key: cord-0999044-d5ncgb0b
authors: Loth, K.A.; Ji, Z.; Wolfson, J.; Berge, J.M.; Neumark-Sztainer, D.; Fisher, J.O.
title: COVID-19 pandemic shifts in food-related parenting practices within an ethnically/racially and socioeconomically diverse sample of families of preschool-aged children
date: 2021-10-05
journal: Appetite
DOI: 10.1016/j.appet.2021.105714
sha: 366c4ed92cd18d5cf515c66646f490f045340732
doc_id: 999044
cord_uid: d5ncgb0b

This study aimed to evaluate the influence of the COVID-19 pandemic on food parenting practices used by parents of young children. Ecological Momentary Assessment (EMA) was used to evaluate parents’ use of coercive, indulgent, structured, and autonomy supportive food parenting practices before and during the COVID-19 pandemic among a diverse racial/ethnic sample (n = 72) of parents of preschool-aged children. The impact of parent and child mood/behavior on use of specific food parenting practices was also evaluated during both time periods. Results revealed that most parents of preschoolers use a variety of food parenting practices, including coercive control, indulgence, structure, and autonomy support practices. The use of structured and autonomy supportive practices, however, decreased during the COVID-19 pandemic. Further, the types of practices used by parents were contextually associated with the mood of the parent as well as child mood. Parent negative mood during COVID-19 was associated with higher levels of coercive control and indulgence and lower levels of structure, whereas child positive child mood was associated with greater use of autonomy supportive practices. These findings suggest that effects of the COVID-19 pandemic on family dynamics around feeding young children include shifts away from theoretically supportive approaches to parenting and highlight the roles of parent and child mood/behavior as potentially important momentary influences on food parenting during this time. Public health practitioners and clinicians working with parents of young children during COVID-19, and in years to come, should consider the potential impact of parental mood and stress, as well as child mood and behaviors. Additional research is needed to better understand how to best help parents maintain supportive feeding practices in the face of challenging situations.

Efforts to contain the spread of the novel coronavirus disease-2019 (COVID-19) following its emergence in December 2019 dramatically changed the day-to-day lives of families in the US and throughout the world. In an effort to mitigate exponential growth of COVID-19 cases, national, state, and local governments put into place various mandates, including shelter-inplace laws which included required closure of various non-essential businesses, schools and child-care facilities, and the cancellation of large group gatherings, and social activities. While mandates have varied widely by state and country, and have evolved over time, the pandemic led to significant changes in family life, which are likely to have longer term implications that are important to understand and address going forward.

Families have experienced reduced access to education and childcare (e.g., daycare, school, public libraries), recreational activities (e.g., parks, playmates), and social support (e.g., teachers, family, other caregivers). At the same time, parents have been forced to adapt to significant changes in work, school, and childcare schedules. Qualitative findings from a community-based study of Canadian parents suggests that balancing work responsibilities with childcare and/or support of children's remote schooling while working from home has been a considerable source of stress for many parents. 1 Similarly, a Pew Research Center poll conducted in October 2020 indicated that just over half (52%) of parents with children aged 12 and under found it somewhat or very difficult to handle childcare related responsibilities. 2 Additionally, for many families, the economic fall-out of the pandemic has resulted in job loss, furlough, difficulty paying bills, and decreases in household food security. 2 A September 2020 J o u r n a l P r e -p r o o f Pew Research Center poll found that, since the start of the pandemic, 25% of US adults say that they or someone in their family has lost a job since the start of the pandemic, 25% of families say they have had trouble paying their bills, and 17% say they have gotten food from a food bank/organization since the start of the pandemic. 2 While these data point to a profound impact of the COVID-19 pandemic on family life and have raised concerns about population level impacts on maternal and child nutrition, 3 influences on family dynamics around feeding young children and the home food environment are not well characterized.

A broad and growing body of research has documented that the family and home food environment has considerable influence on the development of eating behaviors, dietary intake, and weight status in early childhood. [1] [2] [3] Specifically, parents influence their children's eating by providing the foods that create the home food environment, modeling of eating behaviors which children learn to emulate, and through their use of food-related parenting practices 4,5 (i.e., goal-directed behaviors to influence children's eating behaviors or dietary intake). 6 Current theoretical frameworks describe three higher-order domains of foodparenting practices: structure, including home food availability and limit setting; autonomy support, including praise and reasoning; and coercive control, including pressure-to-eat and overt food restriction. 1, 7 Indulgence has been discussed as both a sub-domain of structure, 1 as well as a fourth unique high-level domain of potential importance 4 ; indulgent behaviors include being overly permissive by allowing a child complete freedom over what, when, and how much to eat, or engaging in anticipatory catering by only purchasing foods they know the child will enjoy eating to avoid power struggles over food. Laboratory, cross-sectional, and longitudinal J o u r n a l P r e -p r o o f research studies to date have generally found that structure and autonomy support are associated with children's healthful dietary intake and eating behaviors, whereas coercive and indulgent practices have been associated with healthful dietary intake, a higher body mass index, and the development of maladaptive eating behaviors over time. 2, 3, [8] [9] [10] The conceptual framework put forward by Vaughn and colleagues to guide future research in this area 1 describes feeding practices within the structure and autonomy support domain as "supportive" and those practices within the coercive control and indulgent domains as "unsupportive".

Nevertheless, the strength of the evidence linking specific food-related parenting practices to child outcomes is mixed; the strongest associations of food parenting with child outcomes have been observed between the home food availability of healthful foods and parenting modeling of healthful dietary intake and positive weight-related outcomes in children. [1] [2] [3] 8 Research conducted prior to the COVID-19 pandemic demonstrated that parental stress and family-level food insecurity have the potential to impact children's eating behaviors through changes to food-related parenting practices. [11] [12] [13] [14] Specifically, previous research conducted with diverse families with school-aged children found that high levels of momentary parental stress or depressive symptoms experienced earlier in the day were associated with more controlling parent feeding practices at dinner the same evening. 9,10 Additionally, parents experiencing food insecurity are more likely to report engagement in coercive or controlling, as well as indulgent, food-related parenting practices as compared to families without food insecurity. 12, 13 In alignment with these findings, a recent qualitative study by Loth and colleagues conducted within a racially/ethnically and socioeconomically diverse sample of parents of young children, J o u r n a l P r e -p r o o f found that parents described adapting or shifting their approach to feeding both within and across meals, with the goal of avoiding power struggles with their children around food and mealtimes. 6 Specifically, parents in this sample described shifting their approach from more supportive to less supportive food-related parenting practices in response to momentary or situational factors that were stressful or disruptive, ranging from schedule changes to child mood and behavior.

Given the numerous disruptions to family life brought on by the COVID-19 pandemic and public health attempts to mitigate spread (e.g., virtual school, work closures), it is of interest to understand how parents' approach to feeding might have changed during the pandemic. A cross-sectional study conducted during the COVID-19 pandemic revealed that parents who experienced higher COVID-19-specific stress were more likely to engage in coercive and indulgent feeding practices; interestingly, these parents also reported more structure and positive interactions, including more shared mealtimes and engagement with their children during mealtimes. 8 To our knowledge, no studies have been conducted to date that have been able to directly compare data collected from families on the use of food-related parenting practices before the start of COVID-19 to data collected from the same families during the COVID-19 pandemic. The current research aimed to address this gap by evaluating parents' dayto-day use of a broad range of coercive, indulgent, structured, and autonomy supportive food parenting practices before and during COVID-19 among a diverse racial/ethnic sample of parents of children aged 2-5. A secondary aim was to evaluate potential contributions of parent and child mood/behavior to use of specific food-related parenting practices during both J o u r n a l P r e -p r o o f periods. Following observations of recent work 6 , we hypothesized that parents' use of supportive feeding practices, defined as those practices within the structure and autonomy support domains, would be lower during the COVID-19 pandemic, and parents' use of unsupportive feeding practices, defined as those within the coercive control and indulgent domains, would be higher during the COVID-19 pandemic, as compared to during the time period before the COVID-19 pandemic. Further, we hypothesized that parent and child negative mood, parent stress and child negative behavior would contribute to larger decreases in the use of supportive feeding practices and larger increases in the use of unsupportive feeding practices from prior to the COVID-19 pandemic to during the COVID-19 pandemic.

The current study employed the Real-Time Parent Feeding Practices tool, a novel tool developed for use within Ecological Momentary Assessment (EMA) protocol, to assess parents momentary use of a broad range of food-related parenting practices over the course of multiple days (both pre-and during . The use of EMA provides unique insights into real-time use of food parenting practices across time and contexts as well as the opportunity to evaluate relationships with dynamic variables, such as mood, stress, and context. The use of EMA in the current research provided the opportunity to understand how exposure to stressors in family life brought on by COVID-19 has impacted parents' use of specific food parenting practices. Understanding the impact of the COVID-19 pandemic on food parenting practices will inform the design of public health efforts to support families during the current pandemic and in the event of future public health crises.

This research involved a longitudinal observational design using data from Kids EAT!, a cohort study of food parenting practices among preschool aged children. 11 Kids EAT! is an ancillary study to EAT 2010-2018 (Eating and Activity over Time), a large, population-based cohort study on eating, activity, and weight-related health. 12 

Participants were parents and their preschool aged children from Kids EAT! who, were in turn, recruited from the EAT 2018 study of 1491 young adults (Mean age in 2018: 22.2 years). 12 Only those individuals who participated in the initial Kids EAT! study (n=119) were invited to participate in the follow-up COVID-19 specific data collection based on the following inclusion criteria: young adults who indicated on the EAT 2018 survey that they had at least one child aged 2-5 years who lived with them at least 50% of the time were invited by email to participate in the Kids EAT! study. For families with more than one child aged 2-5, one child in this age range was randomly chosen to be the primary study participant and parents were asked to focus their survey and EMA responses on this child specifically.

Recruitment emails were sent in batches of 10-15, starting in October 2019. Kids EAT! recruitment e-mails indicated that the study goal was to learn more about parents' experiences feeding their pre-school aged child and provided information about study data collection.

Interested participants were instructed to click on an individualized link included in the e-mail, which directed them first to an eligibility screener survey. Once eligibility was confirmed, participants were given the opportunity to review an IRB approved Study Information Sheet which described in full the various data collection components, as well as the risks and benefits related to their participation. Participants could then choose to opt out of participation or to continue on by starting the Kids EAT! online survey. Per IRB recommendations, consent was assumed for those eligible participants who chose to continue on to complete the survey.

Recruitment for the Kids EAT! follow-up study began at the end of March 2020 and was conducted using the same protocol described above. The recruitment e-mail for the follow-up study clarified that the purpose of the follow-up was to deepen our understanding of how families with young children had been impacted by the COVID-19 pandemic. Families were offered an incentive of a $150 gift card for participation in each of the two waves of data collection (total incentive $300). 

Participants completed an online survey, followed by a 10-day EMA at both time points: pre-COVID (October 2019-January 2020) and during COVID (March-April 2020). At each time point, EMA prompts began the day following survey completion. All assessments were completed in English; participants' English language fluency was known given their initial enrollment in the EAT 2010-2018 study.

Food parenting practices as well as parent and child mood/behavior were measured via EMA.

Multiple daily measures were collected from parents using EMA over a period of ten days prior to COVID-19 and during COVID-19. Standardized EMA data collection protocols from prior studies 13 were used, including: (1) signal contingent, (2) event contingent, and (3) end-of-day EMA mobile surveys. Parents completed these EMA surveys using their own electronic device.

Data from both the signal (e.g., parent affect, stress and child affect, behavior) and event contingent (e.g., food-related parenting practices) recordings were used for the current analysis; data from end-of-day recordings was not used for this manuscript.

Signal contingent recordings were researcher initiated. Specifically, participants received prompts via a text message which included a link directing participants to complete a short survey using their cell phone. These prompts were sent four times daily; timing of signal contingent prompts was random, situated within four predetermined 3-hour time blocks of time (e.g., 7-10 am, 11-2 pm, 3-6 pm, 7-10 pm). The surveys expired after 1 hour. The schedule for signal contingent prompts was adjusted for parent shift work and wake times to accommodate parents' differing life situations, using information obtained from the EMA registration form. The percent compliance for signal contingent prompts was 76% both pre-and during COVID-19; this means that out of the four signal contingent surveys sent daily, participants responded to an average of about three prompts daily.

Event contingent recordings were self-initiated by parents whenever the child ate in the presence of the parent; they used their phone to click a study provided link that directed them to the correct survey. On average parents completed 2.67 event contingent surveys per day in the initial Kids EAT! Study and 3.07 in the COVID-19 follow-up study. The average EMA survey took participants 2-3 minutes to complete.

Participants were asked to respond to at least two signal, two event, and one end-of-day prompts for the day to be considered "complete". At both time points, the study incentive (i.e., $150 Visa Giftcard) was provided to parents once they completed the survey and finished ten complete days of EMA. If a parent missed a day or failed to engage with the necessary prompts J o u r n a l P r e -p r o o f for a day to be considered complete, another day was added to their data collection time period until ten full days were completed. All families that completed data collection received the full incentive (total incentive for both time points = $300). On average, it took participants 15.9 days to achieve ten complete days. Table 1 . Individual questions were designed to measure specific sub-constructs as outlined in Vaughn's content map of fundamental constructs in food parenting practices 1 . Individual items were taken from existing questionnaires where possible, such as the Child Feeding Questionnaire 14 and the Food Parenting Inventory 15 , and adapted for use in an EMA protocol. For example, an item on the Child Feeding Questionnaire designed to measure parental pressure to eat reads, "I have to be especially careful to make sure my child eats enough". This question was adapted for EMA to focus on a parent's specific behavior at the most recent meal or snack consumed by their child to read, "Thinking of this meal or snack, did you have to encourage your child to eat more food than they wanted to?". Child-(e.g., age, sex), parent-(e.g., age, sex, educational attainment), and family-level (e.g., income, family structure) demographic characteristics were assessed via questions on the Kids EAT! baseline survey 18 .

For each food-related parenting domain (i.e., coercive control, indulgent, structure, autonomy support), a mean value was generated for each participant by calculating the average use of Table 4 . Since each mood/behavior variable was analyzed in a separate model, collinearity between these predictor variables was not a concern. Table 5 shows the results of the same analyses repeated for the outcome of proportion of items endorsed within each domain.

All data management and statistical analysis were performed in R (version 4.0.2). P values of <0.05 were used to infer statistical significance, and were not adjusted for multiple testing.

As illustrated in Figure 1 , the relative frequency with which participants used practices within each food parenting domain was similar prior to, and during, COVID-19. At both time points, structure (e.g., mealtime rules and routines) and autonomy support (e.g., guided choices, Use of coercive and indulgent practices were positively correlated with one another (r=0.56, p<0.05) and negatively correlated with the use of structured practices (r=-0.63, p<0.05 and r=-0.47, p<0.05, respectively), but unassociated with autonomy supportive practices ( Table 3) .

Structured practices were also negatively correlated with the use of autonomy supportive practices (r=-0.64, p<0.05). 

Parent mood. As shown in Table 4 Using the proportion, rather than number, of items endorsed in each domain yielded the same pattern of statistical significance with different magnitudes of association that allow effects to be more readily compared across domains (see Supplemental Table 5 ). For example, child negative behavior had a similar impact on the proportion of coercive (0.0054 pre-COVID and 0.0056 during COVID, both p < 0.001) and indulgent feeding practices (0.0048 pre-COVID and 0.0040 during COVID, both p < 0.05), whereas effects on the number of coercive and indulgent practices endorsed were quite different (0.0269 and 0.0281 vs. 0.0145 and 0.0121).

To our knowledge, this is the first prospective study to evaluate food parenting before and during the COVID-19 pandemic using the rich methodological strengths of EMA. Whereas traditional surveys assessing food-related parenting practices ask parents to retrospectively J o u r n a l P r e -p r o o f report on their usual use of specific practices, 19 EMA relies on repeated assessment in real-time of the diversity of practices parents use across meals and days. 13 Results revealed that most parents of preschoolers use a variety of food parenting practices in the day-to-day that span four higher-order domains of coercive control (e.g., restriction, pressure-to-eat), indulgence (e.g., anticipatory catering, child choosing meals), structure (e.g., mealtime rules and routines), and autonomy support (e.g., guided choices, nutrition education). However, in alignment with study hypotheses, the use of food-related parenting practices known to be associated with more healthful dietary intake and eating patterns in children (i.e., structure and autonomy support behaviors) decreased during the COVID-19 pandemic. Further, as hypothesized, the types of practices used by parents were situationally associated with the mood of the parent as well as child mood. Parent negative mood during COVID-19 was associated with higher levels of coercive control and lower levels of structure, whereas positive child mood was associated with greater use of autonomy supportive practices. These findings suggest that effects of the COVID-19 pandemic on family dynamics around feeding young children include shifts away from theoretically 1 and empirically 2,3 supportive approaches to food parenting and highlight the roles of parent and child mood/behavior as potentially important momentary influences on food parenting during this time. Additionally, observed associations between parent stress and mood, child behavior, and use of specific food-related parenting practices highlight the interconnected and likely bidirectional nature of these biopsychosocial relationships. 15 For example, the child's mood and behavior may shape the parent's approach to feeding (and vis a versa) which in turn influences the child's dietary intake. Similarly, it is possible that a parents' negative affect or stress may increase as they attempt to use a variety of feeding approaches J o u r n a l P r e -p r o o f that may or may not be successful at achieving their feeding goals. Future research should pursue a deepened understanding of the interconnected relationship between parent and child with respect to parental use of food-related parenting practices leading to differences in child eating patterns and dietary intake, with the goal of understanding how to best intervene on the development of food-related parenting practices that are less helpful to children over time.

In the present study, mean levels of coercive control or indulgent feeding practices during COVID-19 did not differ from those pre-COVID-19. This finding contrasts to our study hypotheses, as well as the recently published cross-sectional work of Jansen and colleagues, 8 which found that higher COVID-19-specific stress was associated with more coercive and indulgent feeding practices. Further, in the present study, parents were found to be less reliant on structure and autonomy support during COVID-19. It might be that increases in stress and demands on their time or financial resources have made it harder for parents to maintain a similar level of structure around their meals and/or snack times or to devote time to autonomy support activities, such as including their child in choices about food or meal preparation. Shifts in food parenting practices may also reflect broader changes to eating behavior within families during COVID-19. In an online survey of 254 Canadian families, for instance, more than half reported that eating and meal routines had changed during COVID-19, with the most commonly reported changes involving eating more food, eating more snacks, and eating less take-out food. 1 Similarly, a recent retrospective online survey of 584 US parents of children between 5-18 years of age revealed increases in high-calorie snack foods and desserts and sweets in the J o u r n a l P r e -p r o o f home during vs. before the COVID-19 pandemic as well as parents' use of coercive feeding practices (i.e., restriction and pressure-to-eat). 21 In this study, parent negative mood during COVID-19 was associated with higher levels of coercive control and indulgence and lower levels of structure. Associations of negative mood with higher indulgence and lower structure were also seen pre-COVID. These findings align with study hypotheses, as well as the the qualitative work of Loth and colleagues 6 in which parents described shifting from aspirational feeding practices (e.g., structure and autonomy support) to responsive practices (e.g. coercive control and indulgent) when faced with situational challenges, such as periods of high stress or low mood. One might hypothesize that when parents are struggling with low mood, they rely on feeding practices that either help them to "get the job done" (e.g., coercive control) or "eliminate the need for power struggles" (e.g., indulgent practices). Interestingly, in the current study, parental stress was found to be associated with increased use of feeding practices from all domains, although this association was less consistent during the pre-COVID time period. Previous research has found that parental stress is positively associated with use of controlling feeding practices, such as pressure to eat and restriction. Taken together, these observations suggest that that when faced with higher levels of stress, parents may increase the variety of feeding techniques to manage the demands of the feeding situation. Previous qualitative research highlights the wide range of situational factors cited by parents as influencing the approach to feeding, including changes to family schedules (e.g., parent work), child activities, parent mood, time constraints, type of eating occasion (e.g., snack versus dinner), and child mood/behavior. 6 While disruptions J o u r n a l P r e -p r o o f to family eating brought on by COVID-19 represent a deviation from the norm for families, it will be important for researchers to continue to consider the role of parental negative affect and stress when examining the use of specific food-related parenting practices, as many parents experience these feelings outside of the context of a pandemic.

There are both strengths and limitations to this study. This study adds significantly to the emerging literature aimed at broadening our conceptualization of food parenting practices, by being the first, to our knowledge, study to use EMA to objectively measure the dimensions proposed in the content map developed by Vaughn and other leading experts in the field.

Further, this study adds to the evolving conversation about food parenting practices as dynamic and context specific constructs by exploring situational or momentary influences of parental and child mood/behavior on food parenting practices. Finally, the longitudinal design of the current study adds to our understanding of how the COVID-19 pandemic has impacted parents' use of food-related parenting practices. This understanding will be useful in the development of public health programs designed to support families during the pandemic and as we emerge from the pandemic, as patterns may continue. While the sample was drawn from a large, population-based study and was racially/ethnically and socioeconomically diverse, the demographic characteristics of the participants in this sample are not reflective of the demographics of parents within the US. Specifically, parents within this sample included a larger percentage of families from low-income and racial minority groups (e.g., Black, Hispanic, Asian American) than would be included in a nationally representative sample; parental educational attainment in the current sample aligned closely with the general population. 16 The J o u r n a l P r e -p r o o f higher level of diversity within the sample represents a study strength, given the need to learn more about families disproportionally affected by the COVID-19 pandemic. However, extrapolations to the broader US parent population should be made cautiously; it is possible that our findings indicate a larger shift in food-related parenting practices than would be seen in a population-based sample of parents of preschoolers. Additionally, our EMA protocol allowed parents to add additional observations days as needed to achieve 10 study days with complete data and on average it took participants 15.9 days to achieve 10 complete days of data collection. It is possible that families were less capable of compliance with EMA protocols on days when stress levels were higher, moods were lower, and/or child behaviors were more difficult to manage; no data was collected on reasons for noncompliance, challenging our ability to explore this further which is a limitation in our study design. With regard to our COVID-19 specific findings, it is important to recognize that parents completed EMA for a 10-day period; these data do not capture variation in family dynamics around feeding occurring across time during the COVID-19 pandemic. Further, the COVID-19 specific data were collected during the early months of the COVID-19 pandemic (March-April 2020) and this timing may have an impact on observed differences. For example, it might be that some families experienced a shift in their use of specific food-related parenting practices during these very early months, yet were able to return to their baseline use of feeding practices somewhat quickly. Alternatively, it might be that some families experienced a small shift in their use of specific food-related parenting practices in the early months of the pandemic, and as the pandemic and its impacts persisted over time, these small shifts grew to represent larger and more ingrained changes in behavior. Understanding of the longevity of such shifts to food parenting practices with stresses 

The COVID-19 pandemic has had a profound impact on the day-to-day lives of families with young children. Findings from the current study indicate that food parenting practices used by parents of preschool-aged children during COVID-19 have involved lower levels of structure and autonomy support and are situationally responsive to parent and child mood. These findings contribute to the understanding of the COVID-19 pandemic on family dynamics around eating and suggest that the pandemic has shifted feeding practices away from those theorized to be most supportive to child dietary and weight outcomes. The significance of the findings for child nutrition and growth is underscored by the fact that young children have spent much less time in the care of others and at school during the pandemic. Despite these shifts, structure and autonomy support practices represented the vast majority of practices used by parents at both time points. This observation is interesting in light of the fact that much of research on feeding young children has historically focused on "control" in feeding. 5 While newer studies have found associations of practices reflecting structure (e.g., food availability) and autonomy support (e.g., praise) with children's intake of healthful foods, 4,7 research on these higher domains of food parenting remains limited and is clearly a priority. Finally, the findings highlight the important role of parental stress and mood in the day-to-day experience of feeding young children. Public health practitioners and clinicians working with parents of young children J o u r n a l P r e -p r o o f during COVID-19 should consider the potential impact of parental mood and stress, as well as child mood and behaviors. Additional research is needed to better understand the role of the emotional climate of feeding on food parenting as well as to tailor intervention strategies to help parents maintain supportive feeding practices in the face of challenging situations.

J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f a Mixed-effects regressions with the meal-level frequency of the food parenting activities of domains as outcomes. The predictors include: race, income, one of the parent and child mood/behavior factors, a dummy variable indicating pre-or during COVID-19, an interaction term between the dummy variable and the included mood/behavior factor, and an individual random effect term. There are 4 domains 7 the child and parent mood/behavior factors = 28 regressions in total.

Note that the parent or child mood/behavior factors are the daily mean values of the observations. Most factors have different scales, so the magnitude of coefficients cannot be directly compared across factors. The during COVID-19 effects are calculated by using the fixed effect estimations and the corresponding interaction terms.

J o u r n a l P r e -p r o o f * implies association of parent or child mood/behavior with food parenting domain by meal time has p-value < 0.05, the p-value is in parenthesis. Underline indicates change in coefficient from pre to during COVID-19 has p-value < 0.05.

Interpretation example: During the pre COVID-19 time period, with a one unit increase in daily mean for parent positive mood (range 10 to 50), an average individual in our population would engage in 0.0064 more coercive parenting behaviors at each observed meal time after adjusting for the race and income; the fixed effect is significant with p<0.05. During COVID-19, this same one unit increase in daily mean for parent positive mood is associated with an increase in coercive parenting behaviors by 0.0008, an amount not significantly different from 0. The change between the pre COVID-19 and during COVID-19 parent positive mood effect on coercive feeding practices is statistically significant. a Mixed-effects regressions with the meal-level frequency of the food parenting activities of domains as outcomes, scaled by number behaviors per domain. The predictors include: race, income, one of the child or parent mood/behavior factors, a dummy variable indicating pre-or during COVID-19, an interaction term between the dummy variable and the included mood/behavior factor, and an individual random effect term. There are 4 domains 7 the child and parent mood/behavior factors = 28 regressions in total.

Note that the parent or child mood/behavior factor are the daily mean value of the observations. Most factors have different scales, so the magnitude of coefficients cannot be directly compared across factors. The during COVID-19 effects are calculated by using the fixed main effects and corresponding interaction terms. J o u r n a l P r e -p r o o f Legend. Each column in the figures corresponds to one study participant and shows the relative frequency with which they used parenting practices in each domain. Relative frequency was computed by averaging the proportion of endorsed items in each domain across all a participant's meal surveys. For example, if the average proportion of endorsed items was 45%, 35%, 50%, and 20% for the four parenting practice domains, the relative frequency would be calculated as (45/150, 35/150, 50/150, 20/150) = (0.3, 0.23, 0.33, 0.13). The columns are arranged in order of increasing proportion of use of structure and autonomy support practices, ranging from approximately 50% to 100% across participants.

J o u r n a l P r e -p r o o f 

Fundamental constructs in food parenting practices: a content map to guide future research

Parenting Styles, Feeding Styles, Feeding Practices, and Weight Status in 4-12 Year-Old Children: A Systematic Review of the Literature

The influence of parental practices on child promotive and preventive food consumption behaviors: a systematic review and meta-analysis

A qualitative exploration into momentary impacts on food parenting practices among parents of pre-school aged children

Food-related parenting practices and child and adolescent weight and weight-related behaviors

Psychological influences on the childhood diet

Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition experts input

Parent-Child Feeding Strategies and Their Relationships to Child Eating and Weight Status

Food parenting practices and Children's weight outcomes: A systematic review of prospective studies

Food Parenting and Children's Diet and Weight Outcome

Momentary Parental Stress and Food-Related Parenting Practices

Food Insecurity, the Home Food Environment, and Parent Feeding Practices in the Era of COVID-19

Parent Feeding Practices in the Context of Food Insecurity

Associations between parental stress, parent feeding practices, and child eating behaviors within the context of food insecurity

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

America's Families and Living Arrangements: 2020. The United States Census Bureau

Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness

The Food Parenting Inventory: Factor structure, reliability, and validity in a low-income, Latina sample

Parental feeding style and the inter-generational transmission of obesity risk

Comprehensive Feeding Practices Questionnaire: validation of a new measure of parental feeding practices

Parental child-feeding strategies in relation to Dutch children's fruit and vegetable intake

Differences between parents' and adolescents' perceptions of family food rules and availability

Examining the Relationships Between Family Meal Practices, Family Stressors, and the Weight of Youth in the Family

Influence of mother's educational level on food parenting practices and food habits of young children

The Parent Mealtime Action Scale (PMAS). Development and association with children's diet and weight