Katherine E. Darling

Integrating Mediation and Moderation to Advance Theory Development and Testing

OBJECTIVE The concepts and associated analyses of mediation and moderation are important to the field of psychology. Although pediatric psychologists frequently incorporate mediation and moderation in their theories and empirical research, on few occasions have we integrated mediation and moderation. In this article, conceptual reasons for integrating mediation and moderation are offered. METHOD We illustrate a model that integrates mediation and moderation. RESULTS In our illustration, the strength of an indirect or a mediating effect varied as a function of a moderating variable. CONCLUSIONS Clinical implications of the integration of mediation and moderation are discussed, as is the potential of integrated models to advance research programs in pediatric psychology.

Physical and mental health outcomes associated with prior food insecurity among young adults

Following a biopsychosocial model of food insecurity, this study examined differences in physical health and mental health outcomes among young adults (N = 98) with and without a history of food insecurity. Young adults with a history of food insecurity had higher average levels of body mass index, waist-to-height ratio, depressive symptoms, stress, and disordered eating scores than individuals with no history of food insecurity. No differences were found with symptoms of anxiety. Future research should examine interventions targeted at decreasing negative mental health outcomes and risk for overweight among young adults who have experienced food insecurity.

Does Social Support Buffer the Association Between Stress Eating and Weight Gain During the Transition to College? Differences by Gender

This study sought to examine whether social support moderates the relationship between stress eating and body mass index (BMI) change over the freshman year in males and females. This longitudinal study included 70 college students (72.9% female; M age = 18.23) who completed self-reported measures of stress eating and perceived social support, with objective height and weight measurements collected. Among males, social support moderated the relationship between stress eating and BMI change. Among males, social support may serve as a buffer against the impact of stress eating on weight gain during the freshman year of college.

Predictors of Emotional Eating during Adolescents' Transition to College: Does Body Mass Index Moderate the Association between Stress and Emotional Eating?.

Abstract Objective: This study sought to (1) examine perceived stress and resources to cope with stress as predictors of emotional eating during the transition to college and (2) determine whether body mass index (BMI) moderated the emotional eating-stress relationship. Participants: Participants were 97 college freshmen (73% female; BMI: M = 25.3 kg/m2, SD = 5.7 kg/m2). Research was conducted in September 2012. Methods: Participants completed the Perceived Stress Scale, Emotional Eating Scale, and Eating and Appraisal Due to Emotions and Stress Questionnaire during the first month of college. Height and weight were measured objectively. Results: BMI moderated the relationship between perceived stress and emotional eating. Higher stress predicted greater emotional eating for the lower BMI groups, but not the highest group. Greater resources to cope with stress predicted lower emotional eating. Conclusions: Greater perceived stress and poorer resources to cope with stress may contribute to emotional eating during the transition to college. The relationship between perceived stress and emotional eating may vary by BMI.

Provider perceptions of pediatric obesity management in clinical practice

ABSTRACT The current study examined the association between barriers that primary care providers (PCPs) face in addressing pediatric obesity and current pediatric weight management practices. Seventy-six (77% female) PCPs in a midwestern children’s hospital system completed a survey of their current practices for obesity and barriers to addressing pediatric obesity. Regression analysis showed higher levels of barriers were associated with lower levels of current practices (β = –0.39, p = 0.001). Provider preferences of tools (e.g., handouts, trainings) for pediatric weight management are reported. Development of tools to aide intervention for pediatric weight management may be vital to optimal weight management intervention within primary care.

Controlling feeding practices mediate the association between food insecurity and parent-reported child BMI percentile

ABSTRACT Although literature is mixed, some research suggests that food insecurity likely predicts obesity beginning in childhood. Child feeding practices may be one possible mechanism for this association. Parents of children ages 7–17 (n = 790) completed the USDA Core Food Security Module and the Child Feeding Questionnaire. Child BMI percentile was calculated using parent-reported child height and weight. Restrictive and controlling feeding practices each mediated the association between food insecurity and child BMI percentile, controlling for familial income and child age. Findings from this preliminary study suggest that feeding practices may be one mechanism through which food insecurity is related to obesity.

Familial Influences on the use of Controlling Feeding Practices with Adolescents

Little is known about what factors influence a caregiver to use controlling feeding practices with adolescents. The present study examines potential predictors (e.g., parent and child eating, parent and child weight, and the home environment) of the use of controlling feeding practices among adolescents, an age group that has not received much attention. Parents (N = 54, M age = 43.63 years, SD = 6.42; 94.4% female) of adolescents ages 12-17 (N = 54, M age = 13.94 years, SD = 1.75; 43.6% female) completed measures assessing their child feeding practices, eating patterns and the home environment. Adolescents completed measures of their eating patterns. Regression analyses were used to determine the most salient predictors of controlling child feeding practices, specifically restriction of food intake and pressure to eat. After controlling for adolescent age, parental dietary restraint was significantly associated with restriction and accounted for 15.2% of the variance in the use of restriction, F (1, 51) = 10.4, p<.01. Adolescent emotional eating and income-to-needs ratio were significantly associated with use of pressure above and beyond adolescent age and accounted for 29.1% of the variance in the use of pressure, F (2, 48) = 10.2, p<.001. This study suggests that future research should include factors from different levels of influence, such as child, parent and home environment. As understanding of these influences grows, efforts can be made to target specific contributors within intervention settings to address potential adverse outcomes associated with controlling feeding practices.