A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices

Journal Pre-proofs A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices Allison D. Hepworth, Kameron J. Moding, Cynthia A. Stifter PII: DOI: Reference:

S0950-3293(19)30612-3 https://doi.org/10.1016/j.foodqual.2020.103898 FQAP 103898

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Food Quality and Preference

Received Date: Revised Date: Accepted Date:

23 August 2019 25 January 2020 31 January 2020

Please cite this article as: Hepworth, A.D., Moding, K.J., Stifter, C.A., A laboratory-based assessment of motherchild snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices, Food Quality and Preference (2020), doi: https://doi.org/10.1016/j.foodqual. 2020.103898

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Title: A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices

Author names and affiliations: Allison D. Hepworth, PhDa a. 525 West Redwood Street, University of Maryland School of Social Work, Baltimore, MD 21201, USA [email protected] Kameron J. Moding, PhDb b. Fowler Memorial House, 1200 West State Street, Purdue University, West Lafayette, IN, 47907, USA [email protected] Cynthia A. Stifter, PhDc c. 236 Health and Human Development Building, Pennsylvania State University, University Park, PA 16802, USA [email protected]

Corresponding author: Allison Hepworth, PhD [email protected] 525 West Redwood Street, Baltimore, MD 21201, USA

2 1

Abstract

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This study explored how mothers' observed and self-reported child feeding practices

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(child control over food choices, encouragement of balance and variety, and teaching about

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nutrition) were associated with mother-child snack food selections and child snack food

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consumption in a laboratory setting. Mothers (N = 107) and their 4.5-year-old children (52%

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female) selected up to 5 snack foods (out of 9 snack foods: 6 higher-energy-density [ED] and 3

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lower-ED) for optional child consumption throughout a one-hour laboratory visit. Mothers’ in-

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the-moment child feeding practices during the snack food selection task were coded using

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observational coding schemes, and mothers’ global child feeding practices (i.e., across meals and

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snacking occasions) were self-reported using the Comprehensive Feeding Practices

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Questionnaire (Musher-Eizenman & Holub, 2007). Results of multiple linear regression analyses

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with covariates showed that higher-ED snack food selections were positively associated with

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observed child control over food choices (B = 0.35, SE = 0.12, p = .006) and self-reported

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teaching about nutrition (B = 0.49, SE = 0.19, p = .010), and negatively associated with self-

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reported encouragement of balance and variety (B = -0.66, SE = 0.24, p = .007). Lower-ED

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snack food selections were positively associated with self-reported encouragement of balance

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and variety (B = 0.53, SE = 0.20, p = .008). Child consumption of higher-ED or lower-ED snack

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foods were not significantly associated with mothers’ child feeding practices (observed or self-

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reported). We discuss the implications of these findings for future research on children’s snack

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food selection and consumption.

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Keywords: Snacking; Snack foods; Child feeding practices; Food parenting; Food choice; Behavioral coding

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1. Introduction

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Accumulating evidence suggests that snacking behaviors are associated with total dietary

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energy intake (Deming et al., 2017; Shriver et al., 2018), overall dietary quality (Kachurak et al.,

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2019), and obesity risk (Kachurak et al., 2018) among preschool-aged children (aged 2 to 5

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years) in the United States. Therefore, it is important to identify factors that are associated with

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preschoolers’ snacking behaviors, including their selection and consumption of snack foods.

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Snacking is broadly defined as consuming foods or beverages between meals, and items

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consumed between these occasions are labeled, “snack foods” (Blaine et al., 2017; Hess et al.,

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2016). Although snack foods are sometimes defined by their nutritional value (e.g., low-nutrient,

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high-energy-density foods/beverages; Hess et al., 2016), our definition includes all

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foods/beverages in order to identify factors associated with variations in the energy density of

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preschoolers’ snack food selections and consumption.

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Over the past four decades, the average number of snacking occasions among

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preschoolers’ in the United States has increased from one to three snacking occasions per day

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(Dunford & Popkin, 2018). Preschoolers currently consume over 25% of their average daily

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calories during snacking occasions (Shriver et al., 2018), primarily from high-energy-density

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foods, such as cookies, potato chips and sugar-sweetened beverages (Deming et al., 2017;

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Shriver et al., 2018; Welker et al., 2018). Developmental research suggests that preschoolers

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naturally prefer foods that are high in fat and sugar, which tend to be higher in energy density,

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and dislike foods with strong bitter flavors, which tend to be lower in energy density, such as

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green vegetables (Anzman-Frasca et al., 2018; Birch, 1999). Problematically, consuming high-

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energy-density snack foods has been linked to lower overall dietary quality among preschoolers

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(Kachurak et al., 2019). Higher overall dietary energy density (i.e. across meals and snacking

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occasions) has in turn been associated with greater obesity risk among children aged 2 to 8 years

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(Vernarelli et al., 2011), which highlights the importance of research to identify factors

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associated with the energy density of preschoolers’ snack food selections and consumption

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(Rolls & Leahy, 2010). Such research stands to inform strategies to improve preschoolers’

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dietary quality and reduce their obesity risk, and is critical in light of evidence demonstrating

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poor dietary quality (Hamner & Moore, 2020) and recent increases in the prevalence of severe

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obesity (Skinner et al., 2018) among preschoolers in the United States.

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Mothers and other primary caregivers influence the development of preschoolers’ eating

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behavior through their child feeding practices (Savage et al., 2007; Scaglioni et al., 2018;

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Vaughn et al., 2016). In the context of snacking, child feeding practices (also known as food

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parenting practices) include parenting behaviors such as determining the level of child control

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over snack food choices, encouraging balance and variety in children’s snack food choices, and

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teaching children about nutritional proprieties of different snack foods (Davison et al., 2015;

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Gevers et al., 2014). Numerous studies have investigated mothers’ child feeding practices during

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meals, while relatively fewer have examined mothers’ child feeding practices during snacking

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occasions (see Blaine et al., 2017 for a review). This is an important gap in the literature because

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associations between child feeding practices and children’s eating behavior may differ in the

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context of snacking occasions compared to meals. Indeed, results of two qualitative studies

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suggest that mothers perceive snacking occasions as distinct from meals, and that parents vary

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both what and how they feed their children depending on the context (Fisher et al., 2015; Loth,

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Nogueira de Brito, et al., 2018). For example, parents reported giving preschoolers more control

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over what and when they ate during snacking occasions compared to during meals (Loth,

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Nogueira de Brito, et al., 2018). These findings highlight the need for additional research on

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associations between mothers’ child feeding practices and preschoolers’ snacking behavior. Although there are numerous child feeding practices that warrant further investigation

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(see Davison et al., 2015 and Vaughn et al., 2016) child control over food choices,

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encouragement of balance and variety, and teaching about nutrition are especially relevant to

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studies of preschoolers’ snacking behavior; these child feeding practices can be observed during

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snack food selections and have corresponding self-report measures of global child feeding

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practices. Assessing child feeding practices using both observational and self-report measures

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can allow for more nuanced insights into associations between mothers’ child feeding practices

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and preschoolers’ snacking behavior (Fries et al., 2019; Pesch & Lumeng, 2017). For example,

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observational measures during snacking occasions can capture “in-the-moment” child feeding

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practices, while global self-report measures can capture parents’ perceptions of their child

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feeding practices across meals and snacking occasions. Importantly, associations between

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mothers’ child feeding practices and children’s eating behavior may differ by measurement

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approach due to the strengths and limitations that are unique to observational and self-report

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measures (Pesch & Lumeng, 2017). A number of studies conducted during meals have shown

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inconsistencies between observational and self-report measures of child feeding practices (e.g.,

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Bergmeier et al., 2015; Farrow et al., 2011; Fries et al., 2019). The extent to which observational

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and self-report measures of mothers’ child feeding practices differentially predict preschoolers’

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snacking behavior is currently unknown, which limits the development of nutrition education

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programming that aims to improve preschoolers’ dietary quality and reduce obesity risk through

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modifying mothers’ child feeding practices during snacking occasions.

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A few studies have examined why parents offer snacks to children (e.g., Blaine et

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al., 2015; Damen et al., 2019, 2020), while much remains to be explored regarding how parents

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affect preschoolers’ snacking behavior through their child feeding practices. A few studies have

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linked variations in parents’ self-reported child feeding practices to the energy density of

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children’s snack food preferences and consumption. Regarding high-energy-density (ED) snack

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foods, children’s liking (Boots et al., 2019) and consumption (Boots et al., 2018; Corsini et al.,

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2018; Fisher & Birch, 1999) of high-ED snack foods have been linked to higher self-reported

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global coercive parental control over preschoolers’ eating behavior (e.g., restriction). However,

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similar associations with self-reported global restriction have not been found in some other

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studies (e.g., Bauer et al., 2017; Harris, Mallan, Nambiar, & Daniels, 2014). On the other end of

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the spectrum, parental self-reports of granting children higher control over their own eating

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behavior have been positively associated with preschoolers’ selection (Wellard et al., 2014) and

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consumption (Chaidez et al., 2014) of high-ED foods, although these associations were not

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specific to snacking occasions. Lastly, parents of 4- to 12-year-olds who reported lower child

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consumption of high-ED snack foods also highly endorsed globally encouraging healthy food

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and teaching children about food (Gevers et al., 2015).

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Few studies have examined how parents’ child feeding practices are associated with

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children’s selection and consumption of low-ED foods, both generally and specific to snacking

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(see Yee et al., 2017 for a review). There are two notable exceptions: In one study, parents of 3-

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to 7-year-olds reported lower child liking of fruits when they also reported higher global child

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control over food choices (Vollmer & Baietto, 2017). Another study found that parents of 2- to

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5-year-olds reported higher child fruit and vegetable consumption when they reported higher

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global encouragement of balance and variety and teaching about nutrition (Shim et al., 2016).

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Additional research is needed to clarify associations between mothers’ child feeding practices

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and preschoolers’ selection and consumption of snack foods that vary in energy density.

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In the current study, we pursued two related aims on associations between mothers’ child

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feeding practices and preschoolers’ snacking behavior. This study adds uniquely to the literature

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through our use of both observational and self-report measures of mothers’ child feeding

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practices (specifically, child control over food choices, encouragement of balance and variety,

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and teaching about nutrition). First, we explored the correspondence between mothers' observed

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feeding practices in the context of a mother-child snack food selection task, and mothers’ self-

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report of global child feeding practices (i.e., across meals and snacking occasions). Next, we

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explored how mothers’ child feeding practices (observed and self-reported) were associated with

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mother-child selections, and child consumption, of higher-energy-density and lower-energy-

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density snack foods in a laboratory setting. Given the mixed and/or limited findings on these

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associations in the literature, all analyses were exploratory.

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2. Method 2.1 Participants Mother-child dyads were recruited through birth announcements and a local community

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hospital in central Pennsylvania to participate in a longitudinal study that began when children

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were 4 to 6 months of age. Mothers were told that the longitudinal study focused on children’s

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basic needs (e.g., eating, crying, sleeping, soothing) and children’s emotional and physical

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development. The inclusion criteria for participation in the longitudinal study were: Maternal age

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≥ 18 years, full-term pregnancy (≥ 37 weeks) without complications (e.g., low birth weight), and

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plans to remain in the geographic area for at least two years. As part of their on-going

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participation in the longitudinal study, a subset of the sample participated in a follow-up study

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between 2014 to 2017 when the children were 4.5 years of age, including a laboratory visit and

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questionnaire measures. The analytic sample for the current study included only those

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participants with complete data for the laboratory visit and questionnaire measures collected at

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age 4.5 years (N = 107). Few dyads were excluded due to missing either the laboratory visit (n =

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4), or questionnaire measures (n = 1), having only a male primary caregiver (n = 2), or child food

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allergies that could not be accommodated in the mother-child snack food selections task (n = 1).

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2.2 Procedures and Measures

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Mother-child dyads came to the laboratory to complete a battery of behavioral tasks that

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assessed parenting behaviors and children’s cognitive and emotional development within two

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weeks of being 4.5 years of age. Anthropometric data (i.e., height and weight) were collected at

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the end of the laboratory visit. Mother-child dyads were continuously video-recorded throughout

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the laboratory visit, which lasted approximately 1.5 hours. Mothers completed questionnaire

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measures within approximately one month of completing the laboratory visit. All study

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procedures were reviewed and approved by the university Institutional Review Board. Mothers

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provided written consent for their own and their child’s study participation.

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2.2.1 Mother-child snack food selections. Mother-child snack food selections were

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assessed approximately 20-minutes into the laboratory visit using a standardized protocol: A

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research assistant entered the observation room to present a small, three-tiered shelf lined with

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nine snack food options (described below) and an empty tray to the mother and child. The

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research assistant told the dyad to select up to five snack foods for the child to have available

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throughout the remainder of the laboratory visit (approximately one hour). The research assistant

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exited the room while the mother and child selected snack foods and placed them on the tray.

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Dyads took a mean of 2.48 minutes (SD = 0.81) to make their selections. After the dyad made

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their selections, the research assistant re-entered the observation room, removed snack foods that

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were not selected, and placed the snack tray on a table within the child’s reach. The research

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assistant reminded the dyad that the selected snack foods would remain available throughout the

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remainder of the laboratory visit and began the next task.

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The snack food options included in this task were consistent with common options in

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food retail settings in the United States (e.g., gas stations, convenience stores; Tester et al.,

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2011), and with qualitative definitions of snack foods provided by mothers of preschoolers, such

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as relatively small portions of food (Blake et al., 2015). The energy density values of the snack

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food options were calculated from the Nutrition Facts label information and categorized

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according to typical energy density standards (Rolls & Leahy, 2010, p. 545). The snack food

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options were unevenly divided by energy density category to reflect the current unbalanced food

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environment in the United States (Krebs-Smith et al., 2010) and included 6 higher-energy-

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density snack foods (≥ 1.5 kcal/g) and 3 lower-ED snack foods (< 1.5 kcal/g). The higher-ED

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snack foods were: chocolate candy (0.6 ounce Milky Way, 4.40 kcal/g; or 0.6 ounce Twix, 4.71

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kcal/g); pastry (1.8 ounce Little Debbie honeybun, 4.31 kcal/g); chocolate chip cookies (1.1

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ounce Chips Ahoy mini, 4.84 kcal/g; or 1.2 ounce Famous Amos bite size; 5.00 kcal/g); Fruit

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Roll-up (0.5 ounce Betty Crocker, flavor varied, 3.57 kcal/g); popcorn (1 ounce SmartFood,

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white cheddar, 5.71 kcal/g); and potato chips (1 ounce Lays, regular, 5.71 kcal/g; or 1 ounce Utz,

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regular, 5.36 kcal/g). The lower-ED snack foods were: small, whole apple (Macintosh, 0.47

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kcal/g); applesauce (4 ounce Mott’s, original, 0.79 kcal/g); and baby carrots (2 ounce,

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0.44kcal/g). Snack foods were presented in the same order on the shelf for each mother-child

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dyad. In rare cases, select snack foods were substituted (n = 5) with snack foods that were

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comparable in energy density to accommodate child food sensitivities or allergies.

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Trained research assistants recorded which snack foods were selected for the snack tray in real time (i.e., live-coded) during the task. For descriptive purposes, we calculated the number

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of children who selected each snack food, and the total number of snack foods selected (any

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energy density). For our principal analyses, we calculated the total number of higher-ED and

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lower-ED snack foods selected.

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2.2.2 Child snack food consumption. Trained research assistants coded video

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recordings of the laboratory visit to indicate which snack foods, if any, the child consumed. If the

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child consumed any amount of a snack food, ranging from a single bite to the full portion, the

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snack food was coded as consumed. Video recordings did not allow for more precise estimates of

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snack food consumption due to limited camera angles. For descriptive purposes, the proportion

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of snacking occasions initiated by the child (as compared to snacking occasions initiated by the

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mother) was calculated. For our principal analyses, we calculated the total number of higher-ED

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and lower-ED snack foods consumed.

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2.2.3 Observed maternal child feeding practices. Trained research assistants coded

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mothers’ child feeding practices during the snack food selections task. Observational coding

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schemes for child control over food choices (i.e., “child control”), encouragement of balance and

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variety (i.e., “encourage balance”), and teaching about nutrition (i.e., “teach nutrition”) were

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developed based on corresponding parental self-report measures of the same child feeding

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practices (Musher-Eizenman & Holub, 2007). These child feeding practices were chosen because

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they could be observed during snack food selection, and few studies have observed these child

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feeding practices, particularly in the context of snacking (Blaine et al., 2017; Yee et al., 2017).

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Observed child control indicated the degree to which the mother allowed the child to control

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snack food selections. Coded values ranged from 0 to 4, with higher scores indicating greater

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child control over snack food selections. Observed encouragement of balance and variety

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indicated the degree to which the mother promoted varied and nutritious (according to the

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mother’s perception) snack food selections. Coded values ranged from 0 to 2, with higher scores

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indicating greater encouragement of balance and variety. Observed teaching about nutrition

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indicated the degree to which the mother used didactic (i.e., instructional, informational)

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techniques to encourage the selection of nutritious (according to the mothers’ perception) snack

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foods. Coded values ranged from 0 to 2, with higher scores indicating greater maternal teaching

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about nutrition. Research assistants trained on the coding schemes until they reached reliability,

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defined as a single measures intra-class correlation coefficient (ICC) of 0.85 or higher (Hallgren,

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2012). Approximately 20% of video-recordings (n = 25) were double-coded for reliability during

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the final coding stage. Coders demonstrated strong reliability for all constructs (ICC ≥ 0.95). We

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used the coded values for each observed child feeding practice in our principal analyses.

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2.2.4 Maternal self-reported child feeding practices. Mothers completed the

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Comprehensive Feeding Practices Questionnaire (CFPQ; Musher-Eizenman & Holub, 2007).

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The CFPQ is a validated self-report assessment of twelve global child feeding practices (i.e.,

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across all meals and snacks). Relevant to the current study, the CFPQ was developed with

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parents of preschool-aged children (Musher-Eizenman & Holub, 2007), and has demonstrated

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associations with parent-reported food preferences among 3- to 7-year olds (Vollmer & Baietto,

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2017). Three of the CFPQ scales corresponded to the observed child feeding practices measured

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during the snack food selections task and were included in the current study: child control over

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food choices (5-items, α = .66), encourage balance and variety (4-items, α = .69), and teaching

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about nutrition (3-items, α = .56). All items were assessed on a 5-point Likert scale, with higher

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scores indicating greater endorsement of the child feeding practice. We calculated the mean

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scores of the items corresponding to each self-reported child feeding practice for our principal

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analyses.

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2.2.5 Study covariates. Since the time elapsed since a child last ate may be associated

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with snack food selections and consumption, it was tested as a potential study covariate. In

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addition, prior research suggests that associations between mothers’ child feeding practices and

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children’s eating behavior may be explained in part by maternal and child sociodemographic and

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weight status characteristics (Bergmeier et al., 2020; McPhie et al., 2014; Patel et al., 2018).

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Therefore, we tested the following variables as covariates: maternal age, maternal education

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level, maternal BMI, household income, child sex, and child BMI-for-age z-score. Variables that

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had statistically significant (p < .05) bivariate associations with mothers’ child feeding practices

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(observed and/or self-reported), mother-child snack food selections, and/or children’s snack food

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consumption were retained in multiple linear regression analyses predicting mother-child snack

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food selections and children’s snack food consumption; this allowed us to estimate the amount of

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variance explained by mothers’ child feeding practices above and beyond maternal and child

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sociodemographic and weight status characteristics.

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2.2.5.1 Time elapsed since the child last ate. Mothers reported the time of their child’s

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last meal or snack prior to the laboratory visit. The number of minutes elapsed between the meal

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or snack and the start time of the laboratory visit was calculated. Values that exceeded the 95th

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percentile (n = 5) were Winsorized to (i.e., replaced with) the 95th percentile value. Two missing

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values were assigned the Winsorized mean, resulting in a sample mean of 111.78 minutes (SD =

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62.86, min = 20.00, max = 267.00). The number of minutes elapsed since the child last ate (i.e.,

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“child last ate”) was treated as a continuous variable in the analyses.

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2.2.5.2 Maternal BMI. Trained research assistants measured mothers’ height (measured

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at child age 6 months) and weight (measured at child age 4.5 years) using a standard stadiometer

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(Seca 213) and scale (Tanita UM-080). Maternal BMI was calculated from height and weight

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(kg/m2) and treated as a continuous variable in the analyses. Mothers who were pregnant (n = 5)

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were excluded from the analytic sample in all analyses including maternal BMI.

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2.2.5.3 Child BMI-for-age z-score. Trained research assistants measured child height and

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weight at child age 4.5 years using a standard stadiometer (Seca 213) and scale (Tanita UM-

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080). Child weight, height, sex, and age on the date of measurement were entered into the U.S.

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Centers for Disease Control and Prevention (CDC) SAS program (2016) to calculate child BMI-

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for-age z-scores (BMIz) according to the 2000 growth charts (Kuczmarski et al., 2002). Child

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BMIz was treated as a continuous variable in the analyses.

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2.3 Analyses

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As preliminary analyses, we calculated descriptive statistics (e.g., means, standard

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deviations (SD), frequencies) for participant sociodemographic and weight characteristics and all

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study variables. We also conducted Pearson correlations to explore bivariate associations among

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all potential covariates and study variables. For our principal analyses, we first conducted

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Pearson correlations to explore the correspondence between observed and self-reported measures

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of mothers’ child feeding practices. Next, we conducted multiple linear regression analyses to

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explore how mothers’ child feeding practices (observed and self-reported) were associated with

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mother-child selections, and child consumption, of higher-ED and lower-ED snack foods. There

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was no evidence of multicollinearity (all variance inflation factors ≤ 2) in the regression

271

analyses. Analyses were conducted using SPSS version 24 (IBM Corporation, 2016). Results

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were considered statistically significant at p < .05.

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3. Results 3.1 Preliminary Analyses Participant characteristics are presented in Table 1. The majority of mothers identified as

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non-Hispanic, White and were married. Children were evenly represented by sex and were

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primarily non-Hispanic, White. The prevalence of obesity among mothers (n = 30, 28%) and

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children (n = 11, 10%) was consistent with national averages in the United States (Flegal et al.,

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2016; Skinner et al., 2018).

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Descriptive statistics on mother-child snack food selections and child snack food

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consumption are presented in Table 2. The majority of dyads (n = 85, 79%) selected the

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maximum of 5 snack foods (min = 1, max = 5). Chocolate chip cookies were the most commonly

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selected snack food (n = 73, 68%), followed by applesauce (n = 68, 64%), apple (n = 59, 55%),

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chocolate candy (n = 57, 53%), fruit roll-up (n = 57, 53%), popcorn (n = 52, 49%), carrots (n =

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48, 45%), potato chips (n = 42, 39%), and honeybun (n = 37, 35%).

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Approximately two-thirds of children (n = 67, 63%) consumed at least one snack food

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(any amount) during the one-hour observation period following snack food selections. The fruit

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roll-up was the most commonly consumed snack food (n = 25, 23%), followed by apple (n = 22,

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21%), chocolate chip cookies (n = 21, 20%), applesauce (n = 18, 17%), popcorn (n = 14, 13%),

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chocolate candy (n = 13, 12%), honeybun (n = 8, 8%), carrots (n = 7, 7%), and potato chips (n =

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7, 7%). Among children who consumed any snack foods, children initiated the vast majority of

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snacking occasions (Mproportion = 0.88, SD = 0.31, min = 0.00, max = 1.00); children were the sole

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initiators of snacking occasions in most dyads (82%).

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3.1.1. Covariate associations. There were several small, statistically significant bivariate associations involving potential covariate variables (see Table 3). There were no statistically

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significant associations involving household income, child sex, or child BMI-for-age z-score (p >

297

.05; data not shown). Therefore, we retained the time elapsed since the child last ate, maternal

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age, maternal education, and maternal BMI as covariates in the multiple regression analyses

299

predicting mother-child snack food selections and children’s snack food consumption. In

300

addition, these preliminary analyses revealed that the number of higher-ED and lower-ED

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density snack foods selected had small correlations with the number of these snacks foods that

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children consumed (see Table 3). Therefore, we also included the number of higher-ED and

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lower-ED snack foods selected as a covariate in the multiple linear regression analysis predicting

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children’s consumption of snacks foods corresponding in energy density.

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3.2 Principal Analyses

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Results of the Pearson correlation analyses testing associations between the observational

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and self-report assessments of mothers’ child feeding practices are presented in Table 3. Notably,

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observed child control over food choices was not correlated with self-reported child control (r =

309

0.02, p = .842). On the other hand, observed encouragement of balance and variety and observed

310

teaching about nutrition had small, positive correlations with their corresponding self-report

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measures (r = 0.21, p = .030, and r = 0.24, p = .013, respectively).

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Results of the multiple linear regression analyses for mother-child snack food selections

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and child snack food consumption are presented in Table 5 and Table 6, respectively. Only the

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models predicting higher-ED snack food selections (R2 = 0.22, F = 2.56, p = .009) and lower-ED

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snack food selections (R2 = 0.19, F = 2.13, p = .030) were statistically significant. Regarding

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higher-ED snack food selections, mother-child dyads tended to select more higher-ED snack

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foods when mothers were observed to give children higher levels of control over food choices,

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and when mothers reported higher levels of teaching about nutrition. Specifically, each one-unit

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in increase observed child control (measured on a 0 to 4 scale) was associated with selecting 0.35

320

more higher-ED snack foods (SE = 0.12, p = .006). Each one-unit increase in self-reported

321

teaching about nutrition (measured on a 1 to 5 scale) was associated with selecting 0.49 more

322

higher-ED snack foods (SE = 0.19, p = .010). Dyads tended to select fewer higher-ED snack

323

foods when mothers self-reported higher encouragement of balance and variety: Each one-unit

324

increase in self-reported encouragement of balance and variety (measured on a 1 to 5 scale) was

325

associated with selecting 0.66 fewer higher-ED snack foods (SE = 0.24, p = .007). Regarding

326

lower-ED snack food selections, dyads tended to select more lower-ED snack foods when

327

mothers self-reported higher encouragement of balance and variety. Specifically, each one unit

328

increased in self-reported encouragement of balance and variety was associated with selecting

329

0.53 more lower-ED snack foods (SE = 0.20, p = .008).

330

4. Discussion

331

Preschool-aged children the United States tend to consume high-energy-density foods

332

during snacking occasions (Deming et al., 2017; Shriver et al., 2018; Welker et al., 2018). Given

333

concerning evidence linking children’s consumption of high-energy-density foods to lower

334

dietary quality (Kachurak et al., 2019) and higher childhood obesity risk (Vernarelli et al., 2011),

335

it is critical to identify factors that reduce preschoolers’ selection and consumption of higher-

336

energy-density foods, and promote their selection and consumption of lower-energy density

337

foods during snacking occasions. Considering parents’ proximal influence on preschoolers’

338

eating behaviors (Savage et al., 2007; Scaglioni et al., 2018), the current study explored

339

associations among mothers’ child feeding practices (observed and self-reported), mother-child

340

snack food selections, and children’s snack food consumption in a laboratory setting.

17 341

For our first aim, we explored the correspondence between mothers’ child feeding

342

practices observed during a mother-child snack food selection task in the laboratory, and

343

mothers’ self-reported global child feeding practices (i.e., across meals and snacks). We found a

344

small degree of positive correspondence in the observed and self-reported measures of

345

encouragement of balance and variety and teaching about nutrition, and no correspondence in the

346

observed and self-reported measures of child control over food choices. These results add to

347

existing literature demonstrating inconsistencies between observational and self-report measures

348

of child feeding practices during meals (Bergmeier et al., 2015; Farrow et al., 2011; Fries et al.,

349

2019). To our knowledge, the current study is among the first to compare observational and self-

350

report measures of encouragement of balance and variety and teaching about nutrition. Our

351

results demonstrated that mothers were somewhat consistent in their use of encouragement of

352

balance and variety and teaching about nutrition during snack food selections (observed) and

353

globally across meals and snacking occasions (self-reported). These findings highlight the need

354

for additional research on how parents develop these child feeding practices, as their consistent

355

use (or non-use) across meals and snacking occasions may compound their effects on children’s

356

dietary quality and obesity risk over time (Yee et al., 2017).

357

The null association between observed and self-reported child control over food choices

358

is consistent with a prior study conducted with parents of 1-to-3-year olds, which found that

359

observed and self-reported measures of allowing children to choose foods during meals had

360

among the lowest consistency of the child feeding practices they assessed (Fries et al., 2019).

361

There are a few possible explanations for the lack of an association between observed and self-

362

reported measures of child control over food choices in the current study. This finding may

363

reflect differences in the context of measurement: Mothers may exert different levels of control

18 364

over snack food selection compared to globally across all meals and snacks, as suggested by a

365

qualitative study of parents of preschool-aged children (Loth, Uy, et al., 2018). Alternatively, it

366

may be that mothers underestimate the extent to which they grant their children control over food

367

choices when asked in a questionnaire. However, this explanation is limited by the differences in

368

the context of measurement. As a third explanation, it may be that in observed assessments,

369

mothers are responding to their children’s desires in-the-moment, allowing children more control

370

while also giving them information about their choices in a more covert effort to guide food

371

selection (Stifter & Moding, 2019). Future studies should continue to explore reasons for

372

agreement or disagreement between observed in-the-moment and global maternal self-report

373

assessments of child control, including agreement between observed and self-report assessments

374

that are both specific to snacking.

375

For our second aim, we explored how mothers’ child feeding practices (observed and

376

self-reported) were associated with mother-child snack food selections and children’s snack food

377

consumption. We found that mothers’ child feeding practices explained a small amount of

378

variance of selections of both higher-energy-density and lower-energy-density foods, above and

379

beyond covariates. However, mothers’ child feeding practices did not explain a statistically

380

significant amount of variance in children’s consumption of higher-energy-density or lower-

381

energy-density foods during the one-hour observation period following snack food selections.

382

The relatively small amount of variance explained by our multiple linear regression models is

383

consistent with nutrition research examining complex health outcomes, such as child feeding

384

practices, and suggest that unmeasured factors affected snack food selection and consumption

385

(Pounis, 2019).

19 386

With regard to snack food selections, mother-child dyads selected more higher-energy-

387

density snack foods when mothers were observed to give children greater control over the snack

388

food choices. This finding is consistent with a previous study of parents of 3- to 12-year-olds,

389

which found that the mean energy content of a hypothetically selected fast food meal was higher

390

when parents self-reported greater child control over food choices (Wellard et al., 2014). The

391

positive association between observed child control over food choices and higher-energy-density

392

snack food selection may be explained by children’s natural preferences for foods that are higher

393

in energy density (Anzman-Frasca et al., 2018; Birch, 1999). Recent evidence for this preference

394

has come from a hypothetical food choice study in which children aged 3 to 14 years rated

395

higher-energy-density foods as more preferred than lower-energy-density foods (Potter et al.,

396

2017). Mothers’ self-reported global child control over food choices, however, was not

397

associated with the energy density of mother-child snack food selections. This inconsistency

398

suggests that children’s in-the-moment control over food choices was more salient to snack food

399

selections than the amount of control children generally have over their food selections across

400

meals and snacks. This may be explained by differences in the level of child control mothers’

401

grant children during snacking occasions versus their more global practices across meals and

402

snacks, as suggested by the null bivariate association we found between these two measures.

403

Alternatively, this finding may reflect differences in the timescale of measurement; observed

404

child control and mother-child snack food selections were assessed simultaneously, whereas

405

mothers self-reported global child control was assessed within one-month of the laboratory visit.

406

Mother’s self-reported encouragement of balance and variety had favorable associations

407

with the energy density of dyads’ snack food selections. These findings are among the first to

408

show an association between mother’s encouragement of balance and variety and mother-child

20 409

snack food selections of lower-energy-density snack foods, and complement existing research

410

demonstrating similar associations between higher global encouragement and balance and

411

variety and children’s lower consumption of higher-energy-density snacks foods (Gevers et al.,

412

2015), and children’s higher consumption of fruits and vegetables (Shim et al., 2016). The null

413

associations between observed encouragement of balance and variety and snack food selections

414

may suggest that mothers’ global use of this practice was more salient to dyads’ snack food

415

selections than their in-the-moment use of this practice. The favorable associations between

416

mothers’ self-reported global encouragement of balance and variety, and the energy density of

417

dyads’ snack food selections may be explained by social influences on children’s eating behavior

418

over time, as parental encouragement can influence children’s food choices despite children’s

419

preferences for high-energy-density foods (see Scaglioni et al., 2018 for a review).

420

In contrast, when mothers self-reported higher teaching about nutrition, dyads tended to

421

select more higher-energy-density snack foods. Again, this finding is among the first to show an

422

association between mothers’ teaching about nutrition and mother-child snack food selections of

423

high-energy-density snack foods, and in some respects complements existing research

424

demonstrating positive associations between restrictive child feeding and children’s consumption

425

of high-energy-density snack foods (Boots et al., 2018; Corsini et al., 2018; Fisher & Birch,

426

1999). However, observed teaching about nutrition had an opposite, marginally significant

427

negative association with higher-energy-density snack food selections. Associations between

428

teaching about nutrition and snack food selections may depend on how mothers contextualize

429

their nutrition education messages to children. For example, mothers may teach children about

430

food in the context of weight loss, which has been associated with negative child eating behavior

431

outcomes such as early dieting (Balantekin et al., 2014). Or, mothers may teach children about

21 432

foods in the context of supporting healthy growth and active play, which has been linked to

433

positive effects on children’s eating behavior such as increasing children’s liking and intake of

434

lentils (a lower-energy-density food; Ramsay et al., 2017). Additional research on how mothers

435

frame their nutrition education messages to children would help clarify associations between

436

teaching about nutrition and children’s snacking behavior.

437

Regarding children’s snack food consumption, we found that the child feeding practices

438

we assessed in this study using both observed and self-reported measures explained little

439

variance in children’s consumption of higher- or lower-energy-density snack foods. These

440

findings are in contrast to prior studies that have linked parent self-report measures of child

441

control, encouragement of balance and variety, and teaching about nutrition to parent-reported

442

child consumption of higher-energy-density and lower-energy-density foods (Chaidez et al.,

443

2014; Gevers et al., 2015; Shim et al., 2016). Our conflicting findings may be explained by

444

differences in assessment approaches for child feeding practices and/or children’s snack food

445

consumption, and by differences in sample characteristics across studies. Interestingly, children’s

446

consumption of higher- and lower-energy density snack foods had a medium bivariate

447

association in the current study, which suggests that children who consumed snack foods were

448

more interested in snacking generally than considering the energy density of the snack foods.

449

Additionally, although children’s hunger levels were not measured in the current study, the

450

amount of time elapsed since the child’s last meal or snack was not associated with child snack

451

food consumption. This finding provides additional evidence that most preschoolers will

452

consume at least some amount of snack foods when they are available, which is consistent with

453

existing research showing high rates of eating in the absence of hunger among preschool-aged

454

children (Corsini et al., 2018; Harris et al., 2014). Taken together, these findings support recent

22 455

calls for additional research on associations between children’s appetitive traits and snacking

456

behavior (see Kral et al., 2018 and Porter et al., 2018), particularly given that child sex and BMI

457

were also not associated with snack food selections or consumption in the current study.

458

4.1 Strengths, Limitations, and Future Directions

459

This study has several strengths and a few notable limitations. A primary strength is our

460

use of observational measures to assess mothers’ child feeding practices, mother-child snack

461

food selections, and children’s snack food consumption. Observational measures overcome some

462

limitations of self-reported measures of child feeding practices and eating behavior (e.g., social

463

desirability and recall bias), and allowed us to compare participants under the same conditions

464

(e.g., standardized snack food options and duration of time for consumption), which strengthens

465

the validity of our results (Bruemmer et al., 2009; Pesch & Lumeng, 2017). At the same time,

466

our findings are limited to behaviors that occurred in a laboratory setting, which may not

467

generalize to behaviors in more typical contexts, such as homes or food retail locations. For

468

example, mothers and children may have behaved atypically due to being video recorded and/or

469

having few other competing demands for their attention during the snack food selection task.

470

Further, we focused on child feeding practices that could be observed during the snack food

471

selection task and had corresponding self-report measures on the Comprehensive Feeding

472

Practices Questionnaire (Musher-Eizenman & Holub, 2007). Additional insight could be gained

473

in studies investigating a broader range of child feeding practices (e.g., child involvement in food

474

preparation, maternal role modeling) in the context of snacking.

475

There are other unmeasured factors that may have impacted the total number of higher-

476

energy-density and lower-energy-density snack foods selected and/or consumed in this study.

477

We did not assess children’s liking of the snack food options, children’s perceptions of the taste

23 478

or sensory properties of the snack food options, or children’s hunger levels, although we did

479

assess the time elapsed since the child had last eaten. The snack food options were unevenly

480

divided by energy density category to reflect the current food environment (Krebs-Smith et al.,

481

2010) such that more higher-energy-density snack foods were available for selection than lower-

482

energy-density snack foods; this unequal division may have increased the number of higher-ED

483

snack foods that mother-child dyads selected by chance alone, and prevented us from comparing

484

mother-child snack food selections and children’s consumption between energy density

485

categories. The precise amount of each snack food consumed was not measured and could not be

486

assessed retrospectively from video recording due to limited camera angles, which prohibited

487

more detailed analyses of child snack food consumption such as caloric or macronutrient intake.

488

Despite this limitation, our observational assessment overcomes some of the limitations

489

associated with parent-reported food frequency questionnaires (e.g., recall bias), which are

490

among the most common assessments in the existing literature on children’s snacking behavior

491

(Blaine et al., 2017). Lastly, mothers were the only primary caregivers represented in this

492

sample, and most participants identified as non-Hispanic, White. Additional research is needed

493

to test the generalizability of these findings in samples that are more diverse in

494

sociodemographic characteristics.

495

5. Conclusions

496

Snacking occasions are an area of opportunity to reduce children’s dietary energy

497

density, which may in turn improve overall dietary quality and decrease childhood obesity risk

498

(Dunford & Popkin, 2018). The results of this exploratory, laboratory-based study revealed that

499

mothers’ child feeding practices were associated with mother-child selections of higher-energy-

500

density and lower-energy-density snack foods, but not children’s consumption of these snack

24 501

foods. Associations with snack food selections varied depending on whether mothers’ child

502

feeding practices were assessed using an observational measure administered while dyads

503

selected the snack foods, or using a self-report measure of mothers’ global child feeding

504

practices (i.e., across all meals and snacks). Further, mothers’ child feeding practices (both

505

observed and self-reported) explained a relatively small amount of variance in the selection of

506

higher-energy-density and lower-energy-density snack food selections, suggesting that other

507

factors influence snack food choices. Future studies should continue to explore how parents’

508

child feeding practices and other factors (e.g., child appetitive traits) influence preschool-aged

509

children’s snacking behavior.

510

6. Acknowledgements

511

Funding: This work was supported by a grant from the NIDDK: National Institute of

512

Diabetes and Digestive and Kidney Diseases (DK081512) awarded to the third author. The

513

funding source had no role in the design, analyses, or presentation of this research. Declaration

514

of interest: None. The authors thank the families for their time and participation in this research

515

study.

25 References Anzman-Frasca, S., Ventura, A. K., Ehrenberg, S., & Myers, K. P. (2018). Promoting healthy food preferences from the start: A narrative review of food preference learning from the prenatal period through early childhood. Obesity Reviews, 19(4), 576–604. https://doi.org/10.1111/obr.12658 Balantekin, K. N., Savage, J. S., Marini, M. E., & Birch, L. L. (2014). Parental encouragement of dieting promotes daughters’ early dieting. Appetite, 80, 190–196. https://doi.org/10.1016/j.appet.2014.05.016 Bauer, K. W., Haines, J., Miller, A. L., Rosenblum, K., Appugliese, D. P., Lumeng, J. C., & Kaciroti, N. A. (2017). Maternal restrictive feeding and eating in the absence of hunger among toddlers: A cohort study. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 172. https://doi.org/10.1186/s12966-017-0630-8 Bergmeier, H. J., Paxton, S. J., Milgrom, J., Anderson, S. E., Baur, L., Hill, B., Lim, S., Green, R., & Skouteris, H. (2020). Early mother-child dyadic pathways to childhood obesity risk: A conceptual model. Appetite, 144, 104459. https://doi.org/10.1016/j.appet.2019.104459 Bergmeier, H. J., Skouteris, H., Haycraft, E., Haines, J., & Hooley, M. (2015). Reported and observed controlling feeding practices predict child eating behavior after 12 months. Journal of Nutrition, 145(6), 1311–1316. https://doi.org/10.3945/jn.114.206268 Birch, L. L. (1999). Development of food preferences. Annual Review of Nutrition, 19(1), 41–62. https://doi.org/10.1146/annurev.nutr.19.1.41 Blaine, R. E., Fisher, J. O., Taveras, E. M., Geller, A. C., Rimm, E. B., Land, T., Perkins, M., & Davison, K. K. (2015). Reasons low-income parents offer snacks to children: How

26 feeding rationale influences snack frequency and adherence to dietary recommendations. Nutrients, 7(7), 5982–5999. https://doi.org/10.3390/nu7075265 Blaine, R. E., Kachurak, A., Davison, K. K., Klabunde, R., & Fisher, J. O. (2017). Food parenting and child snacking: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 14. https://doi.org/10.1186/s12966-017-0593-9 Blake, C. E., Fisher, J. O., Ganter, C., Younginer, N., Orloski, A., Blaine, R. E., Bruton, Y., & Davison, K. K. (2015). A qualitative study of parents’ perceptions and use of portion size strategies for preschool children’s snacks. Appetite, 88, 17–23. https://doi.org/10.1016/j.appet.2014.11.005 Boots, S. B., Tiggemann, M., & Corsini, N. (2018). “That’s enough now!”: A prospective study of the effects of maternal control on children’s snack intake. Appetite, 126, 1–7. https://doi.org/10.1016/j.appet.2018.03.008 Boots, S. B., Tiggemann, M., & Corsini, N. (2019). Pumpkin is “yucky”!: A prospective study of overt and covert restriction in the development of young children’s food preferences. Appetite, 135, 54–60. https://doi.org/10.1016/j.appet.2018.12.035 Bruemmer, B., Harris, J., Gleason, P., Boushey, C. J., Sheean, P. M., Archer, S., & Van Horn, L. (2009). Publishing nutrition research: A review of epidemiologic methods. Journal of the American Dietetic Association, 109(10), 1728–1737. https://doi.org/10.1016/j.jada.2009.07.011 Centers for Disease Control and Prevention (CDC). (2016). A SAS program for the 2000 CDC growth charts (ages 0 to <20 years). https://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm

27 Chaidez, V., McNiven, S., Vosti, S. A., & Kaiser, L. L. (2014). Sweetened food purchases and indulgent feeding are associated with increased toddler anthropometry. Journal of Nutrition Education and Behavior, 46(4), 293–298. https://doi.org/10.1016/j.jneb.2013.05.011 Corsini, N., Kettler, L., Danthiir, V., & Wilson, C. (2018). Parental feeding practices to manage snack food intake: Associations with energy intake regulation in young children. Appetite, 123, 233–240. https://doi.org/10.1016/j.appet.2017.12.024 Damen, F. W. M., Luning, P. A., Fogliano, V., & Steenbekkers, B. L. P. A. (2019). What influences mothers’ snack choices for their children aged 2–7? Food Quality and Preference, 74, 10–20. https://doi.org/10.1016/j.foodqual.2018.12.012 Damen, F. W. M., Steenbekkers, B. L. P. A., Fogliano, V., & Luning, P. A. (2020). Youngest versus oldest child: Why does mothers’ snack choice differ? Appetite, 144, 104455. https://doi.org/10.1016/j.appet.2019.104455 Davison, K. K., Blake, C. E., Blaine, R. E., Younginer, N. A., Orloski, A., Hamtil, H. A., Ganter, C., Bruton, Y. P., Vaughn, A. E., & Fisher, J. O. (2015). Parenting around child snacking: Development of a theoretically-guided, empirically informed conceptual model. International Journal of Behavioral Nutrition and Physical Activity, 12, 109. https://doi.org/10.1186/s12966-015-0268-3 Deming, D. M., Reidy, K. C., Fox, M. K., Briefel, R. R., Jacquier, E., & Eldridge, A. L. (2017). Cross-sectional analysis of eating patterns and snacking in the US Feeding Infants and Toddlers Study 2008. Public Health Nutrition, 20(9), 1584–1592. https://doi.org/10.1017/S136898001700043X

28 Dunford, E. K., & Popkin, B. M. (2018). 37 year snacking trends for US children 1977-2014. Pediatric Obesity, 13(4), 247–255. https://doi.org/10.1111/ijpo.12220 Farrow, C., Blissett, J., & Haycraft, E. (2011). Does child weight influence how mothers report their feeding practices? Pediatric Obesity, 6(3–4), 306–313. https://doi.org/10.3109/17477166.2011.575160 Fisher, J. O., & Birch, L. L. (1999). Restricting access to palatable foods affects children’s behavioral response, food selection, and intake. American Journal of Clinical Nutrition, 69(6), 1264–1272. Fisher, J. O., Wright, G., Herman, A. N., Malhotra, K., Serrano, E. L., Foster, G. D., & Whitaker, R. C. (2015). “Snacks are not food”. Low-income, urban mothers’ perceptions of feeding snacks to their preschool-aged children. Appetite, 84, 61–67. https://doi.org/10.1016/j.appet.2014.09.007 Flegal, K., Kruszon-Moran, D., Carroll, M., Fryar, C., & Ogden, C. (2016). Trends in obesity among adults in the United States, 2005 to 2014. JAMA, 315(21), 2284–2291. https://doi.org/10.1001/jama.2016.6458 Fries, L. R., van der Horst, K., Moding, K. J., Hughes, S. O., & Johnson, S. L. (2019). Consistency between parent-reported feeding practices and behavioral observation during toddler meals. Journal of Nutrition Education and Behavior, 51(10), 1159–1167. https://doi.org/10.1016/j.jneb.2019.08.005 Gevers, D. W. M., Kremers, S. P. J., de Vries, N. K., & van Assema, P. (2014). Clarifying concepts of food parenting practices. A Delphi study with an application to snacking behavior. Appetite, 79, 51–57. https://doi.org/10.1016/j.appet.2014.04.002

29 Gevers, D. W. M., Kremers, S. P. J., de Vries, N. K., & van Assema, P. (2015). Patterns of food parenting practices and children’s intake of energy-dense snack foods. Nutrients, 7(6), 4093–4106. https://doi.org/10.3390/nu7064093 Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorials in Quantitative Methods for Psychology, 8(1), 23–34. Hamner, H. C., & Moore, L. V. (2020). Dietary quality among children from 6 months to 4 years, NHANES 2011–2016. The American Journal of Clinical Nutrition, 111(1), 61–69. https://doi.org/10.1093/ajcn/nqz261 Harris, H., Mallan, K. M., Nambiar, S., & Daniels, L. A. (2014). The relationship between controlling feeding practices and boys’ and girls’ eating in the absence of hunger. Eating Behaviors, 15(4), 519–522. https://doi.org/10.1016/j.eatbeh.2014.07.003 Hess, J. M., Jonnalagadda, S. S., & Slavin, J. L. (2016). What is a snack, why do we snack, and how can we choose better snacks? A review of the definitions of snacking, motivations to snack, contributions to dietary intake, and recommendations for improvement. Advances in Nutrition, 7(3), 466–475. https://doi.org/10.3945/an.115.009571 IBM Corporation. (2016). IBM SPSS Statistics for Macintosh, Version 24.0. IBM Corporation. Kachurak, A., Bailey, R. L., Davey, A., Dabritz, L., & Fisher, J. O. (2019). Daily snacking occasions, snack size, and snack energy density as predictors of diet quality among US children aged 2 to 5 years. Nutrients, 11(7), 1440. https://doi.org/10.3390/nu11071440 Kachurak, A., Davey, A., Bailey, R. L., & Fisher, J. O. (2018). Daily snacking occasions and weight status among US children aged 1 to 5 years. Obesity, 26(6), 1034–1042. https://doi.org/10.1002/oby.22172

30 Kral, T. V. E., Moore, R. H., Chittams, J., Jones, E., O’Malley, L., & Fisher, J. O. (2018). Identifying behavioral phenotypes for childhood obesity. Appetite, 127, 87–96. https://doi.org/10.1016/j.appet.2018.04.021 Krebs-Smith, S. M., Reedy, J., & Bosire, C. (2010). Healthfulness of the U.S. food supply: Little improvement despite decades of dietary guidance. American Journal of Preventive Medicine, 38(5), 472–477. https://doi.org/10.1016/j.amepre.2010.01.016 Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., Wei, R., Curtin, L. R., Roche, A. F., & Johnson, C. L. (2002). 2000 CDC growth charts for the United States: Methods and development. Vital and Health Statistics. Series 11, Data from the National Health Survey, 246, 1–190. Loth, K. A., Nogueira de Brito, J., Neumark-Sztainer, D., Fisher, J. O., & Berge, J. M. (2018). A qualitative exploration into the parent–child feeding relationship: How parents of preschoolers divide the responsibilities of feeding with their children. Journal of Nutrition Education and Behavior, 50(7), 655–667. https://doi.org/10.1016/j.jneb.2018.03.004 Loth, K. A., Uy, M., Neumark-Sztainer, D., Fisher, J. O., & Berge, J. M. (2018). A qualitative exploration into momentary impacts on food parenting practices among parents of preschool aged children. Appetite, 130, 35–44. https://doi.org/10.1016/j.appet.2018.07.027 McPhie, S., Skouteris, H., Daniels, L., & Jansen, E. (2014). Maternal correlates of maternal child feeding practices: A systematic review. Maternal & Child Nutrition, 10(1), 18–43. https://doi.org/10.1111/j.1740-8709.2012.00452.x

31 Musher-Eizenman, D. R., & Holub, S. (2007). Comprehensive Feeding Practices Questionnaire: Validation of a new measure of parental feeding practices. Journal of Pediatric Psychology, 32(8), 960–972. https://doi.org/10.1093/jpepsy/jsm037 Patel, C., Karasouli, E., Shuttlewood, E., & Meyer, C. (2018). Food parenting practices among parents with overweight and obesity: A systematic review. Nutrients, 10(12), 1966. https://doi.org/10.3390/nu10121966 Pesch, M. H., & Lumeng, J. C. (2017). Methodological considerations for observational coding of eating and feeding behaviors in children and their families. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 170. https://doi.org/10.1186/s12966017-0619-3 Porter, L., Bailey-Jones, C., Priudokaite, G., Allen, S., Wood, K., Stiles, K., Parvin, O., Javaid, M., Verbruggen, F., & Lawrence, N. S. (2018). From cookies to carrots; The effect of inhibitory control training on children’s snack selections. Appetite, 124, 111–123. https://doi.org/10.1016/j.appet.2017.05.010 Potter, C., Griggs, R. L., Ferriday, D., Rogers, P. J., & Brunstrom, J. M. (2017). Individual variability in preference for energy-dense foods fails to predict child BMI percentile. Physiology & Behavior, 176, 3–8. https://doi.org/10.1016/j.physbeh.2017.03.047 Pounis, G. (2019). Statistical analysis of retrospective health and nutrition data. In G. Pounis (Ed.), Analysis in nutrition research: Principles of statistical methodology and interpretation of the results (pp. 103–144). Academic Press. https://doi.org/10.1016/B978-0-12-814556-2.00005-1 Ramsay, S. A., Roe, A. J., Davis, J. N., Price, W. J., & Johnson, S. L. (2017). Repeated exposures and child centered nutrition phrases increases young children’s consumption

32 and liking of lentils. Food Quality and Preference, 62, 317–322. https://doi.org/10.1016/j.foodqual.2017.03.002 Rolls, B. J., & Leahy, K. E. (2010). Reductions in dietary energy density to moderate children’s energy intake. In L. Dubé, A. Bechara, A. Dagher, A. Drewnowski, J. Lebel, P. James, & R. Y. Yada (Eds.), Obesity prevention (pp. 543–554). Academic Press. https://doi.org/10.1016/B978-0-12-374387-9.00044-1 Savage, J. S., Fisher, J. O., & Birch, L. L. (2007). Parental influence on eating behavior: Conception to adolescence. Journal of Law, Medicine & Ethics, 35(1), 22–34. https://doi.org/10.1111/j.1748-720X.2007.00111.x Scaglioni, S., De Cosmi, V., Ciappolino, V., Parazzini, F., Brambilla, P., & Agostoni, C. (2018). Factors influencing children’s eating behaviours. Nutrients, 10(6), 706. https://doi.org/10.3390/nu10060706 Shim, J. E., Kim, J., Lee, Y., & STRONG Kids Team. (2016). Fruit and vegetable intakes of preschool children are associated with feeding practices facilitating internalization of extrinsic motivation. Journal of Nutrition Education and Behavior, 48(5), 311-317.e1. https://doi.org/10.1016/j.jneb.2016.01.003 Shriver, L. H., Marriage, B. J., Bloch, T. D., Spees, C. K., Ramsay, S. A., Watowicz, R. P., & Taylor, C. A. (2018). Contribution of snacks to dietary intakes of young children in the United States. Maternal & Child Nutrition, 14(1). https://doi.org/10.1111/mcn.12454 Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics, 141(3), e20173459. https://doi.org/10.1542/peds.2017-3459

33 Stifter, C. A., & Moding, K. J. (2019). Temperament in obesity-related research: Concepts, challenges, and considerations for future research. Appetite, 141, 104308. https://doi.org/10.1016/j.appet.2019.05.039 Vaughn, A. E., Ward, D. S., Fisher, J. O., Faith, M. S., Hughes, S. O., Kremers, S. P. J., MusherEizenman, D. R., O’Connor, T. M., Patrick, H., & Power, T. G. (2016). Fundamental constructs in food parenting practices: A content map to guide future research. Nutrition Reviews, 74(2), 98–117. https://doi.org/10.1093/nutrit/nuv061 Vernarelli, J. A., Mitchell, D. C., Hartman, T. J., & Rolls, B. J. (2011). Dietary energy density is associated with body weight status and vegetable intake in U.S. children. Journal of Nutrition, 141(12), 2204–2210. https://doi.org/10.3945/jn.111.146092 Vollmer, R. L., & Baietto, J. (2017). Practices and preferences: Exploring the relationships between food-related parenting practices and child food preferences for high fat and/or sugar foods, fruits, and vegetables. Appetite, 113, 134–140. https://doi.org/10.1016/j.appet.2017.02.019 Welker, E. B., Jacquier, E. F., Catellier, D. J., Anater, A. S., & Story, M. T. (2018). Room for improvement remains in food consumption patterns of young children aged 2–4 years. Journal of Nutrition, 148(Suppl 3), 1536S-1546S. https://doi.org/10.1093/jn/nxx053 Wellard, L., Chapman, K., Wolfenden, L., Dodds, P., Hughes, C., & Wiggers, J. (2014). Who is responsible for selecting children’s fast food meals, and what impact does this have on energy content of the selected meals? Nutrition & Dietetics, 71(3), 172–177. https://doi.org/10.1111/1747-0080.12106 Yee, A. Z. H., Lwin, M. O., & Ho, S. S. (2017). The influence of parental practices on child promotive and preventive food consumption behaviors: A systematic review and meta-

34 analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 47. https://doi.org/10.1186/s12966-017-0501-3

35 Table 1 Participant Sociodemographic and Weight Status Characteristics (N = 107) n (%) Maternal characteristics Non-Hispanic, White 101 (94%) Married 95 (89%) Age, years Education Less than high school-level (< 12 years) 0 (0%) High school-level (12 years) 19 (18%) Some college-level (≤ 13 < 16 years) 24 (22%) College-level (16 years) 21 (20%) Graduate-level (> 16 years) 43 (40%) Annual household income $10,000 - $39,999 16 (15%) $40,000 - $59,999 25 (23%) $60,000 - $79,999 19 (18%) $80,000 - $99,999 18 (17%) $100,000 + 29 (27%) a BMI Underweight (BMI < 18) 0 (0%) Normal weight (BMI ≤ 18 < 25) 35 (33%) Overweight (BMI ≤ 25 < 30 ) 37 (35%) Obese (BMI ≥ 30) 30 (28%) Child characteristics Female 56 (52%) Non-Hispanic, White 96 (90%) First-born 31 (29%) Age, years BMI-for-age z-score Underweight (< 5th percentile) 4 (4%) Normal weight (≤ 5th < 85th percentile) 76 (71%) Overweight (≤ 85th < 95th percentile) 16 (15%) Obese (≥ 95th percentile) 11 (10%) Note. BMI = Body mass index. aMaternal BMI calculations excluded pregnant mothers (n = 5).

M (SD)

34.70 (4.64)

28.88 (7.07)

4.53 (0.09) 0.37 (1.06)

36 Table 2 Descriptive Statistics for Mother-Child Snack Food Selections and Child Snack Food Consumption (N = 107) Snack food Selected for snack tray Child consumed M (SD) Selected M (SD) Consumed n (%) n (%) All snack foods 4.61 (0.87) 1.25 (1.28) Higher-ED snack foodsa 2.97 (0.99) 0.82 (0.91) Chocolate candy 57 (53%) 13 (12%) Chocolate chip cookies 73 (68%) 21 (20%) Fruit Roll-up 57 (53%) 25 (23%) Honeybun 37 (35%) 8 (8%) Popcorn 52 (49%) 14 (13%) Potato chips 42 (39%) 7 (7%) b Lower-ED snack foods 1.64 (0.79) 0.44 (0.63) Apple 59 (55%) 22 (21%) Applesauce 68 (64%) 18 (17%) Carrots 48 (45%) 7 (7%) Note. ED = energy density. aHigher-ED snack foods contained ≥ 1.5 kcal/g. bLower-ED snack foods contained < 1.5 kcal/g.

37 Table 3 Pearson Correlation Results for Study Variables (N = 107) M (SD)

1

2

3

4

5

1.

Child last ate (minutes)

2.

Maternal age (years)

34.70 (4.64)

.06

3.

Maternal education (years)

15.33 (2.23)

-.17†

.17†

4.

Maternal BMIa

28.88 (7.07)

.20*

.09

-.22*

5.

OB: Child controlb

3.21 (0.89)

.06

-.21*

-.11

.16

6.

OB: Encourage balancec

0.86 (0.73)

-.17

.18

-.01

-.20*

-.49***

7.

OB: Teach nutritiond

0.98 (0.46)

.07

.05

.15

-.24*

-.25*

8.

SR: Child controle

2.53 (0.61)

-.05

.17†

-.19

9.

SR: Encourage balance

4.21 (0.53)

-.12

.09

10. SR: Teach nutrition

3.84 (0.66)

-.11

.16

11. Higher-ED selectedf

2.97 (0.99)

-.06

-.13

-.10

-.01

12. Higher-ED consumedg

0.82 (0.91)

.03

.11

.01

13. Lower-ED selectedh

1.64 (0.79)

.19*

-.01

14. Lower-ED consumedi

0.44 (0.63)

.10

.03

6

7

8

9

10

11

12

13

111.78 (62.86)

.25*

.27**

.02

-.08

-.02

.27**

-.28**

-.19*

.21*

.12

-.07

.22*

-.12

-.24*

.18†

.24*

-.07

.32**

-.16†

-.19*

.00

-.21*

-.01

-.06

.01

-.08

-.05

-.10

.07

.22*

.02

.07

-.12

.11

.14

-.15

.18†

.01

-.54***

-.20*

-.07

-.04

-.05

.05

-.04

-.15

.14

.11

-.10

.35***

.63**

.23*

Note. BMI = body mass index; ED = energy density; OB = observed; SR = self-reported. aCorrelations with maternal BMI excluded pregnant mothers (n = 5). bMeasured on a 0 to 4 scale. cMeasured on a 0 to 2 scale. dMeasured on a 0 to 2 scale. eAll self-reported child feeding practices were measured on a 1 to 5 scale. fTotal number of high-ED snack food selected. gTotal number of higher-ED snack foods consumed. hTotal number of lower-ED snack foods selected. iTotal number of lower-ED snack foods consumed. †p < .10. *p < .05. **p < .01. *** p < .001.

.30**

38 Table 4 Multiple Linear Regression Results for Mother-Child Snack Food Selections (n = 102)a Variable

Covariates Child last ate (minutes) Maternal age (years) Maternal education (years) Maternal BMI Observed maternal child feeding practices Child control Encourage balance Teach nutrition Self-reported maternal child feeding practices Child control Encourage balance Teach nutrition

Number of higher-ED snack foods selected B SE β R2 F .22 2.56

p .009

Number of lower-ED snack foods selected B SE β R2 F .19 2.13

p .030

0.00† 0.00 0.00 0.02*

0.00 -0.02 -0.02 -0.02

0.00 0.02 0.05 0.02

-0.03 -0.08 -0.04 -0.16

.754 .411 .692 .127

0.35** 0.05 -0.39†

0.12 0.15 0.22

0.32 0.03 -0.18

.006 .768 .082

0.08 -0.66** 0.49*

0.17 0.24 0.19

0.05 -0.35 0.33

.645 .007 .010

0.00 0.02 0.04 0.01

0.18 0.00 0.01 0.22

.097 .975 .925 .048

-0.11 0.05 0.25

0.10 0.13 0.18

-0.12 0.05 0.15

.293 .685 .176

-0.25† 0.53** -0.29†

0.14 0.20 0.15

-0.19 0.35 -0.24

.068 .008 .064

Note. ED = energy density; BMI = body mass index. aAnalytic sample reduced due to missing BMI data for pregnant mothers (n = 5). †p < .10. *p < .05. **p < .01.

39 Table 5 Multiple Linear Regression Results for Child Snack Food Consumption (n = 102)a Variable

Covariates Child last ate (minutes) Higher-ED selectedb Lower-ED selectedc Maternal age (years) Maternal education (years) Maternal BMI Observed maternal child feeding practices Child control Encourage balance Teach nutrition Self-reported maternal child feeding practices Child control Encourage balance Teach nutrition

Number of higher-ED snack foods consumed B SE β R2 F † 1.72 .17

0.00 0.22*

0.00 0.10

0.01 0.24

p .082

.924 .030

Number of lower-ED snack foods consumed B SE β R2 F .15 1.45

p .165

0.00

0.00

0.05

.658

0.09 0.02 0.03 0.01

0.30 0.05 -0.15 -0.08

.006 .656 .185 .470

-0.03 -0.01

0.02 0.04 0.02

0.19 -0.07 -0.07

.070 .494 .513

0.24** 0.01 -0.04 -0.01

-0.10 -0.21 -0.13

0.12 0.15 0.22

-0.10 -0.17 -0.06

.430 .155 .563

0.00 -0.01 -0.16

0.08 0.10 0.15

0.00 -0.01 -0.11

.973 .937 .308

-0.24 -0.10 0.35†

0.16 0.24 0.19

-0.16 -0.06 0.25

.137 .677 .067

-0.08 0.08 0.09

0.11 0.17 0.13

-0.08 0.07 0.09

.468 .645 .488

0.04†

Note. ED = energy density; BMI = body mass index. aAnalytic sample reduced due to missing BMI data for pregnant mothers (n = 5). bTotal number of high-ED snack food selected. cTotal number of lower-ED snack foods selected. †p < .10. *p < .05. **p < .01.

40 Allison D. Hepworth: Conceptualization, Methodology, Formal analysis, Writing – Original Draft Kameron J. Moding: Conceptualization, Methodology, Writing – Reviewing and Editing Cynthia A. Stifter: Funding acquisition, Conceptualization, Methodology, Writing – Reviewing and Editing Highlights     

Observed child control positively related to higher-energy-density snack choices Reported teaching about nutrition positively related to higher-ED snack choices Reported encourage balance and variety negatively related to higher-ED snack choices Reported encourage balance and variety positively related to lower-ED snack choices The assessed child feeding practices did not relate to child snack consumption