Abstract Body: Background
Feeding practices, such as using food as a reward or for emotional regulation, may impact the ability of children to develop healthy emotional coping strategies increasing the risk of weight gain. However, the association between feeding practices and behavioral cardiovascular health (bCVH) in children and adolescents is poorly understood.

Methods
We utilized data from the Young Hearts study, an ongoing cohort of children and adolescents that aims to study CVH. Parents completed surveys on CVH behaviors and a modified version of the Comprehensive Feeding Practices Questionnaire. We included all children ages 0-17 with complete baseline surveys. Feeding practice scores were calculated by summing parent-reported behaviors (0-5). We calculated a composite bCVH score by averaging scores on the four behavioral components of the American Heart Association Life’s Essential 8 (diet, physical activity, nicotine exposure, and sleep) and self-reported body mass index (all ranging from 0=poorest to 100=most ideal). We used linear regression to assess the association between feeding practices and bCVH adjusting for age, sex, race, ethnicity, and household income.

Results
Of 6,892 included children, 47.6% were female and 46% were non-Hispanic White, with an average age of 8.7 [SD 5.5] years. In adjusted models, each 1-unit higher score for food as reward and food for emotional regulation feeding practices, respectively, were associated with -2.23 (95% CI = -2.61,-1.86) and -2.81 (-3.20, -2.41) point lower bCVH scores. Among individual CVH metrics, food as reward was most strongly associated with diet (-4.90; -5.65, -4.15), whereas food for emotional regulation was most strongly associated with physical activity (-4.98; -5.90, -4.06).

Conclusion
Select feeding practices are inversely associated with multiple CVH behaviors, not just diet quality, among children and adolescents. Promoting positive emotional coping strategies in place of food may improve CVH in children and adolescents.