Barbara H. Fiese

Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Adolescents

OBJECTIVE: We used meta-analytic methods to examine the frequency of shared family mealtimes in relation to nutritional health in children and adolescents. The primary objective was to determine consistency and strength of effects across 17 studies that examined overweight and obese, food consumption and eating patterns, and disordered eating. METHODS: The total sample size for all studies was 182 836 children and adolescents (mean sample age: 2.8–17.3 years). Pooled odds ratios were calculated. A random-effects model was used to estimate all outcomes. RESULTS: The frequency of shared family meals is significantly related to nutritional health in children and adolescents. Children and adolescents who share family meals 3 or more times per week are more likely to be in a normal weight range and have healthier dietary and eating patterns than those who share fewer than 3 family meals together. In addition, they are less likely to engage in disordered eating. CONCLUSIONS: Educational and public health initiatives aimed at promoting shared family mealtimes may improve nutritional health of children and adolescents. Clinicians may advise their patients about the benefits of sharing 3 or more family mealtimes per week; benefits include a reduction in the odds for overweight (12%), eating unhealthy foods (20%), and disordered eating (35%) and an increase in the odds for eating healthy foods (24%).

Family routines and rituals: A context for development in the lives of young children

Naturally occurring family routines and meaningful rituals provide both a predictable structure that guides behavior and an emotional climate that supports early development. In this article, we highlight recent evidence that suggests that variations in the practice of family routines and the meaning connected to family rituals are associated with variations in socioemotional, language, academic, and social skill development. We offer definitions of routines and rituals and contrast their different elements. We briefly review how variations in routines have been found to be associated with variations in language development, academic achievement, and social skill development. We examine how variations in the emotional investment in family rituals are associated with variations in family relationship satisfaction. We place our review in the framework of the transactional model whereby characteristics of the child and parent affect each other in the creation and sustainability of routines over time. Potential mechanisms of effect (parental efficacy, behavior monitoring, family relationship coherence) are discussed. We conclude with a brief description of methods of assessment and intervention suitable for practitioners working with families of young children.

Extension of the Children's Perceptions of Interparental Conflict Scale for use with late adolescents

Although many studies have documented an association between interparental conflict (IPC) and child outcomes, the relation of specific dimensions of conflict to the adjustment of offspring remains largely unexplored. The Childrens Perceptions of Interparental Conflict Scale (CPIC) was developed by J. H. Grych, M. Seid, and F. D. Fincham (1992) to assess school-aged childrens perceptions of several dimensions of IPC. The purpose of the current study was to examine the suitability of the CPIC for use with late adolescents. The factor structure of the CPIC dimensions and indexes of reliability and validity were examined in a sample of 215 participants 17 to 21 years old. The emergent factor structure closely resembled the factor structure found with the younger sample. The CPIC also demonstrated good reliability and external validity. Over the past several decades, empirical support has accumulated for the association between interparental conflict (IPC) and the adjustment of offspring in both divorced and intact families. Correlational and analogue studies have identified negative child outcomes in the areas of behavior problems, self-esteem, depression, anxiety, cognitive competence, and social skills (for reviews, see Amato & Keith, 1991; Emery, 1982; Grych & Fincham, 1990). Fincham (1994) recently drew a distinction between first-generation and second-generation research in this area. He suggested that firstgeneration research, which focuses on documenting the association between IPC and child adjustment and ruling out other variables that might mediate or moderate this association, has been extensive. On the other hand, secondgeneration research, aimed at explaining the mechanisms that may account for the association between IPC and child outcomes, has lagged behind. One of the issues highlighted by Fincham (1994) is the need to assess the rela

Asthma severity and child quality of life in pediatric asthma: A systematic review

OBJECTIVE To systematically review evidence of asthma severity as a correlate of child quality of life (QOL) in pediatric asthma. METHODS Online bibliographic databases (PsycINFO, PsycARTICLES, and MEDLINE) were used to identify relevant studies that specifically considered the relationship between asthma severity and child QOL. RESULTS Fourteen studies matching inclusion and exclusion criteria were reviewed. Asthma severity was significantly related to child QOL in nine of these studies. Informant of QOL and type of QOL measure were found to influence the strength of the relationship between severity and child QOL in pediatric asthma. CONCLUSIONS Findings suggest that asthma severity is a correlate of child QOL. Children whose asthma symptoms are not well-managed are likely to experience an impaired level of QOL. Findings also suggest the need to utilize asthma-specific QOL measures and an informant of QOL other than the childs parent in order to receive the most accurate information about the childs level of functioning. PRACTICE IMPLICATIONS Researchers and healthcare providers basing clinical outcomes on QOL assessments should consider asthma severity in their evaluations. Further, researchers and healthcare providers should recognize the continued need to reduce asthma severity and improve asthma symptom control in their attempts to improve the QOL of children with asthma.

Family mealtimes: A contextual approach to understanding childhood obesity

There has been a growing interest in the role that shared family mealtimes may play in promoting the health and well-being of children. Families that regularly eat their main meal together four or more times a week are more likely to have children who do better in school, are of average weight, less likely to use drugs and alcohol at an early age, and consume more fruits and vegetables. The mere fact that families eat together does not address the process by which shared family mealtimes may protect children from unhealthy weight gain. Just as there is no simple explanation for the rising rates of obesity, the link between shared family mealtimes and childhood obesity is a complex one including socioeconomic and cultural context. In this paper, we provide an overview of how shared family mealtimes are embedded in a socio-cultural context that may either support or derail healthy eating patterns for children and youth. Evidence from an observational study of 200 family mealtimes demonstrates the complex interplay between socio-economic factors, family mealtime behaviors, and child obesity status. Families who had a child of healthy weight spent more time engaged with each other during the meal, expressed more positive communication, and considered mealtimes more important and meaningful than families who had a child who was overweight or obese. Using a cumulative risk model, it was found that the combination of family level and neighborhood risk factors predicted child overweight status. Recommendations are made for future research directions and policies directed toward families living in diverse economic circumstances.

Risk Factors for Overweight/Obesity in Preschool Children: An Ecological Approach

BACKGROUND Identification of risk factors is critical to preventing the childhood obesity epidemic. Risk factors that contribute to obesity are multifactorial. However, limited research has focused on identifying obesity risk factors using an ecological approach. METHODS Baseline self-report survey data from the STRONG Kids program were used. The sample consisted of 329 parent-child dyads recruited from childcare programs in east-central Illinois. Child height and weight were measured and converted to age- and sex-specific z-scores using standard growth charts. An ecological model provided the theoretical framework for the selection of 22 previously reported childhood obesity risk factors. Multiple logistic regression analyses were used to identify risk factors. RESULTS Of 22 potential risk factors, three were found to be significantly associated with child overweight/obesity. These included child nighttime sleep duration (χ(2)=8.56; p=0.003), parent BMI (χ(2)=5.62; p=0.01), and parental restrictive feeding for weight control (χ(2)=4.77; p=0.02). Children who slept for 8 hours and less were 2.2 times more likely to be overweight/obese [95% confidence interval (CI): 1.3-3.7), whereas children with an overweight/obese parent were 1.9 times more likely to be overweight/obese (95% CI: 1.12-3.2). Finally, children whose parents used restrictive feeding practices were 1.75 times more likely to be overweight/obese (95% CI: 1.06-2.9). CONCLUSIONS Using an ecological approach, we conclude that childhood obesity prevention efforts may benefit from targeting the key risk factors of child sleep duration, parent BMI, and parental restrictive feeding practices as focus areas for obesity prevention.

Nighttime Waking in Children With Asthma: An Exploratory Study of Daily Fluctuations in Family Climate

Children with asthma are at increased risk for waking in the night, and there is the potential for the entire household to feel the effects. The authors conducted a telephone-based diary study to examine whether daily fluctuations in parent mood, parenting hassles, and family routines would distinguish nights in which waking occurred from nights in which they did not. Forty-seven families with a child with asthma were contacted 4 times a week every 3 months over a period of 1 year, resulting in 500 daily observations. Parent negative mood, perceived parenting hassles, and disruptions in bedtime routines were associated with increased odds that the child would wake in the middle of the night. Results underscore the importance of considering family climate in childrens disturbed sleep.

Family Rituals in Alcoholic and Nonalcoholic Households: Relations to Adolescent Health Symptomatology and Problem Drinking.

7The report of meaningfulfamily rituals relative to being raised in an alcoholic or nonalcoholic household and the possible role of family rituals were examined. Data were collected from 241 adolescents, 114 of their mothers, and 104 of their fathers. COAs and non-COAs differed on their report of the meaning associated with family rituals. A significant interaction was found between father-adolescent family ritual scores and adolescent health-related anxiety symptoms. Inconsistent results were found for adolescent problem drinking.

The ABCs of Family Mealtimes: Observational Lessons for Promoting Healthy Outcomes for Children With Persistent Asthma

Family mealtimes have the potential to promote healthy child development. This observational study of 200 family mealtimes examined the relation between child health in a group of children (ages 5 to 12) with persistent asthma and 3 dimensions of mealtime interaction: Action, Behavior Control, and Communication. Percent time spent in Action and Positive Communication varied by asthma severity, child quality of life, and sociodemographic variables. Positive communication during mealtimes predicted child quality of life. Significant interactions between demographic variables and behavior control suggested that higher levels of behavior control affected child quality of life in the context of lower maternal education. Guidance is offered for practitioners and policy makers toward promoting healthy family mealtimes as a public health priority.

Do family mealtime interactions mediate the association between asthma symptoms and separation anxiety

BACKGROUND Respiratory problems have been shown to be associated with the development of panic anxiety. Family members play an essential role for children to emotionally manage their symptoms. This study aimed to examine the relation between severity of respiratory symptoms in children with asthma and separation anxiety. Relying on direct observation of family interactions during a mealtime, a model is tested whereby family interactions mediate the relation between asthma severity and separation anxiety symptoms. METHODS Sixty-three children (ages 9-12 years) with persistent asthma were interviewed via the Diagnostic Interview Schedule for Children IV; family interactions were assessed via direct observation of a mealtime; primary caregivers completed the Childhood Asthma Severity Scale; youth pulmonary function was ascertained with pre- and post-bronchodilator spirometry; adherence to asthma medications was objectively tracked for six weeks. RESULTS Poorer pulmonary function and higher functional asthma severity were related to higher numbers of separation anxiety symptoms. Controlling for medication adherence, family interaction patterns mediated the relationship between poorer pulmonary function and child separation anxiety symptoms. CONCLUSIONS Family mealtime interactions may be a mechanism by which respiratory disorders are associated with separation anxiety symptoms in children, potentially through increasing the childs capacity to cognitively frame asthma symptoms as less threatening, or through increasing the childs sense of security within their family relationships.