The need as indicated by stakeholders:

The prevalence of youth obesity in the United States (US) is high (22.2% among 12-15 year-olds, 2017-2020) with disproportionately higher rates among non-Hispanic African American and Hispanic children than other races/ethnicities (Stierman et al., 2021) and among youth from low-income compared to higher income households (Stierman et al., 2021; Ogden et al. 2018). The National Health and Nutrition Examination Survey (NHANES) data from 1999-2016 were used to project that 46% of adolescents would become overweight or obese by 2030 (Wang et al., 2020). Adolescents with overweight or obesity are at greater risk of becoming adults with obesity (Craigie et al., 2011; Simmonds et al., 2016) and developing associated non-communicable health conditions and psychosocial problems in the short- and long-term (Park et al., 2012; Kelsey et al., 2014). Therefore, obesity reduction among adolescents needs to be addressed to reduce the overall burden of adult obesity and associated health risks in the US.

Poor dietary quality increases the risk for obesity (Hruby et al., 2016). More than half of US youth (12-19 years) had poor quality diets based on NHANES surveys from 1999-2016 (Liu et al. 2020) indicating a need for improvement to meet recommendations for health promotion. More specifically, results indicated that 17.5% of total energy intake among US children (2-19 years) was from junk food, with the largest contributions from sweet bakery products (6.4%) and savory snacks (4.6%) (Liu et al., 2021). Marriott et al. (2019) found that US children’s (2-19 years) energy intake from sugar sweetened beverages (SSBs) was 120.5 kcal/day, total sugar intake was 114.2 grams/day, and total energy intake was 2032 kcal/day (NHANES 2015-2016) (Marriott et al., 2019), thus the recommendation of 10% of energy from added sugars was unlikely to be met by many adolescents. Further, Doherty et al. (2021) found that Healthy Eating Index (HEI)-2015 scores were higher among adolescents not consuming SSBs compared to high SSB consumers (53 vs. 46, P < 0.001) (NHANES (2009-2014); although HEI scores for all adolescents were low. USDA Dietary Data Briefs (NHANES 2017-2018) have also shown that only 47% of adolescents (12-19 years) consumed vegetables on a given day (Hoy et al., 2021a) and 35% consumed fruit on a given day (Hoy et al., 2021b). Poor diet can contribute to chronic diseases including obesity (Micha et al., 2017; Liberall et al, 2020), thus factors influencing poor food choices should be examined further, especially among those at highest risk for negative health outcomes.

A socioecological model (SEM) was used to describe the dynamic interrelationships among concentric layers of influence on adolescent obesity, including intrapersonal, interpersonal, community, organization, government, industry and societal domains (Jebeile et al., 2022; Ohri-Vachaspati et al. 2015). Among the intrapersonal and interpersonal layers involving the individual, family and peers, and school, factors such as family socioeconomic position and structure, parenting practices, and food environments can influence consumption of foods and beverages associated with child and adolescent obesity. Cross-sectional data from 560 parents of predominantly low income, minority children 3-18 years were used to show that the SEM layers representing parent characteristics and perceptions of neighborhoods were strong predictors of children’s weight status (Ohri-vachaspati et al. 2015). Parent perceptions of neighborhood environments such as the ability to purchase healthy foods were associated with better child weight outcomes, suggesting that parent perception of availability and accessibility are important for child health (Ohri-vachaspati et al. 2015). Along with the neighborhood and built environment, other social determinants of health (SDOH) domains including economic stability, social and community context, and health care access and quality, together were associated with a 4.38 odds of having a higher BMI category compared to adolescents with the lowest-risk SDOH profiles (Blasingame et al. 2023). These findings suggest that interventions to reduce childhood obesity should also address health equity.

Obesogenic eating behaviors among adolescents (11-14 years) may be more likely to occur during independent eating occasions (iEOs) when parents/caregivers are not present at home, or in other environments away from home including friends’ homes, school, restaurants or convenience stores (Reicks et al. 2015). The frequency of iEOs among adolescents is a concern because food choices during these occasions may be less healthful than when parents/caregivers are present (Reicks et al., 2019), leading to potential development of overweight or obesity (Reicks et al., 2019; Shirasawa et al., 2018). Banna et al. (2020) interviewed low-income early adolescents and their parents to determine characteristics of iEOs based on pictures adolescents took of all eating occasions over a one-day period. Of all eating occasions, 57% were iEOs. Of the iEOs, most occurred at home with many as snack occasions (65%), frequently including sweets, fruit, and dairy foods, which were selected based on preferences, convenience and availability. 

Factors influencing the frequency of adolescent iEOs include the increase in single-parent households and participation of mothers and fathers in the workforce (Mather et al., 2019; US Bureau of Labor Statistics, 2023). These societal shifts may explain a low prevalence of family meals for some adolescents indicated by NHANES data from 2007-2010, which showed that the prevalence of having 0-2, 3-6, and ≥7 family meals per week was 18%, 32% and 50%, respectively among the US population with 2 or more individuals living in the household (Newman, Tumin, Andridge, & Anderson, 2015). A population-based study involving adolescents showed that the percentage consuming shared family meals was lower among lower socioeconomic status groups (Neumark-Sztainer et al., 2013). In addition to a low prevalence of family meals for some adolescents, NHANES data (2011-2014) showed that among US children 12-18 years, the mean daily calorie intake from snacks was 459, based on a mean 2.4 snacks per day with the greatest contributions to snack calorie intake from desserts and sweets, and salty snacks (Dunford and Popkin, 2018). In a large population-based study, frequency of adolescent snack consumption was associated with higher energy and sugar-sweetened beverage (SSB) intakes, lower fruit and vegetable intakes, and more frequent fast-food intake (Larson et al., 2016). Collectively, these factors may contribute to a greater number of adolescent iEOs with less healthy food choices and a greater likelihood of overweight and obesity.

Positive food parenting practices in general are thought to impact adolescent healthy food choices by providing structure (e.g., meal and snack routines, food availability, rules and limits, modeling), and supporting autonomy (e.g., teaching, involving) (Vaughn et al., 2016). In the W-4003 project, our team conducted several foundational studies to improve our understanding of the relationship between parenting practices and adolescent iEO food and beverage consumption. Gunther et al. (2019) examined perspectives on parenting practices that influence iEO food choices based on parent and adolescent interviews. We used these results to create and test a questionnaire based on six parenting practices (Reicks et al., 2020), which was used to collect data from 622 parents of adolescents across the US in the fall of 2021 (Reicks et al., 2023). The findings from these studies and those currently underway will be used to inform the development of future interventions that focus on promoting food parenting practices associated with healthy adolescent iEO food choices.

The importance of the work, and what the consequences are if it is not done:

The limited number of studies that have examined the frequency of adolescent iEOs and eating behaviors have shown that more frequent iEOs are associated with poorer dietary intake and higher weight status among adolescents (Reicks et al., 2019; Shirasawa et al., 2018). Parenting practices associated with adolescent iEO intake were identified by our team in W-4003 among low-income, multiethnic adolescents, with availability and role modeling being the only parenting practices reported by both parents and adolescents that were associated with fruit and vegetable intake (Reicks et al., 2023). An intervention mapping protocol will be employed to design an intervention to promote making healthy foods available for early adolescents during iEOs. Tech-driven approaches such as mobile apps, artificial intelligence (AI), and virtual education approaches will be reviewed to develop an educational module prototype to promote parenting practices that may improve adolescent iEO food choices and assist in childhood obesity prevention (Objective 1). For Objective 2, we will develop and pilot test the intervention for user experience and implementation for feasibility, acceptability, and preliminary health outcome effectiveness and cost effectiveness. For Objective 3, grant proposals will be prepared to scale up the intervention and disseminate findings to health professionals. If the proposed work for W-5003 is not done, the goal of promoting positive parenting practices that improve food choices during adolescent iEOs will not be achieved. Therefore, the risk of adverse consequences of overweight and obesity will not be reduced with respect to health, psychosocial, and economic issues among adolescents and families in the short- and long-term.

The technical feasibility of the research:

Research team members for the W-5003 project have successfully collaborated on two or more Agricultural Experiment Station (AES) funded multistate projects (W-1003, W-2003, W-3003, and W-4003) to study influences of parenting practices on parent and adolescent dietary behaviors. The team has previously developed, tested and implemented survey instruments involving parent/adolescent dyads across 10-12 states to identify calcium rich food and beverage (CRF/B) related parenting practices associated with CRF/B intake among adolescents and published results in which all researchers were involved (Edlefsen et al., 2008; Cluskey et al., 2008, 2015; Richards et al., 2014; Vyduna et al. 2016; Reicks et al. 2011, 2012; Banna et al., 2019). The most recent successful collaborative adolescent iEO project (W-4003), in which all researchers were involved, were based on qualitative approaches (Gunther et al., 2019b, 2023; Banna et al., 2020), and quantitative approaches surveying large samples of parent/adolescent dyads (Monroe-Lord et al., 2022a, 2022b; Reicks et al., 2019, 2020, 2023). The diversity of expertise has functioned well for this team in the past and is expected to contribute to the feasibility of developing and pilot testing digital communications for parent/adolescent dyads regarding parenting practices that influence adolescent iEO eating behaviors. For example, within their own institutions, team members have conducted interventions among parent/adolescent dyads involving in-person cooking interventions (Overcash et al., 2018; Gunther et al., 2019), meal planning using meal calendar websites (Jones, 2018; Jones, Evich, & Gaskins, 2017), and experiential learning in a virtual world environment (Meng, Wong, Manore, & Patton-Lopez, 2018). These initiatives have potential application to adolescents’ food consumption during iEOs. The team includes nutrition researchers and Cooperative Extension Nutrition Specialists, as well as two couple and family therapy researchers and a developmental/health psychologist, who all work together to provide expertise from a family social science perspective.

The advantages for doing the work as a multistate effort:

This project has several advantages for being implemented as an AES multistate project. This particular research group has 13 participants in 8 states and the District of Columbia. Researchers have positions as faculty with research experience in community nutrition, eating behavior, and family dynamics including parent-child relationships. Several have appointments within Extension, which provides opportunities for broad access to potential participants. Researchers represent a cross-section of geographic areas within the U.S. with opportunities for reaching low-income, multiethnic groups from which the project can explore, focus and tailor behavior change strategies. Finally, this group has 20+ years of experience working together to conduct cross-disciplinary collaborative investigations reaching a large number of participants. Researchers understand how to successfully assure that all researchers follow an identical protocol and have been successful with this approach in previous multistate projects (W-1003, W-2003, W-3003, and W-4003).

What the likely impacts will be from successfully completing the work:

Parenting practices within the SEM influence adolescent eating behaviors and therefore play an essential role in preventing obesity. The work completed in W-4003 identified parenting practices associated with healthful dietary intake during iEOs among low-income, multiethnic adolescents from both a parent and child perspective (Reicks et al., 2023), providing the rationale for the development of an intervention that promotes use of those parenting practices. The proposed W-5003 project will focus on developing an intervention (Objective 1) that will be pilot-tested (Objective 2) to determine the effectiveness of a tech-driven educational module prototype to impact healthy adolescent iEO food choices. A grant proposal to take the intervention full-scale will be developed based on the results of the pilot test (Objective 3). The ability to build on findings from previous multistate projects (W-1003, W-2003, W-3003, and W-4003) will allow the team to promote parenting practices that result in adolescents choosing healthy foods during iEOs, thereby addressing the need to improve diet quality and prevent obesity among adolescents.