Dietary Behaviors Research Articles

Excessive Gestational Weight Gain, Independent of Body Mass Index, Is Associated With Child Fat Mass Index at Age 2 Years in the Growing life, Optimizing Wellness Study

BackgroundExcessive gestational weight gain (eGWG) increases risk for pregnancy complications and future obesity for pregnant persons and children. Yet, it is unclear whether eGWG leads to higher child adiposity at 2 years, independent of the pregnant person’s body mass index (BMI) while considering important covariates. Moreover, understanding the characteristics of pregnant persons experiencing eGWG will help design future targeted interventions. ObjectiveThe objectives of the analyses were to assess the association between eGWG and childhood adiposity at age 2 years, while controlling for pregnant persons’ BMI and other important covariates and to describe the characteristics of pregnant persons who experience eGWG during their second pregnancy. DesignThis is a secondary analysis of 221 pregnant persons and their children aged 2 years who were enrolled in the Growing Life, Optimizing Wellness longitudinal observational study. Participants/settingParticipants were recruited between 2011 and 2014 in central Arkansas. Participants were secundigravida persons with BMI 18.5 to 35, older than age 20 years, and who conceived without assistance. Main outcome measuresThe main outcome measure was fat mass index of children aged 2 years measured by quantitative nuclear magnetic resonance imaging. Secondary outcomes included first pregnancy GWG, dietary and physical activity characteristics between pregnancies, second pregnancy nausea levels, and motivation level to adhere to the GWG guidelines. Statistical analysis performedMultivariable regression analyses were used to examine the associations between GWG and childhood fat mass index at age 2 years. Pearson correlations and Wilcoxon rank sum tests were used to identify the characteristics of pregnant persons who experienced eGWG. ResultsPregnant persons’ eGWG (β = .503; P = .03) was positively associated with child adiposity at age 2 years independent of maternal BMI (P = 0.3). Pregnant persons who experienced eGWG during their second pregnancy had greater odds of eGWG during first pregnancies (odds ratio 7.5; P < .001), dieting behavior (odds ratio 14.3; P = .02), and low motivation to adhere to the GWG guidelines (odds ratio 11.2; P = .009). Fewer participants had eGWG during their second pregnancy (52.5%) compared with their first pregnancy (66.8%), which was different by BMI groups (BMI 18.5 to 24.9: 23.6% decrease in participants who gained eGWG, BMI 25 to 29.9: 20.0% decrease, and BMI ≥ 30: 37.9% decrease). ConclusionseGWG among pregnant persons is associated with child adiposity at age 2 years. Pregnant persons who experienced eGWG during their second pregnancy reported low motivation to gain weight within guidelines, eGWG in first pregnancy, and reported prior dieting behavior. Future research focusing on patients with these characteristics may increase success of interventions designed to limit eGWG.

Maternal low-dose caffeine intake during the perinatal period promotes short- and long-term sex-dependent hormonal and behavior changes in the offspring.

Maternal caffeine crosses the placenta and mammary barriers, reaching the baby and, because his/her caffeine metabolism is immature, our hypothesis is that even a low caffeine intake (250 mg/day), lower than the dose limit recommended by the World Health Organization, can promote caffeine overexposure in the offspring, leading to short- and long-term changes. Pregnant Wistar rats received intragastric caffeine (CAF) (25 mg/Kg/day) or vehicle during the gestation and lactation periods. We evaluated morphometrical, metabolic, hormonal, and behavioral parameters of male and female offspring at different ages. Even a low caffeine intake promoted lower maternal body mass and adiposity, higher plasma cholesterol and lower plasma T3, without changes in plasma corticosterone. Female CAF offspring exhibited lower birth weight, body mass gain and food intake throughout life, and hyperinsulinemia at weaning, while male CAF offspring showed reduced food intake and lower plasma T3 at weaning. At puberty and adulthood, male CAF showed higher preference for palatable food, aversion to caffeine intake and higher locomotor activity, while female CAF only showed lower preference for high fat diet (HFD) and lower anxiety-like behavior. At adulthood, both male and female offspring showed higher plasma T3. Male CAF showed hypertestosteronemia, while female CAF showed hypoinsulinemia without effect on glucose tolerance. A low caffeine intake during the perinatal period affects rat's offspring development, promoting sex-dependent hormonal and behavior changes. Current data suggest the need to review caffeine recommendations during the perinatal period.

Parental norms and attitudes in Relation to Children’s sugar consumption − A mediation analysis of the “Are You Too Sweet?” intervention study

Parental influence on children’s dietary behaviour makes parents an obvious target for prevention strategies with nutritional foci. Mediation analysis is considered a valuable tool for understanding the underlying mechanisms of influence in intervention studies aimed at implementing behaviour change strategies.The present study used data from the multi-component cluster-randomised intervention “Are You Too Sweet?” with 153 Danish children (5–7 years) to explore mediating effects and role of parental determinants on added sugar intake in children.A pre-and post-intervention questionnaire evaluated parental knowledge, practices, self-efficacy, norms, and attitudes. Children’s dietary intake was estimated from a seven-day dietary record. Associations between children’s added sugar intake and parental responses and changes in responses following the intervention were evaluated using linear mixed models. Exploring potential behaviour change pathways of the intervention was done using mediation analyses.Children’s reduction in added sugar consumption was partly mediated by changes in parental norms and attitudes regarding limiting sugar-rich foods and drinks to special occasions. Parental knowledge of guidelines on the intake of sugar-rich discretionary foods and drinks increased as an intervention effect but did not demonstrate a mediating effect. No significant changes or mediating effects were found in parental self-efficacy or practices.The findings highlight parental norms and attitudes regarding restricting sugar-rich foods and drinks to special occasions as modifiable and a mediator for reducing added sugar intake in the “Are You Too Sweet?” intervention study.Trial registration: Retrospectively registered at ISRCTN: ISRCTN10409779.

Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study

IntroductionThe majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This...

Active Substance Use and Associated Consumer Dietary Behaviors

Active Substance Use and Associated Consumer Dietary Behaviors

Health Action Process Approach Correlates With Emerging Adult Dietary Behavior

Health Action Process Approach Correlates With Emerging Adult Dietary Behavior

Tailoring Diet Messages Using Health Regulatory Focus to Improve Dietary Behavior Change Intentions in Persons at Risk for Diabetes

Tailoring Diet Messages Using Health Regulatory Focus to Improve Dietary Behavior Change Intentions in Persons at Risk for Diabetes

Self-care practices and influencing factors among type 2 diabetes mellitus patients: A hospital-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a widespread non-communicable disease in India that significantly affects the healthcare system owing to its acute and chronic complications. The traditional approach to diabetes care has focused on medical professionals, but recent research has indicated that self-care among patients is crucial. Effective self-care practices can enhance the quality of life of T2DM patients. This study aimed to evaluate self-care practices among T2DM patients at a sub-district hospital in Gujarat State, India. MethodsThis cross-sectional study included 93 T2DM patients. Self-care activities were assessed using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Descriptive statistics and comparative analyses were performed. ResultsThe majority of the participants were male (55.9 %) and over 60 years of age (67.7 %). Participants demonstrated high adherence to medication regimens (mean score = 6.66 ± 0.86). However, adherence to other self-care practices was significantly lower; only 11.8 % reported good dietary behavior, 55.91 % engaged in regular exercise, and 50.5 % performed regular foot care. While 83.8 % reported good monitoring behavior, this contradicts the low adherence to blood glucose testing (mean score = 0.38 ± 0.59). Participants aged <60 years tended to report slightly better adherence to blood glucose testing than those aged ≥60 years. ConclusionThis study revealed a gap in self-care practices among T2DM patients in Gujarat. Despite good medication adherence, the patients demonstrated poor adherence to diet, exercise, and foot care. These findings emphasize the importance of customized interventions to improve self-management education and support, particularly for older adults.

Characteristics of Dietary Behaviors and Effects of Dietary Acculturation in East African Immigrants Living in the San Diego Area: Preliminary Insights from the HAWAASH2 Study

Characteristics of Dietary Behaviors and Effects of Dietary Acculturation in East African Immigrants Living in the San Diego Area: Preliminary Insights from the HAWAASH2 Study

Digital data collection protocols and template design for an oral health survey of elite athletes in Ireland

AimTo design a digital template for form building, data collection and data management to assess the diet and oral health of elite athletes.Subject and methodsA web-based open-source platform, KoboToolbox (KBTB), was used to aid design and manufacture of a digital data collection form for use in oral health surveys. KBTB frontend form builder was used to create a customised questionnaire. Dental charting systems for the chosen indices were designed using XLSForms, converted to XForm and uploaded to the KBTB interface to create a single form for digital data input. This template was used to collect data for a cross-sectional study investigating the diet and oral health of a convenience sample of elite athletes in Ireland.ResultsA digital data collection (DDC) form was designed for use in oral health surveys. The customised form was then used to collect data for a survey of 88 elite athletes on the KBTB platform. Dietary behaviours were recorded by the participants using KBTB. Following data collection, the dataset was downloaded from KBTB and cleaned for subsequent analysis.ConclusionThe design of a versatile form and oral health questionnaire template using digital tools customised for elite athletes was useful for efficient, comprehensive field data collection. DDC tools are convenient for data form design, collection, and storage. This template can be easily modified for use by other researchers planning oral health surveys.

Determination of Salivary Cortisol Levels and Nutrition, Smoking and Physical Activity Status of University Students during the Exam Period

Objective: The aim of this study is to determine the salivary cortisol levels and nutrition, smoking and physical activity status of university students during the exam period. Method: This study was conducted at Bayburt University Faculty of Health Sciences during the 2023-2024 final exam period. A questionnaire determined the demographic characteristics, dietary and physical activity behaviors, while anthropometric measurements were taken and nutritional status was evaluated. ELISA analyzed the cortisol hormone levels in saliva samples taken before and after the final exam. Results: The study was conducted on 120 volunteer students between the ages of 18-25 who had no clinical health problems. In the study, a significant difference was found between the students' salivary cortisol levels before and after the exam (p

Longevity records for bird species from the central Monte desert, Argentina

ABSTRACT Longevity is a key life-history parameter of bird species, highly relevant for the development of evolutionary biology, the study of ecological patterns and conservation planning. However, there is a marked paucity of data for Neotropical birds, mainly because estimating longevity requires long-term studies that are very scarce in temperate South America. We report data on the longevity of 25 bird species obtained in an 8-year long-term capture–recapture programme carried out in the Monte desert in Argentina and evaluate the influence of diet and migratory status on this life-history trait. The maximum value recorded was 105 months for Microspingus torquatus and the minimum was 13 months for Synallaxis albescens. Resident birds had higher average longevity than migratory birds, while species consuming mainly plant material had higher longevity values than those consuming mainly animal foods. Our results are similar to the few published records from temperate South America, although more data are needed to assess the impact of diet and migratory behaviour on longevity of Neotropical species.

Association of Competitive Adolescent Athletes from Lean and Non-Lean Sports Physical, Social and Psychological Characteristics with Adherence to Mediterranean Diet.

Mediterranean diet (MD) is regarded as one of the healthier dietary patterns which is recommended for athletes. This study aims to investigate the adherence to the Mediterranean diet (AMD) and associated beliefs in a large, diverse sample of competitive adolescent athletes from various sports, including both lean and non-lean sports. Additionally, the study examines factors important regarding intention to AMD within the Theory of Planned Behavior (TPB). In the study took part 711 adolescents (357 male, aged = 14.93 ± 1.38, and 354 female, aged = 14.85 ± 1.35) athletes. The level of AMD was not a significant different between lean (mean = 4.98, SD = ±3.90) and non-lean (mean = 4.77, SD = ±3.68) sport. According to the sport type the 35% of lean sport athletes demonstrated low AMD, 34.1% moderate adherence and 30.9% a high degree. The non lean athletes demonstrated low AMD in 36.3%, moderate adherence 33% and high degree in 30.7%. The results of the mediation analysis indicated a significant mediation effect of intention in the relationship between TPB variables and MD. Based on the results of the study the type of sport does not play a role in the AMD, which, as in the general population, is low. Also validate the TPB and underscore the significance of targeting individuals' intentions to promote positive dietary behaviors.

Exploration of Food Attitudes and Management of Eating Behavior from a Psycho-Nutritional Perspective.

This study investigates the relationship between food attitudes and the management of eating behavior from a psycho-nutritional perspective, with a focus on the Health Belief Model (HBM). The objective was to explore how emotional food cravings influence different aspects of eating behavior and dietary attitudes, and to identify indirect pathways through which these cravings affect attitudes toward dieting behaviors. Data were collected from 659 participants using validated scales that assessed dieting tendencies, bulimia and food preoccupation, culinary behaviors, food preoccupation, expectations of positive outcomes, and emotional food cravings. Descriptive statistics, Pearson's correlations, and network analysis were employed to uncover significant associations among these variables. A sequential mediation analysis was conducted using SPSS PROCESS Macro Model 6 to identify indirect pathways. The analysis revealed significant associations among the variables. Emotional food craving had a negative indirect effect on dieting attitudes through bulimia tendencies (effect size: -0.523) and a positive indirect effect through food preoccupation (effect size: 0.1006). These results highlight the complex interplay between emotional food cravings, bulimia tendencies, and food preoccupation in shaping dieting attitudes. The findings emphasize the complex dynamic between emotional food cravings, bulimia tendencies, and food preoccupation, and their collective impact on dieting attitudes. This study provides insights into potential intervention strategies aimed at improving eating habits by addressing emotional food cravings and their indirect effects on dietary behavior.

Untangling the dairy paradox: How vegetarians experience and navigate the cognitive dissonance aroused by their dairy consumption

Most people eat meat, yet report valuing the environment, animal life, and their health, which contradicts this dietary behaviour. The psychological discomfort aroused by this value-behaviour inconsistency, and the strategies meat eaters use to resolve this unpleasant state, is termed the ‘meat paradox’. Vegetarians eschew meat consumption, but the negative implications of dairy are comparable to meat. We investigated the ‘dairy paradox’ in a sample of vegetarians (N = 378) using an experimental design. Specifically, we tested whether vegetarians experienced cognitive dissonance after reading about the environmental, animal welfare, and health impacts of dairy consumption when compared to a control group not exposed to this information. Then, we examined to what extent perceiving dairy consumption as Natural, Necessary, Normal, Nice, or Neglectable, and denial of cows' mental states (Experience or Agency) predicted reduced cognitive dissonance. Vegetarians in the dissonance-induction condition reported experiencing significantly greater dissonance, though they more strongly rejected the justification strategies. Instead, they reported greater intentions to reduce their dairy consumption than vegetarians in the control condition. Rather than replicating findings from the meat paradox literature, these results suggest that vegetarians respond to uncomfortable feelings about their value-behaviour conflict with a greater intention to abandon the incongruent behaviour, rather than endorsing the cognitions that justify it. This research provides evidence that vegetarians experience a dairy paradox. Given the success of our study in shifting participants away from behavioural justification and toward behavioural change intentions, our findings can help guide the design of interventions seeking to reduce dairy consumption.

Changes in unhealthy food consumption among vulnerable elementary-aged children in the United States during the COVID-19 pandemic: a serial cross-sectional analysis.

Several studies suggest that during the early pandemic, amidst socioeconomic instability, children from underserved families were more likely to resort to consuming cheaper, lower-quality foods with longer shelf lives. This study investigated the change in unhealthy food consumption across different phases (pre, early, mid) of the COVID-19 pandemic, and whether the strength of association between unhealthy food consumption and household socioeconomic disadvantage (HSED) varied across phases of the pandemic. This study utilized serial cross-sectional data collected from low-income families enrolled in a school-based food co-op, Brighter Bites. Secondary data analysis included 5,384 surveys from families who had complete data: 3422 pre-pandemic, 944 from the early pandemic, and 1,018 mid-pandemic. Outcome measures included sugary food intake and convenience/fast food intake, each of which was operationalized as a scale using pre-validated items from the surveys. HSED was operationalized as a composite of parent employment, parent education, food insecurity, and participation in government programs; responses were categorized into low, medium, and high HSED groups for analysis. We examined the interaction between HSED and time period to explore how HSED and its association with dietary measures changed over the course of the pandemic. A significant linear negative trend, i.e., a decrease in consumption from pre-to-mid-pandemic period was seen in sugary food intake (p < 0.001), but not in convenience food intake. In data pooled across time-periods, both sugary food and convenience/fast food consumption were inversely associated with HSED, and low unhealthy food consumption was observed among high-disadvantage groups. No significant interaction between time period and HSED was observed on either scale. However, the post-regression estimates from the adjusted interaction model showed a significant association between convenience/fast food consumption and HSED in pre- and mid-pandemic periods. The study highlights the nuances of socioeconomic dynamics on the diet behaviors of children from low-income families during a natural disaster.

Dietary Behaviour of Pregnant Women in Ethiopia: The Missing Aspect of Care.

Background: Nutrition and adequate dietary intake during pregnancy strongly influence the health and well-being of the mother, as well as the physical and cognitive development of the unborn child. While previous studies have documented factors associated with the dietary behaviour of pregnant women in Ethiopia, a comprehensive overview is missing. Objective: The aim of this study was to close this research gap. Methodology: We conducted a mapping review, including 37 studies published between 2000 and 2022 in our analysis. Dietary behaviour refers to all phenomena related to food choice, eating behaviour and dietary intake. We used an innovative approach by integrating a socio-ecological framework with UNICEF's conceptual framework on maternal and child nutrition, which specifies multidimensional individual, underlying and enabling determinants associated with the nutritional status of women. Importantly, we integrated a focus on care for women and healthy environments. Results: A total of 68 factors were identified as influencing the dietary behaviour of pregnant women, with a focus on the intra- (31/68) and interpersonal (21/68) levels, while factors at the community (11/68) and the institutional levels (5/68) were scarce. Few studies investigated socio-cultural aspects, such as gender roles, decision-making power and workload of women, psychological factors and eating practices related to food taboos. None of the studies explored the influence of resources at the institutional level. Conclusions: This attests that the focus in maternal nutrition is still placed on the individual responsibility of women, instead of addressing the structural conditions that would enable women to access resources such as land, education and nutrition information.

Abstract A111: Leveraging African American women as change agents to reduce obesity-related breast cancer risk: An evaluation of a network-based pilot intervention promoting the Mediterranean diet

Abstract BACKGROUND: Obesity is a key risk factor for breast cancer (BC) incidence, recurrence, and mortality among post-menopausal African American (AA) women. Many older AA women are likely to report fewer healthy dietary behaviors, and those who are overweight or obese are likely to share similar dietary patterns as their social networks (SNs). AA women are also likely to receive information on BC risk from their SNs. Thus, AA women who share information on healthy dietary behaviors are well-positioned to become change agents toward reducing obesity and improving BC outcomes among their SNs. This presents a novel opportunity to increase the impact of evidence-based (EB) interventions focused on reducing obesity-related BC risk. This study aimed to assess the effects of the MedDiet-SN pilot intervention among participants trained as change agents to improve obesity-related BC risk reduction behaviors for themselves and their SNs through EB information sharing. Methods: MedDiet-SN was a 10-week, pre-/post- pilot intervention promoting the uptake of the Mediterranean diet, with participant training on effective EB information sharing. A community-based participant advisory board informed the pilot. Study procedures were IRB approved. Eligible participants were AA women, ≥60 years old, overweight or obese, Chicago area residents, and with no severe health conditions. Sixteen women participated, and 30 of their SN members (age ≥18 years) were recruited through participant referral. Predictors included time from pre- to post-study and session dosage for participants, and participant EB information sharing on healthy eating for SN members. Outcomes for both groups included BC and diet knowledge, dietary change attitudes (motivation, self-efficacy), dietary behavior change, and BMI. EB information sharing on healthy eating was an additional outcome for participants. Bivariate and multivariate analyses were performed to assess outcomes. Results: In crude and adjusted time models, participants showed improved knowledge, behavior change, BMI, and EB information sharing (p&amp;lt;0.05). In adjusted dosage models, participants showed improved knowledge, attitudes, and EB information sharing (p&amp;lt;0.05). SN members showed improved attitudes and behavior change based on participant EB information sharing on healthy eating (p&amp;lt;0.05). In addition, there was a high concordance between participant EB information sharing and SN EB information learned (&amp;gt;70%). CONCLUSION: This research is innovative in that it 1) shows the effectiveness of a network-based intervention promoting healthy dietary behaviors for obesity-related BC risk reduction among AA women, 2) supports the value of scaling up interventions by leveraging participants as change agents for EB information sharing among SNs, and 3) provides a contribution to emerging research on positive intervention spillover effects to SNs. It is anticipated that results from this study will inform the development of future network-based interventions that aim to reduce obesity-related BC risk and improve health outcomes for AA women. Citation Format: Nyahne Bergeron, Mona Strahan, Patricia Hardmon, Marja Stanford- Leak, Anita Stevens, Annie Young, Devyanne Ward, Lois White, Eunhye Lee, Lisa Tussing-Humphreys, Marian Fitzgibbon, Yamilé Molina. Leveraging African American women as change agents to reduce obesity-related breast cancer risk: An evaluation of a network-based pilot intervention promoting the Mediterranean diet [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A111.

The Usability and Feasibility of a Dietary Intake Self-Monitoring Application in a Population with Varying Literacy Levels.

Our aim was to study how hemodialysis patients with varying levels of literacy would use a diet and fluid intake monitoring mobile application (DIMA-P) and what would be its impact on their dietary behaviors. We developed a mobile application using user-centered methods and informed by the Integrated Theory of Health Behavior Change (ITHBC). Eight hemodialysis patients were recruited to use the application to record and monitor their diet and fluid intakes for a 6-week study. Overall, the participants had low literacy, numeracy, and technical skills. We collected the data on application usage and administered usability and context-of-use questionnaires to gain insights into the participants' interaction with the application. The participants' portion estimation skills and dietary self-regulation self-efficacy were assessed using various tests. In addition, interdialytic weight gain data were collected to assess the impact of app usage on the participants' health outcomes. The application usage patterns varied, with a general trend towards frequent use (n = 5) correlating with engagement in self-monitoring. The participants gave high comprehensibility, user-friendliness, satisfaction, and usefulness ratings, suggesting that the app was well designed and the target users could easily navigate and interact with the features. While the participants improved in estimating portion sizes, the impact on measuring skills was variable. There was also an improvement in the participants' dietary self-regulation self-efficacy post-study. The interdialytic weight gain trends indicated a slight improvement in fluid and diet management. People with different literacy skills can effectively use icon-based interfaces for portion size estimation and develop personalized usage patterns to self-regulate their fluid and dietary intakes. Moreover, they can experience an enhancement in their dietary self-efficacy skills by using a mobile application aimed at providing nutritional feedback. Furthermore, this research shows that the constructs of the ITHBC are effective in promoting dietary behavior change in a population with varying literacy skills. The target users can benefit from explicitly visualizing the relationship between their health outcomes and the factors influencing those outcomes. These user ambitions could be supported by developing machine learning models. Future research should also focus on enhancing the mechanisms by which technology can further enhance each component of the ITHBC framework.

Provider Perspectives on Techniques for Healthy Eating Promotion and Dietary Behavior Change in Caregiver-Child Dyads.

Child lifestyle behaviors are influenced by their caregivers. Targeting the caregiver-child relationship can establish healthy habits, especially healthful eating patterns, in both the caregiver and child.The purpose of this study was to identify the context for addressing strategies used to establish nutritious eating for the caregiver and child taken together as a unit (e.g., the caregiver-child dyad), through the perspectives of nutrition-promoting professionals.We performed purposive sampling of professionals who address healthful nutrition. Semi-structured qualitative interviews were conducted to elicit perspectives on caregiver-child eating dynamics and techniques to produce dietary behavior change. Data were coded through the constant comparative method, and subthemes and themes were identified by grouping similar codes and excerpts.We identified four themes relevant to dyadic dietary behavior change: (1) factors to consider when approaching nutrition such as family dynamics, (2) dyad-specific strategies for dietary behavior change, (3) patient-centered approaches professionals implement in interactions with the dyad, and (4) time as a barrier to dietary behavior change.In conclusion, study is novel in eliciting the perspectives of professionals across multiple settings to provide a context for dyadic dietary behavior change. Future studies can focus on developing training for lifestyle medicine professionals to approach dyad-specific behavior modification.