Parental Phone use during Mealtime with Toddlers and the Associations with Feeding Practices and Shared Family Meals: A Cross-sectional Study

Parental Phone use during Mealtime with Toddlers and the Associations with Feeding Practices and Shared Family Meals: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Parental Phone use during Mealtime with Toddlers and the Associations with Feeding Practices and Shared Family Meals: A Cross-sectional Study Frøydis Nordgård Vik, Erik Grasaas, Maaike E. M. Polspoel, Margrethe Røed, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-105794/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Apr, 2021 Read the published version in BMC Public Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background Positive parental feeding practices and a higher frequency of family meals are related to healthier child dietary habits. Parents play an essential role when it comes to the development of their child’s eating habits. However, parents are increasingly distracted by their mobile phone during mealtime. The aim of this study was to describe the feeding practices and daily shared family meals among parents who use and do not use mobile phone during mealtime, and further to explore the associations between the use of mobile phone during mealtime and feeding practices and daily shared family meals, respectively. Methods Cross-sectional data from the Food4toddler study were used to explore the association between mobile use during meals and parental feeding practices including family meals. In 2017/2018 parents of toddlers were recruited through social media to participate in the study. In total 298 out of 404 who volunteered to participate, filled in a baseline questionnaire, including questions from the comprehensive feeding practices questionnaire (CFPQ), questions of frequency of family meals and use of mobile phone during meals. Results Herein, 4 out of 10 parents reported various levels of phone use (meal distraction) during mealtimes. Parental phone use was associated with lower use of positive parental feeding practices like modelling (B= -1.05 (95% CI -1.69; -0.41)) and family food environment (B= -0.77 (95% CI -1.51; -0.03)), and more use of negative parental feeding practices like emotional regulation (B= 0.73 (95% CI 0.32; 1.14)) and the use of pressure to eat (B= 1.22 (95% CI 0.41; 2.03)). Furthermore, parental phone use was associated with a lower frequency of daily family breakfast (OR= 0.50 (95% CI 0.31; 0.82)) and dinner (OR= 0.57 (95% CI 0.35; 0.93)). Conclusions Mobile phone use is common among parents during mealtimes, and findings indicate that parental phone use is associated with less healthy feeding practices and shared family meals. These findings highlight the importance of making parents aware of potential impacts of meal distractions. Trial registration: ISRCTN92980420 . Registered 13 September 2017. Retrospectively registered. Health Economics & Outcomes Research Health Policy parental phone use toddlers family meals meals feeding practices Norway Introduction The importance of promoting healthy eating habits early in life cannot be stressed enough. The recent report from the WHO-UNICEF-Lancet commission: A future for the world's children ? states that investing in young children’s health, education, and development are fundamental for the individual’s lifelong health and development, and even for their future children’s health ( 1 ). This report also highlights the importance of good health and nutrition in the prenatal period and early years in order to lay the foundation for a healthy life course ( 1 ). An unhealthy diet early in life tend to endure into adulthood ( 2 ) and increases the risk of non-communicable diseases (NCD’s) ( 3 ) and childhood obesity ( 4 ). Therefore, developing healthy eating habits as a child is essential for maintaining good health throughout life ( 5 ). There are also large societal economic benefits to be made if the population follow dietary guidelines ( 6 ). Different determinants will influence the forming of the child’s eating habits. At one year of age, the toddler’s eating habits are mostly influenced by their parents i.e. the parents will decide what, when and how much the child eats ( 7 , 8 ). Mealtimes serve as a setting for socialization around food and eating for the child together with their family ( 9 ). The feeding practices the parents use are important in developing eating habits for their children and they can promote or restrain a healthy diet ( 10 ). Parental feeding practices are defined by Shloim et al. ( 11 ) as specific goal-directed behaviors that parents use to directly influence the children’s eating. Parental feeding practices can be positive or negative in forming eating habits among small children. An example of a negative feeding practice is if parents pressure their child to eat a particular food item (e.g. broccoli), it may lead to disliking of the actual food item (broccoli), while involving the child in food preparation (e.g. scrambled eggs) can be positive and increase the willingness to try new food ( 12 ). According to Internet Growth Statistics ( 13 ), the usage of digital screens, e.g. computers, mobile phones and tablets have increased largely worldwide over the last decades. Everyone, including people in lower socio-economic groups, e.g. with a low salary, own a mobile phone, and it is increasingly considered a “must have” object for almost everyone; richer and poorer. With increasing screen use among the population, our behaviours change. It is common to see people walking outside using their phone, people at restaurants doing the same, even when they are together with other people. A recent study found that distractions take up a large proportion (almost half) of the average family mealtime ( 14 ). Distractions at mealtimes (e.g. screens) have been shown to be associated with greater intake of unhealthy food ( 15 ). When mealtimes are characterized by disruptions, lack of attention to each other’s moods and eating behaviors, and being away from the table, there is increased risk for poor dietary habits and a stressful eating environment ( 16 , 17 ). During mealtimes with no distractions (e.g., no television (TV), phones, toys), preschoolers have been observed engaging in less fussy eating behaviors, whereas mealtimes with a distraction were characterized by more negative child behavior ( 18 ). There is limited research on implications of distractions on parent feeding practices. One study showed that mothers of infants (< 6 months) reported that 26% of the total feeding time was interrupted by technological use (TV, computer, smartphone, tablet) while 17% of total feedings was interrupted by nontechnological distractions (reading, housework) ( 19 ). Father availability and involvement in feeding practices have been studied in a recent paper and showed that fathers’ absence at mealtimes was associated with more child distractions and less maternal feeding responsiveness ( 14 ). Family meals are defined in different ways, depending on the number of family member who are attending (e.g. are one or both parents present?) or if the setting in which the meal takes place is included (e.g. is the meal at the table or in front of the TV?). Verhage et al uses the definition: The family meal can be seen as a social moment of the day during which food is eaten together with at least one family member ( 20 ). Frequency of family meals are often linked to childhood obesity. A meta-analytic review of 17 studies including more than 180,000 children and adolescents indicated that regularly sharing meals as a family reduced the odds for child overweight by 12% and increased the odds for eating healthy foods by 24% ( 21 ). But frequency of family mealtimes are also related to healthier eating behaviors in children ( 10 ). We hypothesized that parental use of mobile phone during mealtime would be associated with less healthy feeding practices and lower frequency of daily shared family meals. Thus, the objective of this paper was to describe the parental feeding practice and frequency of daily shared family meals among parents who use and do not use mobile phone during mealtime; and further to explore the association between the use of mobile phone during mealtime, feeding practice and daily shared family meals. Methods Study design Food4toddlers is originally a randomized controlled trial evaluating the effect of a digital dietary intervention targeting parents of 1-year olds (22). The current paper reports on cross-sectional baseline data from this study. Sample and procedure In 2017 we recruited parents of toddlers. They were recruited through social media posts on Facebook. Parents voluntarily notified that they wanted to participate after reading written information about the study. In total 404 participants volunteered to participate initially, however of these, only 298 participants filled in the baseline questionnaire. Data from these 298 participants were included in the present study. The study was approved by the Norwegian Centre for Research Data, and by the Faculty ethics committee and has been conducted in line with the Helsinki Declaration of 1985, revised 2008. Instruments The baseline questionnaire included questions of parental and child characteristics like age and educational level, further there were questions regarding use of mobile devices, food frequency questions of child diet and parental diet, frequency of family meals, feeding practices and other intervention specific questions. In the current study the variables use of mobile device during mealtime (independent variables) and feeding practices and shared family meal frequency (dependent variables) are presented. In addition to parent and child characteristics. The use of mobile phone during mealtime, was reported like this: To what extent do you agree with the following statement: I often check my phone during meals . The participants were given the following response alternatives: Disagree, slightly disagree, neither agree or disagree, slightly agree and agree. We dichotomized this variable with the intention to differentiate between those who do not use mobile phones during meals at all and those who do. The participants who filled in “disagree” were defined as the “No phone use during meal” group, while the participants who filled in “slightly disagree, neither agree or disagree, slightly agree and agree” were defined as the “phone use during meal” group. To assess feeding practices, we used the well-known and validated, Comprehensive Feeding Practices Questionnaire (CFPQ) (23). This questionnaire covers 12 dimensions of parental feeding practices. Because the participants of this study were parents of infants, following nine items were considered relevant: Child control (The child is allowed to control his/her own eating behaviours), Emotion regulation (The parents use food to regulate the child’s emotional states), Balance and variety (Parents encourage well-balanced food intake), Environment (Availability of healthy food at home), Food as reward (Use of food to reward child behavior), Modeling (Parents demonstrate healthy eating behavior), Monitoring (Parents keep track of child’s intake of less healthy food), Pressure (Used by parents to make child eat more), Restriction for health and weight control (Parents control the child’s food intake with the purpose of limiting less healthy foods and sweets and to decrease or maintain the child’s weight). The reliability of the ten feeding practices dimensions was evaluated using Cronbach alpha. All scores except Child control and Food as a reward (α = 0.3) showed acceptable reliability (α = 0.5–0.8) (detailed data not shown). The CFPQ items were previously translated from English into Norwegian in another project and a random sample of 10 items were back-translated into English (24). The quality of the translation was considered very good and this translation was therefore used in this project. To assess the frequency of shared family meals, following questions were posed: How often does your child have the following meals together with their family? Herein, meals with family included parents that were married, living in cohabitant families, single or separated / divorced. The participants could choose from the following response alternatives: Never, 1, 2, 3, 4, 5, 6 and 7 times per week for breakfast, lunch, and dinner, respectively. Later, the weekly food frequency was divided into having every specific family meal, every day or not. Parental age was assessed in years, child age in months. Participants reported their own and the other parent’s highest level of education (primary school or less, primary schools plus one year of further education, high school, vocational school, upper secondary school or less, college/university (≤ 4 years), college/university (> 4 years), other, don’t know). These responses were dichotomized into having no university/college education or having university college education and used as a proxy for socio-economic status (SES). Ethnicity of the parents were assessed as native if they were born in Norway or non-native if they were born elsewhere. Statistical analysis The statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY). Demographic data were described using descriptive measures. Continuous variables were described with mean and standard deviation, and categorical variables with frequencies and percentages. For the dependent study variable feeding practice, 9 out of 10 sub-scales had skewness values of ± 1.3 and kurtosis values of ± 1.6, which indicated that these variables are approximately normally distributed. Thus, linear regression analyses were conducted between the dependent variables (feeding practices) on the independent dichotomy variable (phone use / no phone use), and then controlled for SES, ethnicity and age using multiple regression analysis. Binary logistic regression analyses were conducted to calculate odds ratios on the relationship between the dependent dichotomy variable shared family meals and the independent dichotomy variable (phone use / no phone use) controlling for SES, ethnicity and age. Due to the homogeneity of the sample in terms of gender (98% were mothers), adjusting for this variable was not considered relevant. P-values < 0.05 were considered statistically significant and all tests were two-sided. Results Participants The total sample included 298 parents with a mean age of 32.3 (SD ± 4.2) years and their children’s age were 10.9 months (SD ± 0.1). Table 1 presents the descriptive characteristics of the total sample. A great majority of the sample were mothers (98.7%) and consisted of parents who were either married (50.7%), lived in cohabitant families (48.3%) or who were single (0.7%) or divorced / separated (0.3%) at the time of the study. The participants reported primarily a high education level, herein 53.7% reported more than 4 years of University level. Further, about 4 out of 10 parents reported using a mobile phone during mealtime with their children. Most parents were born in Norway, i.e. native. Table 1 Descriptive statistics of the sample (n = 298) Characteristics Values N (%) Relationship to child, N (%) Mother 294 (98.7) Father 4 (1.3) Education level, N (%) Lower secondary school or less 3 (1.0) Upper secondary school 23 (7.7) College/University (≤ 4 years) 101 (33.9) College/University (> 4 years) 160 (53.7) Other 11 (3.7) Marital status, N (%) Married 151 (50.7) Cohabitant 144 (48.3) Single 2 (0.7) Divorced/separated 1 (0.3) Ethnicity, N (%) Native Non-native 257 (86.2) 41 (13.8) Child’s gender, N (%) Female Male 134 (45) 164 (55) Descriptive data of the study variables: Phone use, Feeding practices and Shared Family Meals. A total of 181 of the participants (60.7%) reported no use of mobile phone during mealtime, wherein the remaining 117 participants (39.3%) reported a various level of phone use during mealtime. The largest difference in mean for feeding practice was shown for the subscale pressure , where the group using phone during mealtime reported a mean score of 7.1 (SD ± 3.2) compared to 5.8 (SD ± 3.6) the group with no phone use. Higher frequency of all types of shared family meals were reported by the group with no phone use compared to the group with phone use during mealtime (see Table 2 ). The highest frequency of shared family meals was dinner for both groups (71.3% and 57.3%, respectively). Table 2 Characteristics of feeding practices and daily shared family meals stratified by phone use during mealtime. Dependent study variables Phone use N = 117 (mean/SD) No phone use N = 181 (mean/SD) Feeding practice Child control 6.66 (2.88) 6.25 (2.83) Emotional regulation 3.74 (1.70) 2.98 (1.73) Balance and variety 14.07 (1.90) 14.44 (1.80) Environment 11.85 (3.15) 12.60 (3.10) Food as reward 1.31 (1.69) 1.18 (1.53) Modelling 12.54 (2.91) 13.56 (2.59) Monitoring 14.83 (2.19) 14.39 (3.15) Pressure 7.14 (3.20) 5.82 (3.58) Restriction for Health 5.78 (3.22) 5.65 (3.21) Restriction for Weight 6.20 (3.88) 6.22 (4.34) Family meals Breakfast, N (%) Lunch, N (%) Dinner, N (%) 58 (49.6) 34 (29.1) 67 (57.3) 121 (66.9) 72 (39.8) 129 (71.3) Associations between phone use during mealtime on feeding practice. Phone use during mealtime was a significant predictor for the following feeding practice subscales: emotional regulation (95% CI [0.32; 1.14]), environment (95% CI [-1.51; -0.03]), modeling (95% CI [-1.69; -0.41]) and pressure (95% CI [0.41; 2.03]) (Table 3 ). After adjusting for SES, ethnicity and age, these respective associations remained significant with a p value < 0.05. Table 3 Associations between phone use during mealtime on feeding practice subscales adjusted for SES and age. Feeding practices B 95% CI P value Child control 0.38 -0.29; 1.05 0.27 Emotional regulation 0.73 0.32; 1.14 < 0.001 Balance and variety -0.37 -0.80; 0.07 0.09 Environment -0.77 -1.51; -0.03 < 0.05 Food as reward 0.13 -0.25; 0.50 0.51 Modeling -1.05 -1.69; – 0.41 < 0.001 Monitoring 0.49 -0.17; 1.15 0.14 Pressure 1.22 0.41; 2.03 < 0.01 Restriction (Health) 0.13 -0.64; 0.89 0.74 Restriction (Weight) -0.06 -1.04; 0.90 0.90 B: Beta CI: Confidence Interval SES: socio-economic status Multiple regression analyses were used Associations between phone use on shared family meals. There was a 50% lower odds of breakfast (95% CI [0.31; 0.82]) and a 43% lower odds of dinner (95% CI [0.35; 0.93]) as daily shared family meals among the group using mobile phone compared to the group with no phone use during mealtime. Table 4 Associations between phone use on shared family meals adjusted for SES, ethnicity, and age. Shared family meals OR 95% CI P value Breakfast (phone use vs no phone use) 0.50 0.31; 0.82 < 0.01 Lunch (phone use vs no phone use) 0.63 0.38; 1.05 0.08 Dinner (phone use vs no phone use) 0.57 0.35; 0.93 < 0.05 OR: Odds Ratio CI: Confidence Interval SES: socio-economic status Logistic regression analyses were used Discussion In this study, about 4 out of 10 parents reported various levels of phone use (meal distraction) during mealtimes. Descriptive analyses revealed more frequent family meals among the group with no phone use compared to the group with phone use during mealtime. Dinner was the most commonly shared family meal for both groups. Parental phone use was associated with less use of positive parental feeding practices such as modelling and family food environment and more use of negative parental feeding practices like emotion regulation and use of pressure to eat. Finally, parental phone use was associated with a lower frequency of daily family breakfast and dinner. Few studies have reported theses associations in this age group (toddlers). When the child enters toddlerhood around one year of age, it becomes increasingly common to eat the same as the rest of the family and together with their family. This is a challenging period of transition, and in addition both parents increasingly engage in working life again after parental leave, and consequently have less time for other activities (e.g. family meals). We also know from a previous study that adults, including parents of toddlers, are increasingly exposed to distractions from their mobile phones during family mealtime ( 14 ). Since parental feeding practices and frequency of family meals are important when it comes to child eating development, this “fight for attention” between the phone and the child, represents a growing dilemma. When parents use their mobile phone in the presence of their children, they are physically present, but distracted and probably unresponsive ( 25 ). A small experimental study by Myruski et al. found that infants showed most distress when their mothers were disengaged and used their phones in the presence of their child ( 25 ). We found that even in our higher educated sample, as much as 40% used their phone during meals to some extent. This is higher than reported by an earlier study that found that about 25% of mothers who participated had been distracted by technology use during mealtime ( 26 ). Radesky et al ( 27 ) conducted an observational study in a fast-food restaurant assessing young children's behavior in relation to the use of mobile devices by their parents. The parents' use of mobile phones ranged from lying on the dining table to always being occupied with the phone. The study showed that 73% of the parents used their mobile device while eating, 29% used their mobile devices during the entire meal, and 15% looked at their smartphone mobile device while the child was still eating ( 27 ). We found higher frequency of all types of daily shared family meals among the group with no phone use compared to the group with phone use during mealtime. Given that family meals have been reported to influence the eating habits of the child in a positive way ( 10 ), these findings are of interest. We found that parental meal distraction (phone use) was associated with lower frequency of daily family breakfast and dinner. It may be that if the parents are conscious about not using their phone during meals, this may be associated with other positive meal habits, such as the importance of having shared family meals. Parental meal distraction (e.g. mobile phone use) during meals may influence feeding practices, by less focus on the toddler’s food intake, distraction, negative modelling, and use of food as a reward if the child gets impatient. Also, monitoring; i.e. parents keeping track of child’s intake of less healthy food might be affected by phone use during meals since the attention is drawn away from the child, i.e. the phone and the child are both “fighting for attention” from the parent. A previous study found that mobile device use among mothers was common and associated with fewer interactions with children during a structured interaction task, particularly nonverbal interactions and that during introduction of an unfamiliar food they had less support and modelling from their mother ( 28 ). It is logical to assume that the use of mobile phone during mealtime may influence feeding practices. However, as these are purely associations, opposite directions should be considered, such as parental awareness of demonstrating healthy eating behavior (e.g., modelling) may also influence the use of mobile phone during mealtime. Strengths And Limitations The cross-sectional data analyzed, provide a snapshot of the study sample and cannot identify any causal associations and the findings may only be generalized to a population of parents with toddlers. The presence of fathers at mealtime should not be neglected, as their presence are reported be to positively associated with less child distractions and more maternal feeding responsiveness (14). In this study we were not able to test statistically for potential differences between mothers and fathers due to the homogeneity of the sample (98% were mothers). Further, by dichotomizing the parents into those who use and do not use mobile phone during mealtime have reduced the extent of variation in data and thus, may increase the risk of bias. Nevertheless, there are several strengths to considered such as the relatively high sample size, the use of well-validated questionnaires and the fact that this study extends previous assumptions and research evidence. Conclusions Mobile phone use is increasingly taking up time and attention and may thereby change the way we behave. This may also impact important parental tasks such as feeding practices and attention towards children during family meals. In the present study, 4 out of 10 parents with toddlers reported various levels of phone use during mealtimes. Parental phone use was associated with less use of positive parental feeding practices, more use of negative parental feeding practices and lower frequency of daily family breakfast and dinner. Our results highlight the importance of making parents aware of meal distractions like mobile phone use. Future studies should include fathers and explore longitudinal data. Abbreviations NCD’s: non-communicable diseases TV: television CFPQ: Comprehensive Feeding Practices Questionnaire SES: socio-economic status OR: Odds Ratio CI: Confidence Interval Declarations Ethics approval and consent to participate The study was approved by the Norwegian Centre for Research Data 29/06/2017, ref.: 48643, and by the Faculty ethics committee and has been conducted in line with the Helsinki Declaration of 1985, revised in 2008. The study was voluntary, and written consent was obtained from all parents when they chose to sign up for participation. Consent for publication Not applicable. Availability of data and materials The dataset supporting the conclusions of this article will be available in the UiA Open Research repository (https://dataverse.no/dataverse/uia) https://dataverse.no/dataverse/uia Competing interests The authors declare that they have no competing interests. Funding This study is funded by the University of Agder. The financial contributor was not involved in designing the study, collection, analyses, and interpretation of data or in writing the manuscript. Authors’ contributions FNV, ERH, and NCØ initiated and designed the study. FNV, EG and NCØ initiated and developed the current paper. MR performed the data collection supervised by ERH, FNV, and NCØ. EG performed the statistical analyses of the current paper. FNV, EG and NCØ drafted the first version of the manuscript. All authors gave substantial input to the manuscript. All authors contributed to, read, and approved the final version of this manuscript. Acknowledgment The authors wish to thank the participants. References Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, et al. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet. 2020;395(10224):605-58. Mitchell GL, Farrow C, Haycraft E, Meyer C. Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions. Appetite. 2013;60(1):85-94. WHO. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva, Switzerland; 2013. WHO. Report of the commission on ending childhood obesity. Geneva: World Health Organization; 2016. Schwarzenberg SJ, Georgieff MK. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018;141(2). Sælensminde K, Johansson L, Helleve A. Societals gains of adeherence to dietary guidelines (In Norwegian). Oslo: The Norwegian Directorate of Health; 2016. Blissett J, Fogel A. Intrinsic and extrinsic influences on children's acceptance of new foods. Physiol Behav. 2013;121:89-95. Harrison K, Bost KK, McBride BA, Donovan SM, Grigsby-Toussaint DS, Kim J, et al. Toward a Developmental Conceptualization of Contributors to Overweight and Obesity in Childhood: The Six-Cs Model. Malden, MA :2011. p. 50-8. Larson RW, Branscomb KR, Wiley AR. Forms and functions of family mealtimes: multidisciplinary perspectives. New Dir Child Adolesc Dev. 2006(111):1-15. Scaglioni S, De Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C. Factors Influencing Children's Eating Behaviours. Nutrients. 2018;10(6). Shloim N, Edelson LR, Martin N, Hetherington MM. Parenting Styles, Feeding Styles, Feeding Practices, and Weight Status in 4-12 Year-Old Children: A Systematic Review of the Literature. Frontiers in psychology. 2015;6:1849. Vaughn AE, Ward DS, Fisher JO, Faith MS, Hughes SO, Kremers SP, et al. Fundamental constructs in food parenting practices: a content map to guide future research. Nutr Rev. 2016;74(2):98-117. Internet World Statistics. Internet Growth Statistics: Miniwatts Marketing Group; 2020 [Available from: https://www.internetworldstats.com/emarketing.htm . Saltzman JA, Musaad S, Bost KK, McBride BA, Fiese BH. Associations between father availability, mealtime distractions and routines, and maternal feeding responsiveness: An observational study. J Fam Psychol. 2019;33(4):465-75. Fiese BH, Jones BL, Jarick JM. Family mealtime dynamics and food consumption: An experimental approach to understanding distractions. Couple and Family Psychology: Research and Practice. 2015;4(4):199-211. Kong A, Jones BL, Fiese BH, Schiffer LA, Odoms-Young A, Kim Y, et al. Parent-child mealtime interactions in racially/ethnically diverse families with preschool-age children. Eating behaviors. 2013;14(4):451-5. Malhotra K, Herman AN, Wright G, Bruton Y, Fisher JO, Whitaker RC. Perceived benefits and challenges for low-income mothers of having family meals with preschool-aged children: childhood memories matter. Journal of the Academy of Nutrition and Dietetics. 2013;113(11):1484-93. Powell EM, Frankel LA, Umemura T, Hazen N. The relationship between adult attachment orientation and child self-regulation in eating: The mediating role of persuasive-controlling feeding practices. Eating behaviors. 2017;26:121-8. Ventura AK, Teitelbaum S. Maternal Distraction During Breast- and Bottle Feeding Among WIC and non-WIC Mothers. Journal of nutrition education and behavior. 2017;49(7 Suppl 2):S169-S76.e1. Verhage CL, Gillebaart M, van der Veek SMC, Vereijken C. The relation between family meals and health of infants and toddlers: A review. Appetite. 2018;127:97-109. Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics. 2011;127(6):e1565-74. Røed M, Hillesund ER, Vik FN, Van Lippevelde W, Øverby NC. The Food4toddlers study - study protocol for a web-based intervention to promote healthy diets for toddlers: a randomized controlled trial. BMC Public Health. 2019;19(1):563. Musher-Eizenman D, Holub S. Comprehensive Feeding Practices Questionnaire: validation of a new measure of parental feeding practices. J Pediatr Psychol. 2007;32(8):960-72. Melbye EL, Øverby NC, Øgaard T. Child consumption of fruit and vegetables: the roles of child cognitions and parental feeding practices. Public Health Nutr. 2012;15(6):1047-55. Myruski S, Gulyayeva O, Birk S, Pérez-Edgar K, Buss KA, Dennis-Tiwary TA. Digital disruption? Maternal mobile device use is related to infant social-emotional functioning. Developmental science. 2018;21(4):e12610. McDaniel BT, Coyne SM. “Technoference”: The interference of technology in couple relationships and implications for women’s personal and relational well-being. Psychology of Popular Media Culture. 2016;5 (1):85–98. Radesky JS, Kistin CJ, Zuckerman B, Nitzberg K, Gross J, Kaplan-Sanoff M, et al. Patterns of mobile device use by caregivers and children during meals in fast food restaurants. Pediatrics. 2014;133(4):e843-9. Radesky J, Miller AL, Rosenblum KL, Appugliese D, Kaciroti N, Lumeng JC. Maternal mobile device use during a structured parent-child interaction task. Academic pediatrics. 2015;15(2):238-44. Cite Share Download PDF Status: Published Journal Publication published 20 Apr, 2021 Read the published version in BMC Public Health → Version 1 posted Review # 1 received at journal 04 Jan, 2021 Editorial decision: Major revision 04 Jan, 2021 Review # 2 received at journal 14 Dec, 2020 Reviewer # 2 agreed at journal 17 Nov, 2020 Reviewer # 1 agreed at journal 15 Nov, 2020 Reviewers invited by journal 08 Nov, 2020 Editor assigned by journal 05 Nov, 2020 Submission checks completed at journal 05 Nov, 2020 Editor invited by journal 05 Nov, 2020 First submitted to journal 20 Oct, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-105794","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":4576053,"identity":"1bcaaa99-2888-4916-bf99-96792cee5c5e","order_by":1,"name":"Frøydis Nordgård Vik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIie2PMQrCQBBFR1a0+WobUfQKGwRFLHIVQdDW0kLCimCVAyiId7Cx3mVBGw9gGXsL7S1cSSxsNikF9xUDH/5jZogcjh+kLMwAT4ISM0KmAvmlnHMraSgsVjkOQ0Mfvds0pB7BV5udbtZERcVWpToe17dcU1+Aq/1Bw5PVEbcpAdBtgEvisjRUV6OQRNezbkmUMFW2Gu2cCjMKk2ovtNmYqZRGffMLuDbK+jiBr9Gx/gIwdbk9wxY/LZaPaD4IWqfIj22Kofg+A8Q+mVm6n8o9u+NwOBx/zQsHtEFo4X6EPQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-7324-0070","institution":"Universitetet i Agder","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Frøydis","middleName":"Nordgård","lastName":"Vik","suffix":""},{"id":4576054,"identity":"400c26ad-f5ef-4895-b4b7-8c611126cb2f","order_by":2,"name":"Erik Grasaas","email":"","orcid":"","institution":"University of Agder: Universitetet i Agder","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Erik","middleName":"","lastName":"Grasaas","suffix":""},{"id":4576055,"identity":"5f253137-dc62-4124-8549-ebbee78047d9","order_by":3,"name":"Maaike E. M. Polspoel","email":"","orcid":"","institution":"Wageningen University and Research Wageningen Plant Research","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maaike","middleName":"E. M.","lastName":"Polspoel","suffix":""},{"id":4576056,"identity":"b99ee816-4f96-4575-b12a-2bb2b1ce5f55","order_by":4,"name":"Margrethe Røed","email":"","orcid":"","institution":"University of Agder","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Margrethe","middleName":"","lastName":"Røed","suffix":""},{"id":4576057,"identity":"e94a1544-a0bf-4f31-82d9-5185af992578","order_by":5,"name":"Elisabet R. Hillesund","email":"","orcid":"","institution":"University of Agder: Universitetet i Agder","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Elisabet","middleName":"R.","lastName":"Hillesund","suffix":""},{"id":4576058,"identity":"dfb11e42-e0f7-49e4-8d02-7c8da67086fb","order_by":6,"name":"Nina C. Øverby","email":"","orcid":"","institution":"University of Agder: Universitetet i Agder","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nina","middleName":"C.","lastName":"Øverby","suffix":""}],"badges":[],"createdAt":"2020-11-10 14:49:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-105794/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-105794/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-021-10757-1","type":"published","date":"2021-04-20T19:09:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":13615386,"identity":"a4303115-68d7-4bbc-9986-25a9bb04e369","added_by":"auto","created_at":"2021-09-17 06:45:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":379732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-105794/v1/9a913b22-34d9-4001-a706-978b884dbd89.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eParental Phone use during Mealtime with Toddlers and the Associations with Feeding Practices and Shared Family Meals: A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe importance of promoting healthy eating habits early in life cannot be stressed enough. The recent report from the WHO-UNICEF-Lancet commission: \u003cem\u003eA future for the world's children\u003c/em\u003e? states that investing in young children\u0026rsquo;s health, education, and development are fundamental for the individual\u0026rsquo;s lifelong health and development, and even for their future children\u0026rsquo;s health (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). This report also highlights the importance of good health and nutrition in the prenatal period and early years in order to lay the foundation for a healthy life course (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). An unhealthy diet early in life tend to endure into adulthood (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) and increases the risk of non-communicable diseases (NCD\u0026rsquo;s) (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) and childhood obesity (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). Therefore, developing healthy eating habits as a child is essential for maintaining good health throughout life (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). There are also large societal economic benefits to be made if the population follow dietary guidelines (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eDifferent determinants will influence the forming of the child\u0026rsquo;s eating habits. At one year of age, the toddler\u0026rsquo;s eating habits are mostly influenced by their parents i.e. the parents will decide what, when and how much the child eats (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). Mealtimes serve as a setting for socialization around food and eating for the child together with their family (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). The feeding practices the parents use are important in developing eating habits for their children and they can promote or restrain a healthy diet (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). Parental feeding practices are defined by Shloim et al. (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e) as specific goal-directed behaviors that parents use to directly influence the children\u0026rsquo;s eating. Parental feeding practices can be positive or negative in forming eating habits among small children. An example of a negative feeding practice is if parents pressure their child to eat a particular food item (e.g. broccoli), it may lead to disliking of the actual food item (broccoli), while involving the child in food preparation (e.g. scrambled eggs) can be positive and increase the willingness to try new food (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAccording to Internet Growth Statistics (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e), the usage of digital screens, e.g. computers, mobile phones and tablets have increased largely worldwide over the last decades. Everyone, including people in lower socio-economic groups, e.g. with a low salary, own a mobile phone, and it is increasingly considered a \u0026ldquo;must have\u0026rdquo; object for almost everyone; richer and poorer. With increasing screen use among the population, our behaviours change. It is common to see people walking outside using their phone, people at restaurants doing the same, even when they are together with other people.\u003c/p\u003e\n\u003cp\u003eA recent study found that distractions take up a large proportion (almost half) of the average family mealtime (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). Distractions at mealtimes (e.g. screens) have been shown to be associated with greater intake of unhealthy food (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). When mealtimes are characterized by disruptions, lack of attention to each other\u0026rsquo;s moods and eating behaviors, and being away from the table, there is increased risk for poor dietary habits and a stressful eating environment (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). During mealtimes with no distractions (e.g., no television (TV), phones, toys), preschoolers have been observed engaging in less fussy eating behaviors, whereas mealtimes with a distraction were characterized by more negative child behavior (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). There is limited research on implications of distractions on parent feeding practices. One study showed that mothers of infants (\u0026lt;\u0026thinsp;6 months) reported that 26% of the total feeding time was interrupted by technological use (TV, computer, smartphone, tablet) while 17% of total feedings was interrupted by nontechnological distractions (reading, housework) (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). Father availability and involvement in feeding practices have been studied in a recent paper and showed that fathers\u0026rsquo; absence at mealtimes was associated with more child distractions and less maternal feeding responsiveness (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFamily meals are defined in different ways, depending on the number of family member who are attending (e.g. are one or both parents present?) or if the setting in which the meal takes place is included (e.g. is the meal at the table or in front of the TV?). Verhage et al uses the definition: The family meal can be seen as a social moment of the day during which food is eaten together with at least one family member (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). Frequency of family meals are often linked to childhood obesity. A meta-analytic review of 17 studies including more than 180,000 children and adolescents indicated that regularly sharing meals as a family reduced the odds for child overweight by 12% and increased the odds for eating healthy foods by 24% (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e). But frequency of family mealtimes are also related to healthier eating behaviors in children (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eWe hypothesized that parental use of mobile phone during mealtime would be associated with less healthy feeding practices and lower frequency of daily shared family meals. Thus, the objective of this paper was to describe the parental feeding practice and frequency of daily shared family meals among parents who use and do not use mobile phone during mealtime; and further to explore the association between the use of mobile phone during mealtime, feeding practice and daily shared family meals.\u003c/p\u003e\n\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u0026nbsp;\u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eFood4toddlers is originally a randomized controlled trial evaluating the effect of a digital dietary intervention targeting parents of 1-year olds (22). The current paper reports on cross-sectional baseline data from this study.\u003c/p\u003e\n\u003ch2\u003eSample and procedure\u003c/h2\u003e\n\u003cp\u003eIn 2017 we recruited parents of toddlers. They were recruited through social media posts on Facebook. Parents voluntarily notified that they wanted to participate after reading written information about the study. In total 404 participants volunteered to participate initially, however of these, only 298 participants filled in the baseline questionnaire. Data from these 298 participants were included in the present study. The study was approved by the Norwegian Centre for Research Data, and by the Faculty ethics committee and has been conducted in line with the Helsinki Declaration of 1985, revised 2008.\u003c/p\u003e\n\u003ch2\u003eInstruments\u003c/h2\u003e\n\u003cp\u003eThe baseline questionnaire included questions of parental and child characteristics like age and educational level, further there were questions regarding use of mobile devices, food frequency questions of child diet and parental diet, frequency of family meals, feeding practices and other intervention specific questions. In the current study the variables use of mobile device during mealtime (independent variables) and feeding practices and shared family meal frequency (dependent variables) are presented. In addition to parent and child characteristics.\u003c/p\u003e\n\u003cp\u003eThe use of mobile phone during mealtime, was reported like this: \u003cem\u003eTo what extent do you agree with the following statement: I often check my phone during meals\u003c/em\u003e. The participants were given the following response alternatives: Disagree, slightly disagree, neither agree or disagree, slightly agree and agree. We dichotomized this variable with the intention to differentiate between those who do not use mobile phones during meals at all and those who do. The participants who filled in \u0026ldquo;disagree\u0026rdquo; were defined as the \u0026ldquo;No phone use during meal\u0026rdquo; group, while the participants who filled in \u0026ldquo;slightly disagree, neither agree or disagree, slightly agree and agree\u0026rdquo; were defined as the \u0026ldquo;phone use during meal\u0026rdquo; group.\u003c/p\u003e\n\u003cp\u003eTo assess feeding practices, we used the well-known and validated, Comprehensive Feeding Practices Questionnaire (CFPQ) (23). This questionnaire covers 12 dimensions of parental feeding practices. Because the participants of this study were parents of infants, following nine items were considered relevant: Child control (The child is allowed to control his/her own eating behaviours), Emotion regulation (The parents use food to regulate the child\u0026rsquo;s emotional states), Balance and variety (Parents encourage well-balanced food intake), Environment (Availability of healthy food at home), Food as reward (Use of food to reward child behavior), Modeling (Parents demonstrate healthy eating behavior), Monitoring (Parents keep track of child\u0026rsquo;s intake of less healthy food), Pressure (Used by parents to make child eat more), Restriction for health and weight control (Parents control the child\u0026rsquo;s food intake with the purpose of limiting less healthy foods and sweets and to decrease or maintain the child\u0026rsquo;s weight). The reliability of the ten feeding practices dimensions was evaluated using Cronbach alpha. All scores except \u003cem\u003eChild control\u003c/em\u003e and \u003cem\u003eFood as a reward\u003c/em\u003e (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.3) showed acceptable reliability (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.5\u0026ndash;0.8) (detailed data not shown). The CFPQ items were previously translated from English into Norwegian in another project and a random sample of 10 items were back-translated into English (24). The quality of the translation was considered very good and this translation was therefore used in this project.\u003c/p\u003e\n\u003cp\u003eTo assess the frequency of shared family meals, following questions were posed: How often does your child have the following meals together with their family? Herein, meals with family included parents that were married, living in cohabitant families, single or separated / divorced. The participants could choose from the following response alternatives: Never, 1, 2, 3, 4, 5, 6 and 7 times per week for breakfast, lunch, and dinner, respectively. Later, the weekly food frequency was divided into having every specific family meal, every day or not.\u003c/p\u003e\n\u003cp\u003eParental age was assessed in years, child age in months. Participants reported their own and the other parent\u0026rsquo;s highest level of education (primary school or less, primary schools plus one year of further education, high school, vocational school, upper secondary school or less, college/university (\u0026le;\u0026thinsp;4\u0026nbsp;years), college/university (\u0026gt;\u0026thinsp;4\u0026nbsp;years), other, don\u0026rsquo;t know). These responses were dichotomized into having no university/college education or having university college education and used as a proxy for socio-economic status (SES). Ethnicity of the parents were assessed as native if they were born in Norway or non-native if they were born elsewhere.\u003c/p\u003e\n\u003cdiv\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eThe statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY). Demographic data were described using descriptive measures. Continuous variables were described with mean and standard deviation, and categorical variables with frequencies and percentages. For the dependent study variable feeding practice, 9 out of 10 sub-scales had skewness values of \u0026plusmn;\u0026thinsp;1.3 and kurtosis values of \u0026plusmn;\u0026thinsp;1.6, which indicated that these variables are approximately normally distributed. Thus, linear regression analyses were conducted between the dependent variables (feeding practices) on the independent dichotomy variable (phone use / no phone use), and then controlled for SES, ethnicity and age using multiple regression analysis. Binary logistic regression analyses were conducted to calculate odds ratios on the relationship between the dependent dichotomy variable shared family meals and the independent dichotomy variable (phone use / no phone use) controlling for SES, ethnicity and age. Due to the homogeneity of the sample in terms of gender (98% were mothers), adjusting for this variable was not considered relevant. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant and all tests were two-sided.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eThe total sample included 298 parents with a mean age of 32.3 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2) years and their children\u0026rsquo;s age were 10.9\u0026nbsp;months (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1). Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the descriptive characteristics of the total sample. A great majority of the sample were mothers (98.7%) and consisted of parents who were either married (50.7%), lived in cohabitant families (48.3%) or who were single (0.7%) or divorced / separated (0.3%) at the time of the study. The participants reported primarily a high education level, herein 53.7% reported more than 4\u0026nbsp;years of University level. Further, about 4 out of 10 parents reported using a mobile phone during mealtime with their children. Most parents were born in Norway, i.e. native.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive statistics of the sample (n\u0026thinsp;=\u0026thinsp;298)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eValues\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRelationship to child,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e294 (98.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFather\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eEducation level,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLower secondary school or less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUpper secondary school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege/University (\u0026le;\u0026thinsp;4\u0026nbsp;years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101 (33.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege/University (\u0026gt;\u0026thinsp;4\u0026nbsp;years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160 (53.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (3.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eMarital status,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e151 (50.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCohabitant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e144 (48.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDivorced/separated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEthnicity,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNative\u003c/p\u003e\n\u003cp\u003eNon-native\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e257 (86.2)\u003c/p\u003e\n\u003cp\u003e41 (13.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChild\u0026rsquo;s gender, \u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e134 (45)\u003c/p\u003e\n\u003cp\u003e164 (55)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003eDescriptive data of the study variables: Phone use, Feeding practices and Shared Family Meals.\u003c/h2\u003e\n\u003cp\u003eA total of 181 of the participants (60.7%) reported no use of mobile phone during mealtime, wherein the remaining 117 participants (39.3%) reported a various level of phone use during mealtime. The largest difference in mean for feeding practice was shown for the subscale \u003cem\u003epressure\u003c/em\u003e, where the group using phone during mealtime reported a mean score of 7.1 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2) compared to 5.8 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6) the group with no phone use. Higher frequency of all types of shared family meals were reported by the group with no phone use compared to the group with phone use during mealtime (see Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The highest frequency of shared family meals was dinner for both groups (71.3% and 57.3%, respectively).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of feeding practices and daily shared family meals stratified by phone use during mealtime.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDependent study variables\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePhone use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u0026thinsp;=\u0026thinsp;117\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(mean/SD)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo phone use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u0026thinsp;=\u0026thinsp;181\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(mean/SD)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFeeding practice\u003c/p\u003e\n\u003cp\u003eChild control\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.66 (2.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.25 (2.83)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmotional regulation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.74 (1.70)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.98 (1.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBalance and variety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.07 (1.90)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.44 (1.80)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEnvironment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.85 (3.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.60 (3.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFood as reward\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.31 (1.69)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.18 (1.53)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModelling\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.54 (2.91)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.56 (2.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.83 (2.19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.39 (3.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePressure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.14 (3.20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.82 (3.58)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRestriction for Health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.78 (3.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.65 (3.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRestriction for Weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.20 (3.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.22 (4.34)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamily meals\u003c/p\u003e\n\u003cp\u003eBreakfast,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLunch,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDinner,\u0026nbsp;\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58 (49.6)\u003c/p\u003e\n\u003cp\u003e34 (29.1)\u003c/p\u003e\n\u003cp\u003e67 (57.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121 (66.9)\u003c/p\u003e\n\u003cp\u003e72 (39.8)\u003c/p\u003e\n\u003cp\u003e129 (71.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e\u0026nbsp;\u003c/h2\u003e\n\u003ch2\u003eAssociations between phone use during mealtime on feeding practice.\u003c/h2\u003e\n\u003cp\u003ePhone use during mealtime was a significant predictor for the following feeding practice subscales: emotional regulation (95% CI [0.32; 1.14]), environment (95% CI [-1.51; -0.03]), modeling (95% CI [-1.69; -0.41]) and pressure (95% CI [0.41; 2.03]) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). After adjusting for SES, ethnicity and age, these respective associations remained significant with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAssociations between phone use during mealtime on feeding practice subscales adjusted for SES and age.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFeeding practices\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChild control\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.29; 1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmotional regulation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.32; 1.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBalance and variety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.80; 0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEnvironment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.51; -0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFood as reward\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.25; 0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModeling\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.69; \u0026ndash; 0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.17; 1.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePressure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.41; 2.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRestriction (Health)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.64; 0.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRestriction (Weight)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.04; 0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e\n\u003cp\u003eB: Beta CI: Confidence Interval SES: socio-economic status\u003c/p\u003e\n\u003cp\u003eMultiple regression analyses were used\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAssociations between phone use on shared family meals.\u003c/h2\u003e\n\u003cp\u003eThere was a 50% lower odds of breakfast (95% CI [0.31; 0.82]) and a 43% lower odds of dinner (95% CI [0.35; 0.93]) as daily shared family meals among the group using mobile phone compared to the group with no phone use during mealtime.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAssociations between phone use on shared family meals adjusted for SES, ethnicity, and age.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eShared family meals\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBreakfast\u003c/p\u003e\n\u003cp\u003e(phone use vs no phone use)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.31; 0.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLunch\u003c/p\u003e\n\u003cp\u003e(phone use vs no phone use)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.38; 1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDinner\u003c/p\u003e\n\u003cp\u003e(phone use vs no phone use)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.35; 0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e\n\u003cp\u003eOR: Odds Ratio CI: Confidence Interval SES: socio-economic status\u003c/p\u003e\n\u003cp\u003eLogistic regression analyses were used\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, about 4 out of 10 parents reported various levels of phone use (meal distraction) during mealtimes. Descriptive analyses revealed more frequent family meals among the group with no phone use compared to the group with phone use during mealtime. Dinner was the most commonly shared family meal for both groups. Parental phone use was associated with less use of positive parental feeding practices such as modelling and family food environment and more use of negative parental feeding practices like emotion regulation and use of pressure to eat. Finally, parental phone use was associated with a lower frequency of daily family breakfast and dinner. Few studies have reported theses associations in this age group (toddlers).\u003c/p\u003e\n\u003cp\u003eWhen the child enters toddlerhood around one year of age, it becomes increasingly common to eat the same as the rest of the family and together with their family. This is a challenging period of transition, and in addition both parents increasingly engage in working life again after parental leave, and consequently have less time for other activities (e.g. family meals). We also know from a previous study that adults, including parents of toddlers, are increasingly exposed to distractions from their mobile phones during family mealtime (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). Since parental feeding practices and frequency of family meals are important when it comes to child eating development, this \u0026ldquo;fight for attention\u0026rdquo; between the phone and the child, represents a growing dilemma. When parents use their mobile phone in the presence of their children, they are physically present, but distracted and probably unresponsive (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). A small experimental study by Myruski et al. found that infants showed most distress when their mothers were disengaged and used their phones in the presence of their child (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). We found that even in our higher educated sample, as much as 40% used their phone during meals to some extent. This is higher than reported by an earlier study that found that about 25% of mothers who participated had been distracted by technology use during mealtime (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). Radesky et al (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e) conducted an observational study in a fast-food restaurant assessing young children's behavior in relation to the use of mobile devices by their parents. The parents' use of mobile phones ranged from lying on the dining table to always being occupied with the phone. The study showed that 73% of the parents used their mobile device while eating, 29% used their mobile devices during the entire meal, and 15% looked at their smartphone mobile device while the child was still eating (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eWe found higher frequency of all types of daily shared family meals among the group with no phone use compared to the group with phone use during mealtime. Given that family meals have been reported to influence the eating habits of the child in a positive way (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e), these findings are of interest. We found that parental meal distraction (phone use) was associated with lower frequency of daily family breakfast and dinner. It may be that if the parents are conscious about not using their phone during meals, this may be associated with other positive meal habits, such as the importance of having shared family meals.\u003c/p\u003e\n\u003cp\u003eParental meal distraction (e.g. mobile phone use) during meals may influence feeding practices, by less focus on the toddler\u0026rsquo;s food intake, distraction, negative modelling, and use of food as a reward if the child gets impatient. Also, monitoring; i.e. parents keeping track of child\u0026rsquo;s intake of less healthy food might be affected by phone use during meals since the attention is drawn away from the child, i.e. the phone and the child are both \u0026ldquo;fighting for attention\u0026rdquo; from the parent. A previous study found that mobile device use among mothers was common and associated with fewer interactions with children during a structured interaction task, particularly nonverbal interactions and that during introduction of an unfamiliar food they had less support and modelling from their mother (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e). It is logical to assume that the use of mobile phone during mealtime may influence feeding practices. However, as these are purely associations, opposite directions should be considered, such as parental awareness of demonstrating healthy eating behavior (e.g., modelling) may also influence the use of mobile phone during mealtime.\u003c/p\u003e"},{"header":"Strengths And Limitations","content":"\u003cp\u003eThe cross-sectional data analyzed, provide a snapshot of the study sample and cannot identify any causal associations and the findings may only be generalized to a population of parents with toddlers. The presence of fathers at mealtime should not be neglected, as their presence are reported be to positively associated with less child distractions and more maternal feeding responsiveness (14). In this study we were not able to test statistically for potential differences between mothers and fathers due to the homogeneity of the sample (98% were mothers). Further, by dichotomizing the parents into those who use and do not use mobile phone during mealtime have reduced the extent of variation in data and thus, may increase the risk of bias. Nevertheless, there are several strengths to considered such as the relatively high sample size, the use of well-validated questionnaires and the fact that this study extends previous assumptions and research evidence.\u003c/p\u003e"},{"header":"Conclusions","content":" \u003cp\u003eMobile phone use is increasingly taking up time and attention and may thereby change the way we behave. This may also impact important parental tasks such as feeding practices and attention towards children during family meals. In the present study, 4 out of 10 parents with toddlers reported various levels of phone use during mealtimes. Parental phone use was associated with less use of positive parental feeding practices, more use of negative parental feeding practices and lower frequency of daily family breakfast and dinner. Our results highlight the importance of making parents aware of meal distractions like mobile phone use. Future studies should include fathers and explore longitudinal data.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eNCD\u0026rsquo;s: non-communicable diseases\u003c/p\u003e\n\u003cp\u003eTV: television\u003c/p\u003e\n\u003cp\u003eCFPQ: Comprehensive Feeding Practices Questionnaire\u003c/p\u003e\n\u003cp\u003eSES: socio-economic status\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the Norwegian Centre for Research Data 29/06/2017, ref.: 48643, and by the Faculty ethics committee and has been conducted in line with the Helsinki Declaration of 1985, revised in 2008. The study was voluntary, and written consent was obtained from all parents when they chose to sign up for participation.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article will be available in the UiA Open Research repository (https://dataverse.no/dataverse/uia) https://dataverse.no/dataverse/uia\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThis study is funded by the University of Agder. The financial contributor was not involved in designing the study, collection, analyses, and interpretation of data or in writing the manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eFNV, ERH, and NC\u0026Oslash; initiated and designed the study. FNV, EG and NC\u0026Oslash; initiated and developed the current paper. MR performed the data collection supervised by ERH, FNV, and NC\u0026Oslash;. EG performed the statistical analyses of the current paper. FNV, EG and NC\u0026Oslash; drafted the first version of the manuscript. All authors gave substantial input to the manuscript. All authors contributed to, read, and approved the final version of this manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAcknowledgment \u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors wish to thank the participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, et al. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet. 2020;395(10224):605-58.\u003c/li\u003e\n\u003cli\u003eMitchell GL, Farrow C, Haycraft E, Meyer C. Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions. Appetite. 2013;60(1):85-94.\u003c/li\u003e\n\u003cli\u003eWHO. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva, Switzerland; 2013.\u003c/li\u003e\n\u003cli\u003eWHO. Report of the commission on ending childhood obesity. Geneva: World Health Organization; 2016.\u003c/li\u003e\n\u003cli\u003eSchwarzenberg SJ, Georgieff MK. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018;141(2).\u003c/li\u003e\n\u003cli\u003eS\u0026aelig;lensminde K, Johansson L, Helleve A. Societals gains of adeherence to dietary guidelines (In Norwegian). Oslo: The Norwegian Directorate of Health; 2016.\u003c/li\u003e\n\u003cli\u003eBlissett J, Fogel A. Intrinsic and extrinsic influences on children's acceptance of new foods. Physiol Behav. 2013;121:89-95.\u003c/li\u003e\n\u003cli\u003eHarrison K, Bost KK, McBride BA, Donovan SM, Grigsby-Toussaint DS, Kim J, et al. Toward a Developmental Conceptualization of Contributors to Overweight and Obesity in Childhood: The Six-Cs Model. Malden, MA :2011. p. 50-8.\u003c/li\u003e\n\u003cli\u003eLarson RW, Branscomb KR, Wiley AR. Forms and functions of family mealtimes: multidisciplinary perspectives. New Dir Child Adolesc Dev. 2006(111):1-15.\u003c/li\u003e\n\u003cli\u003eScaglioni S, De Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C. Factors Influencing Children's Eating Behaviours. Nutrients. 2018;10(6).\u003c/li\u003e\n\u003cli\u003eShloim N, Edelson LR, Martin N, Hetherington MM. Parenting Styles, Feeding Styles, Feeding Practices, and Weight Status in 4-12 Year-Old Children: A Systematic Review of the Literature. Frontiers in psychology. 2015;6:1849.\u003c/li\u003e\n\u003cli\u003eVaughn AE, Ward DS, Fisher JO, Faith MS, Hughes SO, Kremers SP, et al. Fundamental constructs in food parenting practices: a content map to guide future research. Nutr Rev. 2016;74(2):98-117.\u003c/li\u003e\n\u003cli\u003eInternet World Statistics. Internet Growth Statistics: Miniwatts Marketing Group; 2020 [Available from: \u003ca href=\"https://www.internetworldstats.com/emarketing.htm\"\u003ehttps://www.internetworldstats.com/emarketing.htm\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eSaltzman JA, Musaad S, Bost KK, McBride BA, Fiese BH. Associations between father availability, mealtime distractions and routines, and maternal feeding responsiveness: An observational study. J Fam Psychol. 2019;33(4):465-75.\u003c/li\u003e\n\u003cli\u003eFiese BH, Jones BL, Jarick JM. Family mealtime dynamics and food consumption: An experimental approach to understanding distractions. Couple and Family Psychology: Research and Practice. 2015;4(4):199-211.\u003c/li\u003e\n\u003cli\u003eKong A, Jones BL, Fiese BH, Schiffer LA, Odoms-Young A, Kim Y, et al. Parent-child mealtime interactions in racially/ethnically diverse families with preschool-age children. Eating behaviors. 2013;14(4):451-5.\u003c/li\u003e\n\u003cli\u003eMalhotra K, Herman AN, Wright G, Bruton Y, Fisher JO, Whitaker RC. Perceived benefits and challenges for low-income mothers of having family meals with preschool-aged children: childhood memories matter. Journal of the Academy of Nutrition and Dietetics. 2013;113(11):1484-93.\u003c/li\u003e\n\u003cli\u003ePowell EM, Frankel LA, Umemura T, Hazen N. The relationship between adult attachment orientation and child self-regulation in eating: The mediating role of persuasive-controlling feeding practices. Eating behaviors. 2017;26:121-8.\u003c/li\u003e\n\u003cli\u003eVentura AK, Teitelbaum S. Maternal Distraction During Breast- and Bottle Feeding Among WIC and non-WIC Mothers. Journal of nutrition education and behavior. 2017;49(7 Suppl 2):S169-S76.e1.\u003c/li\u003e\n\u003cli\u003eVerhage CL, Gillebaart M, van der Veek SMC, Vereijken C. The relation between family meals and health of infants and toddlers: A review. Appetite. 2018;127:97-109.\u003c/li\u003e\n\u003cli\u003eHammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics. 2011;127(6):e1565-74.\u003c/li\u003e\n\u003cli\u003eR\u0026oslash;ed M, Hillesund ER, Vik FN, Van Lippevelde W, \u0026Oslash;verby NC. The Food4toddlers study - study protocol for a web-based intervention to promote healthy diets for toddlers: a randomized controlled trial. BMC Public Health. 2019;19(1):563.\u003c/li\u003e\n\u003cli\u003eMusher-Eizenman D, Holub S. Comprehensive Feeding Practices Questionnaire: validation of a new measure of parental feeding practices. J Pediatr Psychol. 2007;32(8):960-72.\u003c/li\u003e\n\u003cli\u003eMelbye EL, \u0026Oslash;verby NC, \u0026Oslash;gaard T. Child consumption of fruit and vegetables: the roles of child cognitions and parental feeding practices. Public Health Nutr. 2012;15(6):1047-55.\u003c/li\u003e\n\u003cli\u003eMyruski S, Gulyayeva O, Birk S, P\u0026eacute;rez-Edgar K, Buss KA, Dennis-Tiwary TA. Digital disruption? Maternal mobile device use is related to infant social-emotional functioning. Developmental science. 2018;21(4):e12610.\u003c/li\u003e\n\u003cli\u003eMcDaniel BT, Coyne SM. \u0026ldquo;Technoference\u0026rdquo;: The interference of technology in couple relationships and implications for women\u0026rsquo;s personal and relational well-being. Psychology of Popular Media Culture. 2016;5 (1):85\u0026ndash;98.\u003c/li\u003e\n\u003cli\u003eRadesky JS, Kistin CJ, Zuckerman B, Nitzberg K, Gross J, Kaplan-Sanoff M, et al. Patterns of mobile device use by caregivers and children during meals in fast food restaurants. Pediatrics. 2014;133(4):e843-9.\u003c/li\u003e\n\u003cli\u003eRadesky J, Miller AL, Rosenblum KL, Appugliese D, Kaciroti N, Lumeng JC. Maternal mobile device use during a structured parent-child interaction task. Academic pediatrics. 2015;15(2):238-44.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"parental phone use, toddlers, family meals, meals, feeding practices, Norway","lastPublishedDoi":"10.21203/rs.3.rs-105794/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-105794/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePositive parental feeding practices and a higher frequency of family meals are related to healthier child dietary habits. Parents play an essential role when it comes to the development of their child’s eating habits. However, parents are increasingly distracted by their mobile phone during mealtime. The aim of this study was to describe the feeding practices and daily shared family meals among parents who use and do not use mobile phone during mealtime, and further to explore the associations between the use of mobile phone during mealtime and feeding practices and daily shared family meals, respectively.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMethods\u003c/em\u003e \u003c/p\u003e\u003cp\u003eCross-sectional data from the Food4toddler study were used to explore the association between mobile use during meals and parental feeding practices including family meals. In 2017/2018 parents of toddlers were recruited through social media to participate in the study. In total 298 out of 404 who volunteered to participate, filled in a baseline questionnaire, including questions from the comprehensive feeding practices questionnaire (CFPQ), questions of frequency of family meals and use of mobile phone during meals. \u003c/p\u003e\u003cp\u003e\u003cem\u003eResults\u003c/em\u003e\u003c/p\u003e\u003cp\u003eHerein, 4 out of 10 parents reported various levels of phone use (meal distraction) during mealtimes. Parental phone use was associated with lower use of positive parental feeding practices like modelling (B= -1.05 (95% CI -1.69; -0.41)) and family food environment (B= -0.77 (95% CI -1.51; -0.03)), and more use of negative parental feeding practices like emotional regulation (B= 0.73 (95% CI 0.32; 1.14)) and the use of pressure to eat (B= 1.22 (95% CI 0.41; 2.03)). Furthermore, parental phone use was associated with a lower frequency of daily family breakfast (OR= 0.50 (95% CI 0.31; 0.82)) and dinner (OR= 0.57 (95% CI 0.35; 0.93)). \u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cem\u003eConclusions\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMobile phone use is common among parents during mealtimes, and findings indicate that parental phone use is associated with less healthy feeding practices and shared family meals. These findings highlight the importance of making parents aware of potential impacts of meal distractions. \u003c/p\u003e\u003cp\u003eTrial registration: \u003ca href=\"https://doi.org/10.1186/ISRCTN92980420\" rel=\"noopener noreferrer\" target=\"_blank\"\u003eISRCTN92980420\u003c/a\u003e. Registered 13 September 2017. Retrospectively registered.\u003cem\u003e \u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Parental Phone use during Mealtime with Toddlers and the Associations with Feeding Practices and Shared Family Meals: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-11-17 15:40:49","doi":"10.21203/rs.3.rs-105794/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-01-05T00:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThank you for the opportunity to review the manuscript titled: \"Parental phone use during mealtime with toddlers and the associations with feeding practices and shared family meals: a cross-sectional study\". I agree with the authors that mobile phones appear to be an increasing distraction and may therefore negatively impact the potential role that family mealtimes can play in socialising young children's healthy eating behaviours. While it appears that there is a scarcity of research in this area, there are a number of areas that I feel need to considered before determining the manuscripts suitability for publication. My main concern is that while parenting (particularly in relation to child feeding/child eating) has been a major focus, the theoretical basis for this focus has not been introduced. For example, un/responsiveness is mentioned in a couple of sections, but it is not explicit which are the foundational aspects of parenting/parent feeding that appear to promote healthy child development (including eating) and how might this be hindered by mobile phone use. Additionally, sufficient theory/evidence relating to parent feeding practices and mealtimes has not bee included to the degree needed to a) guide the readers' understanding of these topics; b) build the rationale for the current study. The uni-directional nature of this study is also surprising give the advances of research in this area over the past years that consider both the role of parent and child factors in feeding. Specific comments are outlined below in order of line number.\n\nLine 72: \" Different determinants will influence the forming of the child's eating habits\". It would be helpful to include some example of these determinants and supporting reference.\nLine 74: \" Mealtimes serve as a setting for 75 socialization around food and eating for the child together with their family (9).\" I am wondering if this sentence might be easier to follow if re-worded. Eg.\" Family mealtimes serve as a setting for children's socialization of food (not sure what the intention here was - perhaps food habits/patterns) and eating (behaviours/patterns?) (9).\nLine 80: Given a main focus of this study is on parent feeding practices, a more detailed overview of parent feeding practices evidence (beyond the example of pressure and involving children in food preparation) seems necessary here, including a description of the quality of this research (i.e., has it been longitudinal/cross-sectional?; have findings been conclusive or mixed etc?) to really build the readers understanding of the topic and rationale for the current study.\nLine 85: I'm not sure if it is possible to confirm that \"everyone\" owns a mobile phone, therefore it may be more accurate to instead reword this to show that the majority of people across all socio-economic groups own mobile phones (or such).\nLine 100: \"One study 100 showed that mothers of infants (\u003c6months)….\". Given the children are below the recommended age for complimentary feeding, it is not clear if these mothers were bottle/breastfeeding or feeding solids. It would also be helpful here to explain why distractions during feeding infant (given that it is a different developmental stage with very different feeding requirements to toddlers) might also be relevant. E.g. are these early feeding interactions as relevant as they are when children are toddlers?\nLine 105: The study that is cited here refers to maternal responsiveness - yet this is a type of parenting style rather than feeding practice and the relevance of maternal responsiveness has not be shown in this manuscript. The manuscript would benefit from a brief explanation.\nSimilarly, based on the information provided in the manuscript, it is not clear why family meals may reduce risk for obesity? (i.e., The opposite can could be the case if family mealtimes are dysfunctional).\nThe rationale for focusing on mobile phone use (as a distraction in the current study) requires much strengthening. E.g., why is it important that parents are present and engaged during mealtimes? In other words, what is it about well functioning family mealtimes that promote the development of children's healthy eating and weight? There are elements of the rationale interwoven throughout the background (e.g., Line 93 \"When mealtimes are characterized by 94 disruptions, lack of attention to each other's moods and eating behaviors, and being away 95 from the table, there is increased risk for poor dietary habits and a stressful eating 96 environment (16, 17)\". But not in an explicit and logically flowing way that help to set up:\n\nWhich aspects of parenting and or family mealtimes (based on previous literature) is the current study explicitly focusing on? What are the core components of those factors (i.e., family mealtimes are opportunities to provide structure, monitor what children eat, connect emotionally, share enjoyable times, model healthy eating etc./or is it just about how much control a parent exerts during meals to guide what, when and how a child eats? Based on the above, why might mobile phone use be a concern?\nLine 143. I have some concerns regarding the dichotamised approach to the non-validated mobile phone use measure because from a \"parenting theory and practice\" perspective, we know that it is what a parent does most of the time, not only \"all of the time\" that can impact child development. It would be helpful to understand why this study has not considered assessing various levels of mobile phone use?\nLine 153: My understanding that toddlers were included in the study, yet in this line it says infants. This requires clarification.\nLine 162: \"The reliability of the ten feeding practices dimensions was evaluated using\". Based on the dimensions described, my understanding was that there were nine items.\nLine 168: Give that the rationale for the current study has not been clearly established in the manuscript, it is not clear why only family meal frequency was measured (as opposed to components of family mealtimes ie mealtime structure; stress/dysfuction etc)\nLine 256: \"Few studies have reported theses associations in this age group\" - please add citations of examples of these studies.\nLine 257: I realise this may just be a figure of speech, but I believe it is important to guide readers who may not have a background in developmental psychology to understand it is not about the child demanding attention, but rather that parental responsiveness is a fundamental aspect of being able to provide age appropriate guidance and support during mealtimes. Therefore, it is suggested that the term: \"fight for attention\" be reconsidered. It may be more appropriate to sat that the parents' attention is divided or that their capacity to respond/engage etc. is impacted.\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **No**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"decision","content":"Major revision","date":"2021-01-05T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-12-15T00:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nTitle: Parental phone use during mealtime with toddlers and the associations with feeding practices and shared family meals: a cross-sectional study\n\nThank you for the opportunity to review this manuscript for publication in BMC Public Health. This study explores the use of phones during mealtimes among parents of toddlers in Norway and associations between phone use during meals and food parenting practices and family meal frequency. Research exploring the impacts of phone use during mealtimes is important given the space phones take up in our daily lives and will help to provide messaging surrounding reasons to \"unplug\" at the dining table. While this is interesting work, the manuscript would be strengthened by considering the edits outlined below.\n\nMajor Comments:\n\nMethods:\n\n1. Page 8, lines 163: The Child Control and Food as Reward subscales of the CFPQ did not demonstrate appropriate internal consistency in your study. How did authors account for this during data-analysis? The limited internal consistency should be noted in the limitations section of the manuscript. It is possible given the CFPQ was originally validated for children 2-8 years of age, that the questions on these subscales do fully apply to parents of younger children.\n\n2. Page 8, lines 174-179: How was educational status in dual-parent households handled in the data-analysis. Was the highest level of education between the two used? It would be helpful to clarify as Table 1 only reports one parents' education. Further, it would be clearer to call this variable \"parental educational status\" throughout the paper, rather than education in some places and SES in others.\n\n3. Page 8, lines 158-167: It may be helpful to readers who are not familiar with the CFPQ to briefly provide further information about how many items make up each dimension, and how the questionnaire is scored (i.e., higher scores equal more engagement in the practice).\n\nResults:\n\n4. Tables 2, 3 \u0026 4: For ease of reading and contextualizing the results, please edit the results tables such that the means and SD for feeding practices between the mobile phone vs. no mobile phones are presented alongside the linear regression data. Similarly, create a second table with the family dinner data and the ORs exploring differences between the mobile phone vs. no mobile phone groups.\n\n5. Page 11, lines 226-230: For ease of reading, please include the beta values along with the 95% CIs in the text.\n\nDiscussion:\n\n6. Page 13, lines 249-257: For clarity, please present the summary of results in the order that the data was presented in the results section. Data on food parenting should be presented before that of family meal frequency. Similarly, this edit should be made throughout the discussion section. Data on food parenting was presented first in the results section, so these results should be discussed first in the discussion section.\n\n7. There is larger body of research exploring screen use in general (usually TVs) during family mealtimes. The discussion of this paper would be strengthened by exploring the results of this study in context with what is known about other types of screens. Are results consistent between types of screens? Do phones seem to uniquely influence food parenting practices and family meal frequency? Further, I suspect that given how habitual phone use has become, that parents may not even be aware of how often they are checking their phones during meals as use can be much less obvious than having a television on. As such, raising awareness about the importance of also putting phones away during mealtimes is important. Future observational research exploring phone use during mealtimes would be an important next step to this research.\n\nMinor Comments:\n\nAbstract:\n\n8. Page 2, lines 31-34: There seem to be some words missing in this sentence. It should read: \"The aim of this study was to describe the feeding practices and daily shared family meals among parents who use and do not use a mobile phone during mealtimes, and further to explore the associations between the use of a mobile phone during mealtimes and feeding practices and daily shared family meals, respectively.\"\n\nIntroduction:\n\n9. Page 4, lines 73-74: In the division of responsibility in feeding, parents are responsible for \"what\", \"when\" and \"where\" the child eats, and the child is responsible for \"how much\" or whether they eat at all. Please edit this sentence accordingly. When parents are in charge of how much a child eats, children are not provided with the autonomy needed to listen to their internal satiety cues, which is considered coercive feeding.\n\n10. Page 4, lines 80-83: This is a run-on sentence. For clarity, please separate the negative and positive food parenting practice examples into separate sentences.\n\n11. Page 5, line 86: The example of a lower-socioeconomic group, \"e.g., with a low salary\" is not needed as \"low socioeconomic\" clear as is.\n\n12. Page 6, line 119: There are some grammatical mistakes in this sentence. It should read, \"…among parents who use and do not use mobile phones during mealtimes.\" Please check this grammar throughout the paper.\n\nMethods:\n\n13. Page 7, lines 136-139: This is a run-on sentence. Please split up into two sentences for easier comprehension.\n\nDiscussion:\n\n14. Page 14, line 290: The saying \"fighting for attention\" has already been used previously in the discussion. The second use of this example is not needed and should be removed to avoid sounding repetitive.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-11-18T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-11-16T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-11-09T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-11-06T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-11-05T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-05T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-10-21T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"970cb526-8bd4-46d8-a58b-28e2ea880eaf","owner":[],"postedDate":"November 17th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":1103669,"name":"Health Economics \u0026 Outcomes Research"},{"id":1103670,"name":"Health Policy"}],"tags":[],"updatedAt":"2021-08-18T19:37:48+00:00","versionOfRecord":{"articleIdentity":"rs-105794","link":"https://doi.org/10.1186/s12889-021-10757-1","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2021-04-20 19:09:42","publishedOnDateReadable":"April 20th, 2021"},"versionCreatedAt":"2020-11-17 15:40:49","video":"","vorDoi":"10.1186/s12889-021-10757-1","vorDoiUrl":"https://doi.org/10.1186/s12889-021-10757-1","workflowStages":[]},"version":"v1","identity":"rs-105794","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-105794","identity":"rs-105794","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}