Postpartum-specific anxiety and maternal bonding: Further evidence to support the use of childbearing specific mood tools.

Background: Research examining the relationship between postpartum anxiety and maternal bonding is limited by the use of general measures of anxiety which may predict perinatal outcomes less effectively than childbearing specific tools. Objectives: This study aimed to investigate the predictive validity of the Postpartum Specific Anxiety Scale [PSAS] and examine whether it is a more effective predictor of maternal bonding than general measures of anxiety. Methods: Two hundred and sixty one mothers (≤6-months postpartum) completed the PSAS alongside general anxiety and depression measures. Maternal bonding was examined via the Postpartum Bonding Questionnaire [PBQ] two-weeks later. Results: Hierarchical regression models demonstrated that higher levels of postpartum specific anxiety were associated with impaired overall bonding scores, and subscales of impaired general bond, rejection and anger, and infant focused anxieties. As hypothesised, the PSAS predicted unique variance in maternal bonding in these domains after controlling for general measures of anxiety and depression. Conclusion: These findings provide further evidence to support the predictive utility of the PSAS and the use of childbearing-specific measures of mood when predicting perinatal outcomes.

"It's Just Addictive People That Make Addictive Videos": Children's Understanding of and Attitudes Towards Influencer Marketing of Food and Beverages by YouTube Video Bloggers.

Exposure to influencer marketing of foods and beverages high in fat, sugar, and/or salt (HFSS) increases children's immediate intake. This study qualitatively explored children's understanding of, and attitudes towards, this marketing, to elucidate potential mechanisms through which exposure affects behavior. In six focus groups (n = 4) children (10-11 years) were shown a YouTube video featuring influencer marketing of an HFSS product. Inductive thematic analysis identified six themes from children's discussions of this marketing: (1) YouTubers fill a gap in children's lives, (2) the accessibility of YouTubers increases children's understanding of their actions, (3) influencer marketing impacts all-the influencer, the brand, and the viewer, (4) attitudes towards influencer marketing are most affected by a YouTuber's familiarity, (5) YouTuber influencer marketing is effective because they are not 'strangers', (6) children feel able to resist influencer marketing of HFSS products. Children had an understanding of the persuasive intent of this marketing, and although most were sceptical, familiar YouTubers elicited particularly sympathetic attitudes. Children felt affected by influencer marketing of HFSS products, but believed they were able to resist it. Beyond theoretical insight, this study adds to the growing body of evidence to suggest children's exposure to HFSS influencer marketing should be reduced.

The influence of front-of-pack portion size images on children's serving and intake of cereal.

BACKGROUND: Consumption of large portions of energy-dense foods promotes weight gain in children. Breakfast cereal boxes often show portions much larger than the recommended serving size. OBJECTIVE: This experimental study investigated whether front-of-package portion size depictions influence children's self-served portions and consumption. METHODS: In a between-subjects design, 41 children aged 7-11 years (M= 9.0 ± 1.5y) served themselves breakfast cereal from a box, the front of which depicted either a recommended serving size of cereal (30g) or a larger, more typical front-of-pack portion (90g). Cereal served and consumed and total caloric intake (including milk) was recorded. Height and weight, demographic information and measures of children's food responsiveness and enjoyment of food were collected. RESULTS: MANOVA revealed that children exposed to the larger portion size served themselves (+7g, 37%) and consumed (+6g, 63%) significantly more cereal than those exposed to the smaller portion. Despite this, overall caloric intake (milk included) did not differ between conditions, and no other measured variables (hunger, BMI) significantly affected the outcomes. CONCLUSION: This study provides novel evidence of the influence portion-size depictions on food packaging have on children's eating behaviour. This offers possible avenues for intervention and policy change; however, more research is needed.

The effect of influencer marketing of food and a "protective" advertising disclosure on children's food intake.

BACKGROUND: Children are active on social media and consequently are exposed to new and subtle forms of food marketing. OBJECTIVES: To examine whether exposure to a YouTube video featuring influencer marketing of an unhealthy snack affects children's ad libitum snack intake and whether inclusion of an advertising disclosure moderates this effect. METHODS: In a randomized between-subjects design, 151 children (aged 9-11 y; mean, 10.32 y ± 0.6) were exposed to influencer marketing of a non-food product (n = 51), or an unhealthy snack with (n = 50) or without (n = 50) an advertising disclosure. Participants' ad libitum intake of the marketed snack and an alternative brand of the same snack was measured. RESULTS: Children exposed to food marketing with (P < .001, d = 1.40) and without (P < .001, d = 1.07) a disclosure consumed more (kcals) of the marketed snack relative to the alternative; the control did not differ (.186, d = 0.45). Consumption of the alterative brand did not differ across conditions (.287, ηp2 = .02). Children who viewed food marketing with a disclosure (and not those without) consumed 41% more of the marketed snack (.004, ηp2 = .06), compared with control. CONCLUSIONS: Influencer marketing increases children's immediate intake of the promoted snack relative to an alternative brand. Advertising disclosures may enhance the effect.

Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood.

Studies of pregnancy-specific anxiety suggest that it is a distinct construct which predicts perinatal outcomes more effectively than other general measures of anxiety. In response, a novel measure of postpartum-specific anxiety (PSAS) has been developed and validated, but it is not yet clear whether it possesses the same predictive power as its pregnancy-specific counterparts. The aim of this short-term prospective study was to (a) test the predictive validity of the PSAS in the context of one specific perinatal outcome, infant-feeding, and (b) examine whether the PSAS may be more efficacious at predicting infant-feeding outcomes and behaviours than the more commonly used general measures. Eight hundred mothers of infants aged between 0 and 6 months completed the PSAS alongside general measures of anxiety and depression at baseline. A subsample (n = 261) returned to complete a follow-up questionnaire examining infant-feeding outcomes and behaviours two weeks later. Hierarchical regression models revealed that the PSAS was associated with lower odds of breastfeeding exclusively, and breastfeeding in any quantity in the first 6 months postpartum. PSAS scores were also significantly associated with infant-feeding behaviours including a lower perceived enjoyment of food, and greater perceived food responsiveness and satiety responsiveness in the infant. As hypothesised, the PSAS was a stronger predictor of infant-feeding outcomes and behaviours than general anxiety and depression. The findings provide evidence for the predictive validity of the PSAS and call for the use of childbearing specific measures of mood when attempting to predict perinatal outcomes. Replication of these findings across other indices of maternal and infant health is now necessary.

Differences in the emotional and practical experiences of exclusively breastfeeding and combination feeding mothers.

The majority of research examining the barriers to breastfeeding focuses on the physical challenges faced by mothers rather than the risks of encountering negative emotional and practical feeding experiences. We aimed to quantify the emotional and practical experiences of the overall sample of breastfeeding mothers and identify the differences in the emotional and practical experiences of exclusively breastfeeding mothers and combination feeding mothers, by feeding type and intention. Eight hundred forty-five mothers with infants up to 26 weeks of age and who had initiated breastfeeding were recruited through relevant social media via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction with feeding method, and the need to defend themselves due to infant feeding choices. Practical predictors included perceived support from health professionals, main sources of infant feeding information, and respect from their everyday environment, workplace, and when breastfeeding in public. Current feeding type and prenatal feeding intention. In the overall sample, 15% of the mothers reported feeling guilty, 38% stigmatized, and 55% felt the need to defend their feeding choice. Binary logit models revealed that guilt and dissatisfaction were directly associated with feeding type, being higher when supplementing with formula. No associations with feeding intention were identified. This study demonstrates a link between current breastfeeding promotion strategies and the emotional state of breastfeeding mothers who supplement with formula to any extent. To minimize the negative impact on maternal well-being, it is important that future recommendations recognize the challenges that exclusive breastfeeding brings and provide a more balanced and realistic target for mothers.

Postpartum Anxiety and Infant-Feeding Outcomes.

There is increasing evidence for the effect of postpartum anxiety (PPA) on maternal and infant health outcomes. Despite evidence linking suboptimal infant-feeding outcomes with other indices of maternal mental health, the relationship between PPA and infant feeding has not yet been reviewed. A systematic review with narrative synthesis was conducted to examine the relationship between PPA and infant-feeding outcomes. Electronic searches were performed using specific keywords (eg, "postnatal anxiet*"; "breastfeed*"). A hand search of selected journals and reference lists of included articles was then conducted. All studies were considered that provided information related to PPA and infant-feeding outcomes. One hundred and two studies were identified, of which 33 were eligible. Two authors independently extracted data including study design, participants, and results. Results indicated that women with symptoms of PPA are less likely to breastfeed exclusively and more likely to terminate breastfeeding earlier. Some evidence also suggests that those experiencing PPA are less likely to initiate breastfeeding and more likely to supplement with formula in the hospital. In those who do breastfeed, PPA reduces self-efficacy, increases breastfeeding difficulties, and may negatively affect breastfeeding behaviors and breast milk composition. Heterogeneous outcomes and methodological limitations somewhat limit the comparability of findings. However, in combination with a review linking depression with similar negative infant-feeding sequelae, the findings provide evidence for the effect of negative postpartum mood on breastfeeding. Additional support for breastfeeding mothers with PPA is warranted.

The Postpartum Specific Anxiety Scale: development and preliminary validation.

Perinatal symptoms of anxiety are increasingly recognised due to their high prevalence and impact. Studies using pregnancy-specific anxiety measures have found that they may predict perinatal outcomes more effectively than general measures. However, no such measure exists to assess anxieties specific to the postpartum. This study aimed to develop and validate a measure (Postpartum Specific Anxiety Scale; PSAS) that accurately represents the specific anxieties faced by postpartum women, using a four-stage methodology: (1) 51 items were generated from interviews conducted with a group of 19 postpartum women at two time points, (2) the scale was reviewed and refined by a diverse expert panel, (3) an online pilot study (n = 146) was conducted to assess comprehensibility and acceptability and (4) an online sample of 1282 mothers of infants up to 6 months old completed the PSAS against a battery of convergent measures. A subsample (n = 262) repeated the PSAS 2 weeks later. The PSAS possessed good face and content validity and was comprehensible and acceptable to postpartum women. PSAS scores were significantly correlated with other measures indicating good convergent validity. Principal component analyses (PCA) revealed a simple four-factor structure. Reliability of the overall scale and individual PSAS factors proved to be good to excellent. A preliminary receiver operating characteristic (ROC) analysis also suggested that the PSAS may be a useful screening tool. The psychometric evidence suggests that the PSAS is an acceptable, valid, and reliable research tool to assess anxieties, which are specific to the postpartum period. Next steps in the iterative validation process are considered for both research and screening purposes.

The Influence of Brand Equity Characters on Children's Food Preferences and Choices.

OBJECTIVES: To assess the influence of brand equity characters displayed on food packaging on children's food preferences and choices, 2 studies were conducted. Brand equity characters are developed specifically to represent a particular brand or product. Despite existing literature suggesting that promotional characters influence children's food choices, to date, no research has assessed the influence of brand equity characters specifically. STUDY DESIGN: We recruited 209 children 4-8 years of age from schools and childcare centers in the UK. In a mixed-measures design, the children were asked to rate their taste preferences and preferred snack choice for 3 matched food pairs, presented either with or without a brand equity character displayed on packaging. Study 1 addressed congruent food-character associations and study 2 addressed incongruent associations. Participants were also asked to rate their recognition and liking of characters used. Wilcoxon signed-rank tests and χ(2) analyses were used where appropriate. RESULTS: Children were significantly more likely to show a preference for foods with a brand equity character displayed on the packaging compared with a matched food without a brand equity character, for both congruent and incongruent food-character associations. The presence of a brand equity character also significantly influenced the children's within-pair preferences, within-pair choices, and overall snack choice (congruent associations only). CONCLUSIONS: Displaying brand equity characters promotes unhealthy food choices in children. The findings are consistent with those of studies exploring other types of promotional characters. In the context of a childhood obesity epidemic, the use of brand equity characters in the promotion of foods high in fat, salt, and sugar to children should be restricted.