Food insecurity is inversely associated with positive childhood experiences among a nationally representative sample of children ages 0-17 years in the U.S.

Abstract Objective: We examined the association between food insecurity and positive childhood experiences (PCEs). Design: Outcome measure was number of PCEs and seven PCE constructs. Food insecurity was assessed with a three-category measure that ascertained whether the respondent could afford and choose to eat nutritious food. We then used bivariate and multivariable Poisson and logistic regressions to analyze the relationship between food insecurity and the outcome measures. The analyses were further stratified by age (≤5 years, 6-11 years, 12-17 years). Setting: The National Survey of Children’s Health (NSCH) from 2017-2020, a nationally representative sample of children and adolescents in the U.S. Participants: Parents/caregivers who reported on their children’s experiences of PCEs and food insecurity from the 2017-2020 NSCH (n=114,709). Results: Descriptively, 22.13% of respondents reported mild food insecurity, while 3.45% of respondents reported moderate to severe food insecurity. On multivariable Poisson regression analyses, there was a lower rate of PCES among children who experienced mild (IRR=0.93; 95% CI=0.92, 0.94) or moderate/severe food insecurity (IRR=0.84; 95% CI=0.83, 0.86) compared to those who were food secure. We found an inverse relationship between food insecurity and rate of PCEs across all age categories. Conclusions: Our study finding lends evidence to support that interventions, public health programs, as well as public health policies that reduce food insecurity among children and adolescents may be associated with an increase in PCEs. Longitudinal and intervention research are needed to examine the mechanistic relationship between food insecurity and PCEs across the life course

Physical Activity and Screen Time in Adolescents and Their Nominated Friends

Background: The social transmission of obesity has been reported in adolescent social networks. However, the behavioral antecedents to obesity (physical activity [PA], screen time, and diet) are the factors that would actually be transmitted through these networks. To date, little is known about the social influences affecting an individual adolescent’s PA and screen time behaviors. Purpose: To determine the associations between an adolescent’s PA and screen time and his/her nominated friends’ PA and screen time. Methods: Data were obtained from EAT 2010 (Eating and Activity among Teens), a large cross-sectional study (n=2,126) conducted in 20 middle schools and high schools in Minneapolis/St. Paul, Minnesota, USA during the 2009-2010 academic year. Each participant (Ego) nominated up to six friends (Alters) from a school roster and data from those friends was also obtained as part of the school-based data collection procedures. PA and screen time were assessed with previously used and validated questionnaires. Generalized estimating equation models, stratified by gender, were used to assess associations between adolescents’ PA and screen time and their friends’ PA and screen time. Results: Females’ PA was associated with their male and female friends’ PA, including their female best friends (all p\u3c0.05). Males’ PA was associated with their female friends’ PA (p\u3c0.03). Females’ screen time was associated with their male and female friends’ screen time (p\u3c0.03), but not with their best friends. Males’ screen time was only associated with their female friends’ screen time (p=0.04). Conclusions: The associations between individual and friend PA and screen time, especially in females, indicate a need to consider these social relationships when investigating weight-related behaviors in adolescents. Longitudinal data using validated measures of PA and screen time, and analyzed using sophisticated modeling techniques are needed to better understand social influences on adolescent weight-related behaviors and inform future intervention efforts

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3–5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity

The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care

Implementation experts have recently argued for a process of “scaling out” evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system—prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed

Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence

Child and adolescent obesity is increasingly the focus of interventions, because it predicts serious disease morbidity later in life. However, social environments that permit weight-related stigma and body shame may make weight control and loss more difficult. Rarely do youth obesity interventions address these complexities. Drawing on repeated measures in a large sample (N = 1443) of first-year (freshman), campus-resident university students across a nine-month period, we model how weight-related shame predicts depressive symptom levels, how being overweight (assessed by anthropometric measures) shapes that risk, and how social connection (openness to friendship) might mediate/moderate. Body shame directly, clearly, and repeatedly predicts depression symptom levels across the whole school year for all students, but overweight youth have significantly elevated risk. Social connections mediate earlier in the school year, and in all phases moderate, body shame effects on depression. Youth obesity interventions would be well-served recognizing and incorporating the influential roles of social-environmental factors like weight stigma and friendship in program design

Perceptions of Existing School Fruit and Vegetable Marketing Materials Targeted to School Students by School Nutrition Professionals and Youth

Little published research explores the perceptions of school nutrition professionals and youth regarding existing school nutrition marketing materials. A two-phased approach was taken to address this gap. In Phase 1, a national convenience sample of US school nutrition professionals (n = 1546; 89% female; 83.3% white; mean age 50 ± 10.2 years) evaluated a sample of marketing materials via a web-based survey. Phase 2 involved a sample of youth (n = 61; 51% female, 52.5% Hispanic; 98% participation in free/reduced price lunch) living in the Phoenix, Arizona metro area who completed interviews on the top-rated materials from the school nutrition professionals (Phase 1). Main outcome measures included perceived attractiveness/appeal, comprehension, relevance, motivation/persuasion, and uniqueness of marketing materials. In Phase 1, means/standard deviations of school nutrition professionals’ perceptions across materials are provided. For Phase 2, a thematic/subtheme analysis of the youth interviews is provided. School nutrition professionals found the materials easy to understand (82%); however, they rated the materials low in motivational appeal (48%) and low in their ability to influence the selection or consumption of fruits/vegetables (95%). Youth participants discussed their likes, dislikes, comprehension, social aspects, and health aspects of the materials. Results indicate that existing marketing materials were not highly rated by professionals or youth. Greater investment and research are needed to test and develop nutrition marketing materials for schools, with a focus on enhancing their appeal and impact on fruit/vegetable consumption