Laura A. Dwyer

The FLASHE Study: Survey Development, Dyadic Perspectives, and Participant Characteristics

The National Cancer Institute developed the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to examine multiple cancer preventive behaviors within parent-adolescent dyads. The purpose of creating FLASHE was to enable the examination of physical activity, diet, and other cancer preventive behaviors and potential correlates among parent-adolescent dyads. FLASHE surveys were developed from a process involving literature reviews, scientific input from experts in the field, cognitive testing, and usability testing. This cross-sectional, web-based study of parents and their adolescent children (aged 12-17 years) was administered between April and October 2014. The nationwide sample consisted of 1,573 parent-adolescent dyads (1,699 parents and 1,581 adolescents) who returned all FLASHE surveys. FLASHE assessed parent and adolescent reports of several intrapersonal and interpersonal domains (including psychosocial variables, parenting, and the community and home environments). On a subset of example FLASHE items across these domains, responses of parents and adolescents within the same dyads were positively and significantly correlated (r =0.32-0.63). Analyses were run in 2015-2016. FLASHE data present multiple opportunities for studying research questions among individuals or dyads, including the ability to examine similarity between parents and adolescents on many constructs relevant to cancer preventive behaviors. FLASHE data are publicly available for researchers and practitioners to help advance research on cancer preventive health behaviors.

Recruitment, Enrollment, and Response of Parent–Adolescent Dyads in the FLASHE Study

INTRODUCTION In 2014, the National Cancer Institute conducted the Family Life, Activity, Sun, Health, and Eating Study (FLASHE). This parent and adolescent survey examines psychosocial; generational (parent-adolescent); and environmental (home and neighborhood) correlates of cancer-preventive behaviors, with a particular emphasis on diet and physical activity. This paper describes the FLASHE data collection methods and enrollment and response rates. METHODS FLASHE data collection methods included web-based surveys delivered to dyads of parents and their adolescent children, and deployment of accelerometers to a subset of adolescents, to achieve study goals in a nationwide study sample. The National Cancer Institute contracted with Westat, Inc. to recruit, enroll, and collect the data using a consumer opinion panel. RESULTS A total of 5,027 dyads were screened for eligibility, and 1,945 (38.7%) enrolled. Of fully enrolled dyads, 85.6% of those in the Survey-Only group completed all four surveys, and 58.7% of dyads in the Motion Study group completed all surveys and were compliant with the accelerometer protocol for adolescents. The overall study response rate was 29.4%; 1,479 dyads completed all study procedures. The majority of parents were female, whereas the adolescent sample was gender balanced. Data were analyzed in 2015-2016. CONCLUSIONS FLASHE recruited a large sample of parent-adolescent dyads. Although challenges for research in parent-adolescent dyads include enrolling a diverse sample and having multistep enrollment and consent processes, study completion rate was high among fully enrolled dyads. Future panel studies may consider approaches used in FLASHE to encourage study enrollment and completion.

Promoting family meals: a review of existing interventions and opportunities for future research

Evidence suggests that regular family meals protect against unhealthy eating and obesity during childhood and adolescence. However, there is limited information on ways to promote family meals as part of health promotion and obesity prevention efforts. The primary aim of this review was to synthesize the literature on strategies to promote family meals among families with school-aged children and adolescents. First, we reviewed interventions that assess family meals as an outcome and summarized strategies that have been used in these interventions. Second, we reviewed correlates and barriers to family meals to identify focal populations and target constructs for consideration in new interventions. During May 26–27, 2014, PubMed and PsycInfo databases were searched to identify literature on family meals published between January 1, 2000 and May 27, 2014. Two reviewers coded 2,115 titles/abstracts, yielding a sample of 139 articles for full-text review. Six interventions and 43 other studies presenting data on correlates of or barriers to family meals were included in the review. Four interventions resulted in greater family meal frequency. Although there were a small number of interventions, intervention settings were diverse and included the home, community, medical settings, the workplace, and the Internet. Common strategies were goal setting and interactive group activities, and intervention targets included cooking and food preparation, cost, shopping, and adolescent influence. Although methodological nuances may contribute to mixed findings, key correlates of family meals were employment, socioeconomic and demographic factors, family structure, and psychosocial constructs. Barriers to consider in future interventions include time and scheduling challenges, cost, and food preferences. Increasing youth involvement in mealtime, tailoring interventions to family characteristics, and providing support for families experiencing time-related barriers are suggested strategies for future research.

The association between motivation and fruit and vegetable intake: The moderating role of social support

Despite knowing that fruit and vegetable (FV) intake promotes health and well-being, few U.S. adults meet current guidelines. Thus, understanding peoples motivation for FV intake is important for predicting dietary behavior. Applying self-determination theory, the goal of this study was to examine the role of social support as a potential moderator of the link between autonomous and controlled motivations and FV intake. Cross-sectional data from 2959 adults in the United States were analyzed. Autonomous motivation and perceived social support were positively associated with FV intake, while controlled motivation was negatively associated with FV intake. Additionally, there was evidence that the negative association between controlled motivation and FV intake was attenuated by higher levels of perceived social support. Findings suggest the need for a more comprehensive approach to understanding the role of motivation in health behaviors like FV intake and the potential roles played by friends and family in these motivational processes.

Emotion suppression, emotional eating, and eating behavior among parent–adolescent dyads.

Emotion suppression may lead to ironic increases in emotional experience. More important, suppression is a transactional process, creating stress and disrupting interactions for the suppressor and those in social interactions with individuals who are suppressing emotion. However, no research has examined the behavioral consequences of emotion suppression in close relationships. We examine the possibility that emotion suppression will predict eating behaviors as a secondary emotion regulatory strategy among 1,556 parent–adolescent dyads (N = 3,112), consistent with evidence suggesting that suppression influences eating at the individual-level. Actor-partner interdependence models and structural equation modeling demonstrate that one’s own emotion suppression was associated with emotional eating; greater consumption of hedonic—low nutrient, high energy dense—foods; and lower consumption of fruits and vegetables (actor effects). One’s partner’s emotion suppression was also independently associated with one’s own emotional eating; lower consumption of fruits and vegetables; and greater consumption of hedonic foods (partner effects), although this association was most consistent for adolescents’ suppression and parents’ eating (compared with the converse). These analyses suggest that dyadic emotion regulatory processes have implications on eating behavior. Moreover, analyses suggest that emotion suppression has potential implications on eating behaviors of others within close relationships with a suppressor, consistent with the notion that emotion regulation is a transactional process. These findings suggest that interventions to improve eating habits of parents and their adolescent children should consider dyadic emotion regulatory processes.

Perceived weight and barriers to physical activity in parent–adolescent dyads.

Objective: Family-based physical activity interventions have the potential to reduce obesity, but more information is needed regarding physical activity in the family context. This study used an actor–partner interdependence model to estimate the dyadic association between perceived weight status and barriers to physical activity in dyads of adults and their adolescent children. It was hypothesized that greater perceived weight would be associated with greater barriers perceived by both one’s self and one’s partner. Method: Data from 1,568 dyads in the Family Life, Activity, Sun, Health, and Eating study were used to examine the dyadic association between perceived weight status (i.e., greater perceived weight category) and barriers to physical activity. Models were stratified by actual weight (an overweight or obese dyad member vs. two normal weight dyad members) and adjusted for parent education, parent and adolescent age, gender, and race. Results: Among dyads with at least 1 overweight/obese member, greater perceived weight status was positively associated with one’s own perceived barriers (significant actor effects, &bgr;s = 1.17 and 1.03, ps < 0.01) and one’s partner’s perceived barriers (significant partner effects, &bgr;s = 0.38 and 0.62, ps < 0.01). No statistically significant relationships were found for dyads with only normal weight members. Conclusions: Among dyads with at least 1 overweight or obese member, significant partner effects for parents and adolescents demonstrate that the weight perception of 1 dyad member correlates with the barriers of the other member. These dyadic associations highlight the potential importance of family-based interventions for physical activity.

Susceptibility to Food Advertisements and Sugar-Sweetened Beverage Intake in Non-Hispanic Black and Non-Hispanic White Adolescents

Obesity among adolescents in the United States has risen by 16% in the past 30 years. One important contributing factor may be the increased consumption of sugar sweetened beverages (SSBs), which is encouraged by advertisements for unhealthy foods and drinks that are targeted to adolescents. The purpose of this analysis was to determine the association between susceptibility to food and drink advertisements and sugar-sweetened beverage (SSB) consumption in non-Hispanic black (NHB) and non-Hispanic white (NHW) adolescents and to examine if BMI is associated with SSB consumption. Data were obtained from 765 NHB and NHW of ages 14–17 who were surveyed in the Family Life, Activity, Sun, Health, and Eating study sponsored by the National Cancer Institute. Two weighted adjusted logistic regression models were conducted. The first examined the associations of advertisement susceptibility, race, and BMI with SSB consumption. The second examined the associations of race and BMI with advertisement susceptibility. Adolescents with high advertisement susceptibility were more likely to consume at least one SSB daily (OR 1.73, 95% CI 1.21, 2.47). Additionally, non-Hispanic blacks were more likely to consume at least one SSB daily (OR 1.75, 95% CI 1.08, 2.85) and more likely to be highly susceptible to advertisements (OR 1.72, 95% CI 1.19, 2.48) than non-Hispanic whites. No significant associations were found between BMI and advertising susceptibility or BMI and daily SSB consumption. One approach to addressing the consumption of SSBs may be to reduce advertising that markets unhealthy food and beverages to adolescents and minorities.