1
|
Melhado C, Kao E, Evans L, Stephens CQ, Lee H, Jensen AR. Evaluating Health Literacy in Families of Injured Children: A Prospective Observational Cohort Study at a Level One Pediatric Trauma Center. J Pediatr Surg 2024; 59:1315-1318. [PMID: 38614949 DOI: 10.1016/j.jpedsurg.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Low health literacy (HL) has been associated with poor health outcomes in children. Optimal recovery after pediatric injury requires caregiver participation in complicated rehabilitative and medical aftercare. We aimed to quantify HL among guardians of injured children and identify factors associated with low HL of guardians. METHODS A prospective observational cohort study was conducted to evaluate the HL using the Newest Vital Sign™ of guardians of injured children (≤18 years) admitted to a level 1 pediatric trauma center. Patient and guardian characteristics were compared across levels of HL using univariate statistics. We conducted multivariable logistic regression to identify factors independently-associated with low HL. RESULTS A sample of 95 guardian-child dyads were enrolled. The majority of guardians had low HL (n = 52, 55%), followed by moderate HL (n = 36, 38%) and high HL (n = 7, 7%). Many families received public benefits (n = 47, 49%) and 12 guardians (13%) had both housing and employment insecurity. Guardians with low HL were significantly more likely to have insecure housing and not have completed any college. CONCLUSION The majority of injured children had a primary guardian with low HL. Pediatric trauma centers should consider screening for low HL to ensure that families have adequate post-discharge support. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Caroline Melhado
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
| | - Emily Kao
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Lauren Evans
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Caroline Q Stephens
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Hanmin Lee
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Aaron R Jensen
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| |
Collapse
|
2
|
Graciosa MD, Ferronato PAM, Drezner R, de Jesus Manoel E. Emergence of locomotor behaviors: Associations with infant characteristics, developmental status, parental beliefs, and practices in typically developing Brazilian infants aged 5 to 15 months. Infant Behav Dev 2024; 76:101965. [PMID: 38875939 DOI: 10.1016/j.infbeh.2024.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 06/16/2024]
Abstract
Independent locomotion provides autonomy for infants, drastically changing their relationship with their surroundings. From a dynamic systems perspective, the interaction between environment, tasks, and organismic constraints leads to the emergence of new behaviors over time. This 6-month longitudinal study aimed to verify associations between the emergence of locomotor behaviors and infants' characteristics, developmental status, parental beliefs, and practices. This observational study remotely assessed 37 full-term Brazilian infants aged 5 to 15 months, divided into two groups (G1: 5 to 11 months, n = 19; and G2: 9 to 15 months, n = 18). The motor developmental status of infants was closely associated with the emergence of behaviors (p < 0.05). Infants in G2 whose parents agreed with the statement "In typically developing infants, motor development occurs naturally and there is no need to actively stimulate it" started to walk later than those whose parents disagreed. Infants whose parents expected them to walk around 10-11 months walked earlier compared to those expected to walk after 11 months (G2, p = 0.011). Infants in G2 with a high frequency of staying in the supine position started to walk, both with and without support, later than those with a low frequency (p < 0.05). For infants in G1 with a high frequency of playing on the floor, locomotion (p = 0.041) and crawling on hands-and-knees (p = 0.007) started sooner compared to those with a low frequency. Staying in the cradle more frequently was related to a later emergence of supported walk (p = 0.046) among infants in G2. The emergence of locomotor behaviors is associated with motor developmental status, the surfaces where the infant plays, and body position. Parental beliefs and expectations influence how infants are stimulated and, consequently, the emergence of independent walking.
Collapse
Affiliation(s)
| | - Priscilla Augusta Monteiro Ferronato
- Physical Education Course, Paulista University, Sao Paulo, Brazil; McGill University, Medical Faculty, School of Communication Science and Disorders, Montreal, Canada
| | - Rene Drezner
- School of Physical Education and Sports, University of Sao Paulo, Sao Paulo, Brazil
| | | |
Collapse
|
3
|
Díaz-Rodríguez M, Pérez-Muñoz C, Carretero-Bravo J, Santi-Cano MJ, Carrasco-Sánchez P, Barroso-Chirino C, Ferriz-Mas BC. Impact of an early 1000-day intervention for obesity prevention on adiposity and BMI at two years of age: A quasi-experimental study. J Glob Health 2023; 13:04145. [PMID: 38085237 PMCID: PMC10715455 DOI: 10.7189/jogh.13.04145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background The 1000-day period encompassing pregnancy and the first two years of postnatal life is critical for preventing childhood obesity. Existing interventions targeting this period have been characterised by great variability in duration, objectives, and evaluation indicators. We aimed to evaluate the impact of an intervention developed during the entire 1000-day period on body mass index and body fat percentage at two years of age. Methods We designed a prospective, interventional, quasi-experimental study (ie, without randomisation or blinding of both groups) targeting mother-child pairs from the beginning of pregnancy up to two years of age belonging to the basic health area of Puerto Real (Cádiz). We developed and delivered an intervention from pregnancy to two years and assessed its effect. Results The duration of breastfeeding and vitamin D supplementation increased significantly after the intervention. The intervention group showed lowed skinfolds values, a significantly lower body fat percentage, as well as a lower accumulation of factor at two years than the control group. Conclusions The intervention has had an impact on body fat percentage at two years, potentially justified through its overall effect and the lower accumulation of early risk factors.
Collapse
Affiliation(s)
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
| | - Jesús Carretero-Bravo
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | | | | | | | | |
Collapse
|
4
|
Eichner-Seitz N, Pate RR, Paul IM. Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes. Front Endocrinol (Lausanne) 2023; 14:1155925. [PMID: 37293499 PMCID: PMC10244791 DOI: 10.3389/fendo.2023.1155925] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.
Collapse
Affiliation(s)
- Natalie Eichner-Seitz
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ian M. Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| |
Collapse
|
5
|
Pedersen MRL, Ibsen B, Dinkel D, Møller NC, Hestbæk L. The Effect of a Parent-Directed Program to Improve Infants' Motor Skills. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1999. [PMID: 36767365 PMCID: PMC9916076 DOI: 10.3390/ijerph20031999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Poor motor skills are associated with several factors that might delay children's development. Therefore, early programs to promote a child's motor development are essential. Within the first year of life, parents have a critical role in promoting their infant's motor development. However, little research has explored parent-directed programs that promote infant development in a Scandinavian context. This study aimed to evaluate the effectiveness of a parent-directed program to improve infant motor development. METHODS Parents of infants received a parent-directed program that included guidance from health visitors on ways to promote motor development, videos with motor development activities and a bag with related materials. Two municipalities in Denmark took part in the study (one intervention, one control). Health visitors in both municipalities measured the infants' age-appropriate motor skills once when the infants were between 9-11 months of age. A logistic regression model was used to analyze the data. RESULTS No difference was detected in motor development over time in the two municipalities regarding the proportion of children with age-appropriate motor skills. CONCLUSIONS A parent-directed program in which parents were guided to play and encourage motor development with their infant showed no effect on infants' age-appropriate motor skills at 9-11 months.
Collapse
Affiliation(s)
- Marlene Rosager Lund Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Bjarne Ibsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Danae Dinkel
- School of Health and Kinesiology, College of Education, Health, and Human Sciences, University of Nebraska at Omaha, H & K Building, 6001 Dodge Street, Omaha, NE 68182, USA
| | - Niels Christian Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Lise Hestbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| |
Collapse
|
6
|
Lioret S, Harrar F, Boccia D, Hesketh KD, Kuswara K, Van Baaren C, Maritano S, Charles MA, Heude B, Laws R. The effectiveness of interventions during the first 1,000 days to improve energy balance-related behaviors or prevent overweight/obesity in children from socio-economically disadvantaged families of high-income countries: a systematic review. Obes Rev 2023; 24:e13524. [PMID: 36394375 PMCID: PMC10078443 DOI: 10.1111/obr.13524] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance-related behaviors or prevent overweight/obesity in children from families experiencing socio-economic disadvantage. We identified 24 interventions, from 33 articles, since 1990. Overall, despite their heterogeneity and variability in internal and external validity, there was some evidence of beneficial impact of interventions on obesity risk (4/15), and associated behaviors, e.g.: breastfeeding (9/18), responsive feeding (11/16), diet (7/8), sedentary (1/3) and movement (4/7) behaviors, and sleep (1/2). The most effective interventions aimed at promoting breastfeeding commenced antenatally; this was similar for the prevention of obesity, provided the intervention continued for at least 2 years postnatally and was multi-behavioral. Effective interventions were more likely to target first-time mothers and involve professional delivery agents, multidisciplinary teams and peer groups. Among ethnic/racial minorities, interventions delivered by lay agents had some impact on dietary behavior but not weight outcomes. Co-creation with stakeholders, including parents, and adherence to theoretical frameworks were additional ingredients for more pragmatic, inclusive, non-judgmental, and effective programs. The growing body of evidence on obesity prevention interventions targeting families experiencing socio-economic disadvantage is promising for reducing early inequalities in obesity risk.
Collapse
Affiliation(s)
| | - Faryal Harrar
- Université Paris Cité, INSERM, INRAE, CRESS, Paris, France
| | - Delia Boccia
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Konsita Kuswara
- Department of Medical Sciences, Università di Torino, Cancer Epidemiology Unit, Turin, Italy
| | | | - Silvia Maritano
- Department of Medical Sciences, Università di Torino, Cancer Epidemiology Unit, Turin, Italy
| | | | - Barbara Heude
- Université Paris Cité, INSERM, INRAE, CRESS, Paris, France
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| |
Collapse
|
7
|
Daiani Graciosa M, Augusta Monteiro Ferronato P, Ribeiro de Lima AA, Cristina da Silva Pacheco S, Gerdi Kittel Ries L, de Jesus Manoel E. Brazilian Mother’s Practice on Infant Body Position From Birth to 6 Months Old. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There is a gap in the understanding of what has been recommended by health professionals to Brazilian mothers regarding infant body positioning whereas the description of this parenting practice can provide criteria for guidance programs already in the maternity ward. This study aimed to record the time (hours/day) Brazilian mothers reported that their infants spent awake or sleeping in 1 of the four body postures: Prone, supine, lateral positions and sitting. The second aim of this study was to verify whether this reported time was associated with birth weight, gestational age, infant chronological age and maternal age. A cross sectional study assessed 92 mothers divided into six groups according to the age of their full-term infant, in months (Mth): 1 Mth (n= 15), 2 Mth (n= 15), 3 Mth (n= 15), 4 Mth (n= 15), 5 Mth (n= 17), and 6 Mth (n= 15). Mothers registered in a 24-hour schedule the most frequent positioning of each infant in 1 day based on the week prior to the assessment day. Infant chronological age was associated with time spent in positions reported by mothers (p< .05). 47.8% of mothers stated not placing infants in prone position anytime in the awake period. Some mothers reported that the infant slept in the prone position. Brazilian caregivers still need to be alerted that the practice of not placing infants to lay in prone might hinder developmental opportunities for them, as well as, on the risks of SIDS and the importance of supine position for infants to sleep.
Collapse
|
8
|
White MJ, Kay MC, Truong T, Green CL, Yin HS, Flower KB, Rothman RL, Sanders LM, Delamater AM, Duke NN, Perrin EM. Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors. Acad Pediatr 2022; 22:1429-1436. [PMID: 35227910 PMCID: PMC10078964 DOI: 10.1016/j.acap.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors. METHODS Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics. RESULTS Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support. CONCLUSIONS Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.
Collapse
Affiliation(s)
- Michelle J White
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC.
| | - Melissa C Kay
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC; Duke Global Digital Health Science Center (MC Kay), Duke University, Durham, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Hsiang Shonna Yin
- Departments of Pediatrics and Population Health (HS Yin), New York University Grossman School of Medicine, New York, NY
| | - Kori B Flower
- University of North Carolina at Chapel Hill School of Medicine (KB Flower), Chapel Hill, NC
| | - Russell L Rothman
- Department of Pediatrics (RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn
| | - Lee M Sanders
- Departments of Pediatrics and Health Policy (LM Sanders), Stanford University, Stanford, Calif
| | - Alan M Delamater
- Mailman Center for Child Development (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Naomi N Duke
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins Schools of Medicine and Nursing, Baltimore, Md
| |
Collapse
|
9
|
Pedersen MRL, Hansen AF. Interventions by Caregivers to Promote Motor Development in Young Children, the Caregivers' Attitudes and Benefits Hereof: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11543. [PMID: 36141815 PMCID: PMC9517187 DOI: 10.3390/ijerph191811543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
In the first year of life, the child's caregivers, including parents and daycare staff, play an essential role, as they are responsible for implementing daily activities to promote the motor development of young children. However, what does the research show about interventions to promote the motor development of 0-36-month-olds carried out by the child's caregivers, and what are the caregivers' experiences and attitudes hereof? This scoping review aims to provide an overview of the published studies to derive an overall interpretation. A systematic search was conducted in five scientific databases, resulting in 10,219 articles, of which 9 met the inclusion criteria. The results indicate that providing early intervention to 0-36-month-old children, in which the caregivers carry out the activities, promotes the young child's motor development. Furthermore, the interventions increase the caregivers' interest and motivation to promote the young child's motor development, which is essential in maintaining the behaviour after the end of the interventions. Supervision and guidance provided for the child's caregivers concerning knowledge and skills about age-appropriate behaviours and facilitation of their child's motor development increases the caregivers' self-confidence, interest, and motivation.
Collapse
Affiliation(s)
- Marlene Rosager Lund Pedersen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anne Faber Hansen
- Department of Research and Analysis, University Library of Southern Denmark, 5230 Odense M, Denmark
| |
Collapse
|
10
|
Hewitt L, Frohmuller C, Wen LM, Okely AD. Effect of a multicomponent intervention in postnatal mothers' groups on meeting the Australian Physical Activity Guidelines for infants: protocol for a randomised controlled trial. BMJ Open 2022; 12:e054183. [PMID: 35440448 PMCID: PMC9020305 DOI: 10.1136/bmjopen-2021-054183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Given the importance of tummy time and the low levels of tummy time reported globally, there is a need for high-quality intervention strategies to promote tummy time. This study describes the protocol of a randomised controlled trial that aims to determine the effectiveness of a multicomponent intervention delivered in postnatal mothers' groups in increasing infant tummy time. METHODS AND ANALYSIS A randomised controlled trial will be conducted. Eligible participants will be mothers and their infants attending postnatal mothers' groups (New South Wales, Australia). Participants will be randomised to participate in either (1) infant tummy time intervention group (practice, education, WhatsApp) plus usual care; or (2) usual care group. Randomisation process and outcome assessors will be blinded. The intervention will comprise an online education and practice session (60 min) and 4 weeks of WhatsApp messaging (standardised, three times per week). Usual care will be attendance at a mothers group once per week for 3 weeks for information and support for ad hoc mother craft activities (standard practice provided by early childhood nurses for this local health district). The primary outcome will be the amount of infant tummy time using the GENEActiv accelerometer and a questionnaire (post intervention). The accelerometer will be worn on the right hip secured by an elastic belt around the waist. Wear and non-wear time will be classified using temperature and z-axis cut points as per previous research. This protocol paper presents the scientific background and proposed methods of the randomised controlled trial. Findings will inform the design of practically based strategies to inform clinicians, educators and parents about infant physical activity. ETHICS AND DISSEMINATION The University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee approved the study (2020/ETH02970). Dissemination plan is publication, staff training and conference presentations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12621000575831; Pre-results.
Collapse
Affiliation(s)
- Lyndel Hewitt
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Carolyn Frohmuller
- Kids and Families, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Preventive Research Collaboration, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Anthony D Okely
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
11
|
Zachry AH, Woods L. Using the Theoretical Domains Framework and the Behavior Change Wheel to Design a Tummy Time Intervention. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2022. [DOI: 10.1080/19411243.2022.2048429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anne H. Zachry
- Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lauren Woods
- Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
12
|
Fang Y, Lian Y, Yang Z, Duan Y, He Y. Associations between Feeding Patterns and Infant Health in China: A Propensity Score Matching Approach. Nutrients 2021; 13:4518. [PMID: 34960071 PMCID: PMC8706916 DOI: 10.3390/nu13124518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Breastmilk is the optimal food for infants. Feeding pattern is closely related to physical development and health during infancy. Understanding the associations between feeding patterns and health status can inform related policy interventions and advocacy in China. This study aimed to investigate the relationship between infant feeding patterns and health status in China infants. The China National Nutrition and Health Surveillance 2013 was a national-representative cross-sectional study performed particularly for children aged 0-5 years. A total of 3974 infants aged under 1 year were included in the analysis, of whom 1082 (27.2%) made up the formula feeding group, and 2892 (72.8%) made up the breastfeeding group. The associations between feeding patterns and physical development and health were investigated using propensity score matching and multivariable logistic regression models. Among breastfeeding and formula feeding infants aged 9-11 months old, weight-for-age z score was 1.1 ± 1.1 and 0.9 ± 1.3, respectively, and weight-for-length z score was 1.0 ± 1.3 and 0.7 ± 1.4, respectively. Hemoglobin in 0-2, 3-5, 6-8, and 9-11 months old breastfeeding infants was 121.4 ± 15.2 g/L, 117.1 ± 13.0 g/L, 113. 9 ± 11.9 g/L, and 114.4 ± 14.0 g/L, while in 0-2, 3-5, 6-8, and 9-11 months formula feeding infants was 116.3 ± 14.8 g/L, 120.4 ± 11.3 g/L, 119.8 ± 11.2 g/L, and 120.0 ± 11.5 g/L, respectively. Breastfeeding was associated with lower risk of respiratory disease (OR: 0.79; 95% CI: 0.64, 0.99) and diarrhea (OR: 0.75; 95% CI: 0.57, 0.98). Breastfeeding could slightly improve infant physical development, and had a protective effect on the diarrheal and respiratory diseases. Infants aged 3-11 months who were breastfeeding showed lower hemoglobin than that of formula-fed infants and thus should increase intake of iron rich complementary foods.
Collapse
Affiliation(s)
| | | | | | | | - Yuna He
- Key Laboratory of Trace Element Nutrition of National Health and Family Planning Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Xicheng District, Beijing 100050, China; (Y.F.); (Y.L.); (Z.Y.); (Y.D.)
| |
Collapse
|
13
|
Hospodar CM, Hoch JE, Lee DK, Shrout PE, Adolph KE. Practice and proficiency: Factors that facilitate infant walking skill. Dev Psychobiol 2021; 63:e22187. [PMID: 34674233 DOI: 10.1002/dev.22187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 01/07/2023]
Abstract
Infant walking skill improves with practice-crudely estimated by elapsed time since walk onset. However, despite the robust relation between elapsed time (months walking) and skill, practice is likely constrained and facilitated by infants' home environments, sociodemographic influences, and spontaneous activity. Individual pathways are tremendously diverse in the timing of walk onset and the trajectory of improvement, and presumably, in the amount and type of practice. So, what factors affect the development of walking skill? We examined the role of months walking, walk onset age, spontaneous locomotor activity, body dimensions, and environmental factors on the development of walking skill in two sociodemographically distinct samples (ns = 38 and 44) of 13-, 15-, and 19-month-old infants. Months walking best predicted how well infants walked, but environmental factors and spontaneous activity explained additional variance in walking skill. Specifically, less crowded homes, a larger percentage of time in spontaneous walking, and a smaller percentage of short walking bouts predicted more mature walking. Walk onset age differed by sample but did not affect walking skill. Findings indicate that elapsed time since walk onset remains a robust predictor of walking skill, but environmental factors and spontaneous activity also contribute to infants' practice, thereby affecting walking skill.
Collapse
Affiliation(s)
| | - Justine E Hoch
- Department of Psychology, New York University, New York, New York, USA
| | - Do Kyeong Lee
- Department of Kinesiology, California State University, Fullerton, California, USA
| | - Patrick E Shrout
- Department of Psychology, New York University, New York, New York, USA
| | - Karen E Adolph
- Department of Psychology, New York University, New York, New York, USA
| |
Collapse
|
14
|
Pawellek M, Kopf FM, Egger N, Dresch C, Matterne U, Brandstetter S. Pathways linking parental health literacy with health behaviours directed at the child: a scoping review. Health Promot Int 2021; 37:6403923. [PMID: 34668013 DOI: 10.1093/heapro/daab154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.
Collapse
Affiliation(s)
- Maja Pawellek
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Felicitas Maria Kopf
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Nina Egger
- Department of Public Health and Health Education, Freiburg University of Education, Kunzenweg 21, Freiburg 79117, Germany
| | - Carolin Dresch
- Department of Research Methods, Freiburg University of Education, Kunzenweg 21, Freiburg 79117, Germany
| | - Uwe Matterne
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Leipziger Str. 44, Magdeburg 39120, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| |
Collapse
|
15
|
A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time. J Phys Act Health 2021; 18:1215-1222. [PMID: 34380110 DOI: 10.1123/jpah.2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants' health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. METHODS A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. RESULTS Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08-2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. CONCLUSIONS Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.
Collapse
|
16
|
Melwani S, Cleland V, Patterson K, Nash R. A scoping review: global health literacy interventions for pregnant women and mothers with young children. Health Promot Int 2021; 37:6322401. [PMID: 34269394 DOI: 10.1093/heapro/daab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization is focused on enhancing health literacy (HL) throughout the life-course to address the growing burden of non-communicable diseases (NCDs) globally. Pregnancy and early motherhood offer a window of opportunity to address NCDs risk earlier in the life-course. Empowering women through HL may help to reduce the intergenerational impact of NCDs. A scoping review of the international literature was conducted to identify HL interventions that focused on improving NCD-related health outcomes or health behaviors of pregnant women and/or mothers with young children. The search was conducted on 4 databases and identified 5019 articles. After full text screening, 25 studies met the inclusion criteria. No study acknowledged their intervention as an HL intervention, even though they were assessed as targeting various HL dimensions. Only one study measured the HL of mothers. The review suggests that HL interventions are being underutilized and highlight the need to create awareness about the importance of addressing HL of pregnant women and mothers using appropriate tools to understand HL strengths and challenges in achieving healthy lifestyle practices. This can help to co-design locally responsive solutions that may enable women to make informed healthier lifestyle choices for themselves and for their children and thus may accelerate prevention of NCDs globally.
Collapse
Affiliation(s)
- Satish Melwani
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Kira Patterson
- School of Education, College of Arts, Law and Education, University of Tasmania, Launceston, TAS 7250, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| |
Collapse
|
17
|
Vandyousefi S, Gross RS, Katzow MW, Scott MA, Messito MJ. Infant and Early Child Appetite Traits and Child Weight and Obesity Risk in Low-Income Hispanic Families. J Acad Nutr Diet 2021; 121:2210-2220. [PMID: 33994142 DOI: 10.1016/j.jand.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Child appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight. OBJECTIVE To determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children. DESIGN A secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial. PARTICIPANTS/SETTING Three hundred twenty-two low-income, Hispanic mother-child pairs enrolled between 2012 and 2014 in a public hospital in New York City. MAIN OUTCOME MEASURES ATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years. STATISTICAL ANALYSES PERFORMED AT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years. RESULTS There was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = -0.18, 95% CI -0.33 to -0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = -0.29, 95% CI -0.47 to -0.12; P < 0.01; B = -0.36, 95% CI -0.55 to -0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = -0.74, 95% CI -1.18 to -0.2 [Slowness in Eating]; B = -1.19, 95% CI -1.87 to -0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002). CONCLUSIONS Infants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.
Collapse
|
18
|
Sanders LM, Perrin EM, Yin HS, Delamater AM, Flower KB, Bian A, Schildcrout JS, Rothman RL. A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-049866. [PMID: 33911032 PMCID: PMC8086006 DOI: 10.1542/peds.2020-049866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months. METHODS In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score). RESULTS A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively. CONCLUSIONS The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
Collapse
Affiliation(s)
- Lee M. Sanders
- Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California
| | - Eliana M. Perrin
- Division of Primary Care and Duke Center for Childhood Obesity Research, Department of Pediatrics, Medical Center, Duke University, Durham, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University and Department of Pediatrics, Bellevue Hospital Center, New York City, New York
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, Florida
| | | | - Aihua Bian
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan S. Schildcrout
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | | |
Collapse
|
19
|
Pesch MH, Levitt KJ, Danziger P, Orringer K. Pediatrician's Beliefs and Practices Around Rapid Infant Weight Gain: A Qualitative Study. Glob Pediatr Health 2021; 8:2333794X21992164. [PMID: 33614855 PMCID: PMC7874340 DOI: 10.1177/2333794x21992164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/29/2020] [Accepted: 01/14/2021] [Indexed: 01/11/2023] Open
Abstract
Rapid infant weight gain is a risk factor for later obesity. The objective of this study was to examine primary care pediatricians’ beliefs and practices around rapid infant weight gain. Primary care pediatricians (N = 16) participated in a semi-structured interview about infant growth. Interviews were transcribed, analyzed for themes using the grounded theory and the constant comparative method then reliably coded for the presence of each theme. Three themes were identified, pediatricians (1) are uncertain about the concept, definition, and implications of excessive or rapid infant weight gain (N = 16, 100%), (2) are more comfortable with management of inadequate versus excessive or rapid weight gain (N = 10, 62.5%), and (3) perceive the primary cause of excessive or rapid infant weight gain to be overfeeding (N = 10, 62.5%). In conclusion, pediatricians are uncertain about the concept, definition, management, and long-term risks of rapid infant weight gain. Interventions to increase awareness and pediatrician sense of competence in management of rapid infant weight gain are needed.
Collapse
|
20
|
Hewitt L, Stephens S, Spencer A, Stanley RM, Okely AD. Weekly group tummy time classes are feasible and acceptable to mothers with infants: a pilot cluster randomized controlled trial. Pilot Feasibility Stud 2020; 6:155. [PMID: 33072396 PMCID: PMC7556919 DOI: 10.1186/s40814-020-00695-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The World Health Organization recommends 30 min of tummy time daily for improved motor development and reduced likelihood of plagiocephaly. As only 30% of infants meet this recommendation, parents require strategies and support to increase this proportion. METHODS The aim of this study was to determine the feasibility, acceptability, and potential efficacy of a group intervention to promote tummy time. The design is a cluster randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Five groups of healthy infants (N = 35, baseline mean (SD) age 5.9 (2.8) weeks) and their mothers attending local mother's groups (Australia) were randomly allocated to the intervention or control group. The intervention group received group tummy time classes in addition to usual care. The control group received usual care with their child and family health nurse. Primary outcomes were intervention feasibility and acceptability. Secondary outcomes were tummy time duration (accelerometry), adherence to physical activity guidelines, head shape, and motor development. Measures were taken at baseline, post-intervention, and when infants were 6 months of age. Analyses were by linear mixed models and Cohen's d statistic. RESULTS Recruitment, retention, and collection of objective data met feasibility targets. Acceptability was also met with intervention mothers reporting the information, goal planning, and handouts significantly more useful and relevant than control group mothers (p < 0.01). Moderate effect sizes were also found at post-intervention for tummy time duration, adherence to physical activity guidelines and infant ability in prone and supine favoring the intervention group (intervention infants had a mean of 30 min and 30% adherence to guidelines (95% CI 0 to 60.6 min) compared to the control infants who had a mean of 16.6 min and 13% adherence to the guidelines (95% CI 0 to 42.1 min, Cohen's d = 0.5). Limitations were the small sample size, 4-week intervention, limited accelerometer use, and a homogenous sample of participants. CONCLUSION Group tummy time classes delivered in a mother's group setting were shown to be feasible and acceptable. A larger randomized controlled trial is warranted. TRIAL REGISTRATION ANZCTR, ACTRN12617001298303p. Registered 11 September 2017.
Collapse
Affiliation(s)
- Lyndel Hewitt
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2500 Australia
- Illawarra Shoalhaven Local Health District, Illawarra and Shoalhaven Regions, New South Wales Australia
| | - Samantha Stephens
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia
- Illawarra Shoalhaven Local Health District, Illawarra and Shoalhaven Regions, New South Wales Australia
| | - Abbe Spencer
- Illawarra Shoalhaven Local Health District, Illawarra and Shoalhaven Regions, New South Wales Australia
| | - Rebecca M. Stanley
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2500 Australia
| | - Anthony D. Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2500 Australia
| |
Collapse
|
21
|
Messito MJ, Mendelsohn AL, Katzow MW, Scott MA, Vandyousefi S, Gross RS. Prenatal and Pediatric Primary Care-Based Child Obesity Prevention Program: A Randomized Trial. Pediatrics 2020; 146:e20200709. [PMID: 32883807 PMCID: PMC7546096 DOI: 10.1542/peds.2020-0709] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families. METHODS A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age z-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects. RESULTS Pregnant women (n = 566) were enrolled in the third trimester; 533 randomized to intervention (n = 266) or control (n = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, P = .04) and 2 years (0.56 vs 0.81, P = .03) but not at 3 years (0.63 vs 0.59, P = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, P = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, P = .02) decreased as attendance increased with low, medium, and high attendance. CONCLUSIONS Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.
Collapse
Affiliation(s)
| | - Alan L Mendelsohn
- Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine and
| | - Michelle W Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York; and
| | | | | |
Collapse
|
22
|
Messito MJ, Katzow MW, Mendelsohn AL, Gross RS. Starting Early Program Impacts on Feeding at Infant 10 Months Age: A Randomized Controlled Trial. Child Obes 2020; 16:S4-S13. [PMID: 31934788 PMCID: PMC7469695 DOI: 10.1089/chi.2019.0236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Disparities in obesity-promoting feeding patterns begin in pregnancy and infancy, underscoring the need for early primary prevention in high-risk groups. We sought to determine the impact of a primary care-based child obesity prevention intervention beginning during pregnancy on maternal infant feeding practices, knowledge, and styles at 10 months in low-income Hispanic families. Methods: The Starting Early Program (StEP) randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomized to standard care or an intervention with prenatal/postpartum individual nutrition counseling and nutrition and parenting support groups coordinated with pediatric visits. Feeding practices (breastfeeding, family meals, juice, and cereal in the bottle) were assessed using questions from the Infant Feeding Practices Study II. Feeding styles were assessed using the Infant Feeding Style Questionnaire. We analyzed impacts on feeding practices, knowledge, and styles using regression analyses adjusting for covariates. Results: Four hundred twelve mothers completed 10-month assessments. Intervention mothers were more likely to give breast milk as the only milk source [adjusted odds ratio (AOR) 1.65, 95% confidence interval (CI) 1.06-2.58] and have daily family meals (AOR 1.91, 95% CI 1.19-3.05), and less likely to give juice (AOR 0.60, 95% CI 0.39-0.92) or cereal in the bottle (AOR 0.54, 95% CI 0.30-0.97) compared to controls. Intervention mothers were more likely to exhibit lower pressuring, indulgent and laissez-faire feeding styles, and to have higher knowledge. Attending a greater number of group sessions increased intervention impacts. Conclusions: StEP led to reduced obesity-promoting feeding practices and styles, and increased knowledge and provides great potential for population-scalability.
Collapse
Affiliation(s)
- Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY, USA.,Address correspondence to: Mary Jo Messito, MD, Division of Pediatrics, Department of Pediatrics, New York University School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Michelle W. Katzow
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
23
|
Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy Time and Infant Health Outcomes: A Systematic Review. Pediatrics 2020; 145:peds.2019-2168. [PMID: 32371428 DOI: 10.1542/peds.2019-2168] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation. OBJECTIVE To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes. DATA SOURCES Electronic databases were searched between June 2018 and April 2019. STUDY SELECTION Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms). DATA EXTRACTION Two reviewers independently extracted data and assessed their quality. RESULTS Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication. LIMITATIONS Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present. CONCLUSIONS These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.
Collapse
Affiliation(s)
- Lyndel Hewitt
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Erin Kerr
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Rebecca M Stanley
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| |
Collapse
|
24
|
Felzer-Kim IT, Erickson K, Adkins C, Hauck JL. Wakeful Prone "Tummy Time" During Infancy: How Can We Help Parents? Phys Occup Ther Pediatr 2020; 40:651-668. [PMID: 32192403 DOI: 10.1080/01942638.2020.1742847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS This study's purpose is to present facilitators and barriers for wakeful prone positioning or "tummy time" during infancy by exploring the personal perspectives of infant caregivers attempting to provide daily tummy time. METHODS The study was qualitative in design, using thematic analysis to identify major and minor themes from semi-structured interviews. The Capability, Opportunity, Motivation - Behavior Model provided a conceptual framework for the interview guide and categorization of major themes. RESULTS Within capability, opportunity, and motivation, the major themes of self-efficacy, scheduling, variations, siblings, committed adult help, social responses of acquaintances, and caregiver enjoyment could be barriers or facilitators, depending on the context. Optimized physical circumstances, caregiver interest, perceived benefits to the infant, pride and accomplishment, and obligation were identified as facilitators only. Barriers included negative infant affect. CONCLUSIONS These results offer preliminary guidance in a knowledge gap: tummy time support that addresses the self-identified concerns of infant caregivers.
Collapse
Affiliation(s)
| | - Karl Erickson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Chelsea Adkins
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Janet L Hauck
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
25
|
Hennessy M, Heary C, Laws R, Van Rhoon L, Toomey E, Wolstenholme H, Byrne M. Health professional-delivered obesity prevention interventions during the first 1,000 days: A systematic review of external validity reporting. HRB Open Res 2019. [PMID: 32002513 DOI: 10.12688/hrbopenres.12924.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Childhood obesity prevention interventions delivered by health professionals during the first 1,000 days show some evidence of effectiveness, particularly in relation to behavioural outcomes. External validity refers to how generalisable interventions are to populations or settings beyond those in the original study. The degree to which external validity elements are reported in such studies is unclear however. This systematic review aimed to determine the extent to which childhood obesity interventions delivered by health professionals during the first 1,000 days report on elements that can be used to inform generalizability across settings and populations. Methods: Eligible studies meeting study inclusion and exclusion criteria were identified through a systematic review of 11 databases and three trial registers. An assessment tool based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to assess the external validity of included studies. It comprised five dimensions: reach and representativeness of individuals, reach and representativeness of settings, implementation and adaptation, outcomes for decision making maintenance and/or institutionalisation. Two authors independently assessed the external validity of 20% of included studies; discrepancies were resolved, and then one author completed assessments of the remaining studies. Results: In total, 39 trials involving 46 interventions published between 1999 and 2019 were identified. The majority of studies were randomized controlled trials (n=24). Reporting varied within and between dimensions. External validity elements that were poorly described included: representativeness of individuals and settings, treatment receipt, intervention mechanisms and moderators, cost effectiveness, and intervention sustainability and acceptability. Conclusions: Our review suggests that more emphasis is needed on research designs that consider generalisability, and the reporting of external validity elements in early life childhood obesity prevention interventions. Important gaps in external validity reporting were identified that could facilitate decisions around the translation and scale-up of interventions from research to practice. Registration: PROSPERO CRD42016050793 03/11/16.
Collapse
Affiliation(s)
- Marita Hennessy
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Luke Van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Hazel Wolstenholme
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| |
Collapse
|
26
|
Abstract
Health literacy is an important issue to consider in the provision of health-care to children. Similar to the adult population, most parents face health literacy challenges. Of particular concern, 1 in 4 parents have low health literacy, greatly affecting their ability to use health information to make health decisions for their child. High expectations are placed on parents and children to achieve effective disease management and positive health outcomes in the context of complex health-care systems and disease treatment regimens. Low health literacy affects parent acquisition of knowledge, attitudes, and behaviors, as well as child health outcomes across the domains of disease prevention, acute illness care, and chronic illness care. The effect of low health literacy is wide ranging, including 1) poor nutrition knowledge and behaviors, 2) higher obesity rates, 3) more medication errors, 4) more emergency department use, and 5) poor asthma knowledge, behaviors, and outcomes. Health-care providers can mitigate the effects of health literacy by seeking to align health-care demands with the health literacy skills of families. Effective health literacy-informed interventions provide insights into methods that can be used by providers and health systems to improve health outcomes. Health literacy-informed communication strategies should be used with all families in a "universal precautions approach" because all parents likely benefit from clear communication. As scientific advances are made in disease prevention and management, unless families understand how to follow provider recommendations, the benefit of these advances will not be realized and disparities in outcomes will be exacerbated.
Collapse
Affiliation(s)
- Andrea K Morrison
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - H Shonna Yin
- Department of Pediatrics and.,Department of Population Health, New York University School of Medicine/NYU Langone Health, New York, NY
| |
Collapse
|
27
|
Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, Gross R, Katzow M, Jay M, Razavian N, Elbel B. Predicting childhood obesity using electronic health records and publicly available data. PLoS One 2019; 14:e0215571. [PMID: 31009509 PMCID: PMC6476510 DOI: 10.1371/journal.pone.0215571] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 04/05/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Because of the strong link between childhood obesity and adulthood obesity comorbidities, and the difficulty in decreasing body mass index (BMI) later in life, effective strategies are needed to address this condition in early childhood. The ability to predict obesity before age five could be a useful tool, allowing prevention strategies to focus on high risk children. The few existing prediction models for obesity in childhood have primarily employed data from longitudinal cohort studies, relying on difficult to collect data that are not readily available to all practitioners. Instead, we utilized real-world unaugmented electronic health record (EHR) data from the first two years of life to predict obesity status at age five, an approach not yet taken in pediatric obesity research. METHODS AND FINDINGS We trained a variety of machine learning algorithms to perform both binary classification and regression. Following previous studies demonstrating different obesity determinants for boys and girls, we similarly developed separate models for both groups. In each of the separate models for boys and girls we found that weight for length z-score, BMI between 19 and 24 months, and the last BMI measure recorded before age two were the most important features for prediction. The best performing models were able to predict obesity with an Area Under the Receiver Operator Characteristic Curve (AUC) of 81.7% for girls and 76.1% for boys. CONCLUSIONS We were able to predict obesity at age five using EHR data with an AUC comparable to cohort-based studies, reducing the need for investment in additional data collection. Our results suggest that machine learning approaches for predicting future childhood obesity using EHR data could improve the ability of clinicians and researchers to drive future policy, intervention design, and the decision-making process in a clinical setting.
Collapse
Affiliation(s)
- Robert Hammond
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
| | - Rodoniki Athanasiadou
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
| | - Silvia Curado
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Cell Biology, NYU School of Medicine, New York, New York, United States of America
| | - Yindalon Aphinyanaphongs
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Courtney Abrams
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Mary Jo Messito
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital Center, New York, New York, United States of America
| | - Rachel Gross
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital Center, New York, New York, United States of America
| | - Michelle Katzow
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital Center, New York, New York, United States of America
| | - Melanie Jay
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
- Department of Medicine, NYU School of Medicine, New York, New York, United States of America
| | - Narges Razavian
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
- Department of Radiology, NYU School of Medicine, New York, New York, United States of America
| | - Brian Elbel
- NYU Langone Comprehensive Program on Obesity, NYU School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
- NYU Wagner Graduate School of Public Service, New York, New York, United States of America
| |
Collapse
|
28
|
Hewitt L, Stanley RM, Cliff D, Okely AD. Objective measurement of tummy time in infants (0-6 months): A validation study. PLoS One 2019; 14:e0210977. [PMID: 30811395 PMCID: PMC6392225 DOI: 10.1371/journal.pone.0210977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/04/2019] [Indexed: 01/01/2023] Open
Abstract
The 2017 Australian and Canadian 24-hour movement guidelines recommend infants receive 30 minutes of tummy time daily. Currently, there are no validated objective measurement tools or devices to assess tummy time. The purpose of this study was to: 1) test the practicality of using devices on infants as an objective measure of tummy time, and 2) test the accuracy of developed algorithms and cut-points for predicting prone posture. Thirty-two healthy infants aged 4 to 25 weeks completed a protocol of 12 positions. Infants were placed in each position for 3 minutes while wearing a MonBaby (chest), GENEActiv (right hip) and two ActiGraphs (right hip and ankle). Direct observation was the criterion measure. The accuracy of the algorithms or cut-points to predict prone on floor, non-prone and prone supported positions were analyzed. Parents also completed a practicality questionnaire. Algorithms and cut-points to classify posture using devices from MonBaby, GENEActiv and ActiGraph (hip and ankle) were 79%, 95%, 90% and 88% accurate at defining tummy time and 100%, 98%, 100% and 96% accurate at defining non-prone positions, respectively. GENEActiv had the smallest mean difference and limits of agreement (-8.4s, limits of agreement [LoA]: -78.2 to 61.3s) for the prone on floor positions and ActiGraph Hip had the smallest mean difference and LoA for the non-prone positions (-0.2s, LoA: -1.2 to 0.9s). The majority of parents agreed all devices were practical and feasible to use with MonBaby being the preferred device. The evaluated algorithms and cut-points for GENEActiv and ActiGraph (hip) are of acceptable accuracy to objectively measure tummy time (time spent prone on floor). Accurate measurement of infant positioning practices will be important in the observation of 24-hour movement guidelines in the early years.
Collapse
Affiliation(s)
- Lyndel Hewitt
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
| | - Rebecca M. Stanley
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
| | - Dylan Cliff
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
| | - Anthony D. Okely
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
| |
Collapse
|
29
|
Koren A, Kahn-D'angelo L, Reece SM, Gore R. Examining Childhood Obesity From Infancy: The Relationship Between Tummy Time, Infant BMI-z, Weight Gain, and Motor Development-An Exploratory Study. J Pediatr Health Care 2019; 33:80-91. [PMID: 30131199 DOI: 10.1016/j.pedhc.2018.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/09/2018] [Accepted: 06/16/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION This exploratory study investigated the infant time spent in tummy time (TT) in relation to body mass index z score (BMI-z), weight gain, and motor development in infants from birth to 4 months. METHOD Mothers and their infants were telephone surveyed at 2 and 4 months. Mother demographics; TT; feeding practices; and infant length, and height, and development were collected each time. RESULTS Results from Cochran-Mantel-Haenszel and single logistic regression showed a significant association between development, level of BMI-z, and time spent in TT at 2 months of age (p < .0001). The threshold model showed there was a decline in BMI-z at 4 months as daily time in TT increases past the threshold value of approximately 12 minutes per day. Mother education and TT at 2 months were significant predictors of BMI-z at 4 months. DISCUSSION Study outcomes suggest that infant positioning and time in TT promote infant motor development and may moderate rapid infant weight gain.
Collapse
Affiliation(s)
- Ainat Koren
- Ainat Koren, Associate Professor, Susan and Alan Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA..
| | - Linda Kahn-D'angelo
- Linda Kahn-D'angelo, Professor, Department of Physiotherapy, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA
| | - Susan M Reece
- Susan M. Reece, Professor Emeritus, Susan and Alan Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA
| | - Rebecca Gore
- Rebecca Gore, Senior Biostatistician, School of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA
| |
Collapse
|
30
|
Gross RS, Mendelsohn AL, Messito MJ. Prenatal Material Hardship and the Internal Locus of Control Over the Prevention of Child Obesity: Progress Report. Acad Pediatr 2018; 18:603-604. [PMID: 29421167 PMCID: PMC6077113 DOI: 10.1016/j.acap.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 01/15/2018] [Accepted: 01/26/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY.
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| |
Collapse
|
31
|
Gross RS, Mendelsohn AL, Messito MJ. Additive effects of household food insecurity during pregnancy and infancy on maternal infant feeding styles and practices. Appetite 2018; 130:20-28. [PMID: 30031787 DOI: 10.1016/j.appet.2018.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/02/2018] [Accepted: 07/16/2018] [Indexed: 12/28/2022]
Abstract
Food insecurity, or the limited access to food, has been associated with maternal child feeding styles and practices. While studies in other parenting domains suggest differential and additive impacts of poverty-associated stressors during pregnancy and infancy, few studies have assessed relations between food insecurity during these sensitive times and maternal infant feeding styles and practices. This study sought to analyze these relations in low-income Hispanic mother-infant pairs enrolled in a randomized controlled trial of an early obesity prevention program (Starting Early). Food insecurity was measured prenatally and during infancy at 10 months. Food insecurity timing was categorized as never, prenatal only, infancy only, or both. Regression analyses were used to determine relations between food insecurity timing and styles and practices at 10 months, using never experiencing food insecurity as the reference, adjusting for family characteristics and material hardships. 412 mother-infant pairs completed 10-month assessments. Prolonged food insecurity during both periods was associated with greater pressuring, indulgent and laissez-faire styles compared to never experiencing food insecurity. Prenatal food insecurity was associated with less vegetable and more juice intake. If food insecurity is identified during pregnancy, interventions to prevent food insecurity from persisting into infancy may mitigate the development of obesity-promoting feeding styles and practices.
Collapse
Affiliation(s)
- Rachel S Gross
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA.
| | - Alan L Mendelsohn
- Department of Pediatrics, Division of Developmental - Behavioral Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA.
| | - Mary Jo Messito
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA.
| |
Collapse
|
32
|
Khajeheian D, Colabi AM, Ahmad Kharman Shah NB, Bt Wan Mohamed Radzi CWJ, Jenatabadi HS. Effect of Social Media on Child Obesity: Application of Structural Equation Modeling with the Taguchi Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071343. [PMID: 29949902 PMCID: PMC6069160 DOI: 10.3390/ijerph15071343] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
Through public health studies, specifically on child obesity modeling, research scholars have been attempting to identify the factors affecting obesity using suitable statistical techniques. In recent years, regression, structural equation modeling (SEM) and partial least squares (PLS) regression have been the most widely employed statistical modeling techniques in public health studies. The main objective of this study to apply the Taguchi method to introduce a new pattern rather than a model for analyzing the body mass index (BMI) of children as a representative of childhood obesity levels mainly related to social media use. The data analysis includes two main parts. The first part entails selecting significant indicators for the proposed framework by applying SEM for primary and high school students separately. The second part introduces the Taguchi method as a realistic and reliable approach to exploring which combination of significant variables leads to high obesity levels in children. AMOS software (IBM, Armonk, NY, USA) was applied in the first part of data analysis and MINITAB software (Minitab Inc., State College, PA, USA) was utilized for the Taguchi experimental analysis (second data analysis part). This study will help research scholars view the data and a pattern rather than a model, as a combination of different factor levels for target factor optimization.
Collapse
Affiliation(s)
- Datis Khajeheian
- Department of Media Management, Faculty of Management, University of Tehran, Tehran 141556311, Iran.
| | - Amir Mohammad Colabi
- Department of Business Management, Faculty of Management and Economics, Tarbiat Modares University, Tehran 1439813141, Iran.
| | - Nordiana Binti Ahmad Kharman Shah
- Department of Library and Information Science, Faculty of Computer Science & Information Technology, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | | | - Hashem Salarzadeh Jenatabadi
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia.
| |
Collapse
|
33
|
Adams EL, Marini ME, Stokes J, Birch LL, Paul IM, Savage JS. INSIGHT responsive parenting intervention reduces infant's screen time and television exposure. Int J Behav Nutr Phys Act 2018; 15:24. [PMID: 29544506 PMCID: PMC5855973 DOI: 10.1186/s12966-018-0657-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Sedentary behaviors, including screen time, in childhood have been associated with an increased risk for overweight. Beginning in infancy, we sought to reduce screen time and television exposure and increase time spent in interactive play as one component of a responsive parenting (RP) intervention designed for obesity prevention. Methods The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control intervention. Primiparous mother-newborn dyads (N = 279) were randomized after childbirth. Research nurses delivered intervention content at infant ages 3, 16, 28, and 40 weeks and research center visits at 1 and 2 years. As one component of INSIGHT, developmentally appropriate messages on minimizing screen time, reducing television exposure in the home, and promoting parent-child engagement through interactive play were delivered. Mothers self-reported their infant’s screen time at ages 44 weeks, 1, 1.5, 2 and 2.5 years; interactive play was reported at 8 and 20 weeks and 2 years. Results More RP than control parents reported their infants met the American Academy of Pediatrics’ no screen time recommendation at 44 weeks (53.0% vs. 30.2%) and at 1 year on weekdays (42.5% vs. 27.6%) and weekends (45.5% vs. 26.8%), but not after age 1 year. RP mothers and RP children had less daily screen time than controls at each time point (p ≤ 0.01). Fewer RP than control group mothers reported the television was ever on during infant meals (p < 0.05). The frequency of tummy time and floor play did not differ by study group; approximately 95% of infants spent time in restrictive devices (i.e. swing) at 8 and 20 weeks. At 2 years of age, there were no study group differences for time children spent in interactive play. Conclusion From infancy to early childhood, the INSIGHT RP intervention reduced screen time and television exposure, but did not increase the frequency or amount of interactive play. Trial registration clinicaltrials.gov NCT01167270. Registered on 21 July 2010. Electronic supplementary material The online version of this article (10.1186/s12966-018-0657-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elizabeth L Adams
- Center for Childhood Obesity Research, Penn State University, 129 Noll Laboratory, University Park, PA, 16802, USA.,Department of Nutritional Sciences, Penn State University, University Park, PA, USA
| | - Michele E Marini
- Center for Childhood Obesity Research, Penn State University, 129 Noll Laboratory, University Park, PA, 16802, USA
| | - Jennifer Stokes
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Penn State University, 129 Noll Laboratory, University Park, PA, 16802, USA. .,Department of Nutritional Sciences, Penn State University, University Park, PA, USA.
| |
Collapse
|
34
|
Prioreschi A, Brage S, Hesketh KD, Hnatiuk J, Westgate K, Micklesfield LK. Describing objectively measured physical activity levels, patterns, and correlates in a cross sectional sample of infants and toddlers from South Africa. Int J Behav Nutr Phys Act 2017; 14:176. [PMID: 29273035 PMCID: PMC5741959 DOI: 10.1186/s12966-017-0633-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/11/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Physical activity is considered to have health benefits across the lifespan but levels, patterns, and correlates have not been well described in infants and toddlers under the age of two years. METHODS This study aimed to describe objectively and subjectively measured physical activity in a group of South African infants aged 3- to 24-months (n = 140), and to investigate individual and maternal correlates of physical activity in this sample. Infants' physical activity was measured using an Axivity AX3 wrist-worn accelerometer for one week and the mean vector magnitude was calculated. In addition, mothers reported the average amount of time their infant spent in various types of activities (including in front of the TV), their beliefs about infants' physical activity, access to equipment in the home environment, and ages of motor development milestone attainment. Analysis of variance (ANOVA) and pair-wise correlations were used to test age and sex differences and associations with potential correlates. RESULTS There were significant age and sex effects on the distribution of time spent at different physical activity intensities (Wilks' lambda = 0.06, p < 0.01). In all cases, the trend was for boys to spend more time in higher intensity physical activity and less time in lower intensity activity than girls; and for time spent in higher intensity activities to be higher in older children. Time spent outside was higher in boys, and this reached significance at 18-months (F = 3.84, p = 0.02). Less concern around floor play was associated with higher physical activity at 12-months in females only (p = 0.03, r = 0.54), and no other maternal beliefs were correlated with physical activity. The majority (94%) of children were exceeding TV time recommendations. When controlling for age and sex, overall TV time was positively associated with BMI z-score (β=0.01, p = 0.05). CONCLUSION This study is the first to show sex and age differences in the patterns of physical activity, and to report on objectively measured and maternal reported physical activity and sedentary behaviour in the first two years of life in South Africa infants. Infants and toddlers should be provided with as many opportunities to be active through play as possible, and TV time should be limited.
Collapse
Affiliation(s)
- Alessandra Prioreschi
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Jill Hnatiuk
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Lisa K. Micklesfield
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
35
|
Gillman MW. Early infancy interventions to prevent childhood obesity. Obesity (Silver Spring) 2017; 25:817-818. [PMID: 28337849 DOI: 10.1002/oby.21829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Matthew W Gillman
- Environmental Influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Rockville, Maryland, USA
| |
Collapse
|