Parent feeding practices in infants and toddlers referred to a hospital-based feeding program in the United States.

While considerable research exists on parent feeding practices for infants and toddlers, past research has not focused on children with feeding problems. The goal of this study was to identify parent feeding practices in a sample of infants (n = 178) and toddlers (n = 221) referred to a hospital-based feeding clinic and then examine how these parent feeding practices were correlated with specific feeding problems. Parents completed surveys to report child demographics, feeding problems, and use of 54 feeding practices. Forty-eight (88.8%) of 54 practices were utilized more often for toddlers than for infants. Exploratory factor analysis with the 54 practices and the full sample (n = 399) produced the 16-item Baby Parent Mealtime Action Scale (BPMAS) with three dimensions: Multiple Food Offers, Use of Cereal/Pureed Foods, Use of Toys/TV. Controlling for demographics, hierarchical regression examined how each BPMAS dimension was associated with five feeding problems (underweight, tube feeding, texture problems, limited diet, mealtime disruption). Multiple Food Offers (e.g., daily offering of vegetables, offering foods from the family meal) was the dimension most correlated with fewer feeding problems such as tube feeding (ß = -0.220, p < 0.001), texture rejection (ß = -0.361, p < 0.001), and limited diet variety (ß = -0.175, p < 0.001), but also with more mealtime disruption (ß = 0.231, p < 0.001). Use of Toys/TV was correlated with more mealtime disruption (ß = 0.260, p < 0.001). In addition to demonstrating a correlation between parent feeding practices and feeding problems, this study also found adding cereal/pureed foods to be common and while the dimension, Use of Cereal/Pureed Foods, was not significantly correlated with any specific feeding problem, this dimension provides an expanded understanding of cereal usage.

The Lunchbox Study: A Pilot Examination of Packed Lunches of Children with Autism Spectrum Disorder.

Background: This study examined foods packed and consumed by children with autism spectrum disorder (ASD) and calculated the percentage of packed school lunches meeting National School Lunch Program (NSLP) standards. Fruit and vegetable (FV) consumption was further examined by investigating its association with the number and type of foods packed. Methods: Participants included 59 private school students observed for five school meals. Servings of foods and beverages packed and consumed and the percentages of correspondence between food packed and consumed were calculated. Next, the percentages of lunches meeting NSLP guidelines were calculated. Finally, mealtime means were calculated for the number of foods packed, FVs packed, and FVs consumed. Results: There was a high correspondence between foods packed and consumed. Fresh fruits and sugar-added drinks were most often packed and consumed. The percentage of meals meeting NSLP guidelines was higher than previous non-ASD samples. More FV consumption was associated with more FVs packed and fewer total foods packed. FV consumption was highest with 4 < 5 foods packed, including 2+ FVs. Conclusions: Future studies should compare foods packed and consumed by children with and without ASD. The FV consumption findings suggest parents may increase children's FV consumption by packing approximately four total foods with two FVs.

Improvements in Children's Feeding Behavior after Intensive Interdisciplinary Behavioral Treatment: Comparisons by Developmental and Medical Status.

This study examined changes in child mealtime behavior, diet variety, and family mealtime environment after intensive interdisciplinary behavioral treatment (IIBT) for 52 children referred to a day treatment feeding program. Children fell into three developmental status groups including autism spectrum disorder (n = 16), other special needs (n = 19), and no special needs (n = 17), with some having no known medical problems (n = 22) and some having gastrointestinal, cardiopulmonary, and/or endocrine-metabolic problems (n = 28). At pre-intervention and post-intervention, caregivers completed the About Your Child's Eating scale, the Brief Assessment of Mealtime Behavior in Children, and a food preference inventory of 70 common foods (20 fruits, 23 vegetables, 12 proteins, 8 grains, 7 dairy). Mixed-factor 2 × 3 ANOVAs compared each of the 11 feeding outcomes across the two study phases (pre-, post-intervention) for the three developmental status groups. All feeding outcomes except fruit acceptance showed significant improvements from pre- to post-intervention, with no main effects for developmental status, and no interaction effects. Additionally, mixed-factor 2 × 2 ANOVAs compared each of the 11 feeding outcomes across the two study phases (pre-, post-intervention) for children with and without medical problems. All feeding outcomes except fruit acceptance showed significant improvements from pre- to post-intervention, with no main effects for medical status, and no interaction effects. Present results suggest that IIBT is effective for improving a number of children's feeding problems, regardless of their developmental or medical status.

Associations between obesity severity and medical comorbidities for children with obesity in low intensity hospital intervention.

BACKGROUND: Childhood obesity has increased dramatically in the United States. Most available research has followed obesity prevalence with little attention to medical comorbidities, which could guide prevention and intervention. METHODS: A retrospective chart review examined 2038 children referred to a Pediatric Weight Management Clinic providing low intensity (<26 contact hours) intervention. Linear regression examined associations between obesity severity level (I, II, III) and blood pressure percentile scores (systolic, diastolic) while controlling for gender, age group, and ethnicity. Logistical regression examined associations between obesity severity level and five medical diagnoses (hypertension, type 2 diabetes, elevated ALT, hyperlipidemia, obstructive sleep apnea), again controlling for demographics. RESULTS: Results revealed that children with Class III obesity severity had significantly greater risk for five of the seven medical conditions examined, with higher systolic and diastolic blood pressure scores, and higher odds for hypertension, type 2 diabetes, and obstructive sleep apnea. CONCLUSION: The US Preventive Services Task Force has documented the effectiveness of intensive behavioral interventions (>26 contact hours for changes in diet, exercise, screen time) for reducing obesity severity in children. Additional research is required to determine whether more intensive behavioral approaches should be added before a child's obesity reaches the Class III level of severity in order to prevent medical comorbidities.

Do painkillers serve as "hillbilly heroin" for rural adults with high levels of psychosocial stress?

Nonmedical use of painkillers has increased in recent years, with some authors suggesting that painkillers serve as "hillbilly heroin": a drug chosen by rural adults to cope with psychosocial stresses in their lives. The present study compared rural and urban adults for their reported use of 5 drugs during the past year (painkillers, marijuana, cocaine, methamphetamine, heroin) and for associations between these 5 drugs and their reported psychosocial stressors. This study conducted secondary analyses of anonymous survey data provided by the 2014 National Survey on Drug Use and Health with responses from 8,699 rural and 18,481 urban adults. The survey included demographics (gender, age, race, education, marital status, family income), reports of whether participants had used each of 5 illicit drugs during the past year, and measures of psychological distress and social functioning problems. Controlling for demographics, rural adults showed no greater prevalence of painkiller use than urban adults, but rural adults were more likely than urban adults to use methamphetamine and less likely to use marijuana, cocaine, and heroin. Controlling for demographics, rural adults showed no associations between psychological or social stressors and the use of painkillers, but such stressors were significantly associated with the use of marijuana, methamphetamine, and heroin. Urban adults showed significant associations of psychological and social stressors with the use of painkillers, as well as with the use of marijuana, cocaine, and heroin. Results suggest that painkillers are unlikely to serve as "hillbilly heroin" for rural adults, but they may serve as "big-city heroin" for urban adults.

The Glucose Control Resistance Scale

Objective: While past research found family conflict, disordered eating, body image concerns and anxious self-doubts may affect adolescent diabetic glucose control, available measures of adherence mainly focus on management tasks. The current study aimed to combine measures of emotional distress and beliefs with decisions concerning management in a new measure of resistance to treatment adherence: the 12-item Glucose Control Resistance Scale (GCRS). Methods: Participants included 135 adolescents and their parents from a pediatric diabetes clinic. Family conflict, body image concerns, anxious self-doubts and glucose control resistance were assessed. Results: Factor analysis identified 12 items, with loadings of ≥0.40, which were used to form the GCRS. The scale had adequate reliability and there was a significant correlation between child and parent GCRS scores. One factor, family conflict, was significantly related to hemoglobin A1c (HbA1c) levels, but a set of four factors explained a total of 12% of the variance in HbA1c levels. Of the demographic variables considered (gender, number of parents at home, age, body mass index z-score), only gender was significantly associated with adolescent perceptions of family conflict. Conclusion: The GCRS may allow diabetic care teams to better understand the origin of family conflict perceptions and the motivational beliefs that modify behavior and contribute to independent self-management and glucose control. Each question was designed to be meaningful in interventions by addressing common items of resistance to adherence and impulsive management decisions. The GCRS may be used by providers as an initial short screening survey on an annual or semi-annual basis.

Sensory Eating Problems Scale (SEPS) for children: Psychometrics and associations with mealtime problems behaviors.

The present study developed the 22-item Sensory Eating Problems Scale (SEPS) to measure sensory aspects for children surrounding eating, documented psychometrics of SEPS subscales, and examined their association with mealtime behavior problems. Study participants were 449 caretakers of children referred to feeding clinics, including children in three special needs status groups: autism spectrum disorder (ASD), other special needs, and no special needs. Caretakers completed surveys to report children's demographics, four measures of children's mealtime behavior problems, and five-point ratings for how often children showed various sensory feeding reactions. Exploratory factor analysis of the sensory feeding items identified six SEPS subscales with acceptable goodness-of-fit, internal reliability, and test-retest reliability: Food Touch Aversion, Single Food Focus, Gagging, Temperature Sensitivity, Expulsion, and Overstuffing. ANCOVAs revealed that child demographics most associated with higher SEPS subscale scores were younger age and special needs. Multiple regression analyses found that children's mealtime behavior problems were most often associated with SEPS subscales of Food Touch Aversion, Single Food Focus, Expulsion, and Overstuffing, with the set of six subscales explaining 18-44% of variance in mealtime behavior problems. Suggestions for how clinicians and researchers may find the SEPS useful for assessment and intervention are provided.

Improvements in Child Behavior and Family Mealtime Environment After an Intensive Behavioral Feeding Intervention.

The present study examined changes in child and family mealtime patterns before and after intensive behavioral feeding intervention at a multidisciplinary hospital-based program for 50 children. At preintervention and postintervention, caregivers completed surveys to report child feeding goals and the About Your Child's Eating scale (AYCE). In addition, at postintervention, each caregiver rated intervention effectiveness for his or her child's feeding goals identified at preintervention and provided intervention satisfaction ratings. Results revealed that caregivers perceived all three AYCE family mealtime patterns to improve from preintervention to postintervention, the majority of caregivers rated intervention as being effective for improving the specific child feeding goals identified at preintervention, and caregivers gave high satisfaction ratings for the intervention.

Measurement of math beliefs and their associations with math behaviors in college students.

Our purpose in the present study was to expand understanding of math beliefs in college students by developing 3 new psychometrically tested scales as guided by expectancy-value theory, self-efficacy theory, and health belief model. Additionally, we identified which math beliefs (and which theory) best explained variance in math behaviors and performance by college students and which students were most likely to have problematic math beliefs. Study participants included 368 college math students who completed questionnaires to report math behaviors (attending class, doing homework, reading textbooks, asking for help) and used a 5-point rating scale to indicate a variety of math beliefs. For a subset of 84 students, math professors provided final math grades. Factor analyses produced a 10-item Math Value Scale with 2 subscales (Class Devaluation, No Future Value), a 7-item single-dimension Math Confidence Scale, and an 11-item Math Barriers Scale with 2 subscales (Math Anxiety, Discouraging Words). Hierarchical multiple regression revealed that high levels of the newly discovered class devaluation belief (guided by expectancy-value theory) were most consistently associated with poor math behaviors in college students, with high math anxiety (guided by health belief model) and low math confidence (guided by self-efficacy theory) also found to be significant. Analyses of covariance revealed that younger and male students were at increased risk for class devaluation and older students were at increased risk for poor math confidence.

Parent Attribution for Child Eating Scale (PACES). Psychometric characteristics and associations with child and parent variables.

Parent participation in interventions for their children's feeding problems may depend on parent attributions for the origins of these problems, but no measure is available to identify these parent perceptions. The purpose of the present paper was to develop a new Parent Attribution for Child Eating Scale (PACES), then to examine how parent perceptions measured by the PACES were associated with child variables and parent feeding practices. Participants included parents of 393 children from a hospital feeding clinic (68.2% boys; mean age = 55.4 months). Parents completed surveys to report children's demographic, medical, and feeding variables, three-point ratings for possible origins of these feeding problems, and their own use of nine child-feeding practices. Exploratory factor analysis of the parent ratings produced the 21-item PACES with four dimensions: Permissive Parenting, Medical Treatments, Oral Problems, and Vomiting Fear. The PACES showed acceptable goodness-of-fit, internal reliability, test-retest reliability, and support for its validity with expected correlations with child and parent variables. Multiple regression revealed that nine child variables (age, body mass index, gender, autism, gastrointestinal problems, neurological problems, oral motor problems, texture feeding problems, diet variety) explained 19-41% of the variance in the four PACES attributions, with oral motor problems significantly correlated with all of them (negatively with Permissive Parenting, positively with the other three), suggesting that its occurrence in combination with other child variables guides parent explanations for children's feeding problems. Multiple regression also found that Many Food Choices was the only parent feeding practice significantly correlated with all four PACES attributions (positively with Permissive Parenting, negatively with the other three), suggesting that it may be parents' primary response to attributions they develop for their children's feeding problems.

Behavioral variables associated with obesity in police officers.

Past research has documented that non-behavioral variables (such as long work hours, exposure to police stressors) are associated with obesity risk in police officers, but limited research has examined behavioral variables that might be targeted by Employee Assistance Programs for police weight management. The present study compared non-obese and obese officers for behavioral variables found associated with obesity in other adult samples: physical activity (cardiovascular, strength-training, stretching), sleep duration, and consumption of alcohol, fruit and vegetables, and snack foods. Participants included 172 male police officers who completed questionnaires to report height and weight, used to calculate body mass index (BMI = kg/m(2)) and to divide them into "non-obese" and "obese" groups. They also reported the above behaviors and six non-behavioral variables found associated with obesity risk: age, health problems, family support, police work hours, police stressors, police support. ANCOVAs compared each behavioral variable across obesity status (non-obese, obese), with the six non-behavioral variables used as covariates. Results revealed that cardiovascular and strength-training physical activity were the only behavioral variables that differed significantly between non-obese and obese police officers. The use of self-reported height and weight values may provide Employee Assistance Program with improved cost, time, and officer participation.

Variables associated with the use of complete oral calorie supplements in children with feeding problems.

OBJECTIVE: To examine child and parent variables associated with complete oral calorie supplement use among children with feeding problems. DESIGN: Correlational examination of data from patient intake surveys. SETTING: Hospital-based feeding program. PARTICIPANTS: Participants included 281 parents of children referred to a hospital-based feeding clinic, including 114 who received supplements (70.2% boys; mean age, 60.1 months) and 167 who did not receive (79.6% boys; mean age, 67.5 months). VARIABLES MEASURED: Children's age, gender, weight status, diagnostic category (no special needs, autism, or other special needs), supplement intake, oral motor problems, child mealtime behavior (using the Child Eating Behavior Questionnaire), parent feeding practices (using the Parent Mealtime Action Scale), and diet variety for child and parent. ANALYSIS: Chi-square analyses compared children who did and did not receive supplements for their percentage of gender, diagnostic, and weight status categories; t tests or Mann-Whitney U tests compared children who did and did not receive supplements, for age, oral motor problems, children's mealtime behavior, parent feeding practices, and diet variety. RESULTS: Compared with children who did not receive nutritional supplements, those who did were younger (P < .01) and more underweight (P < .001), and showed less Food Responsiveness (P < .001), less Food Enjoyment (P < .001), more Food Satiety (P < .001, and more Slow Eating (P < .001), and their parents were more likely to use Insistence on Eating (P < .001). CONCLUSIONS: Whereas supplement use was related to underweight, 78.2% of children receiving them were normal weight or overweight, which suggests that supplements are being used to address mealtime selective eating. The use of supplements should be considered carefully because they do not appear to increase diet variety and may increase the chance of overweight over time.

Mother's feeding practices for children 3-10 years of age and their associations with child demographics.

The present study examined relationships between mothers' feeding practices and child demographics such as gender, age, weight status, and family income. This cross-sectional analysis was conducted using data from 2259 children between 3 and 10 years of age who were sampled for the development of the Parent Mealtime Action Scale. No child gender differences were found in mothers' feeding practices. Older children received more Fat Reduction and Many Food Choices, but less Positive Persuasion, Use of Rewards, Insistence on Eating, and Special Meals, with differences in these feeding practices being most notable from before to after school age. Overweight children received less Insistence on Eating and more Fat Reduction than underweight or normal weight children. Children with the lowest family incomes received less Fat Reduction, less Daily FV Availability, more Use of Rewards. Results suggest that mothers respond to changing conditions, possibly including feedback from school nurses, increases in children's weight status, and availability of financial resources.

Which comes first in food-mood relationships, foods or moods?

College students (n=44) completed seven-day records of foods and moods. Nutritionist™ software measured daily nutrition scores including calories, carbohydrates, saturated fat, and sodium. Hierarchical stepwise multiple regression (controlling for gender, restrained eating) revealed that nutrition scores were more consistently associated with negative moods than positive moods, and with moods across a two-day span rather than a one-day span as typically studied in past research. The more calories, saturated fat, and sodium consumed by the students, the more negative mood they reported 2 days later. Results suggest that foods come first in the temporal sequence of food-mood relationships.

Adult violence with the mother and sibling as predictors of partner violence.

The present study provides the first available evaluation of how violence with the mother and siblings during adulthood is associated with the occurrence of partner violence in young adults. Because a pattern of reciprocal partner violence is well documented, the authors hypothesized that reciprocal violence would also be found for adults and their mothers and for adults and their siblings. The authors also hypothesized that reciprocal violence with the mother and sisters would explain variance in partner violence even when controlling for other known predictors (poverty, poor family support, stress, anger, low self-esteem). Study participants included 377 college adults (114 men, 263 women; mean age = 24.4 years) who completed questionnaires to report their present violence to and from their mothers, sisters, brothers, and romantic partners. Violence is measured with a modified Conflict Tactics Scale. No sibling gender differences are found in violence reported as adults. Factor analysis confirms good fit for three clusters of reciprocal violence for adults: violence with the mother, violence with siblings, violence with the romantic partner. Violence with the mother and siblings significantly explains variance in partner violence even after controlling for other contextual variables, but only for women. One interpretation of present results is that because women receive less socialization than men to use violence, these two within-family models of violence have more significance for increasing their risk of partner violence. Partner violence prevention programs could include participation of mothers and siblings to enhance development of more peaceful conflict resolution patterns within and outside the family.

Kid's Choice Program improves weight management behaviors and weight status in school children.

The present study examined the effectiveness of the Kid's Choice Program (KCP) for increasing children's weight management behaviors, and decreasing body mass index percentile (BMI%) for overweight and average-weight children. It also evaluated KCP characteristics relevant to long-term application in schools. Participants included 382 children assigned to two groups: a KCP group that received token rewards for three "Good Health Behaviors" including eating fruits or vegetables first at meals (FVFIRST), choosing low-fat and low-sugar healthy drinks (HDRINK), and showing 5000 exercise steps recorded on pedometers (EXERCISE), or a control group that received token rewards for three "Good Citizenship Behaviors." School lunch observations and pedometer records were completed for one month under baseline and three months under reward conditions. The school nurse calculated children's BMI% one year before baseline, at baseline, at the end of KCP application, and six months later. The KCP increased FVFIRST, HDRINK, and EXERCISE from baseline through reward conditions, with ANCOVAs demonstrating that these increases were associated with both the offer of reward and nearby peer models. Overweight (n=112) and average-weight (n=200) children showed drops in BMI% after the three-month KCP, but overweight children re-gained weight six months later, suggesting the need for more ongoing KCP application. HDRINK choice was the behavior most associated with BMI% drops for overweight children. Small teams of parent volunteers effectively delivered the KCP, and school staff endorsed parent volunteers as the best personnel to deliver the KCP, which costs approximately two U.S. dollars per child per month of application.

The Screening Tool of Feeding Problems applied to children (STEP-CHILD): psychometric characteristics and associations with child and parent variables.

The present study evaluated the 23-item Screening Tool for Feeding Problems (STEP; Matson & Kuhn, 2001) with a sample of children referred to a hospital-based feeding clinic to examine the scale's psychometric characteristics and then demonstrate how a children's revision of the STEP, the STEP-CHILD is associated with child and parent variables. Participants included 142 children (95 boys, 47 girls; mean age = 61.4 months; 43 with autism, 51 with other special needs, 48 with no special needs). Children ranged in age from 24 months to 18 years. Factor analysis revealed a 15-item STEP-CHILD with six subscales of child feeding problems: chewing problems, rapid eating, food refusal, food selectivity, vomiting, and stealing food. Mediation analysis documented that "overly permissive" actions by parents (such as infrequent insistence on eating during meals, or frequent preparation of Special Meals for children different than the family meal) explained over 34% of the links between children's feeding problems and poor weight and diet outcomes.

Validation of the parent mealtime action scale (PMAS) when applied to children referred to a hospital-based feeding clinic.

The purpose of this study was to validate the Parent Mealtime Action Scale (PMAS) when applied to a clinical sample of 231 children with feeding problems and then to examine its association with demographic variables, diet, and weight. Parents completed questionnaires that included the PMAS, the Child Eating Behavior Questionnaire, and measure of diet variety. Confirmatory factor analysis revealed good fit for the nine dimensions of parent mealtime action found in the original PMAS study. Results from the present study suggest that the PMAS provides a valid tool for measuring parent mealtime actions of hospital samples of children with feeding problems.

Parent mealtime actions that mediate associations between children's fussy-eating and their weight and diet.

The present study evaluated parent mealtime actions that mediate associations between children's fussy-eating and their weight and diet. Participants included 236 feeding-clinic children in three diagnostic groups: 50 with autism, 84 with other special needs, and 102 without special needs. Children's weight was measured as body mass index percentile (BMI%), with only 26.4% of the present sample found to be underweight (BMI% less than 10). Parents reported children's diet variety as the number of 139 common foods accepted, children's FUSSINESS with the Child Eating Behavior Questionnaire, and their own use of four actions from the Parent Mealtime Action Scale: POSITIVE PERSUASION, INSISTENCE ON EATING, SNACK MODELING, SPECIAL MEALS. Multiple regression found that only SPECIAL MEALS explained variance in children's BMI% and diet variety. For children without special needs, mediation analysis revealed that variance in children's BMI% explained by FUSSINESS was accounted for entirely by the parent's preparation of SPECIAL MEALS. For all diagnostic groups, mediation analyses revealed that variance in children's diet variety explained by FUSSINESS was accounted for by the parent's use of SPECIAL MEALS. We conclude that although the parent's use of SPECIAL MEALS may improve BMI% in fussy-eating clinic children, it may also perpetuate their limited diet variety.

The Parent Mealtime Action Scale (PMAS). Development and association with children's diet and weight.

A new and comprehensive Parent Mealtime Action Scale (PMAS) was developed to identify dimensions of mealtime behaviors used by parents, then examined for its usefulness to explain variance in children's diet and weight status. Exploratory factor analysis with 2008 mothers and two confirmatory factor analyses with 541 mothers and 439 fathers produced a 31-item scale with nine dimensions. Mothers reported more gentle PMAS actions like setting SNACK LIMITS, ensuring DAILY FV AVAILABILITY, and using FAT REDUCTION and POSITIVE PERSUASION during meals, whereas fathers reported more forceful PMAS actions like INSISTENCE ON EATING. Seven PMAS dimensions explained variance in children's diet and weight status even when in competition with three well-known predictors (genetic risk, exercise, television). Children with healthier diets and weight had parents who often ensured DAILY FV AVAILABILITY and used FAT REDUCTION, POSITIVE PERSUASION, and INSISTENCE ON EATING during meals, but who rarely showed SNACK MODELING, allowed children too MANY FOOD CHOICES, or made them SPECIAL MEALS different from the shared family meal. Parents also may respond to children's overweight by using more FAT REDUCTION. The PMAS offers a new research, clinical, and educational tool to guide parents in actions most associated with children's diet and weight status.