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Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in practice, academic faculty have often experienced these 3 missions as competing rather than complementary priorities. This siloed approach has interfered with innovation as a learning health system in which the tripartite missions reinforce each other in practical ways. This paper presents a longitudinal case example of harmonizing academic missions in a large family medicine department so that missions and people interact in mutually beneficial ways to create value for patients, learners, and faculty. We describe specific experiences, implementation, and examples of harmonizing missions as a feasible strategy and culture. 'Harmonized' means that no one mission subordinates or drives out the others; each mission informs and strengthens the others (quickly in practice) while faculty experience the triparate mission as a coherent whole faculty job. Because an academic department is a complex system of work and relationships, concepts for leading a complex adaptive system were employed: (1) a 'good enough' vision, (2) frequent and productive interactions, and (3) a few simple rules. These helped people harmonize their work without telling them exactly what to do, when, and how. Our goal here is to highlight concrete examples of harmonizing missions as a feasible operating method, suggesting ways it builds a foundation for a learning health system and potentially improving faculty well-being. https://doi.org/10.1370/afm.3108, INTRODUCTION Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in l practice, carrying out this tripartite mission [...]

BackgroundParents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input.MethodA previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested.ResultsThe experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions.ConclusionThe comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

BackgroundParents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input.MethodA previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested.ResultsThe experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions.ConclusionThe comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

Objective: Although stressful life events (SLEs) have been suggested to be associated with child well-being, few studies have examined SLEs with child and family behavioral and emotional well-being, especially within diverse populations. The current study examined the associations between SLEs and child behavioral and emotional outcomes, in addition to family-level measures of well-being. Method: Children 5-7 years old and their families (n = 150) from 6 racial and ethnic groups (n = 25 each for African American, Hispanic, Hmong, Native American, Somali, White families) participated in this mixed-methods study. Participants were recruited through primary care clinics. Results: Results showed that all racially and ethnically diverse immigrant and refugee families were experiencing SLEs. The majority of diverse children were experiencing emotional and behavioral problems (i.e., hyperactivity, emotional) in the face of SLEs (i.e., combined SLE score, health-related events), with Somali children being at highest risk. Additionally, the majority of diverse families did not experience lower family functioning in response the SLEs, except regarding certain SLEs (i.e., health-related, legal). However, specific families (i.e., Somali) experienced lower family functioning in the face of multiple SLEs. Discussion: Health care practitioners should consider screening and providing extra resources for reducing stress in children, given all children in the study had some emotional and behavioral problems in the face of SLEs. Additionally, it would be important for practitioners to know which families are at greatest risk for experiencing SLEs (i.e., African American, Native American, Somali families) to ensure they are provided with the resources necessary to mitigate the impact of SLEs. Public Significance Statement This study investigated Stressful Life Events (SLEs) in racially/ethnically diverse populations. SLEs were prevalent and were associated with lower levels of emotional and behavioral well-being in some children. Many families experienced high levels of family functioning, despite having SLEs, which may provide potential intervention targets. Keywords: stressful life events, emotional well-being, behavioral problems, diverse families, immigrants/refugees, Stressful life events (SLEs) are discrete, acute stressors that disrupt an individual's usual activities and typically result in substantial change and readjustment (Cronholm et al., 2015; Manyema, Norris, & Richter, [...]

Introduction: To determine the prevalence of reaching multiple Healthy People 2020 (HP 2020) objectives including nutrition and weight status, sleep health, physical activity, health-related quality of life, social determinants of health, and education among low-income, diverse children and adults. Methods: Children ages 5- to7-years-old (n = 150; 47% female) and their parents (mean age = 35; 91% mothers) from 6 racial/ethnic and immigrant/refugee groups (n = 25 from each; African American, Native American, Hispanic, Hmong, Somali, White) participated in this cross-sectional mixed-methods study. Results: Overall, the majority of HP 2020 objectives were not being met across this low-income, racially/ethnically diverse, and immigrant/refugee sample of children and adults. In particular, African American children and parents consistently fell below the majority of the HP 2020 targets, with only 5 of the 24 HP 2020 objectives being met. Additionally, immigrant children and parents met less than 2/3 of the HP 2020 objectives. Discussion: Concerted public health efforts are needed to address the disparities in reaching the HP 2020 objectives and informing the development of the future HP 2030 objectives among low-income, racially/ethnically diverse, and immigrant children and parents. In order to achieve and assess the current and future HP objectives in these diverse populations, changes may be needed in both interventions and assessment tools.Keywords: Healthy People 2020, health disparities, immigrants, weight-related behaviors, Healthy People 2020 (HP 2020) is a nationwide health promotion and disease prevention agenda that includes over 1,200 objectives in 42 focus areas (Healthy People 2020 Objectives, 2014). This initiative, [...]

BackgroundRetrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. ObjectiveThis study aimed to examine the associations between the parent’s EMA report of their child’s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous–intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. MethodsA total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. ResultsThe parent’s EMA report of their child’s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent’s EMA report of their child’s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P.31). ConclusionsWhen the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child’s PA and SB, the parent’s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA’s strong associations with accelerometer-measured PA and ST.

Introduction: This study utilizes triadic data to examine the association between mother-father-adolescent concordance (agreement) and discordance (disagreement) on home environment factors (i.e., parental encouragement of dieting, family functioning) and adolescent unhealthy weight control behaviors and binge eating. Method: A subsample of adolescent-mother-father triads (n = 833; adolescents ages 10-22) from two coordinated population-based studies (EAT 2010 and F-EAT) were used. Poisson regression analysis was used to estimate the relative risks of each eating disordered behavior. Results: Triads were more concordant (range 9-42%) than discordant (range 4-24%). Triadic agreement that parents did not encourage dieting was associated with a lower risk of adolescent eating disordered behaviors in some triadic combinations. Additionally, triadic concordance on high family functioning was also associated with a lower risk of adolescent eating disordered behaviors among some triadic combinations. Discussion: Results suggest that triadic concordance on healthy home environment factors is associated with fewer adolescent disordered eating behaviors in some triads. Family based interventions may want to consider focusing on strategies to help move mother-father-adolescent triads closer on seeing the home environment more similarly. Future research is needed on triadic concordance/discordance and disordered eating behaviors to confirm study results and to inform the development of family based interventions. Keywords: concordance/discordance, unhealthy weight control behaviors, binge eating, encouragement of dieting, family functioning, Adolescent disordered eating behaviors, including unhealthy weight control behaviors (e.g., fasting, skipping meals, purging) and binge eating, are concerning, due to their high prevalence and damaging consequences (Neumark-Sztainer, Croll, et [...]

Introduction: This large mixed-method study examines the prevalence of reported positive and negative weight-related comments from significant others and ways in which they are associated with weight-control and muscle-enhancing behaviors and emotional well-being in young adults. Method: As part of Project EAT (Eating and Activity in Teens and Young Adults)--IV, survey data were provided by 1,436 young adult men and women with a significant other in 2015-2016 (mean age = 31.1 years; 58.6% women). Independent variables included the reported frequency of receiving positive or negative comments about body shape or size; written examples of positive comments were qualitatively coded for subtypes. Analysis of covariance, adjusting for body mass index, tested associations between comments and weight-control behaviors, muscle-enhancing behaviors, and various measures of emotional well-being (i.e., body satisfaction, self-esteem, and depressive symptoms). Results: About twice as many participants received positive comments from their significant others compared to negative comments (75% vs. 36%). Receiving positive and/or negative comments was related to body satisfaction, self-esteem, and depressive symptoms but was largely unrelated to weight-control and muscle-enhancing behaviors. In almost all cases, receiving no comments was associated with significantly better well-being than was receiving only negative comments. There were few differences in weight-control or muscle-enhancing behaviors or emotional well-being across subtypes of positive comments. Discussion: Reporting the receipt of negative comments from significant others was associated with poorer emotional well-being than was receiving positive comments or no weight-related comments at all. Therapists and other health professionals working with couples should consider advising young adults on the apparent advantages of providing positive feedback regarding weight and shape or abstaining from commenting altogether. Keywords: significant others, weight control, body image, mental health, Weight-control behaviors, muscle-enhancing behaviors, and poor emotional well-being (i.e., poor body satisfaction, low self-esteem, and depressive symptoms) are widespread among young adults (Fallon, Harris, & Johnson, 2014; Field et al., [...]

Introduction: Research examining the implementation and effectiveness of integrated behavioral health (BH) care in family medicine/primary care is growing. However, research identifying ways to consistently use integrated BH in busy [...]

Introduction: The limited research examining weight conversations (i.e., conversations about weight, body shape, or size) in adult romantic relationships has shown associations between engaging in these conversations and disordered eating [...]

Background: To date there has been limited success with childhood obesity prevention interventions. This may be due in part, to the challenge of reaching and engaging parents in interventions. The [...]

Community-based participatory research (CBPR) is an action research approach that emphasizes collaborative partnerships between community members, community organizations, health care providers, and researchers to generate knowledge and solve local problems. Although relatively new to the field of family social science, family and health researchers have been using CBPR for over a decade. This paper introduces CBPR methods, illustrates the usefulness of CBPR methods in families and health research, describes two CBPR projects related to diabetes, and concludes with lessons learned and strengths and weaknesses of CBPR.

This article integrates theory and research related to boundary ambiguity in parents of children with a chronic health condition. We propose that boundary ambiguity is a risk factor for psychological distress in these parents. Clinical applications and a case example highlight how boundary ambiguity can be assessed and managed in clinical settings by professionals working with parents with chronically ill children. Questions are provided for assessing boundary ambiguity in clinical and research settings, and implications for research are discussed.

Introduction: Understanding parental health is an important part of understanding family health. Previous research suggests that family meals, familial relationship satisfaction, and family physical activity may separately be related to [...]

This paper aims to describe the prevalence of parent-adolescent conversations about eating, physical activity and weight across sociodemographic characteristics and to examine associations with adolescent body mass index (BMI), dietary intake, physical activity and sedentary behaviors. Data from two linked epidemiological studies were used for cross-sectional analysis. Parents (n = 3,424; 62% females) and adolescents (n = 2,182; 53.2% girls) were socioeconomically and racially/ethnically diverse. Fathers reported more parent-adolescent conversations about healthful eating and physical activity with their sons and mothers reported more weight-focused conversations with their daughters. Parents of Hispanic/Latino and Asian/ Hmong youth and parents from lower socioeconomic status categories engaged in more conversations about weight and size. Adolescents whose mothers or fathers had weight-focused conversations with them had higher BMI percentiles. Adolescents who had two parents engaging in weight related conversations had higher BMI percentiles. Healthcare providers may want to talk about the types of weight-related conversations parents are having with their adolescents and emphasize avoiding conversations about weight specifically. Keywords Weight conversations * Parents * Adolescents * Obesity * Dietary intake * Physical activity, Introduction Given the high prevalence and adverse consequences associated with obesity in adolescents (Daniels, 2009; Ogden et al., 2012), it is important for parents to understand how to approach parent-adolescent [...]

To examine the unique and additive associations of family functioning and parenting practices with adolescent disordered eating behaviors (i.e., dieting, unhealthy weight control behaviors, binge eating). Data from EAT (Eating and Activity in Teens) 2010, a population-based study assessing eating and activity among racially/ethnically and socio-economically diverse adolescents (n = 2,793; mean age = 14.4, SD = 2.0; age range = 11-19) was used. Logistic regression models were used to examine associations between adolescent dieting and disordered eating behaviors and family functioning and parenting variables, including interactions. All analyses controlled for demographics and body mass index. Higher family functioning, parent connection, and parental knowledge about child's whereabouts (e.g. who child is with, what they are doing, where they are at) were significantly associated with lower odds of engaging in dieting and disordered eating behaviors in adolescents, while parent psychological control was associated with greater odds of engaging in dieting and disordered eating behaviors. Although the majority of interactions were non-significant, parental psychological control moderated the protective relationship between family functioning and disordered eating behaviors in adolescent girls. Clinicians and health care providers may want to discuss the importance of balancing specific parenting behaviors, such as increasing parent knowledge about child whereabouts while decreasing psychological control in order to enhance the protective relationship between family functioning and disordered eating behaviors in adolescents. Keywords Adolescents * Family functioning * Parenting * Weight control behaviors * Binge eating * Dieting, Introduction Disordered eating behaviors, including frequent dieting, unhealthy weight control behaviors (e.g., fasting, self-induced vomiting, and skipping meals for weight loss) and binge eating are prevalent among adolescents (Ackard & [...]

Previous research has shown strong positive associations between physical and psychological health outcomes and being in a committed relationship, such as marriage; however, little research has investigated whether being in [...]

Although there is a well-established literature showing a positive association between the frequency of family meals and child and adolescent healthful dietary intake and lower body mass index (BMI), little [...]

Although integrated care for adults in primary care has steadily increased over the last several decades, there remains a paucity of research regarding integrated care for children in primary care. [...]

Transition to adulthood has not been adequately studied in young adults with cystic fibrosis (CF). Technological advances have extended life expectancy into the thirties, making the young adult CF population [...]

Many studies report that couples with children who have chronic health conditions have more marital dissatisfaction and depressive symptoms than other parents. However, much of the research is cross-sectional and [...]

Abstract Background Having a significant other has been shown to be protective against physical and psychological health conditions for adults. Less is known about the period of emerging young adulthood and associations between significant others’ weight and weight-related health behaviors (e.g. healthy dietary intake, the frequency of physical activity, weight status). This study examined the association between significant others’ health attitudes and behaviors regarding eating and physical activity and young adults’ weight status, dietary intake, and physical activity. Methods This study uses data from Project EAT-III, a population-based cohort study with emerging young adults from diverse ethnic and socioeconomic backgrounds (n = 1212). Logistic regression models examining cross-sectional associations, adjusted for sociodemographics and health behaviors five years earlier, were used to estimate predicted probabilities and calculate prevalence differences. Results Young adult women whose significant others had health promoting attitudes/behaviors were significantly less likely to be overweight/obese and were more likely to eat ≥ 5 fruits/vegetables per day and engage in ≥ 3.5 hours/week of physical activity, compared to women whose significant others did not have health promoting behaviors/attitudes. Young adult men whose significant other had health promoting behaviors/attitudes were more likely to engage in ≥ 3.5 hours/week of physical activity compared to men whose significant others did not have health promoting behaviors/attitudes. Conclusions Findings suggest the protective nature of the significant other with regard to weight-related health behaviors of young adults, particularly for young adult women. Obesity prevention efforts should consider the importance of including the significant other in intervention efforts with young adult women and potentially men.