Search Results (18)

This study investigates the impact of family engagement on student reading achievement in the United Arab Emirates (UAE) using counterfactual explainable artificial intelligence (CXAI) analysis. Drawing data from 24,600 students in the UAE PISA dataset, the analysis employed Gradient Boosting, SHAP (SHapley Additive exPlanations), and counterfactual simulations to model and interpret the influence of ten parental involvement variables. The results identified time spent talking with parents, frequency of family meals, and encouragement to achieve good marks as the strongest predictors of reading performance. Counterfactual analysis revealed that increasing the time spent talking with parents and frequency of family meals from their minimum (1) to maximum (5) levels, while holding other variables constant at their medians, could increase the predicted reading score from the baseline of 358.93 to as high as 448.68, marking an improvement of nearly 90 points. These findings emphasize the educational value of culturally compatible parental behaviors. The study also contributes to methodological advancement by integrating interpretable machine learning with prescriptive insights, demonstrating the potential of XAI for educational policy and intervention design. Implications for educators, policymakers, and families highlight the importance of promoting high-impact family practices to support literacy development. The approach offers a replicable model for leveraging AI to understand and enhance student learning outcomes across diverse contexts. Full article

Background/Objectives: Animal models have suggested a link between maternal nutrition and offspring pubertal onset. Due to ethical and practical concerns, human studies on this topic remained scarce and focused on extreme nutritional shocks in high-income settings, such as Dutch famine. This paper expands on these findings by investigating the effects of a milder form of nutritional alteration during pregnancy—Ramadan fasting—in a middle-income context, Indonesia. We use offspring age at menarche (AAM) as an indicator of pubertal timing and female reproductive health. Our research has broader implications beyond the Muslim community, as intermittent fasting during pregnancy is also widely practiced by non-Muslims, e.g., meal-skipping. Methods: We used data from the Indonesian Family Life Survey (1993–2014, n = 8081) and Indonesian Demographic and Health Surveys (2002–2007, n = 13,241). OLS and Cox regressions were applied to compare the AAM of female Muslims who were prenatally exposed to Ramadan and those of female Muslims who were not. Exposure was determined based on the overlap between pregnancy and a Ramadan. We further subdivided this overlap into trimester-specific categories, adjusting for urban–rural residence, birth month, birth year, birth year squared, and survey wave. Results: No associations between Ramadan during pregnancy and AAM were found, irrespective of the pregnancy trimester overlapping with Ramadan. These results were stable when we restricted the sample to women with shorter recall periods and younger women at the time of survey. Conclusions: While subtle restrictions in maternal nutrition during pregnancy are critical for offspring health, the impact on menarcheal onset might be limited. Full article

Background/Objectives: Childhood eating behaviors result from a complex interplay of familial, social, and environmental factors, influenced by socioeconomic and cultural contexts. These behaviors impact dietary habits, nutritional status, and long-term health. Using the Social Ecological Model (SEM), this narrative review synthesizes evidence on key determinants of childhood eating behaviors and proposes a framework for multi-level interventions. Methods: A structured literature search was conducted across PubMed, PsycINFO, and CINAHL, focusing on studies published between January 2014 and September 2024. Keywords related to childhood eating behaviors, familial determinants, and social influences were used to identify relevant studies. Inclusion criteria centered on empirical research examining how social and familial factors impact childhood eating behaviors within the SEM framework. Results: The review highlights critical determinants, including parental feeding practices, home food environments, peer influences, screen time, school meal programs, and socioeconomic disparities. These factors interact across multiple levels, emphasizing the importance of holistic interventions that target both individual behaviors and broader systemic influences. Conclusions: Addressing childhood eating behaviors requires a multi-level approach that integrates caregiver education, peer-led interventions, improved food environments, and supportive policies. Healthcare providers and policymakers play a crucial role in implementing strategies that foster healthier dietary behaviors and mitigate childhood obesity risks. Full article

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2–19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted. Full article

Consuming too few fruits and vegetables and excess fat can increase the risk of childhood obesity. Interventions which target mediators such as caregivers’ dietary intake, parenting strategies, and the family meal context can improve children’s diets. A quasi-experimental, pre–post intervention with four conditions (healthcare (HC-only), public health (PH-only), HC + PH, and control) was implemented to assess the effects of the interventions and the effects of the mediators. HC (implemented with the Obesity Care Model) and PH interventions entailed capacity building; policy, system, and environment changes; and a small-scale media campaign to promote healthy eating. Linear mixed models were used to assess intervention effects and the mediation analysis was performed. Predominantly Hispanic/Latino children and caregivers from rural communities in Imperial County, California, were measured at baseline (N = 1186 children/848 caregivers) and 12 months post-baseline (N = 985/706, respectively). Children who were overweight/obese in the HC-only condition (M = 1.32) consumed more cups of fruits at the 12-month follow-up than those in the control condition (M = 1.09; p = 0.04). No significant mediation was observed. Children in the PH-only condition consumed a significantly higher percentage of energy from fat (M = 36.01) at the follow-up than those in the control condition (M = 34.94, p < 0.01). An obesity intervention delivered through healthcare settings slightly improved fruit intake among at-risk children, but the mechanisms of effect remain unclear. Full article

Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study’s objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants’ health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students’ daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one’s body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one’s body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse. Full article

In the context of the WHO’s measles and rubella elimination targets and European Immunization Agenda 2030, this large cross-sectional study aimed to identify inequalities in measles vaccination coverage in Wales, UK. The vaccination status of individuals aged 2 to 25 years of age, alive and resident in Wales as of 31 August 2021, was ascertained through linkage of the National Community Child Health Database and primary care data. A series of predictor variables were derived from five national datasets and all analysis was carried out in the Secure Anonymised Information Linkage Databank at Swansea University. In these 648,895 individuals, coverage of the first dose of measles-containing vaccine (due at 12–13 months of age) was 97.1%, and coverage of the second dose (due at 3 years and 4 months) in 4 to 25-year-olds was 93.8%. In multivariable analysis, excluding 0.7% with known refusal, the strongest association with being unvaccinated was birth order (families with six or more children) and being born outside of the UK. Living in a deprived area, being eligible for free school meals, a lower level of maternal education, and having a recorded language other than English or Welsh were also associated with lower coverage. Some of these factors may also be associated with refusal. This knowledge can be used to target future interventions and prioritise areas for catch up in a time of limited resource. Full article

A massive incorporation of ultra-processed products into young children’s diets worldwide and in Mexico has been documented. The aim of this study is to understand the role of sociocultural factors in principal caregivers’ decisions to give a type of ultra-processed food to children under age five, called ‘comida chatarra’ (‘junk food’ in English), usually includes sugar-sweetened beverages, sweet and salty snacks, and sweet breakfast cereals. We conducted a descriptive, observational qualitative study. The research was conducted in urban and rural communities in two Mexican states. Twenty-four principal caregivers were equally distributed between the two states and types of communities. They were interviewed in person. Phenomenology underpinned this study. Results highlight the preponderant role of culture in food choices and feeding practices with junk food. Local culture influences child-feeding with ultra-processed products through social norms, knowledge, or socially constructed attitudes. These social norms, built in the context of abundant ultra-processed products and omnipresent marketing, ‘justify’ children’s consumption of junk food. They acquire these products from the principal caregivers, family members, and neighbors, among others, who reward and pamper them. These actors also define what amount (small amounts) and when (after meals as snacks) children are given these products. Cultural factors must be considered in the development of effective public policies and programs that aim to change the culture around ultra-processed products among children and avoid their consumption. Full article

Adolescence is a vital period of growth and development, both of which are dependent on adequate nutrition; however, concerns persist about poor nutrition and inappropriate food behaviours. In addition to nutrition assessment, the context of food and health behaviour is necessary to understand how dietary choices are shaped and related to diet quality. This study describes food-related behaviours and health indicators associated with dietary quality among adolescents in Manitoba, Canada. A stratified two-stage sampling method was used to collect data on the diet, food behaviours and health indicators of 1587 grade nine students. Diet quality was analysed using the Healthy Eating Index-Canada. Several food behaviours and health indicators varied by gender and school region (urban, rural, northern). The Independent Samples t-test and one-way ANOVA (analysis of variance) assessed differences between groups on the Healthy Eating Index-Canada. Higher Healthy Eating Index-Canada scores were found for those eating family dinners more frequently; consuming breakfast and lunch more frequently; consuming breakfast at home; eating lunch and morning snacks at school; purchasing fewer meals and snacks from cafeterias and vending machines; believing that food and nutrition education is important; not attempting to lose weight; being classified as ‘healthy weight’; and getting more sleep. Many Manitoba youth are exhibiting food and health behaviours that increase their risk of having a poor diet. Full article

Family is the most fundamental and proximal context for children, and children’s eating behavior occurs mostly in the home or together with family members. With this study, we aimed to evaluate the distribution of family food environment dimensions and their relationship with healthy and unhealthy food consumption in primary and secondary students in order to provide evidence in the Chinese context and explore environmental solutions for improved child nutrition. Multi-stage stratified cluster sampling was used to conduct a cross-sectional survey among students in Beijing, China, from September 2020 to June 2021. Family food environment (FFE) was measured by the validated Family Food Environment Questionnaire for Chinese School-age Children, which was self-administered by the children’s caregivers. The students were asked to answer questions about food consumption frequencies in the past 7 days. Binary logistic regression models were used to investigate the relationships between food consumption frequency and FFE, and odds ratios (ORs) with 95% confidence intervals (CI) were computed for independent variables. Among the study population, 9686 students in grades 3–12 and their caregivers completed the survey. The mean score of FFE was 65.7 (±8.4) out of a total possible score of 100, with 76.6% of students categorized as relatively healthier according to their FFE score (≥ 60). Compared with the reference group, students in primary schools and those cared for principally by parents were more likely to be in a healthy FFE category (p < 0.05). Daily consumption of fruits and vegetables was reported by 62.6% and 71.6% of students, respectively, and weekly sugared soft drink consumption was reported by 70.9% of the students. Students with a healthier FFE score (≥60) were more likely to consume fruits (OR = 1.578, 95% CI: 1.428~1.744) and vegetables (OR = 1.402, 95% CI: 1.263~1.556) but less likely to consume sugared soft drinks (OR = 0.592, 95% CI: 0.526~0.667). Family food availability (β = 0.137), caregivers’ nutritional literacy (β = 0.093), meal practices (β = 0.079) and food rules (β = 0.050) were positively correlated with food consumption behavior (p < 0.05). The students with healthier FFE scores (OR = 1.130, 95% CI: 1.014~1.258) and whose caregiver was obese (OR = 2.278, 95% CI: 1.973~2.631) were more likely to be overweight. The family food environment plays an important role in shaping food consumption in children. Provision of healthy foods instead of unhealthy foods, positive meal practices and food rules, and nutrition education for parents can promote healthy eating in children. Full article

Detrimental effects exerted by biomass-based traditional cookstoves on health, environment, hygiene, and the soaring price of gas makes it imperative to investigate the feasibility of electric cooking as a promising clean cooking fuel in the context of Bangladesh. However, the adoption of electric cooking is unlikely to be welcomed if the monthly cost of electricity consumed by the electric cooking appliances is not comparable to traditional cooking fuels. So far, no study has been reported in this respect. Therefore, this paper is aimed to assess the energy consumption of available electric cooking appliances for cooking typical Bangladeshi dishes. Estimated monthly electricity cost of electric cooking is also reported and then compared to that of traditional cooking fuels. For the study purpose, three respondent families were provided with a rice cooker, hot plate, induction cooker and electric pressure cooker for cooking their daily meals. After four months of use, data related to dish cooked, amount of food, cooking time, and energy consumption were collected which shows that hot plate and rice cooker were the least preferred appliances due to their poor workmanship and limited use respectively. On the contrary, despite the fact that electric pressure cookers cannot perform all types of frying, it was the most preferred appliance owing to its ability to significantly reduce the cooking time and its less energy consumption. Induction cooker was less preferred for the additional requirement of compatible cook pots. The study also reveals that monthly energy requirements for electric cooking varied from 72–87 kWh corresponding to a cooking electricity bill ranging from BDT 504–609 per month (USD 6–7.5) which is less expensive as compared with biomass and LPG based cooking. This paper also highlights the prospects and challenges associated with the adoption of electricity as the primary cooking fuel in Bangladesh. Full article

The financial crisis associated with the COVID-19 pandemic has exacerbated food insecurity in the United States. The emergency provides an opportunity to re-think the American nutrition-assistance system. In this paper, we describe findings from a community-based project conducted in urban Alaska before the pandemic in collaboration with a local food pantry. We conducted semi-structured interviews with nineteen food recipients, half of them twice, about how they procure food and prepare their meals in the context of juggling other expenses and demands on their time. What participants in our study do fits mainstream American patterns. Our study adds to the knowledge base by focusing on how families think strategically about their situations in context. In addition to cost, participants take nutrition and flavor into account. Most importantly, they do not think about assistance programs in isolation but holistically. Full article

The health benefits and importance of family mealtimes have been extensively documented. Picky eating can impact this complex activity and has numerous extrinsic (or external) and intrinsic (or internal) features. Occupational therapists work with children and their families by looking at both intrinsic and extrinsic influences and are therefore well-placed to work within this context. This scoping review comprises a comprehensive search of key health industry databases using pre-determined search terms. A robust screening process took place using the authors pre-agreed inclusion and exclusion criteria. There were 80 studies that met the inclusion criteria, which were then mapped using content analysis. The most common assessments used to identify picky eating relied on parental reports and recall. Often additional assessments were included in studies to identify both the intrinsic and extrinsic features and presentation. The most common reported intrinsic features of the child who is a picky eater included increased sensitivity particularly to taste and smell and the child’s personality. Extrinsic features which appear to increase the likelihood of picky eating are authoritarian parenting, rewards for eating, and pressuring the child to eat. Most commonly reported extrinsic features that decrease the likelihood of picky eating are family meals, responsive parents, and involving the child in the preparation of food. In conclusion, there is a lack of published papers addressing the role of occupational therapists in the assessment and identification of picky eating in children. There appears to be a complex interplay between intrinsic and extrinsic features which impact caregiver responses and therefore on the picky eater. Full article

Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observations of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Future implementation of the intervention should tailor the strategies to the local context to ensure optimal adherence to the intervention. Full article

The COVID-19 pandemic has disrupted many aspects of daily life. The purpose of this study was to identify how health behaviors, level of stress, financial and food security have been impacted by the pandemic among Canadian families with young children. Parents (mothers, n = 235 and fathers, n = 126) from 254 families participating in an ongoing study completed an online survey that included close and open-ended questions. Descriptive statistics were used to summarize the quantitative data and qualitative responses were analyzed using thematic analysis. More than half of our sample reported that their eating and meal routines have changed since COVID-19; most commonly reported changes were eating more snack foods and spending more time cooking. Screen time increased among 74% of mothers, 61% of fathers, and 87% of children and physical activity decreased among 59% of mothers, 52% of fathers, and 52% of children. Key factors influencing family stress include balancing work with childcare/homeschooling and financial instability. While some unhealthful behaviors appeared to have been exacerbated, other more healthful behaviors also emerged since COVID-19. Research is needed to determine the longer-term impact of the pandemic on behaviors and to identify effective strategies to support families in the post-COVID-19 context. Full article