Development of Parent and Adolescent Questionnaires to Assess Food Parenting Practices That Address Adolescent Consumption During Independent Eating Occasions

ObjectiveTo develop and test parent and early adolescent questionnaires to assess food parenting practices that influence early adolescent food consumption during independent eating occasions (iEOs).MethodsCross-sectional online questionnaires were completed by 206 and 62 low-income parent/early adolescent (11–14 years) dyads at Time 1 and 2, respectively, recruited via a Qualtrics (Provo, UT) US national panel database. Principal component analyses, internal consistency, and test–retest reliability checks were performed.ResultsSix parallel components were identified for parents and early adolescents with acceptable internal consistency and test–retest reliability. Scales included autonomy support, monitoring, availability, indulgence, expectations, and modeling. All except indulgence were positively correlated with importance of helping early adolescents make healthy choices during iEOs.Conclusions and ImplicationsAdditional research is needed to test the questionnaires’ validity regarding relationships between parenting practices and early adolescent consumption during iEOs. Findings could inform development of interventions to improve consumption during these occasions.     

Food Parenting Practices That Influence Early Adolescents’ Food Choices During Independent Eating Occasions

ObjectiveTo identify practices that parents use to influence early adolescents’ food choices during independent eating occasions (iEOs) from parent and child perspectives.DesignIn-depth interviews.ParticipantsLow-income parents (n = 49) and early adolescent children (aged 10–13 years; n = 44) from 10 US states and the District of Columbia.Phenomenon of InterestParent and child perspectives on parenting practices that influence food choices during iEOs.AnalysisAudio-recorded interviews transcribed verbatim, NVivo coding, and directed content analysis.ResultsParents reported setting rules and expectations and managing availability or accessibility as the most common practices used to influence iEOs. Other practices included teaching, pressuring to eat, monitoring, and modeling. Children reported that their parents had rules about what they could or could not eat during iEOs and that they used specific strategies (eg, call or text) to monitor their iEOs.Conclusions and ImplicationsAdditional studies are needed to confirm findings from this exploratory study. Future cross-sectional and longitudinal studies could determine whether and to what extent food parenting practices identified in the current study are associated with healthy dietary intake during iEOs, as well as potential racial and ethnic differences.     

Associations Between Parental Concern for Adolescent Weight and the Home Food Environment and Dietary Intake

ObjectiveExamine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices.DesignCross-sectional study.SettingAdolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005.Participants1,448 adolescent–parent pairs.Main Outcome MeasuresParental concern about adolescent weight; adolescent perceptions of their food intake and home food environment.AnalysisChi-square tests, exploratory factor analysis, independent t tests (P < .01).ResultsAlthough 12% of parents perceived their adolescent as overweight, 27% were concerned about their adolescent's weight (under- or overweight). Adolescents of concerned parents reported lower intakes of energy-dense snacks and less home availability of these food items, and they perceived that their parents less often listened to and considered their food preferences when shopping and cooking, than did adolescents of unconcerned parents. Concerned parents were no more likely to provide fruits and vegetables in the home or a positive family mealtime environment than unconcerned parents, at least as reported by their adolescents.Conclusions and ImplicationsParental concern about adolescent weight was associated with lower intakes of energy-dense snacks among adolescents, less home availability of these food items, and less supportive parental feeding practices. Parents should be encouraged to listen to and consider their adolescents' food preferences, and provide supportive family mealtime environments and healthful food in the home.     

Parents Who First Allowed Adolescents to Drink Alcohol in a Family Context During Spring 2020 COVID-19 Emergency Shutdowns

PurposeCOVID-19 stay-at-home orders during Spring 2020 dramatically changed daily life and created significant challenges for families. We document levels and predictors of U.S. parents who newly allowed adolescents to drink alcohol at home during the shutdown.MethodsParticipants in an ongoing longitudinal study were two adolescent siblings (N = 911, M = 14.43, SD = 1.54 years) and one parent (N = 456; 85% mothers) who provided self-report data before the pandemic (T1) and during the shutdown.ResultsNo parents permitted adolescent drinking with family at T1; nearly one in six allowed it during the shutdown. In full models, adolescents who previously drank (without permission) and had light or heavy drinking parents were more likely to be newly permitted to drink.ConclusionsParents’ alcohol permissibility within family contexts changed during the pandemic and was shaped by both parent and adolescent drinking. Well-child visits should continue adolescent alcohol screening and parent support during and after the pandemic.     

A qualitative study on COVID-19 pandemic impacts on parental attitudes and intentions for routine adolescent vaccinations: The role of trust

IntroductionThe COVID-19 pandemic has contributed to declines in routine childhood and adolescent vaccination coverage globally. While the declines in Australia have been less, they are a concern, given steady increases in coverage prior to the pandemic. Given limited evidence on how the experiences of parents during the pandemic affected their attitudes about and intentions towards adolescent vaccinations, with this study we aimed to explore these.MethodsThis was a qualitative study. We invited parents of adolescents eligible for school-based vaccinations in 2021 from metropolitan, regional and rural areas of New South Wales and Victoria (the most affected States) and South Australia (less affected) to half hour-long online semi-structured interviews. We analysed data thematically and applied a conceptual model of trust in vaccination.ResultsIn July 2022 we interviewed 15 accepting, 4 hesitant and two parents who refused adolescent vaccinations. We identified three themes: 1. Pandemic impacting on professional and personal lives and routine immunisations; 2. Pandemic strengthening preexisting vaccine hesitancy, with perceived lack of clarity in governmental information about vaccination and stigma around non-vaccinating as contributing factors; 3. Pandemic raising awareness of the benefits of COVID-19 and routine vaccinations, with communication campaigns and one’s trusted doctor’s vaccination recommendations as contributing factors.ConclusionsFor some parents, experiences of poor system readiness and growing distrust towards health and vaccination systems strengthened their pre-existing vaccine hesitancy. We offer recommendations on how trust in the health system and immunisation can be optimised post-pandemic to increase uptake of routine vaccines. These include improving access to vaccination services and clear, timely information about vaccines; supporting immunisation providers in their immunisation consultations; working alongside communities, and building capacity of vaccine champions.     

Knowledge mobilization tool to promote,protect, and support breastfeeding during COVID-19

SettingThis knowledge mobilization project was conceptualized to increase awareness among breastfeeding mothers and the general public on safe infant feeding practices during the COVID-19 pandemic by addressing myths and misconceptions associated with breastfeeding practices, guiding breastfeeding mothers to make informed decisions around child feeding practices, and offering meaningful guidance in simple language through a short online animated video.InterventionThis project was undertaken in four phases. During phase 1, an informal discussion was held with the breastfeeding mothers, service providers, and community partner in identifying issues surrounding lactation counselling facilities during the COVID-19 pandemic. During phase 2, recommendations from 23 organizations with regard to breastfeeding during COVID-19 were reviewed and analyzed. During phase 3, using evidence from reliable sources, a 5-minute animated e-resource on breastfeeding during COVID-19 was conceptualized and developed. During phase 4, the e-resource was disseminated to the breastfeeding mothers, general public, post-secondary institutions, and organizations providing services to breastfeeding mothers in Canada.OutcomesThis evidence-based e-resource facilitated addressing misconceptions around breastfeeding during COVID-19 and raising public awareness on safe infant feeding practices during this pandemic. Overall, the video was described as an informative, user-friendly, useful, and easily accessible resource by breastfeeding mothers who were in self-isolation with little access to healthcare services during the pandemic.ImplicationsThis project highlighted the importance of patient engagement and collaboration with the community partner in protecting breastfeeding during the COVID-19 pandemic. It further illustrated how informational e-resources can protect breastfeeding in situations where breastfeeding mothers’ access to healthcare services is compromised.     

Spatio-Temporal Clustering of Adolescent Bereavement in the United States During the Extended Response to COVID-19: A Follow-Up Study

PurposeThis follow-up study investigated the spatio-temporal clustering of adolescent bereavement during the extended response to COVID-19 from October 2020–January 2022 in the continental United States.MethodsDeidentified and anonymized bereavement data from Crisis Text Line (CTL), a text-based crisis intervention service, and SaTScan cluster analysis were used to identify space-time clustering of bereavement among adolescents, aged 24 years and less, during the COVID-19 pandemic.ResultsClustering of bereavement conversations occurred during waves of high COVID-19 case and death counts, with the highest risk occurring in the Southeastern United States during the fall of 2020 (relative risk: 5.86, confidence interval: 3.48–8.24). Of the CTL texters who shared their demographic information, Indigenous American, Black, male, and female adolescents were more likely to seek help for bereavement when compared to the other CTL users.DiscussionFindings show an increased need for bereavement counseling resources during periods of high COVID-19 cases and deaths.     

Adolescents' Perceived Socio-Emotional Impact of COVID-19 and Implications for Mental Health: Results From a U.S.-Based Mixed-Methods Study

PurposeCOVID-19 has disrupted many aspects of adolescents' lives, yet little data are available that document their subjective experiences of the pandemic. In a mixed-methods study of U.S. adolescents, we examined (1) adolescents' perceptions of how their social and emotional lives had changed during COVID-19; and (2) associations between these perceived changes and indices of their mental health, above and beyond their prepandemic mental health status.MethodsFour hundred seven U.S. adolescents (M_age = 15.24, standard deviation = 1.69; 50% female; 52%, 20% African American, 17% Hispanic/Latinx) completed surveys before (October 2019) and during (April 2020) the COVID-19 pandemic. They provided qualitative and quantitative responses on their experiences with COVID-19 and reports of their mental health.ResultsAdolescents perceived various changes in their relationships with family and friends (e.g., less perceived friend support) during COVID-19. They also perceived increases in negative affect and decreases in positive affect. These perceived social and emotional changes were associated with elevated depressive symptoms, anxiety symptoms, and loneliness in April 2020, controlling for mental health problems before the pandemic.ConclusionsOur findings sensitize clinicians and scholars to the vulnerabilities (changes in friendship dynamics), as well as resiliencies (supportive family contexts), presented to U.S. adolescents during the early months of COVID-19.     

Children and Adolescents Dietary Habits and Lifestyle Changes during COVID-19 Lockdown in Italy

Background: We evaluated the changes in lifestyle during the COVID-19 pandemic lockdown in a sample of children and adolescents in order to assess any increase in risk factors for the onset of cardiovascular diseases in later ages. Methods: We conducted a cross-sectional study involving 965 parents who completed an online survey about dietary habits and lifestyle during the first lockdown in Italy (from 9 March 2020 to 18 May 2020) and compared their findings with the period before the pandemic. The inclusion criteria were parents (or caregivers) with Italian residency and with children aged between 5 and 18 years. Results: We identified 563 adolescents and 402 children. The mean age was 12.28 years (SD 3.754). The pandemic was associated with an increase in the consumption of high-calorie snack foods. The total amount of food in homes during lockdown compared with before the pandemic increased 50%. Relating to the parent-perceived child weight status, more parents reported obesity in their children after lockdown (+0.6% in the 5–11 age group and +0.2% in the 12–18 age group). We reported a reduction of physical activity, an increase of sedentary lifestyle and sleep habits changes. Conclusion: The COVID-19 pandemic was associated with changes in the lifestyles of children and adolescents; this could cause an increase in the incidence of obesity and of cardiovascular and metabolic diseases in adulthood.     

Qualitative Accounts of School-Aged Children’s Diets during the COVID-19 Pandemic in Rural,Central, Kenya

The COVID-19 pandemic has caused disruption to food security in many countries, including Kenya. However, the impact of this on food provision to children at an individual level is unknown. This small study aimed to provide a qualitative snapshot of the diets of children during the COVID-19 pandemic. During completion of 24-h food recalls, with 15 families with children aged 5–8 years, caregivers were asked about changes they had made to foods given to their children due to the pandemic. Food recalls were analysed to assess nutrient intakes. Qualitative comments were thematically analysed. Most of the families reported making some changes to foods they provided to their children due to COVID-19. Reasons for these changes fell into three themes, inability to access foods (both due to formal restriction of movements and fear of leaving the house), poorer availability of foods, and financial constraints (both decreases in income and increases in food prices). The COVID-19 pandemic has affected some foods parents in rural Kenya can provide to their children.     

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PurposeAdolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents’ postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents’ communities and their postquarantine depressive symptoms.MethodsAdolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.ResultsThe presence of cases in adolescents’ communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents’ spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.ConclusionsThe presence of COVID-19 cases in communities contributed to adolescents’ poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.     

Codevelopment of Healthy and Unhealthy Dietary Behaviors: A Dyadic Examination of Parenting Practices and Adolescent Characteristics

ObjectiveTo identify the pathways through which external, parental, and adolescent factors influence adolescents’ motivation to adopt healthy dietary behaviors.MethodsA total of 28 ethnically and socioeconomically diverse (25% White) families were interviewed in which adolescents (mean age = 12.7 years; 50% girls) and parents (mean age = 43.3 years; 68% mothers) were interviewed separately. Data were first analyzed thematically, and family summaries, supplemented with diagrams, were then used to identify the processes through which factors influenced adolescents’ dietary behaviors.ResultsThe analyses identified 3 main motivational pathways (intrinsic motivation, extrinsic motivation, and amotivation), wherein variability and inconsistencies were observed across and within pathways. The unique combination of external factors, parenting profiles, as well as adolescents’ willingness to be socialized by family members, differentiated these pathways from each other.Conclusions and ImplicationsHealth interventions need to target the overall approaches that parents use to socialize their adolescent to make healthy food choices instead of targeting specific parenting practices.     

The COVID-19 pandemic and weight management: Effective behaviors and pandemic-specific risk factors

BackgroundObesity and comorbid conditions are associated with worse outcomes related to COVID-19. Moreover, social distancing adherence during the COVID-19 pandemic may predict weight gain due to decreased physical activity, increased emotional eating, and social isolation. While early studies suggest that many individuals struggled with weight management during the pandemic, less is known about healthy eating and weight control behaviors among those enrolled in weight loss programs.MethodsThe present study evaluated weight management efforts among weight loss program participants during the COVID-19 pandemic. Participants’ (N = 55, 90.9% female, 36% white, M_age = 49.8) demographics and body mass index were collected two months prior to the COVID-19 statewide shutdown. During the lockdown, an online survey assessed health behaviors, coping, COVID-19 experiences (e.g., social distancing, loneliness), and weight gain. Logistic regressions examined demographics, health behaviors, and COVID-19 factors as predictors of weight gain.ResultsMost participants (58%) reported gaining weight during COVID-19. Weight gain was predicted by challenges with the following health behaviors: physical activity, monitoring food intake, choosing healthy foods, and emotional eating. Loneliness and working remotely significantly related to emotional eating, physical activity, and choosing healthy foods.ConclusionsLoneliness and working remotely increased the difficulty of weight management behaviors during COVID-19 among weight loss program participants. However, staying active, planning and tracking food consumption, choosing healthy foods, and reducing emotional eating protected against weight gain. Thus, these factors may be key areas for weight management efforts during the pandemic.     

Exploring parent-engaged developmental monitoring of young children before and during the COVID-19 pandemic,Porter Novelli Styles 2019 and 2021

BackgroundEarly identification of developmental delays may have been negatively impacted by the COVID-19 pandemic. Parental engagement in developmental monitoring is a key component to successfully identifying developmental concerns.ObjectiveThe purpose of this project was to understand whether parental engagement in developmental monitoring changed over the course of the COVID-19 pandemic, from Spring 2019 to Fall 2021.MethodsSurvey data were obtained from 2019 SpringStyles and 2021 FallStyles Porter Novelli Public Services ConsumerStyles cross-sectional surveys. Only respondents with at least one child under the age of 8 at the time of the survey were included in the analytic sample (2019 N = 403; 2021 N = 344). Participants were asked several questions about how they monitor their children's development. Changes in frequency of developmental monitoring from 2019 to 2021 were estimated using chi-squared tests.ResultsIn both 2019 and 2021, 89% of parents reported engaging in any type of developmental monitoring. Within the group of parents who engaged in any monitoring, there were no differences across years in the percentage of parents reporting using the methods surveyed, except that a smaller percentage reported comparing their children to others in 2021 (25%) compared to 2019 (36%, p < 0.002).ConclusionsDespite major disruptions to families' lives, there were no significant changes to parents’ overall engagement in developmental monitoring prior to and during the COVID-19 pandemic.     

Parenting style and adolescent fruit consumption

The importance of the social environment for dietary behaviour has been highlighted in the past decade. A type of environmental influence that has received increasing research attention in recent years is the influence that parents can have on their children's dietary behaviour through food-related parenting practices. Much of the work done so far, however, has reported inconsistent findings and poorly understood mechanisms of influence. The present study aimed to explore the possible environmental influence of general parenting style on adolescent food choice patterns. Data were collected at schools (N=643; mean age 16.5 years), using self-administered questionnaires on parenting style, fruit intake behaviour and fruit-specific cognitions. Consistent and theoretically predictable differences were found between adolescents who described their parents as authoritative, authoritarian, indulgent or neglectful. Fruit consumption and fruit-specific cognitions were most favourable among adolescents who were being raised with an authoritative parenting style. Children of parents with indulgent parenting styles consumed more fruit than adolescents from authoritarian or neglectful homes. Consequences of these results for the interpretation of earlier studies on the influence of parenting practices are discussed, and a research model is proposed for future studies of parental influences on adolescent dietary behaviours.     

The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study

BackgroundEmerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and “comfort eating” as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how “Big Food” and “Big Alcohol” are capitalizing on the COVID-19 pandemic to market their products and brands.ObjectiveWe aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia.MethodsWe conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia.ResultsNearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice.ConclusionsThis is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. “COVID-washing” by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to “build back better” in a post-COVID-19 world.     

Does Parental Warmth and Responsiveness Moderate the Associations Between Parenting Practices and Children's Health-related Behaviors?

ObjectiveTo determine whether a higher number of parenting practices, such as those concerning meals, bedtime, and limited screen time, is associated with children's health behaviors. In addition, to determine whether perceived parental warmth and responsiveness toward the child strengthens (moderates) the associations between parenting practices and health behaviors.DesignCross-sectional study.SettingSchool-based survey in which children completed questionnaires at school, and parents at home.ParticipantsA total of 805 child-parent dyads were used in analyses.Main Outcome MeasuresIntake of nutrient-dense and energy-rich foods, meal frequency per day, sleep duration, and screen time.AnalysisLinear and logistic regression analyses. Moderation was tested by adding the interaction term of parenting practices and parental warmth/responsiveness to the models. When moderation occurred, stratified analyses were conducted.ResultsA higher number of parenting practices was associated with more favorable health behaviors. Stronger associations between parenting practices and nutrient-dense food intake and meal frequency were found when children perceived high parental warmth/responsiveness. Stronger associations between parenting practices and energy-rich food intake and screen time were found when children perceived low parental warmth/responsiveness.Conclusions and ImplicationsParental warmth/responsiveness seems to strengthen the associations between parenting practices and favorable health behaviors. This knowledge could be used in family-focused obesity interventions.     

Advance Care Planning in Dutch Nursing Homes During the First Wave of the COVID-19 Pandemic

ObjectivesTo explore how physicians in Dutch nursing homes practiced advance care planning (ACP) during the first wave of the COVID-19 pandemic, and to explore whether and how ACP changed during the first wave of the pandemic.DesignQualitative analysis of an online, mainly open-ended questionnaire on ACP among physicians working in nursing homes in the Netherlands during the first wave of the COVID-19 pandemic.Setting and ParticipantsPhysicians in Dutch nursing homes.MethodsRespondents were asked to describe a recent case in which they had a discussion on anticipatory medical care decisions and to indicate whether ACP was influenced by the COVID-19 pandemic in that specific case and in general. Answers were independently coded and a codebook was compiled in which the codes were ordered by themes that emerged from the data.ResultsA total of 129 questionnaires were filled out. Saturation was reached after analyzing 60 questionnaires. Four main themes evolved after coding the questionnaires: reasons for ACP discussion, discussing ACP, topics discussed in ACP, and decision making in ACP. COVID-19–specific changes in ACP indicated by respondents included (1) COVID-19 infection as a reason for initiating ACP, (2) a higher frequency of ACP discussions, (3) less face-to-face contact with surrogate decision makers, and (4) intensive care unit admission as an additional topic in anticipatory medical decision making.Conclusions and ImplicationsACP in Dutch nursing homes has changed because of the COVID-19 pandemic. Maintaining frequent and informal contact with surrogate decision makers fosters mutual understanding and aids the decision-making process in ACP.