating behaviours, respectively, in a sample of Vietnamese mothers of children within the age range of two to five years (n = 100). Children’s weight-for-height z-scores (WHZs) were calculated using weight and height measurements obtained by clinicians. Pearson’s correlation coefficients were used to examine bivariate associations between maternal feeding practices, child eating behaviours, and child WHZs. Significant variables were then entered into a multivariable regression model.ResultsChild WHZs were associated with maternal persuasive feeding, and child slowness in eating, enjoyment of food/food responsiveness, and emotional undereating, but in multivariable regression analysis, only persuasive feeding (β = ?0.44, p = 0.027) and slowness in eating (β = ?0.39, p = 0.036) contributed significantly to the model.ConclusionsThe findings provide some evidence of construct validity for the modified questionnaires. Potential implications of dietary-related behaviours on weight status in preschool-aged children in Viet Nam are evident. However, further validation and analysis in larger datasets must be undertaken in order to examine these associations with increased certainty.     

Effects of built and natural environments on leisure physical activity in residential and workplace neighborhoods

Few studies have investigated relative contributions of the built and natural environments to and their nonlinear associations with leisure physical activity (PA) in different spatial contexts. Applying gradient boosting decision tree models to data comprising 1049 adults collected in Shanghai, we investigated the associations between built and natural environments and leisure PA in residential and workplace neighborhoods. Results show that the built environment is more important than the natural environment to leisure PA in both residences and workplaces. Environmental attributes have nonlinear and threshold effects. Within certain ranges, land use mix and population density have opposite associations with leisure PA in residences and workplaces, whereas the distance to the city center and the area of water are associated with leisure PA in residences and workplaces with the same direction. These findings help urban planners design context-specific environmental interventions for supporting leisure PA.     

Disentangling neighborhood contextual associations with child body mass index,diet, and physical activity: The role of built,socioeconomic, and social environments

Obesity prevalence among US children and adolescents has tripled in the past three decades. Consequently, dramatic increases in chronic disease incidence are expected, particularly among populations already experiencing health disparities. Recent evidence identifies characteristics of “obesogenic” neighborhood environments that affect weight and weight-related behaviors. This study aimed to examine associations between built, socioeconomic, and social characteristics of a child's residential environment on body mass index (BMI), diet, and physical activity. We focused on pre-adolescent children living in New Haven, Connecticut to better understand neighborhood environments' contribution to persistent health disparities. Participants were 1048 fifth and sixth grade students who completed school-based health surveys and physical measures in fall 2009. Student data were linked to US Census, parks, retailer, and crime data. Analyses were conducted using multilevel modeling. Property crimes and living further from a grocery store were associated with higher BMI. Students living within a 5-min walk of a fast food outlet had higher BMI, and those living in a tract with higher density of fast food outlets reported less frequent healthy eating and more frequent unhealthy eating. Students' reported perceptions of access to parks, playgrounds, and gyms were associated with more frequent healthy eating and exercise. Students living in more affluent neighborhoods reported more frequent healthy eating, less unhealthy eating, and less screen time. Neighborhood social ties were positively associated with frequency of exercise. In conclusion, distinct domains of neighborhood environment characteristics were independently related to children's BMI and health behaviors. Findings link healthy behaviors with built, social, and socioeconomic environment assets (access to parks, social ties, affluence), and unhealthy behaviors with built environment inhibitors (access to fast food outlets), suggesting neighborhood environments are an important level at which to intervene to prevent childhood obesity and its adverse consequences.     

Modeling a bivariate residential-workplace neighborhood effect when estimating the effect of proximity to fast-food establishments on body mass index

Hierarchical modeling is the preferred approach of modeling neighborhood effects. When both residential and workplace neighborhoods are known, a bivariate (residential-workplace) neighborhood random effect that quantifies the extent that a neighborhood's residential and workplace effects are correlated may be modeled. However, standard statistical software for hierarchical models does not easily allow correlations between the random effects of distinct clustering variables to be incorporated. To overcome this challenge, we develop a Bayesian model and an accompanying estimation procedure that allows for correlated bivariate neighborhood effects and allows individuals to reside or work in multiple neighborhoods, cross-sectional and longitudinal heterogeneity between individuals, and serial correlation between repeated observations over time. Simulation studies that vary key model parameters evaluate how well each aspect of the model is identified by the data. We apply the model to the motivating Framingham Heart Study linked food establishment data to examine whether (i) proximity to fast-food establishments is associated with body mass index, (ii) workplace neighborhood exposure associations are larger than those for residential neighborhood exposure, and (iii) residential neighborhood exposure associations correlate with workplace neighborhood exposure. Comparisons of the full model to models with restricted versions of the covariance structure illustrate the impact of including each feature of the covariance structure.     

Neighbourhood socioeconomic status, health and working conditions of school teachers

OBJECTIVE: To investigate the associations of workplace neighbourhood socioeconomic status with health behaviours, health and working conditions among school teachers. Method: The survey responses and employer records of 1862 teachers were linked to census data on school neighbourhood socioeconomic status. In the multilevel analysis, adjustments were made for demographics, work factors and the socioeconomic status of the teacher's own residential area. SETTING: 226 public schools in Finland. RESULTS: Teachers working in schools from neighbourhoods with the lowest socioeconomic status reported heavy alcohol consumption (OR 2.25; 95% CI 1.32 to 3.83) and higher probability of doctor-diagnosed mental disorders (OR 1.47; 95% CI 1.02 to 2.12) more often than teachers working in schools located in the wealthiest neighbourhoods. After controlling for the socioeconomic status of the teacher's own residential area, only heavy alcohol consumption remained statistically significant. Teachers working in schools with lower socioeconomic status also reported lower frequency of workplace meetings, lower participation in occupational training, lower teaching efficacy and higher mental workload. CONCLUSIONS: School neighbourhood socioeconomic status is associated with working conditions and health of school teachers. The association with health is partially explained by the socioeconomic status of the teachers' own residential neighbourhoods. An independent association was found between low socioeconomic status of school neighbourhoods and heavy alcohol use among teachers.     

Relationships between temperament and eating behaviours in young children

This study examined the associations between eating behaviours and temperament in a sample of young children. Mothers (N=241) of children aged 3-8 years completed measures of their children's eating behaviours and temperament and reported their child's height and weight. Children with more emotional temperaments were reported to display more food avoidant eating behaviours. Shyness, sociability and activity were not related to children's eating behaviours. Higher child BMI was related to more food approach eating behaviours but BMI was unrelated to child temperament. Future research should explore more specifically how emotional temperaments might influence child eating behaviour.     

Family circumstance and adolescent dietary behaviours

The available information on the contribution of family circumstance to adolescent dietary behaviours is inconsistent. Indicators of family circumstance may impact adolescent behaviours by influencing their daily home environment. This study examined cross-sectional and longitudinal relationships between indicators of family circumstance and (i) breakfast skipping and (ii) consumption of snack food, fast food, fruits and vegetables among adolescents. Dietary behaviour was assessed using a web-based survey completed by 1884 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2 years later. Five indicators of family circumstance (parental marital status, maternal education, maternal employment status, number of brothers and number of sisters) were assessed with a questionnaire completed by parents at baseline only. Logistic regression was used to examine cross-sectional associations between indicators of family circumstance and dietary behaviours. Multinomial logistic regression was used to examine associations between indicators of family circumstance and 2-year change in dietary behaviours. Individual indicators of family circumstance were differentially associated with adolescent dietary behaviours. Cross-sectional and longitudinal associations differed for adolescent boys and girls highlighting the importance of assessing specific dietary behaviours and food types individually by gender. This study highlights the complexity of the relationships between family circumstance and adolescent dietary behaviours. Future research needs to assess the efficacy of strategies promoting maternal nutritional knowledge on the dietary behaviours of adolescents.     

Non-residential neighborhood exposures suppress neighborhood effects on self-rated health

In prior research, neighborhood effects have often been weak or inconsistent in predicting specific causes of mortality and morbidity. To determine whether residential neighborhood effects are suppressed by exposure to other environments, we examined the effect on adult self-rated health of non-residential environments that figure in individuals' daily routines. We linked the 2000 US Census data with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 3323 adults sampled from neighborhoods in LA County. Characteristics of census tracts where respondents lived, worked, shopped, sought medical care, worshipped and spent "other" time were obtained from the 2000 US Census. Weighted multilevel linear and clustered generalized ordered logistic regressions were used to estimate associations between self-rated health and non-residential neighborhood exposures after adjustment for individual-level factors and exposure to residential neighborhoods. We found that residence in disadvantaged neighborhoods was associated with worse self-rated health. In a dose-response fashion, the greater the exposure to less disadvantaged non-residential neighborhoods in the course of routine activities, the greater the magnitude in improved self-rated health. Models including non-residential neighborhood exposure increase the magnitude and significance of the association between residential neighborhoods and health. In conclusion, individuals' exposure to non-residential neighborhoods confounds and suppresses the association of residential neighborhoods with health and could explain why previous studies may not have found robust associations between residential neighborhood predictors and health.     

Responsive complementary feeding in rural Bangladesh

It is now widely recognized that malnutrition can partly be attributed to caregiver-child interaction during feeding episodes. Current conceptual frameworks emphasize the importance of responsiveness (including active and social behaviour), psychomotor abilities of the child to self-feed, and a non-distracting feeding environment. The present observational study had three main objectives: (1) to define operationally key terms such as responsive and active feeding and observe their frequency in a rural Bangladesh sample; (2) to examine whether self-feeding, responsive and active behaviours of the mother and child varied with child's age and amounts eaten; and (3) to determine associations between mother and child behaviours. Fifty-four mother-child pairs were observed during one feeding episode and behaviours were coded for 5 categories, namely self-feeding, responsive, active, social and distracting behaviours. Children were between 8 and 24 months of age. Results indicated that the five behaviours could be observed and reliably coded. Two-thirds of mothers had an active feeding style but only a third were responsive; the two styles did not overlap. With older children, mothers encouraged more eating and more self-feeding, but children did not feed themselves more; instead older children were more negatively responsive (refusing offered food). Positively responsive mothers tended to have active children who explicitly signaled their desire for food or water, and who ate more mouthfuls of food. Positively active mothers adopted different strategies to encourage eating, such as verbally directing the child to eat, focusing, and temporarily diverting. These mothers tended to have children who were negatively responsive and refused food. Children accepted on average 5.31 mouthfuls of food and rejected 2.13. Mothers who used intrusively active strategies (e.g. force feeding) tended to have children who were both positively and negatively responsive, thus partially reinforcing her forceful behaviour. Thus, the responsive feeding framework, once operationalized, has the potential to identify specific behaviours that support or impede mother-child interaction during complementary feeding.     

How impulsiveness and variety influence food intake in a sample of healthy women

This study investigates to what extent an impulsive personality, a varied food environment and their interaction influence food intake. We also investigated whether high-impulsives would exhibit more "eating disordered" thoughts and behaviours. Forty-five low-impulsives and forty-one high-impulsives did a bogus taste test with varied or monotonous food. As expected, high impulsives had a higher food intake compared to low impulsives. Moreover, high-impulsives reported significantly more "eating disordered" thoughts and behaviours than low-impulsives. Neither a main effect of variety nor an interaction between variety and impulsivity were found.     

Residential neighborhood,geographic work environment,and work economic sector: associations with body fat measured by bioelectrical impedance in the RECORD Study

PurposeStudies of associations between geographic environment and obesity have mostly examined body mass index and focused on residential neighborhoods. We investigated associations between residential neighborhoods, geographic work environments, and work economic sectors and the fat mass index (FMI) and percentage of fat mass (%FM).MethodsData on 4331 participants from the French RECORD Study geolocated at their residence and workplace were analyzed. Body composition was assessed by bioelectrical impedance analyzers. Multilevel linear regression was used to investigate the determinants of FMI and %FM.ResultsAfter adjustment, among men, the FMI and %FM increased independently with decreasing density of population and educational level in the residential neighborhood. Among women, the residential educational level was related to the FMI and %FM. Among men, a higher FMI and %FM were observed among participants working in the construction and transportation/communication sectors than in the education sector. For women, the FMI was higher among participants working in the public administration and health/social work sectors than in the transport/communication sector. A long home-work distance was associated with a higher FMI among women. There was evidence that body mass index cannot fully capture work economic sector effects on fat mass.ConclusionsPublic health interventions to reduce social/territorial disparities in obesity should also consider the different contexts to which the participants belong, such as residential environments and work economic sectors.     

Sociodemographic descriptors of personal exposure to fine particles (PM2.5) in EXPOLIS Helsinki

Demographic and socioeconomic differences between population sub-groups were analyzed, as a component of the EXPOLIS (Air Pollution Exposure Distributions Within Adult Urban Populations in Europe) Helsinki study, to explain variation in personal exposures to fine particles (PM2.5). Two-hundred one individuals were randomly selected among 25--55-year-old inhabitants of Helsinki Metropolitan area. Personal exposure samples and residential indoor, residential outdoor and workplace indoor microenvironment measurements of PM2.5 were collected between October 1996 and December 1997. Variation in PM2.5 personal exposures, between sociodemographic sub-groups, was best described by differences in occupational status, education and age. Lower occupational status, less educated and young participants had greater exposures than upper occupational status, more educated and older participants. Different workplace concentrations explained most of the socioeconomic differences, and personal day and night exposures and concentrations in home (but not workplace or outdoor concentrations) caused the PM2.5 exposure differences between age groups. Men had higher exposures and much larger exposure differences between the sociodemographic groups than women. No gender, socioeconomic or age differences were observed in home outdoor concentrations between groups. Exposure to tobacco smoke did not seem to create new differences between the sociodemographic groups; instead, it amplified the existing differences.     

Mediators of longitudinal associations between television viewing and eating behaviours in adolescents

Background  

Television viewing has been associated with poor eating behaviours in adolescents. Changing unhealthy eating behaviours is most likely to be achieved by identifying and targeting factors shown to mediate the association between these behaviours. However, little is known about the mediators of the associations between television viewing and eating behaviours. The aim of this study was to examine mediators of the longitudinal associations between television viewing (TV) and eating behaviours among Australian adolescents.