Family Mealtime Communication in Single- and Dual-Headed Households among Overweight and Obese Hispanic Adolescents

Abstract

Objective:

To investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents.

Design:

Cross-sectional analysis of a randomized control trial

Setting:

18 middle schools in Miami-Dade County, FL.

Participants:

280 Hispanic 7^th and 8th-grade students

Main Outcome Measures:

Physical activity, fruit and vegetable intake, and added sugar intake.

Analysis:

Structural equation modeling.

Results:

The findings indicate that mealtime communication is associated with fruit and vegetable consumption in boys (β = .30, p =.001, 95% CI (.52, 2.68)) and physical activity in girls (β = .26, p =.010, 95% CI (.16, 1.3)). Moreover, a single-parent household is associated with dietary consumption in boys [fruit and vegetable intake (β = .18, p =.039, 95% CI (.02, 2.6)) and added sugar intake (β = .19, p =.043, 95% CI (−0.19, 16.45))] but has a moderating effect on fruit and vegetable consumption in girls (β = .21, p =.015, 95% CI (.14, 2.19)).

Conclusions and Implications:

Family mealtime communication may impact dietary and physical activity outcomes in obese and overweight Hispanic adolescents, but differentially across gender and household parent makeup. Our findings together with the prevalence of single parents combined point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

INTRODUCTION

The prevalence of pediatric obesity continues to be unacceptably high in the United States with 21% of adolescents’ ages 12–19 classified as obese (body mass index [BMI] ≥ 95^th percentile adjusted for age and sex).¹ This national epidemic also remains disproportionately prevalent among ethnic minorities, as it is almost twice as high in Hispanic children (26%) compared to non-Hispanic white children (14%). Previous studies focused on youth from diverse ethnic/racial groups indicate that shared family mealtimes play a crucial role in promoting healthy dietary habits in adolescents, or those promoting healthy weight. These include increased fruit and vegetable consumption, ² decreased risks for eating disorders, ³ and reduced intake of calorie-dense foods. ⁴

Moreover, there is an increasing amount of evidence documenting the positive association between family meal frequency and a myriad of risk and protective factors for children and adolescents, ranging from academic success to substance use.⁵ However, far fewer studies have examined whether other components of family meals may contribute to its protective effects (e.g., actual family dynamics and quality of the mealtime) and how this is associated with behaviors that promote healthy weight in adolescents. The limited research hinders the understanding of the specific mechanisms unique to frequent family meals’ protective effects. It has been posited that mealtime has a positive influence on multiple risk behaviors because it provides an opportunity to communicate, plan activities, monitor mood and problem solve.⁶ Indeed, parents consider family meals an opportunity to increase family connectedness and adolescents have stated that family interactions are in important reason to have family meals.⁷ In one observational study of family mealtimes, researchers found that families with healthy weight children spent more time engaged with one another during the meal, expressed more positive communication, and considered mealtimes more meaningful than families with children who were overweight or obese.⁶ The implications of positive mealtime communication may be especially imperative for Hispanic households as this group has reported the highest frequency of daily family dinners compared to other racial/ethnic groups.⁸

Despite the robust literature to support the relationships between family mealtimes and youth health outcomes, there have been discrepancies about what constitutes a family meal (e.g., who must be present in order for it to be defined as a family meal).⁷ Some studies specify at least one parent whereas others state the whole family/family core must be present. Considering that 42% of Hispanic youth⁹ are now living in single-parent households, there is a need to understand how family variations and their effects on family mealtimes are associated with adolescent health outcomes. This may be especially important since previous research findings demonstrate that: 1) compared to other household structures, adolescents living in households with two parents in the same home reported the highest frequency of family meals,⁸ and 2) children who were raised in single-parent households were more likely to be overweight or obese than those raised in households with at least two adults present.⁶ Even within these key findings lays an important distinction, that is, whether the child is living (and therefore eating) with two biological parents or a single parent and their partner.

Much of the existing literature on family meals in adolescents suggests that participation may be more important and have a more protective effect for females than males.¹⁰ Data from EAT 2010 and Project F-EAT, results demonstrated that greater frequency of family meals was associated with reduced prevalence of dieting, unhealthy weight control behaviors (e.g., food substitutes or skipped meals), and extreme weight control behaviors (e.g., self-induced vomiting or use of diet pills and laxatives) in adolescent girls. In boys, however, family meal frequency was only associated with decreased odds of engaging in unhealthy weight control behaviors. ¹¹ Significant sex differences have also been observed in family mealtimes and adolescent risky and problem behaviors. For example, Sen¹² found that frequency of family dinners was associated with lower probabilities of all substance use for females, binge drinking, physical violence, stealing, and property destruction for males, and running away for both males and females. However, daily shared family meals¹³ and a positive atmosphere at mealtimes ¹⁴ were associated with a lower likelihood of alcohol use in girls but not boys.

The current study is a secondary analysis designed to advance the understanding of the impact of family mealtime on obesity-related health outcomes beyond frequency and instead, focus on family mealtime communication in a sample of overweight Hispanic adolescents. The first objective was to examine the moderating effect of single- vs. dual-headed households on the association of family mealtime communication on physical activity, fruit and vegetable intake, and added sugar intake. The next objective was to investigate possible sex differences within those models. It was hypothesized that household parent makeup would have a moderating effect on the relationship between mealtime communication and obesity-related behaviors and that those relationships would differ by adolescent sex.

METHODS

Data for this cross-sectional analysis are derived from an ongoing randomized clinical trial evaluating the relative efficacy of a family-based intervention on obesity-related lifestyle behaviors among overweight and obese Hispanic adolescents. Study staff recruited 7^th and 8^th graders from 18 middle schools in Miami-Dade County. To be eligible for this study families had to have a Hispanic adolescent who (1) was in the 7th or 8th grade, (2) had a BMI ≥ 85th percentile for their age and sex, (3) lived with an adult primary caregiver willing to participate in the two-year study, (4) had plans to remain a resident of South Florida during the two-year study period. Details of the intervention can be found elsewhere.¹⁵ Participants chose their language of preference for all questionnaires. This study was approved by both the university and county school board Institutional Review Board.

Measures

Mealtime communication.

Mealtime communication was measured using items from the Childhood Family Mealtime Questionnaire (CFMQ). The CFMQ is scale that was originally developed to assess childhood mealtime experiences and was inspired by the literature correlating various eating problems and disorders with early food experiences.¹⁶ Although initially the CFMQ had 69-items, Miller et al conducted a factor analysis that resulted in a subset of 35-items across seven different factors.¹⁶ Those seven factors, in turn, were categorized as subscales of the CFMQ and labeled: 1) Mealtime Communication Based Stress, 2) Mealtime Structure, and 3) Appearance Weight Control, 4) Parental Mealtime Control, 5) Emphasis on Mother’s Weight, 6) Present Parental Meal Influence, 7) and Traditional Family.¹⁶ Recently, this team conducted a series of reliability and validity analyses in order to identify the optimal factor structure of the CFMQ scales as applied to a sample of Hispanic overweight/obese youth.¹⁷ Although one of the original subscales called Mealtime Communication Based Stress is composed of 11 items, we found a similar factor made up of just 5 items (alpha = .81). The reduced subscale named Family Mealtime Communication includes the following items: 1) “I felt mealtimes were a warm and sharing time in my family”, 2) “My family talked during dinner”, 3) “I liked to eat dinner with my family”, 4) “In my family, everyone could speak their views at dinner time”, 5) “I felt able to speak my mind during mealtimes”. Responses were on a 5 point Likert scale: never, rarely, sometimes, usually, and always.

Dietary intake.

Dietary intake (i.e., fruit and vegetable intake, added sugar intake) was assessed using the Dietary Screener Questionnaire of the National Health and Nutrition Examination Survey (NHANES). The questionnaire asks participants how much of 22 specific foods or beverages they have had in the past month. A fruit and vegetable variable was calculated based on participants’ responses to the following specific food items: fruit, fruit juice, salad, fried potatoes, other potatoes, dried beans, other vegetables, tomato sauce, salsa, and pizza. An added sugars variable was calculated based on participants’ responses to the following specific food items: soda, fruit drinks, cookies, cake, pie, doughnuts, ice cream, sugar/honey in coffee/tea, candy, cereal, and cereal type. There are eight responses choices ranging from “Never” to “2 or more times per day.” For the current analyses, we used algorithms developed by the National Cancer Institute (NCI) for use with the DSQ¹⁸ to calculate daily fruit and vegetable consumption (unit: a cup; Mean [SD] = 3.38 [2.53]; skewness = 1.67) and daily added sugar consumption (unit: tsp; Mean [SD] = 17.80 [17.00]; skewness = 2.78). Following George and Mallery, daily sugar intake was positively skewed and was log-transformed for analyses. Development and evaluation of the DSQ have been described elsewhere.¹⁹

Physical activity.

Physical activity was assessed by asking adolescents how many physically active days they had in the past week as is asked in the NHANES Physical Activity and Physical Fitness Questionnaire (NHANES, 2012). Physically active days were those that included at least 60 minutes per day (Mean [SD] = 3.64 [2.34]; skewness = −.002).

Household parent makeup.

Parents were asked, “What is your current marital status?” They choose among the following options: Married, Living with Someone, Separated, Divorced, Widowed, Never Married and Not Living with Someone. Their answers were dichotomized into two groups, single vs. dual-parent households. If they answered married or living with someone they were coded as dual-parent households (coded as 0); the rest were coded as single-parent households (coded as 1).

Sample Size Calculations

Using Monte Carlo simulation analyses in Mplus, power analyses were conducted for the main effect of mealtime communication and the moderating effects between mealtime communication and parental marital status. For the main effects model, with a sample size of 280, the simulation analysis indicated that the study has more than 80% power to detect a small-to-medium effect size (absolute value of β= 0.15)²⁸ on the effect of mealtime communication on obesity-related health outcomes (main effects). For the interaction (moderating) effects between meantime communication and parental marital status, the study also has 80% power to detect interaction effects for a small-to-medium effect size (absolute value of β=0.13).²⁸ Thus, this study is adequately powered to detect small-to-medium main and interaction effects.

Statistical Analyses

A structural equation modeling (SEM) approach²⁰ was used to investigate the moderating role of parent household makeup on the association between family mealtime communication and adolescent obesity-related behaviors. First, a latent variable for family communication was estimated using the aforementioned 5 items, as is described in the validation study.¹⁷ Second, regression paths were specified between family mealtime communication and three adolescent obesity-related behaviors, including parent household makeup as a predictor in the regression model. Third, to estimate the moderating effects of a single parent on the association between family mealtime communication and adolescent obesity-related behaviors, interaction effects were specified into the direct effect model. Given that family mealtime communication is created as a latent variable, the latent moderated structural equation (LMS) approach was employed utilized by Mplus, which advantageously estimates continuous latent interaction effects. Simulation studies have demonstrated how the LMS approach provides efficient parameter estimates, unbiased standard errors, and is preferable to observed moderation approaches (i.e., product-term approach). ^21,22 Centering is not necessary when using a latent interaction approach.²³ See Figure 1 for the depiction of the proposed model.

FIGURE 1: A model proposing that parent marital status moderates the relationship between mealtime communication and 3 obesity related health outcomes.

Hypothesized model

Next, we conducted two separate gender difference tests: (a) a latent variable of mealtime communication and (b) moderating effect path model described in Step 3. In order to evaluate gender difference in the latent construct of mealtime communication, we conducted a series of gender invariance tests of the latent construct in the model (i.e., mealtime communication)²⁷: (a) Configural invariance model (equivalent to unconstrained model), (b) Metric invariance model (equivalent to factor loadings to be equal across the 5 items of mealtime communication), and (c) Scalar invariance model (equivalent to factor loadings and intercepts to be equal across the 5 items of mealtime communication). In order to select the optimal invariance model, statistical significance in p-values of the difference in the chi-squared statistics (∆χ²) between unconstrained and constrained models were investigated. A significant p-value indicates that the unconstrained model is preferred compared to the constrained invariance model. If the scalar invariance model holds, it can be assumed that the group (i.e., gender) has same latent construct.²⁸

In addition, to test differences in females and males in the moderating effect of household parent makeup (see Figure 1), the model was run grouping by sex in Mplus (version 8.00, Muthén & Muthén, Los Angeles, CA, 2019).²⁶ To estimate unique effects, the current study specified three demographic variables as controls: family annual income (continuous), parental education (continuous), and years in the US (more than 10 years [coded as 1] vs. less than 10 years [coded as 0]). Standardized path coefficients (r) are reported as effect sizes.²⁰ To account for missing data, a full-information maximum likelihood (FIML) estimator was used with robust standard errors,²⁷ implemented as MLR in Mplus (version 8.00, Muthén & Muthén, Los Angeles, CA, 2019).²⁶

RESULTS

The study sample consisted of 280 Hispanic overweight (BMI≥ 85^th percentile for age and sex) and obese (BMI≥ 95^th percentile for age and sex) ²⁹ 7^th and 8th-grade youth and their primary caregivers recruited from middle schools in the MDCPS-S (Table 1). Fifty-two percent were female, and the mean age was 13.0y (SD=0.83). Adolescents were mostly born in the U.S. (64%). The majority of adolescents not being born in the U.S. (66.1%) reported living in the USA for more than 9 years (n=185). About two-thirds of children were living in a two-parent household (n=190, 67.8%). Table 1 includes demographic data on parents as well as adolescents. The correlations among study variables ranged from −.071 to .135.

Table 1.

Sociodemographic Characteristics of 280 parent-adolescent dyads.

Variable	Mean (SD) or %
Adolescent
Female	52%
Age	13.01 (0.83)
Country of Origin
United States	64%
Cuba	19.3%
Honduras	4.3%
Venezuela	3.6%
BMI	28.06 (6.07)
Obesity ( > 30 BMI)	23.8%
Percentile*	94.63 (4.08)
Parent
Female	88.2%
Age	44.88 (6.5)
Country of Origin
United States	8.9%
Cuba	34.3%
Nicaragua	15%
Honduras	11.4%
Household parent make-up
Single-parent	32%
Two-parent	68%
Education
Less than high school	7%
Some high school	12%
Completed high school	32%
Some college	29%
Complete college	20%
Full- time employment	50.7%
Annual Income
Less than $30,000	65.4%
Greater than $30,000	20.7%
Greater than $50,000	13.9%
BMI
Obesity ( > 30 BMI)	47.1%

The common factor of family mealtime communication estimated indicated good model fit (CFI / TLI = .979 / .958).³⁰ All standardized factor loadings ranged from .58 to .85 indicating that each item contributed to produce the latent variable of family mealtime communication. Next, how single-parent household moderated the associations between family mealtime communication and adolescents’ obesity-related behaviors was investigated. After controlling for family income, parental education, and years in the US, the results indicated that there was not a moderated effect of single parent-household on the relationship between mealtime communication and physically active days and fruit and vegetable intake. However, family mealtime communication itself was positively associated to both physically active days (β = .24, p =.001, 95% CI (.30, 1.36)) and fruit and vegetable intake (β = .20, p < .001, 95% CI (.30, 1.15)) (Figure 2). Analysis examining if and how parent household makeup moderated the relationship of family mealtime communication on the added sugar intake indicated that though family mealtime communication did not have a direct effect on added sugar intake (β = .06, p = .296, 95% CI (−1.41, 4.4))., single-parent household had a moderating effect on this relationship approaching significance (β = .16, p =.051, 95% CI (−.44, 16.98)). This positive moderating effect indicates that there were stronger positive associations between families’ mealtime communication and sugar intake in single-parent families (β = .27, p = .016, 95% CI (−.80, 15.99)) compared to two-parent families (β = .08, p = .338, 95% CI (−1.72, 4.98)). Additionally, a single-parent household was also associated with additional sugar intake (β = .14, p =.032, 95% CI (.25, 10.06)), the only one of the three health outcomes.

FIGURE 2: Results of the proposed model demonstrating the interaction of parent marital status mealtime communication on 3 obesity related health outcomes.

Note. Only significant standardized coefficients are shown in the figure.

* approaching significance

Sex-specific Findings

The results showed that the chi-squared values of the configured model and metric invariance model were 17.01 (df=10, p=.07) and 25.26 (df= 15, p=.05), respectively. The difference in the chi-squared values between the configured and metric invariance models was not significant (∆χ² = 8.25, p=.14), indicating that males and females had the same metric for mealtime communication. Next, the chi-squared value of the scalar invariance model was 37.70 (df=20, p<.001). However, the difference in the chi-squared values between metric invariance and scalar models was significant (∆χ² = 12.24, p<.05), indicating that the metric invariance model is preferred. Per Putnick and Bornstein³¹, the constraining on one intercept parameter was released and re-conducted invariance models. This approach is known as the partial scalar invariance test.³¹ The chi-squared value of the partial invariance scalar model was 34.94 (df=19, p<.01). The difference in the chi-square value between the metric invariance and partial scalar invariance models was not significant (∆χ² = 12.24, p=.06), indicating that the partial scalar invariance model is preferred. Steinmetz et al.²⁴ suggests that releasing one or two constraints are acceptable to conduct invariance tests. Based on the suggestion, we concluded that the latent construct of mealtime communication is equal between males and females.

Next, family mealtime communication was directly related to physically active days for girls (β = .26, p =.010, 95% CI (.16, 1.3)) (Figure 3). Additionally, for girls, single-parent household had a significant moderating effect on the relationship between family mealtime communication and fruit and vegetable intake (β = .21, p =.015, 95% CI (.14, 2.19)). That is, the associations between family mealtime communications and fruits and vegetable intake is stronger for girls in single-parent households (β = .34, p = .045, 95% CI (−.01, 1.96)) than those in dual-headed households (β = .11, p = .321, 95% CI (−.26, .77)).

FIGURE 3: FOR GIRLS ONLY- Results of the proposed model demonstrating the interaction of parent marital status mealtime communication on 3 obesity related health outcomes.

Note. Only significant standardized coefficients are shown in the figure.

For boys, family mealtime communication was related to fruit and vegetable intake (β = .30, p =.001, 95% CI (.52, 2.68)), but not significantly related to physically active days (β = .09, p =.481, 95% CI (−.79, 21.64)) or added sugar intake (β = .02, p =.837, 95% CI (−7.64, 9.41)) (Figure 4). Single-parent household did not moderate any of the relationships between mealtime communication and the health outcomes, however, it did have an association with fruit and vegetable intake (β = .18, p =.039, 95% CI (.02, 2.6)) and added sugar intake (β = .19, p =.043, 95% CI (−0.19, 16.45)).

FIGURE 4: FOR BOYS ONLY- Results of the proposed model demonstrating the interaction of parent marital status mealtime communication on 3 obesity related health outcomes.

Note. Only significant standardized coefficients are shown in the figure.

In terms of the associations of demographic characteristics on obesity-related behaviors, the results indicated that parent education was significantly associated with added sugar intake only for girls (β = .−0.2, p = .042, 95% CI (−1.49, 0.031)).

DISCUSSION

Following the validation of an abbreviated subscale of the CFMQ in a sample of overweight/obese Hispanic adolescents,¹⁷ the current study aimed to examine the role of single-vs. dual parent household in the relationship between family mealtime communication and obesity related behaviors. In line with the existing family mealtime frequency literature,^2,4,32,33 this study’s findings indicate that family mealtime communication increases fruit and vegetable intake.¹⁷ Although parent involvement and support have been found to play a role in the child’s physical activity,³⁴ this study, in conjunction with the validation of Family Mealtime Communication subscale,¹⁷ extends that understanding by reporting a positive association/relationship between family mealtime in any dimension and physically active days. Qualitative research suggests that families believe that the investment of healthful behaviors, including physical activity, is important for success.³⁵ However, they also acknowledge that family schedules, accessibility, and even youth developmental stage are challenges to engaging in healthy behaviors together. This need for family connectedness and support of healthful behaviors may explain why families with positive mealtime communication have children with healthier habits.

Interestingly, family mealtime communication did not have a direct association with added sugar intake, but there was a moderating effect of household parent makeup on the relationship. Furthermore, there was a correlation (approaching significance) between household parent makeup and added sugar intake. Similarly, researchers have found that total calorie and saturated fatty acid intakes were higher among children of single-parent households than dual-parent households.³⁶ Single parenthood has been cited as a major source of stress that affects food choices, particularly among single employed mothers.³⁷ Preparing meals and sitting down to eat together can be especially difficult for single-headed households considering their unique time constraints and stressors.³⁸ Managing childcare responsibilities and household chores is increasingly challenging for single parents who do not have someone with whom to share everyday tasks³⁹ and previous research has demonstrated that children of single parents are less likely to eat at the table together and watch television during meals.⁴⁰ Furthermore, children from single-parent households reportedly have significantly higher cholesterol levels and lower HDL (higher LDL) levels than children from dual-headed households.³⁶

When evaluating sex differences, the findings suggest that in this sample the adolescent girls alone are driving the relationship between family mealtime communication and physically active days. Among adolescent females, Hispanic ethnicity has been associated with shorter physical activity duration compared with their white peers.⁴¹ However, in previous studies, parental involvement and social support have been reported as key determinants in the physical activity of young girls.⁴² Moreover, in this sample, a significant association between family mealtime communication and fruit and vegetable intake was indicated in girls from single-parent households only. Previous studies have found that negative maternal interactions, like maternal food restriction, is associated with increased energy intake and ultimately weight in girls.⁴³ It follows that positive mealtime communication of single mothers and daughters would be associated with healthy food intake. Considering that 90% of single parents in this study were mothers, the findings begin to help fill the dearth of literature on single mothers’ effects on the dietary habits of their adolescent daughters. Furthermore, there is little to no research specific to the intersection of single parenthood and Hispanic ethnicity.

When examining adolescent boys, however, the results indicated a significant correlation of family mealtime communication and fruit and vegetable intake, as well as between single-parent household and both dietary outcomes. Studies with Latino families have demonstrated inconsistent results on maternal restriction and sex differences. The findings from Silva Garcia et al. ⁴⁴ indicate that Latina mothers of girls gave their girls more choices and were less likely to use restriction than mothers of boys. However, Olvera, Power, & Cousins,⁴⁵ found that Latino mothers are more restrictive with the diet of their daughters than with the diet of their sons. These inconsistencies can be attributed to the fact that the majority of studies in this field has targeted middle class European or European American families and thus have a limited understanding of cultural variations among Latino families in the U.S..⁴⁶ One example being that Latinas from the Caribbean prefer a thinner body size than Latinas from Mexico and Central and South American.⁴⁷ Being a single parent/mother can add another layer of complexity, but again, the interpretation of these findings is limited by the scarcity of literature on families headed by a single parent/mother.

Although this study is novel in many ways, it is important to recognize its limitations. This is a cross-sectional study which limits interpretations to associations. Also, the entire sample is overweight/obese adolescents which implies that the measurement of health behaviors would appear much differently than in a general population. The frequency of family meals was not measured and therefore not included in the model. The model had estimation problems that prohibited the three-way interaction effects that were considered e.g., married parents versus parents living with someone versus single parents. Of note is another study investigating the relationship between family structure and child BMI used married biological parents as the reference group, and found that single parenthood, but not other two-parent family structure, were positively associated with child BMI.⁴⁸ A three-way interaction term between family mealtime communication x adolescent’s sex x single parent household was considered but was limited by a smaller sample. A major strength of this study is that participants were recruited from a large range of Hispanic origins increasing the diversity and representativeness of the sample. This is especially important considering that most of the family mealtime literature is limited to homogeneous, high SES populations. Furthermore, this study investigates distinctions of the association of family mealtime communication and health behaviors within this Hispanic sample, such as parent household makeup and sex, giving us a more nuanced understanding of these complicated relationships.

IMPLICATIONS FOR RESEARCH AND PRACTICE

This study highlights the effects of positive family mealtime communication on obesity-related behaviors among Hispanic overweight/obese adolescents by sex and parent household makeup. Specifically, the results demonstrate that single parent households moderates the relationship between mealtime communication and dietary intake. The findings stress the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions. Future research would benefit from longitudinal studies with more detailed assessments of family mealtime, beyond frequency, to further understand the influences that contribute to the development of childhood obesity. Also, considering the disproportionate distribution of obesity by race/ethnicity, studies examining Hispanic family correlates of childhood obesity can further contribute to efforts to close the gap. Specifically, future research examining whether the family structure and obesity-related behaviors are more strongly associated with the risk of childhood obesity in Hispanic families would be prudent. Finally, since female adolescents are not meeting the recommended physical activity guidelines, future obesity prevention interventions may consider focusing on positive family mealtime communication as an innovative way to promote and target other health behaviors (i.e., physical activity, sedentary behavior) outside of the typical dietary outcomes. Studies addressing this research gap would help inform the design of culturally relevant public health messages and interventions to promote positive family meals.