Qualitative Analysis of Maternal Barriers and Perceptions to Participation in a Federal Supplemental Nutrition Program in Rural Appalachian North Carolina

Background: Little is known about barriers to and perceptions of participation in the in Women, Infants, and Children (WIC) program in rural Appalachia. Purpose: To gain a deeper understanding of maternal barriers and perceptions related to WIC participation in rural Appalachia Methods: Pregnant women and mothers were recruited in-person and via flyers from WIC offices in three counties in Appalachian North Carolina. Four semi-structured focus groups were conducted between May to July 2018. Each focus group was approximately 60 minutes long and included open-ended questions about the overall WIC experience in rural Appalachia. Focus groups were audio-recorded, transcribed verbatim, and content analysis of transcripts was performed by two trained researchers. Identified themes were discussed and consensus was reached by the researchers to generate final themes for four areas of interest: (1) most valued aspects of WIC program, (2) barriers to program participation and benefit redemption, (3) experiences during appointments, and (4) suggestions for improving experiences in program. Results: The most valued aspects of participation were financial benefits and support/resources provided by WIC staff. In contrast, lack of variety of WIC-approved foods and social stigma were perceived as major barriers to participation and redeeming benefits. Implications: This study contributes to a better understanding of the barriers and perceptions related to WIC participation in this geographically and culturally unique area of rural Appalachia. Findings are valuable for informing WIC state-agencies and policymakers whose efforts focus on the identification and development of effective recruitment and retention strategies for WIC-eligible families in rural Appalachia

Associations of actigraphy‐assessed sleep variables with adiposity and serum cardiometabolic outcomes in emerging adults

SummaryThis study assessed associations of actigraphy‐assessed sleep with adiposity and serum cardiometabolic outcomes in emerging adults, and whether sex and race modified these associations. Data on 147 emerging adults (age = 19.4 ± 1.3 years; body mass index = 26.4 ± 7.0 kg m$^{−2}$; 59% female; 65% White) from RIGHT Track Health were used. Actigraphy‐based sleep measures included sleep duration, sleep efficiency, sleep timing midpoint, day‐to‐day sleep duration and sleep timing midpoint variability. Combined sleep duration and sleep timing behaviours were also derived (early‐bed/late‐rise, early‐bed/early‐rise, late‐bed/late‐rise, late‐bed/early‐rise). Outcomes included body mass index and BodPod‐assessed fat mass index, fasting serum leptin, C‐reactive protein, and homeostatic model assessment‐insulin resistance. Sleep duration was 5.4 h per night. We noted an inverse association between sleep duration and homeostatic model assessment‐insulin resistance. The early‐bed/early‐rise group had greater body mass index, C‐reactive protein and homeostatic model assessment‐insulin resistance compared with the early‐bed/late‐rise group (referent). Sex modified associations of sleep efficiency with C‐reactive protein; stratified results revealed positive association between sleep efficiency and C‐reactive protein in males, but not females. Race modified associations of sleep duration with body mass index and leptin, and of sleep duration variability with C‐reactive protein. Stratified analyses revealed inverse associations between sleep duration with body mass index and leptin in Black, multiracial/other race individuals only. Positive association between sleep duration variability and C‐reactive protein was noted in White individuals only. Shorter sleep duration, particularly when combined with earlier sleep timing, is associated with greater adiposity and serum cardiometabolic outcomes. Additional studies are needed to assess individual‐ and contextual‐level factors that may contribute to sex and race differences in sleep health and cardiometabolic risk in emerging adults

Dietary Restraint in Adolescence Predicts Diet Quality in Young Adulthood

Establishing a diet that follows the Dietary Guidelines for Americans has been associated with lower risk of mortality from cardiovascular disease and cancer. Some research has shown that individuals’ desire for weight control is an important factor in determining food choices. The aims of this study were to 1) examine dietary restraint in adolescence as a predictor of overall diet quality in young adulthood and 2) compare selected dietary components by levels of restraint

Maternal sensitivity in play, distress, and feeding contexts: Factor structure, mean differences, and unique correlates

Maternal sensitivity has typically been viewed as a global trait. Recent arguments have been made for domain specificity (Grusec & Davidov, 2010). That is, parenting goals and behaviors, their antecedents, and their impact on relevant child outcomes may vary across developmental domains or contexts. Recent research supports this perspective (Leerkes et al, 2009; 2012; McElwain & Booth LaForce, 2006, Vliet et al., 2022, Teti et al., 2022). The goals of this study are to examine the extent to which maternal sensitivity in free play, distress-eliciting and feeding tasks (a) reflect a single construct or 3 context-specific constructs; (b) demonstrate mean differences; and (c) have similar versus unique antecedents/correlates

Associations between eating behaviors, diet quality and body mass index among adolescents

Objective: Some eating behaviors are associated with negative nutrition-related outcomes in adults, but research is lacking in adolescent samples. The current study examined whether dietary restraint moderates the relationship between disinhibition and weight outcomes and overall diet quality in a community sample of 16-year old adolescents. Methods: Participants were recruited from a longitudinal study examining self-regulation and cardiometabolic risk. Data for this cross-sectional study were collected from questionnaires and laboratory visits when participants were approximately 16 years old (n=178). Disinhibition and restraint were assessed using two subscales of the Three-Factor Eating Questionnaire. Diet quality was determined using Healthy Eating Index-2010 (HEI-2010) scores that were calculated using dietary data from 24-h dietary recalls. Two separate hierarchical linear regression analyses tested whether restraint moderated the associations of disinhibition with BMI-for-age percentile and HEI-2010 scores. Results: After adjusting for covariates, restraint moderated the association between disinhibition and HEI-2010 scores (ß=-0.21, p=0.03). There was a main effect for disinhibition on BMI-for-age percentiles (ß=0.58, p=0.02), but this relationship was not moderated by the level of restraint. Conclusions: The relationship between disinhibition and overall diet quality differed among adolescents according to level of dietary restraint. Although disinhibition independently predicted weight status, the level of restraint had no influence on this association. Future studies should examine restraint in relation to energy intake and weight concerns to better understand how it influences weight and dietary outcomes in this population

A quantitative and qualitative approach to understanding fruit and vegetable availability in low-income african-american families with children enrolled in an urban head start program.

BACKGROUND: Prior studies have shown low-income African Americans have low intakes of fruits and vegetables, which correlate, in part, to area of residence. To address the dietary problem, behavior-change interventions are most effective when they are theoretically based and compatible with cultural/behavioral characteristics of a given population. OBJECTIVE: To use the Transtheoretical Model of Behavior Change to determine whether low-income African Americans were in proportionately different stages of change for increasing fruits and vegetables to their young children and identify differences in decision making, self-efficacy, and use of cognitive and behavioral strategies related to fruit and vegetable availability. DESIGN: The two-phase, descriptive study utilized a mixed methodology consisting of a fruit and vegetable survey and focus groups. SUBJECTS/SETTING: Convenience sample of low-income African-American parents with children enrolled in an urban area Head Start program. STATISTICAL ANALYSES PERFORMED: chi(2) test was calculated to examine the distribution of parents into stages of change for increasing fruit and vegetable availability. Analysis of variance was used to test differences in fruit and vegetable availability to children and parents' decision making, self-efficacy, and use of cognitive and behavioral strategies. Content analysis of focus group transcripts was used to triangulate quantitative findings and further explore meanings of survey responses. RESULTS: Of 94 participants completing the fruit and vegetable survey, 21% staged as precontemplation/contemplation, 25% staged as preparation, and 54% staged as action/maintenance (P<0.001). Parents in action/maintenance stages served significantly more fruits and vegetables (P=0.006) and used behavioral processes significantly more often (P<0.001) compared to parents in precontemplation/contemplation stages. Content analysis of focus group transcripts provided greater insight into the quantitative findings. CONCLUSIONS: Nutrition education targeting low-income African-American parents in earlier stages of change should address planning and preparing convenient and economical meals and snacks that include fruits and vegetables. Interventions targeting parents in later stages of change should address increasing variety and healthful preparation methods. Interventions for both groups can benefit from social support strategies

Variety of fruit and vegetables is related to preschoolers' overall diet quality

Children are encouraged to eat a specific amount of fruits and vegetables to optimize health. The purpose of this study was to assess whether consumption of a variety of fruits and vegetables, respectively, was associated with a greater diet quality among preschool-aged children. Analyses were performed using a cross-sectional, nationally representative sample of US children. Dietary intakes from 24-h dietary recalls of two-five year old children (n = 2595) in 2005–2010 NHANES were examined. Diet quality was evaluated using MyPlate equivalents and the Healthy Eating Index 2010 (HEI-2010). Variety categories were determined based on children's fruit, fruit juice, and vegetable consumption on the recalled day. Differences in diet quality were examined using t-tests. Variety of fruits and vegetables was linked to higher overall diet quality. Children who consumed whole fruit had better diet quality scores for total fruit, whole fruit, whole grains, dairy, seafood, refined grains, sodium, and empty calories (P ≤ 0.018). Significantly higher HEI-2010 scores for total fruit, whole fruit, fatty acids, sodium, and empty calories, but a lower dairy HEI-2010 score, were identified in children who drank fruit juice (P ≤ 0.038). Vegetable consumption was significantly associated with higher total vegetables, greens/beans, and empty calories, but a lower sodium score (P ≤ 0.027). Children who consumed whole fruit, fruit juice and non-starchy vegetables (P ≤ 0.017), but not white potatoes, had significantly higher total HEI-2010 scores. Reinforcing fruit and 100% fruit juice consumption may indirectly support healthier diets among children. However, underlying associations between fruit and vegetable intakes and overall diet quality should be examined further

Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image

Emotional eating is associated with an increased risk of binge eating, eating in the absence of hunger and obesity risk. While previous studies with children and adolescents suggest that emotion regulation may be a key predictor of this dysregulated eating behavior, little is known about what other factors may be influencing the link between emotional regulation and emotional eating in adolescence. This multi-method longitudinal study (n = 138) utilized linear regression models to examine associations between childhood emotion regulation, adolescent weight status and negative body image, and emotional eating at age 17. Emotion regulation predicted adolescent emotional eating and this link was moderated by weight status (β = 1.19, p &lt; 0.01) and negative body image (β = −0.34, p &lt; 0.01). Higher engagement in emotional eating was predicted by lower emotional regulation scores among normal-weight teens (β = −0.46, p &lt; 0.001) but not among overweight/obese teens (β = 0.32, p &gt; 0.10). Higher scores on emotion regulation were significantly associated with lower emotional eating at high (β = −1.59, p &lt; 0.001) and low (β = −1.00, p &lt; 0.01) levels of negative body image. Engagement in emotional eating was predicted by higher negative body image among overweight/obese teens only (β = 0.70, p &lt; 0.001). Our findings show that while better childhood emotion regulation skills are associated with lower emotional eating, weight status and negative body image influence this link and should be considered as important foci in future interventions that aim to reduce emotional eating in adolescence

Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image

Emotional eating is associated with an increased risk of binge eating, eating in the absence of hunger and obesity risk. While previous studies with children and adolescents suggest that emotion regulation may be a key predictor of this dysregulated eating behavior, little is known about what other factors may be influencing the link between emotional regulation and emotional eating in adolescence. This multi-method longitudinal study (n = 138) utilized linear regression models to examine associations between childhood emotion regulation, adolescent weight status and negative body image, and emotional eating at age 17. Emotion regulation predicted adolescent emotional eating and this link was moderated by weight status (&beta; = 1.19, p &lt; 0.01) and negative body image (&beta; = &minus;0.34, p &lt; 0.01). Higher engagement in emotional eating was predicted by lower emotional regulation scores among normal-weight teens (&beta; = &minus;0.46, p &lt; 0.001) but not among overweight/obese teens (&beta; = 0.32, p &gt; 0.10). Higher scores on emotion regulation were significantly associated with lower emotional eating at high (&beta; = &minus;1.59, p &lt; 0.001) and low (&beta; = &minus;1.00, p &lt; 0.01) levels of negative body image. Engagement in emotional eating was predicted by higher negative body image among overweight/obese teens only (&beta; = 0.70, p &lt; 0.001). Our findings show that while better childhood emotion regulation skills are associated with lower emotional eating, weight status and negative body image influence this link and should be considered as important foci in future interventions that aim to reduce emotional eating in adolescence