Purpose: To evaluate cross-sectional and longitudinal associations between controlling parental feeding practices in adolescence (i.e., restrictive feeding and pressure-to-eat [PE]) and intuitive eating (IE) in adolescence and emerging adulthood; and explore child gender and parental concern about child weight as moderators. Methods: The sample included participants (N = 1,383) from the population-based EAT 2010–2018 study who provided data in adolescence (14.4 ± 2.0 years) and emerging adulthood (22.0 ± 2.0 years) and had at least one caregiver complete surveys in adolescence. Generalized estimating equations evaluated cross-sectional and longitudinal associations between restrictive feeding and PE in adolescence and IE in adolescence and emerging adulthood. Interactions with gender and parental concern over child weight in adolescence were explored. Results: Restrictive feeding was cross-sectionally associated with lower IE in adolescence (b = −0.04), though evidence of moderation by parental weight concern indicated this association was only observed in the context of low parental weight concern. Greater PE was associated with lower adolescent IE among boys but higher IE among girls. Longitudinally, the association between PE in adolescence and IE in emerging adulthood differed by parental weight concern; greater PE predicted higher emerging adult IE at high parental weight concern, but lower IE at low parental weight concern. Discussion: Controlling feeding practices in adolescence displayed differential associations with child IE in adolescence and emerging adulthood based on child gender and parental concern over child weight. Notably, PE was associated with greater IE among adolescent girls but lower IE among boys. Results suggest that parental feeding is a valuable intervention target.

Background: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. Methods/design: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI+Virtual Home Visiting with CHW+Video Feedback; and (3) EMI+Hybrid Home Visiting with CHW+Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n=525) with increased risk for cardiovascular disease (i.e., BMI ≥75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. Discussion: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary assessment, intervention, video feedback and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. Trial Registration: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

Given emerging adulthood is a period of increased independence, it is unclear how much contact emerging adults have with their parents, how this communication occurs, and how frequency of communication differs across sociodemographic characteristics. The main aim of this study was to examine communication patterns and modalities between emerging adults and their parents. Data are from an 8-year longitudinal, population-based study of socio-economically and racially/ethnically diverse adolescents followed into emerging adulthood (n = 1539; mean age = 22.1; 53.1% female). Latent profile analysis results supported a 5-class model, in which classes were characterized by patterns of frequency of communication with parents across different modalities. The most common communication modality included medium levels of engagement (i.e., few times/week), with both parents, and was in-person or via the phone (i.e., calls, text messages, email). Results differed by race/ethnicity. Findings from this exploratory study may be useful for supporting positive communication patterns between emerging adults and their parents and may inform what intervention delivery format (e.g., phone, social media-based, in-person) may be more effective for certain parent/emerging adult subgroups engaging in family-based interventions.

Research addressing the impact of the COVID-19 pandemic on psychosocial well-being and health behavior is accumulating; however, implications for emerging adult populations are underexplored. This ...

To examine the racial, ethnic and cultural differences in postpartum participation of women who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy by completing a retrospective analysis of observational data on 35,903 women who enrolled in Minnesota WIC during pregnancy, from April 2018 to March 2020. Descriptive analyses were completed using chi-square tests of association to show differences in postpartum WIC participation by maternal demographics and health risk codes of the WIC participants. Binary logistic regression and multivariate logistic regression were used to obtain odds ratios to compare the likelihood of postpartum WIC participation across different races, ethnicities and cultural groups. Asian/Pacific Islander, East African, Hispanic, Hmong, Multigenerational Black, and Other Black pregnant participants were more likely than White participants to return to WIC postpartum (adjusted odds ratio (AOR) 2.54, 95% confidence interval (CI) 1.87–3.46; AOR 3.35, 95% CI 2.40–4.66; 1.30, 95% CI 1.10–1.54; AOR 6.76, 95% CI 4.39–10.42; AOR 1.40, 95% CI 1.11–1.77, AOR 1.52, 95% CI 1.26–1.83, respectively). American Indian pregnant participants were less likely than White participants to return to WIC postpartum (AOR 0.70, 95% CI 0.54–0.92). These findings can help the Minnesota WIC program, as well as other WIC programs, better understand which cultural groups may need more specific outreach strategies to keep women participating in the program after giving birth. Further research is needed to understand why postpartum women choose to participate, or choose not to participate, in WIC. It is already known that culture, race and ethnicity influence the likelihood of WIC program participation. Research also has shown that WIC participation can have positive impacts on the health of women, infants and children. This research adds depth to previous findings on prenatal WIC participation by describing the differences in postpartum WIC participation by race, ethnicity and cultural group. This research can be used for outreach planning within the WIC program.

Helicopter parenting, a parenting style defined by over-involvement, may lead to poor health outcomes. However, research has primarily focused on children and adolescents from White, high socio-eco...

This paper summarizes the current research on the impact of abstinence-only sex education programs on LGBTQ+ adolescent health in the USA. We also seek to explore the current barriers to implementing comprehensive sex education, as well as discuss the future of LGBTQ+ adolescent health by outlining crucial components of LGBTQ+-inclusive sex education. The US sex education debate is centered on two approaches: abstinence-only and comprehensive. Abstinence-only sex education emphasizes risk reduction through abstaining from sexual behavior and has been found to be ineffective in promoting healthy sexual behavior among adolescents, compared to comprehensive sex education which centers on disseminating inclusive and medically accurate information. Abstinence-only sex education is taught through a heteronormative framework that excludes and devalues the experiences of LGBTQ+ adolescents. LGBTQ+ individuals are at increased risk for negative health outcomes as compared to their cisgender heterosexual counterparts. Lack of knowledge regarding safe sexual practices and consent, coupled with the shame and fear-based messaging promoted by abstinence-only sex education, further contributes to the health disparities experienced by LGBTQ+ youth. The content and inclusivity of sex education has important implications for the health of LGBTQ+ youth. Abstinence-only sex education further compounds the health disparities experienced by LGBTQ+ adolescents by erasing LGBTQ+ representation and leaving out crucial information on diverse, non-heterosexual sex practices. Numerous barriers exist to implementing comprehensive, inclusive sex education including funding, policies, teacher training, and attitudes toward sex and LGBTQ+ individuals. To address these health disparities, we must listen to and amplify the voices of LGBTQ+ youth to promote safe, comprehensive, and LGBTQ+-inclusive content within our sex education system in the USA.

<p>Understanding social determinants that shape pertinent developmental shifts during emerging adulthood (i.e., those aged 18-25) and their associations with psychological health requires a nuanced approach. In our exploratory study, we investigated how multiple social identities and lived experiences generated by systems of marginalization and power (e.g., racism, classism, sexism) intersect in connection to the mental-emotional well-being of emerging adults (EAs). EAT-2018 (Eating and Activity over Time) data were collected from 1,568 EAs (mean age = 22.2±2.0 years) recruited initially in 2010 from Minneapolis/St Paul schools. Conditional inference tree (CIT) analyses were employed to treat ‘social location’ and systems of marginalization and power as interdependent social factors influencing EAs’ mental-emotional well-being outcomes: depressive symptoms, stress, self-esteem, and self-compassion. CITs identified EAs subgroups with differing mean levels of mental-emotional well-being outcomes, distinguished primarily by marginalized social experiences (e.g., discrimination, financial difficulties) rather than social identities themselves. The relative positioning of EAs’ experiences of social marginalization (e.g., discrimination) to their social identities (e.g., race/ethnicity) suggests the social experiences generated by systems of privilege and oppression (e.g., racism) are more adjacent social determinants of mental-emotional well-being than the social identities used in public health research to proxy the oppressive systems that give them social meaning.</p>

Objective: To determine individual- and country-level factors associated with self-reported changes in solo and partnered sexual behaviors in an international sample of adults during COVID-19. Methods: Data were from the International Sexual Health And REproductive Health during COVID-19 study (I-SHARE)—a cross-sectional, multi-country study (N = 26 countries) assessing adult (N = 19,654) sexual/reproductive health before and during the first wave of COVID-19. We examined self-reported changes (three-point scale: decreased, no change, increased) in solo masturbation, hugging/holding hands/cuddling with a partner, sex with a primary partner, sex with a casual partner, sexting with a partner, viewing sexually explicit media and partnered cybersex. Ordinal regression assessed the impact of individual (age, gender- and sexual-identity, romantic partnership status, employment and income stability, household change and content, mental well-being, changes in alcohol use, and changes in marijuana use) and country-level (e.g., Oxford Stringency Index, Human Development Index, and the Palma Ratio) factors on behavior change. Results: The most common behavior to increase was hugging, kissing, or cuddling with a partner (21.5%), and the most common behavior to decrease was sex with a main partner (36.7%). Household factors like job/income instability and having children over the age of 12 years were significantly associated with decreased affectionate and sexual partnered sexual behaviors; more frequent substance use was linked to significantly increased solo, partnered, and virtual sexual behaviors. Conclusions: Understanding changes in sexual behaviors—as well as the factors that make changes more or less likely among adults around the world—are important to ensure adequate sexual health support development for future public health emergencies.

Objective: Disordered eating behaviors (DEBs) have long-term, deleterious effects on health and are more prevalent among socially marginalized groups, likely as a result of systemic inequities across social determinants of health (SDoH). This exploratory study aimed to identify subgroups of emerging adults characterized by main and interactive associations between SDoH and two forms of DEB (binge eating, extreme unhealthy weight control behaviors). Method: Participants (n = 1568; age 22.2 ± 2.1 years) from the United States were drawn from the EAT 2010-2018 longitudinal study. Conditional inference tree (CIT) analyses derived main and intersecting SDoH related to DEB across 33 input variables collected during adolescence and emerging adulthood. Results: The binge eating CIT revealed five subgroups (prevalence: 6.3-23.2%) shaped by variables collected during emerging adulthood: appearance-based teasing (p < .001), financial difficulty (p = .003), gender (p < .001), and everyday discrimination (p = .008). The CIT results for extreme unhealthy weight control behaviors derived six subgroups (prevalence: 2.3-45.5%) shaped by weight teasing (p < .001) and gender (p < .001) during emerging adulthood and public assistance (p = .008) and neighborhood safety (p = .007) in adolescence. Discussion: This exploratory study revealed distinct subgroups of emerging adults with varying DEB prevalence, suggesting that variability in DEB prevalence may be partially explained by intersecting SDoH during adolescence and emerging adulthood. Hypothesis-driven research and replication studies are needed to further explore the associations between SDoH and DEB during emerging adulthood. Public Significance Statement: Disordered eating behaviors are common among young people in the United States and have long-term health consequences. This exploratory study identified subgroups of young people, characterized by combinations of social inequities (e.g., financial difficulties, teasing). Results highlight high-risk

Emerging evidence suggests a cross-sectional association between food insecurity (FI) and disordered eating among adults, while evidence among adolescents is limited. Longitudinal research is needed to elucidate the temporality of this relationship and clarify whether the association differs by age. Three waves of prospective data came from 1813 participants in the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. Data were collected at five-year intervals, with the baseline survey in 1998–1999 (EAT-I; Mage = 14.9 years) and follow-up surveys in 2003–2004 (EAT-II; Mage = 19.5 years) and 2008–2009 (EAT-III; Mage = 24.9 years). Severe FI was assessed as any past-year hunger with one item from the U.S. Household Food Security Survey Module, and a range of disordered eating behaviors were self-reported. Associations adjusted for sociodemographic characteristics were examined with generalized estimating equations. Effect modification by age was also tested. Cross-sectionally, severe FI was significantly associated with greater prevalence of all disordered eating behaviors examined, with the strongest associations observed for extreme weight-control behaviors (prevalence ratio [PR] = 1.49, 95% confidence interval [CI]: 1.13–1.95) and binge eating (PR = 1.49, 95% CI: 1.04–2.12). Longitudinally, severe FI significantly predicted 1.41 (95% CI: 1.05–1.90) times greater prevalence of binge eating five years later after accounting for prior binge eating. Effect modification by age indicated a stronger cross-sectional association between severe FI and unhealthy weight-control behaviors among younger participants. Results support a cross-sectional link between severe FI and disordered eating and provide longitudinal evidence suggesting severe FI is a risk factor for binge eating.

Objective: Digital technology use and muscle-building behaviors reflect a wide range of behaviors with associated health risks. However, links between digital technology use and muscle-building behaviors remain unknown and this study aimed to address this gap. Method: Data were collected from a diverse sample of 1,483 young adults (mean age 22.2 ± 2.0 years) participating in the population-based Eating and Activity over Time 2018 study. Gender-stratified-modified Poisson regression models were used to determine cross-sectional associations between three types of digital technology use (screen time, social media, weight-related self-monitoring apps) and five types of muscle-building behaviors (changing eating, exercise, protein powders/shakes, pre-workout drinks, steroids/growth hormone/creatine/amino acids) in young adulthood, adjusted for sociodemographic characteristics and body mass index. Results: Screen time and social media were either not found to be associated with muscle-building behaviors or in a few instances, associated with less use of these behaviors (e.g., screen time and pre-workout drinks in men). In contrast, the use of weight-related self-monitoring apps was positively associated with all muscle-building behaviors, including steroids/growth hormone/creatine/amino acids in men (prevalence ratio [PR] = 1.83; 95% confidence interval [CI]: 1.13–2.97) and women (PR = 4.43; 95% CI: 1.68–11.68). Discussion: While most recreational screen time may represent sedentary behaviors not related to muscle-building behaviors, weight-related self-monitoring apps are highly associated with more muscle-building behaviors and could be a future target for interventions to discourage the use of steroids and other harmful muscle-building substances.

Background Low: syphilis testing uptake is a major public health issue among : men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. Methods and findings An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win U S$15: if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% : CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US $26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing.

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18–30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3–3.7] and PR = 3.1, [95% CI = 2.0–4.7], respectively) and lower intuitive (β = −0.4, [95% CI = −0.7, −0.2] and β = −0.5 [95% CI = −0.8, −0.3], respectively), and mindful eating scores (β = −0.3, [95% CI = −0.6, −0.1] and β = −0.5 [95% CI = −0.8, −0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

Purpose: Growing evidence indicates that experiencing household food insecurity during adolescence is associated with disordered eating and elevated body mass index (BMI). However, little is known about the temporal nature of these relationships. The current longitudinal study examined how adolescent experiences of household food insecurity are related to disordered eating and weight status 8 years later. Methods: A population-based sample of ethnically/racially and socioeconomically diverse participants (n = 1,340) were surveyed as adolescents (mean age = 14.5 years) and as young adults (mean age = 22.0 years). Parents/caregivers completed the six-item U.S. Household Food Security Survey Module at baseline. Results: Household food insecurity was common at baseline (37.8% of sample). In analyses adjusted for ethnicity/race and parental education, adolescent food insecurity longitudinally predicted a higher new onset of binge eating (food insecure: 21.3% vs. food secure: 16.2%, p = .038) and BMI ≥30 kg/m2 (food insecure: 15.9% vs. food secure: 11.0%, p = .024), but not unhealthy weight control behaviors in young adulthood. The majority of adolescents with unhealthy weight control behaviors and elevated BMI still had these problems in young adulthood, but persistence was not associated with adolescent household food insecurity for any outcome. Discussion: Results of this longitudinal study suggest that household food insecurity during adolescence is a risk factor for disordered eating and elevated BMI in young adulthood, highlighting a need to comprehensively address these intersecting problems.