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Alsikhan R, Almotiry A. Perspectives of Family Medicine Providers on Nutrition of Maternal-Infant by Group Care Visits: A Cross-Sectional Study. Cureus 2024; 16:e61428. [PMID: 38947639 PMCID: PMC11214731 DOI: 10.7759/cureus.61428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Group care in child welfare and primary care settings has evolved, becoming a popular approach for maternal and infant health care. This study focuses on the perspectives of family medicine providers on group care visits for maternal and infant nutrition, a crucial aspect of primary healthcare. Hence, this study aimed to explore current practices and opinions regarding the efficacy of group care models in delivering nutrition education to mother-infant dyads. METHODOLOGY A quantitative, cross-sectional study was conducted among family physicians in Buraydah, Saudi Arabia, from June to August 2023. Participants were recruited using a randomized sampling method from primary healthcare centers. Data were collected through a well-structured, self-administered questionnaire. The total participant count was 60. Statistical analyses were conducted using descriptive and inferential methods. RESULTS The majority of participants were men (n=32, 53.3%), under 30 years of age (n=31, 51.7%), and had 0 to five years of experience in medical practice (n=32, 53.4%). A high weekly volume of infant and maternal clinic visits was reported (n=44, 73.3%) but predominantly conducted individual nutrition education sessions (n=60, 100%). A significant majority (n=41, 68.3%) expressed a positive potential for group care in nutrition education. CONCLUSION The study revealed a positive inclination among family medicine providers towards group care models for maternal and infant nutrition education. However, current practices largely involved one-on-one sessions, indicating a gap between the recognition and implementation of group care models. It underscores the need for enhanced integration of group care approaches into clinical practice, highlighting their perceived benefits in efficiency and comprehensiveness. Future steps include implementing group care programs addressing participant concerns and assessing their efficacy in educating mothers on infant nutrition.
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Affiliation(s)
- Rafeef Alsikhan
- Family Medicine, Academy of Family Medicine, Qassim Health Cluster, Al Qassim, SAU
| | - Abdulrahman Almotiry
- Family Medicine, Academy of Family Medicine, Qassim Health Cluster, Al Qassim, SAU
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2
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Fong M, Kenny RPW, Thomson K, Jesurasa A, Lavans A, Patterson M, Sermin-Reed L, Nguyen G, Aquino MRJ, Cullen E, O'Keefe H, Moffat M, Heslehurst N. Effectiveness and implementation of lower-intensity weight management interventions delivered by the non-specialist workforce in postnatal women: a mixed-methods systematic review. Front Public Health 2024; 12:1359680. [PMID: 38605879 PMCID: PMC11008719 DOI: 10.3389/fpubh.2024.1359680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
Lower-intensity interventions delivered in primary and community care contacts could provide more equitable and scalable weight management support for postnatal women. This mixed-methods systematic review aimed to explore the effectiveness, implementation, and experiences of lower-intensity weight management support delivered by the non-specialist workforce. We included quantitative and qualitative studies of any design that evaluated a lower-intensity weight management intervention delivered by non-specialist workforce in women up to 5 years post-natal, and where intervention effectiveness (weight-related and/or behavioural outcomes), implementation and/or acceptability were reported. PRISMA guidelines were followed, and the review was prospectively registered on PROSPERO (CRD42022371828). Nine electronic databases were searched to identify literature published between database inception to January 2023. This was supplemented with grey literature searches and citation chaining for all included studies and related reviews (completed June 2023). Screening, data extraction and risk of bias assessments were performed in duplicate. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Narrative methods were used to synthesise outcomes. Seven unique studies described in 11 reports were included from the Netherlands (n = 2), and the United Kingdom, Germany, Taiwan, Finland, and the United States (n = 1 each). All studies reported weight-related outcomes; four reported diet; four reported physical activity; four reported intervention implementation and process outcomes; and two reported intervention acceptability and experiences. The longest follow-up was 13-months postnatal. Interventions had mixed effects on weight-related outcomes: three studies reported greater weight reduction and/or lower postnatal weight retention in the intervention group, whereas four found no difference or mixed effects. Most studies reporting physical activity or diet outcomes showed no intervention effect, or mixed effects. Interventions were generally perceived as acceptable by women and care providers, although providers had concerns about translation into routine practice. The main limitations of the review were the limited volume of evidence available, and significant heterogeneity in interventions and outcome reporting which limited meaningful comparisons across studies. There is a need for more intervention studies, including process evaluations, with longer follow-up in the postnatal period to understand the role of primary and community care in supporting women's weight management. Public Health Wales was the primary funder of this review.
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Affiliation(s)
- Mackenzie Fong
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Ryan Patrick William Kenny
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Amrita Jesurasa
- Primary Care Division, Public Health Wales, Cardiff, United Kingdom
| | - Amber Lavans
- Primary Care Division, Public Health Wales, Cardiff, United Kingdom
| | - Maddey Patterson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Letitia Sermin-Reed
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Giang Nguyen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Emer Cullen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Hannah O'Keefe
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
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Resnicow K, Delacroix E, Sonneville KR, Considine S, Grundmeier RW, Shu D, Faerber JA, Fiks AG, Steffes J, Harris D, Woo H, Proctor T, Wright ME, Shone LP, Barlow SE, Wasserman RC, Siegel R, Stockwell MS. Outcome of BMI2+: Motivational Interviewing to Reduce BMI Through Primary Care AAP PROS Practices. Pediatrics 2024; 153:e2023062462. [PMID: 38282541 PMCID: PMC10827646 DOI: 10.1542/peds.2023-062462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Pediatric obesity rates in the United States remain at an all-time high. Pediatric primary care clinicians and registered dietitians can help treat childhood obesity, and motivational interviewing (MI) has shown promising effects in prior trials. METHODS We randomized 18 pediatric primary care practices to receive the Brief Motivational Interviewing to Reduce BMI or BMI2+ intervention or continue with usual care (UC). Practices were recruited through the American Academy of Pediatrics Pediatric Research in Office Settings network. The intervention comprised 4 components1: in-person and telehealth MI counseling by pediatric clinicians; 4 recommended sessions,2 6 telephone MI counseling sessions from a registered dietitian,3 text message reminders and tailored motivational messages, and4 parent educational materials. The main outcome was the change in the percentage of the 95th percentile of BMI. The study was conducted 2017 through 2021. RESULTS There was a significant treatment x time interaction (b = 0.017, 95% confidence interval: [0.0066-0.027]) for the main outcome, favoring the UC group, with youth in the intervention arm showing a greater relative increase in their percent of the 95th percentile. CONCLUSIONS There was no overall benefit of the intervention and, contrary to expectations, youth in the intervention arm gained more weight, based on percent of the distance from the 95th percentile than matched youth from UC practices. The absolute excess weight gain among intervention relative to UC youth was small, approximately 0.5 BMI units and 1 kg over 2 years. We offer several potential explanations for these unexpected findings.
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Affiliation(s)
- Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emerson Delacroix
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Shannon Considine
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Di Shu
- Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | - Jennifer Steffes
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Donna Harris
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Heide Woo
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California
| | - Tim Proctor
- Physician’s Computer Company, Winooski, Vermont
| | | | | | - Sarah E. Barlow
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas
| | | | - Robert Siegel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Melissa S. Stockwell
- Division of Child Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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Hale I, Fergus T, Buhler H, Purcell M, Amed S. RAISE (Raising Infants to Be Smart Eaters) Pilot Study. Child Obes 2023; 19:25-33. [PMID: 35325551 DOI: 10.1089/chi.2021.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Many of the complex determinants of obesity originate during infancy when small changes in the environment can permanently influence appetite, behavior, and energy metabolism. Parent feeding style ("how" rather than "what" to feed) has emerged as a potentially important factor in early obesity prevention. Objectives: (1) To assess the feasibility of conducting a brief responsive feeding education intervention by public health nurses during routine well-baby visits. (2) To assess whether this intervention affects parents' attitudes and behavior related to responsive feeding. Methods: Prospective, nonrandomized, comparative pilot study conducted in two communities. Intervention participants were exposed to enhanced responsive feeding education by public health nurses at routine well-baby visits from 0 to 18 months along with wall posters, handouts, automated text messages and tangible takeaways. Parent knowledge and behavior were measured using the Infant Feeding Style Questionnaire and the Toddler Development Index. Feasibility and acceptability were assessed by patients and nurses through open text feedback forms and mid-point and exit interviews. Results: Recruitment (18 intervention; 9 control) and retention fell below targets. Average adherence to protocol by nurses from 0 to 12 months was 89%. Delivery of the intervention was feasible and acceptable, but the additional research-related tasks were challenging in a busy clinical setting. Parents found the different formats and information new and helpful. There was a trend toward less nonresponsive (pressuring, restrictive, laissez-faire) feeding practices in the intervention group. Conclusions: This pilot study demonstrated encouraging results related to overall feasibility and effect on parent feeding style.
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Affiliation(s)
- Ilona Hale
- Department of Family Practice, University of British Columbia, Kimberley, British Columbia, Canada
| | - Terri Fergus
- Interior Health Authority, Cranbrook, British Columbia, Canada
| | - Holly Buhler
- Interior Health Authority, Cranbrook, British Columbia, Canada
| | - Megan Purcell
- East Kootenay Division of Family Practice, Cranbrook, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, British Columbia Children and Women's Hospital, University of British Columbia, Kimberley, British Columbia, Canada
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Gregory EF, Maddox AI, Levine LD, Fiks AG, Lorch SA, Resnicow K. Motivational interviewing to promote interconception health: A scoping review of evidence from clinical trials. PATIENT EDUCATION AND COUNSELING 2022; 105:3204-3212. [PMID: 35870992 PMCID: PMC9529865 DOI: 10.1016/j.pec.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Promoting interconception health can improve birth outcomes and long-term women's health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement. OBJECTIVE This scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions. METHODS We searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features. RESULTS There were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes. DISCUSSION MI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion. PRACTICAL VALUE MI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.
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Affiliation(s)
- Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA.
| | - Adya I Maddox
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA
| | - Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Alexander G Fiks
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA
| | - Scott A Lorch
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia. Philadelphia, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
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6
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Johnson SL. What Gets Said, Heard, and Done: Health Care Provider Influences on Early Childhood Feeding Decisions. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:971. [PMID: 36357043 DOI: 10.1016/j.jneb.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Susan L Johnson
- Senior Associate Editor Journal of Nutrition Education and Behavior, Advancing Policy and Practice
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7
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McGowan A, Boundy EO, Nelson JM, Hamner HC. Patterns in Mothers' Recollection of Health Care Providers' Young Child Feeding Recommendations. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1024-1033. [PMID: 36357041 PMCID: PMC11036331 DOI: 10.1016/j.jneb.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Characterize feeding guidance mothers recall receiving from their child's health care provider (HCP). DESIGN Cross-sectional study of mothers participating in the 2017-2019 National Survey of Family Growth. PARTICIPANTS US mothers reporting (n = 1,302) information about their youngest child (aged 6 months to 5 years). VARIABLES MEASURED Weighted percentage of mothers who recalled their child's HCP discussing 6 different feeding topics by demographic characteristics. ANALYSIS Logistic regression assessing the relationship between recall of feeding guidance and demographics. RESULTS In this sample, 36.9% of mothers (95% confidence interval, 32.3-41.4) recalled HCPs recommending solid food before 6 months old (34.6% at 4-5 months, and 2.3% before 4 months). Mothers who were older or had a higher education level were more likely than their counterparts to recall their HCP discussing several of the feeding topics examined. CONCLUSION AND IMPLICATIONS Mothers reported high recollection of early childhood nutrition guidance from their HCP; however, certain topics (eg, appropriate timing of solid food introduction) could be prioritized, and some subpopulations may need additional focus to improve receipt of messages. A better understanding of variability in recall of feeding guidance could provide information for interventions to address barriers to receiving and retaining guidance.
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Affiliation(s)
- Andrea McGowan
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Ellen O Boundy
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service, Rockville, MD
| | - Jennifer M Nelson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service, Rockville, MD
| | - Heather C Hamner
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
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Hollman H, Sui W, Rhodes RE. A feasibility randomized controlled trial of a multi-process action control web-based intervention that targets physical activity in mothers. Women Health 2022; 62:384-401. [DOI: 10.1080/03630242.2022.2072050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Heather Hollman
- Behavioural Medicine Lab, University of Victoria, Victoria, Canada
| | - Wuyou Sui
- Behavioural Medicine Lab, University of Victoria, Victoria, Canada
| | - Ryan E. Rhodes
- Behavioural Medicine Lab, University of Victoria, Victoria, Canada
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9
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Adams EL, Master L, Buxton OM, Savage JS. Sleep parenting practices are associated with infant self-soothing behaviors when measured using actigraphy. Sleep Med 2022; 95:29-36. [DOI: 10.1016/j.sleep.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
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10
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Timm A, Kragelund Nielsen K, Joenck L, Husted Jensen N, Jensen DM, Norgaard O, Terkildsen Maindal H. Strategies to promote health behaviors in parents with small children-A systematic review and realist synthesis of behavioral interventions. Obes Rev 2022; 23:e13359. [PMID: 34734473 DOI: 10.1111/obr.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0-3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context-mechanism-outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home-based activities to change home environment, and (3) offering flexible delivery, for example, phone or website-based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home-based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020.
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Affiliation(s)
- Anne Timm
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Larke Joenck
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Norgaard
- Department of Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
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Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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12
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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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.
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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
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14
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Whittall H, Kahn M, Pillion M, Gradisar M. Parents matter: barriers and solutions when implementing behavioural sleep interventions for infant sleep problems. Sleep Med 2021; 84:244-252. [PMID: 34182352 DOI: 10.1016/j.sleep.2021.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Behavioural sleep interventions (eg, extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep.
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Affiliation(s)
- Hannah Whittall
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia.
| | - Michal Kahn
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Michael Gradisar
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
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15
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Ash T, Taveras EM, Redline S, Haneuse S, Quante M, Davison K. Contextual and Parenting Factors Contribute to Shorter Sleep Among Hispanic/Latinx Compared to Non-Hispanic White Infants. Ann Behav Med 2021; 55:424-435. [PMID: 32914840 DOI: 10.1093/abm/kaaa062] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sleep is an important aspect of child development and health. Disparities in childhood sleep have been observed as early as infancy, but little is known about the factors contributing to them. PURPOSE The objective of this study was to examine whether intrinsic, contextual, and parenting factors contribute to differences in sleep duration between Hispanic/Latinx and non-Hispanic white infants at 6 months of age. METHODS We analyzed data of 119 Hispanic/Latinx and 146 non-Hispanic white infants in Rise & SHINE, a prospective birth cohort study of mother-infant dyads. Mothers reported their infant's sleep patterns using the Brief Infant Sleep Questionnaire at 6 months. Mothers also completed surveys measuring intrinsic (sex, gestational length, and birth weight), contextual (cultural, environmental, and familial), and parenting (behaviors and practices) factors. We used multivariable linear and logistic regression analyses to examine the contributing effects of these clusters of variables on the association between racial/ethnic background and infant sleep duration. RESULTS Hispanic/Latinx infants slept 38 min less than white infants at 6 months (β: -0.63 [95% confidence interval: -1.07, -0.19]) and were nearly three times more likely to not meet the minimum sleep recommendation. The differences persisted after adjustment for intrinsic factors but were attenuated after additional adjustment for contextual and parenting factors, especially having a foreign-born mother and later bedtime. CONCLUSIONS The results of this study demonstrate that differences in sleep duration among Hispanic/Latinx infants compared to their white counterparts are present as early as 6 months of age and that context and parenting matter.
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Affiliation(s)
- Tayla Ash
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.,Center for Health Promotion and Health Equity, Brown School of Public Health Providence, RI, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA, USA.,Department of Nutrition, Harvard Chan School of Public Health, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, MA, USA
| | - Mirja Quante
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Kirsten Davison
- Department of Nutrition, Harvard Chan School of Public Health, Boston, MA, USA.,Boston College School of Social Work, Boston, MA, USA
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16
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Young-Hyman D, Kettel Khan L. Childhood Obesity Evidence Base Project: Building Translational Capacity through Meta-Analytic Methods. Child Obes 2020; 16:S249-S254. [PMID: 32936041 PMCID: PMC7482119 DOI: 10.1089/chi.2020.0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose: The purpose of this article is to demonstrate the need for and utility of using a taxonomic approach for evidence aggregation and meta-analyses, with focus on prevention and reduction of childhood obesity in very young children. As evidence has been generated through heterogeneous efforts, it is important that the field makes use of all available evidence to learn what works, for who, and in what circumstances. Methods: The Childhood Obesity Evidence Base (COEB) project conducted a taxonomic meta-analysis, using Grounded Theory to code elements present in reports of existing studies and initiatives, of diverse design and evaluation approaches, which were then mapped onto the levels of the socio-ecologic model. This article is the fourth in a series that describes the COEB project overall. It discusses both generally and specifically how taxonomies contribute to traditional meta-analytic methods, what questions can and cannot be answered, the method's contribution to translational (implementation) capacity, and ability to inform future efforts. Results: The COEB project illustrates how the taxonomic meta-analytic approach broadens the evidence base, increases translational capacity for effective intervention components, and evaluates the influence of contextual elements to inform future initiatives. How the method is used to establish associations between varying intervention components, contextual elements, and outcomes is discussed. Conclusions: Taxonomies generated through this process can be used for meta-analysis, serving to generate topic-specific questions associated with intervention approaches and outcomes in context, which is adjunctive to traditional meta-analytic methods and can inform public health approaches.
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Affiliation(s)
- Deborah Young-Hyman
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Laura Kettel Khan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Miller CL, Strachan SM. Understanding the role of mother guilt and self-compassion in health behaviors in mothers with young children. Women Health 2020; 60:763-775. [PMID: 31937201 DOI: 10.1080/03630242.2020.1713966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We explored whether the guilt mothers of young children feel about engaging in health behaviors mediates the relationship between self-compassion and self-reported engagement in health-promoting behaviors such as physical activity, eating a healthy diet and getting enough sleep. In this online, cross-sectional study, 143 mothers of young children completed measures of self-compassion, guilt about taking time to engage in health-promoting behaviors, trait guilt, health-promoting behaviors, self-esteem, and demographics. Mediation analysis, using Hayes' PROCESS macro showed that mother guilt mediated the relationship between self-compassion and health-promoting behaviors, ß = .05, Bca CI (.0014, .1133) with a bootstrapped standard error of .03 and a 95% confidence interval. Self-compassion may offer mothers a positive way to deal with guilty feelings about looking after their health.
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18
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Sherwood NE, Levy RL, Seburg EM, Crain AL, Langer SL, JaKa MM, Kunin‐Batson A, Jeffery RW. The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes. Pediatr Obes 2019; 14:e12523. [PMID: 30873752 PMCID: PMC8853652 DOI: 10.1111/ijpo.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/22/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pediatric primary care is an important setting for addressing obesity prevention. OBJECTIVE The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. METHODS Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile. RESULTS There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up. CONCLUSIONS AND RELEVANCE An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.
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Affiliation(s)
- Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- UW School of Social Work (SSW), Seattle, WA, USA
| | | | | | - Shelby L. Langer
- UW School of Social Work (SSW), Seattle, WA, USA,Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Meghan M. JaKa
- DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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19
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Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | - Theresa HM Moore
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Sport and Physical EducationKowloonHong Kong
| | - Amir Zayegh
- The Royal Children's HospitalGeneral MedicineMelbourneVictoriaAustralia3052
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Martha Elwenspoek
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Sophie C Foxen
- Royal Air Force High WycombeDefence Medical ServicesNaphillBucksUKHP14 4UE
| | - Lucia Magee
- Royal United HospitalMedical DepartmentBathUK
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | | | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
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20
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Russell CG, Russell A. A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research. Obes Rev 2019; 20:725-749. [PMID: 30768750 DOI: 10.1111/obr.12838] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.
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Affiliation(s)
- Catherine G Russell
- Faculty of Health, School of Exercise and Nutrition Sciences, Centre for Advanced Sensory Science, Deakin University, Burwood, Australia
| | - Alan Russell
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia
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21
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MacMillan Uribe AL, Woelky KR, Olson BH. Exploring Family-Medicine Providers' Perspectives on Group Care Visits for Maternal and Infant Nutrition Education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:409-418. [PMID: 30773444 DOI: 10.1016/j.jneb.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Explore current maternal and infant nutrition education practices and family medicine primary care providers' views on a group care model to deliver nutrition education to mother-infant dyads. DESIGN In-depth interviews. SETTING Family medicine clinics in 1 Midwestern US hospital system. PARTICIPANTS Family medicine primary care providers (n = 17) who regularly see infants during well-baby visits. PHENOMENON OF INTEREST Current maternal and infant nutrition education practices; views on ideal way to deliver nutrition education to mother-infant dyads; feedback on group care model to deliver nutrition education to mother-infant dyads. ANALYSIS Audio recordings transcribed verbatim and coded using conventional content analysis. RESULTS Family medicine primary care providers are limited in the ability to provide maternal and infant nutrition education and desire a different approach. Group care was the preferred method; it was shared most frequently as the ideal approach to nutrition education delivery and participants reacted favorably when presented with this model. However, there were many concerns with group care (eg, moderating difficult conversations, program implementation logistics, sufficient group volume, and interruption in patient-provider relationship). CONCLUSION AND IMPLICATIONS Family medicine primary care providers desire a different approach to deliver nutrition education to mother-infant dyads in clinic. A group care model may be well-accepted among family medicine primary care providers but issues must be resolved before implementation. These results could inform future group care implementation studies and influence provider buy-in.
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Affiliation(s)
| | - Kaitland R Woelky
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Beth H Olson
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI.
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22
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Orr CJ, Ben-Davies M, Ravanbakht SN, Yin HS, Sanders LM, Rothman RL, Delamater AM, Wood CT, Perrin EM. Parental Feeding Beliefs and Practices and Household Food Insecurity in Infancy. Acad Pediatr 2019; 19:80-89. [PMID: 30248471 PMCID: PMC6599601 DOI: 10.1016/j.acap.2018.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Food insecurity is associated with childhood obesity possibly mediated through caregiver feeding practices and beliefs. We examined if caregiver feeding practices differed by household food security status in a diverse sample of infants. We hypothesized that feeding practices differ based on food security status. PATIENTS AND METHODS Included in the baseline cross-sectional analysis of data from a randomized controlled trial to prevent obesity were 842 caregivers of 2-month-old infants presenting for well-child care at 4 academic institutions. Food insecurity exposure was based on an affirmative answer to 1 of 2 items in a 2-item validated questionnaire. Chi-square tests examined the association between parent feeding practices and food security status. Logistic regression adjusted for covariates. Differences in caregiver feeding practices by food security status and race/ethnicity were explored with an interaction term (food security status x race/ethnicity). RESULTS Forty-three percent of families screened as food insecure. In adjusted logistic regression, parents from food-insecure households were more likely to endorse that "the best way to make an infant stop crying is to feed him or her" (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.28-2.29) and "when my baby cries, I immediately feed him or her" (aOR, 1.40; 95% CI, 1.06-1.83). Food-insecure caregivers less frequently endorsed paying attention to their baby when he or she is full or hungry (OR, 0.57; 95% CI, 0.34-0.96). Racial/ethnic differences in beliefs and behaviors were observed by food security status. CONCLUSIONS During early infancy, feeding practices differed among caregivers by household food security status. Further research is needed to examine whether these practices are associated with increased risk of obesity and obesity-related morbidity.
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Affiliation(s)
- Colin J Orr
- University of North Carolina at Chapel Hill, 260 MacNider Building, CB#7220, UNC School of Medicine, Chapel Hill NC, 27599; ;
| | - Maureen Ben-Davies
- University of North Carolina at Chapel Hill, 260 MacNider Building, CB#7220, UNC School of Medicine, Chapel Hill NC, 27599; ;
| | - Sophie N. Ravanbakht
- Duke University Medical Center Department of Pediatrics and Duke Center for Childhood Obesity Research 146 Civitan Building, 2213 Elba Street Durham, NC 27705; ; ;
| | - H. Shonna Yin
- New York University School of Medicine, Department of Pediatrics and Population Health NYU School of Medicine/Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, New York 10016;
| | - Lee M Sanders
- Stanford University Department of Pediatrics, Center for Health Policy, 117 Encina Commons, Room 182, Stanford, California 94305;
| | - Russell L. Rothman
- Vanderbilt University Medical Center, 6100 Medical Center East, Vanderbilt University Medical Center, Nashville, TB 37232;
| | - Alan M. Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, University of Miami Miller School of Medicine, PO Box 016820, Miami, FL 33101;
| | - Charles T. Wood
- Duke University Medical Center Department of Pediatrics and Duke Center for Childhood Obesity Research 146 Civitan Building, 2213 Elba Street Durham, NC 27705; ; ;
| | - Eliana M Perrin
- Department of Pediatrics and Duke Center for Childhood Obesity Research (SN Ravanbakht, CT Wood, and EM Perrin), Duke University Medical Center, Durham, NC.
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Agaronov A, Ash T, Sepulveda M, Taveras EM, Davison KK. Inclusion of Sleep Promotion in Family-Based Interventions To Prevent Childhood Obesity. Child Obes 2018; 14:485-500. [PMID: 30109955 PMCID: PMC6422003 DOI: 10.1089/chi.2017.0235] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sleep promotion in childhood may reduce the risk of obesity, but little is known of its inclusion in family-based interventions. This study examines the proportion and context of family-based interventions to prevent childhood obesity that promote child sleep. We drew on data from a recent systematic review and content analysis of family-based interventions for childhood obesity prevention published between 2008 and 2015, coupled with new data on sleep promotion strategies, designs, and measures. Out of 119 eligible family-based interventions to prevent childhood obesity, 24 (20%) promoted child sleep. In contrast, 106 (89%) interventions targeted diet, 97 (82%) targeted physical activity, and 63 (53%) targeted media use in children. Most interventions that promoted sleep were implemented in clinics (50%) and home-based settings (38%), conducted in the United States (57%), and included children 2-5 years of age (75%). While most interventions utilized a randomized controlled design (70%), only two examined the promotion of sleep independent of other energy-balance behaviors in a separate study arm. Sleep was predominately promoted by educating parents on sleep hygiene (e.g., age-appropriate sleep duration), followed by instructing parents on responsive feeding practices and limiting media use. One intervention promoted sleep by way of physical activity. A large number promoted sleep by way of bedtime routines. Most interventions measured children's sleep by parent report. Results demonstrate that sleep promotion is underrepresented and variable in family-based childhood obesity interventions. While opportunities exist for increasing its integration, researchers should consider harmonizing and being more explicit about their approach to sleep promotion.
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Affiliation(s)
- Alen Agaronov
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Address correspondence to: Alen Agaronov, MS, RDN, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - Tayla Ash
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Martina Sepulveda
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ
| | - Elsie M. Taveras
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Division of General Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Kirsten K. Davison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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24
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A comparison of low-intensity physical activity, growth, and sleep behavior in 6-month old infants. Infant Behav Dev 2018; 53:18-24. [DOI: 10.1016/j.infbeh.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 12/21/2022]
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25
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Dodd JM, Deussen AR, O’Brien CM, Schoenaker DAJM, Poprzeczny A, Gordon A, Phelan S. Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis. Nutr Rev 2018; 76:639-654. [PMID: 29889259 PMCID: PMC6280945 DOI: 10.1093/nutrit/nuy024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context Many international clinical guidelines recommend that overweight and obese women lose weight prior to pregnancy to reduce the risk of adverse pregnancy outcomes. Women who have recently given birth and plan future pregnancies are an important target population for preconception weight-loss interventions. Objective A systematic review to evaluate postpartum dietary and/or physical activity interventions to promote weight loss and improve health in a subsequent pregnancy was conducted. Data Sources Five databases-the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Embase, the Australian New Zealand Clinical Trials Registry, and the International Clinical Trials Registry-were searched using the following terms: preconception, pregnancy, postpartum, pregnancy outcomes, body mass index, weight gain, weight loss, weight change, postpartum weight retention, dietary or lifestyle intervention, and randomiz(s)ed controlled trial. The date of last search was November 2017. Data Extraction Data were extracted from each identified study using a standard form. The primary outcomes were weight loss at the completion of the intervention and at follow-up assessments. Secondary endpoints included maternal and infant outcomes in a subsequent pregnancy. Data Analysis Mean differences (MDs) were calculated for continuous data and risk ratios for dichotomous data, both with 95%CIs. Results A total of 235 abstracts (193 after duplicates were excluded) were identified, from which 37 manuscripts were selected for full-text review. In total, 27 trials were identified for inclusion. Outcome data were available for approximately 75% of participants (n = 3485). A combined dietary and physical activity intervention provided post partum produced greater postpartum weight loss (MD, -2.49 kg; 95%CI, -3.34 to -1.63 kg [random-effects model]; 12 studies, 1156 women), which was maintained at 12 months post partum (MD, -2.41 kg; 95%CI, -3.89 to -0.93 kg [random-effects model]; 4 studies, 405 women), compared with no intervention. No studies reported maternal or infant health outcomes in a subsequent pregnancy. Conclusions Providing a postpartum intervention is associated with weight loss after birth, but effects on maternal and infant health in a subsequent pregnancy are uncertain.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, Women’s and Babies Division, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Cecelia M O’Brien
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle A J M Schoenaker
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda Poprzeczny
- Discipline of Obstetrics and Gynaecology and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth, South Australia, Australia
| | - Adrienne Gordon
- Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California, USA
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26
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Paranjothy S, Copeland L, Merrett L, Grant A, Phillips R, Gobat N, Sanders J, Fitzsimmons D, Hunter B, Regan S, Playle R, Brown A, Tedstone S, Trickey H, Robling M. A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study. Health Technol Assess 2018; 21:1-138. [PMID: 29265999 DOI: 10.3310/hta21770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer. OBJECTIVE To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the feasibility of delivering it to mothers in areas with high levels of social deprivation. DESIGN Intervention development and a non-randomised multisite feasibility study. SETTING Community maternity services in three areas with high levels of social deprivation and low breastfeeding initiation rates in England and Wales. PARTICIPANTS Pregnant women considering breastfeeding. Women who did not plan to breastfeed, who had a clinical reason that precluded breastfeeding continuation or who were unable to consent were excluded. INTERVENTION The intervention Mam-Kind was informed by a survey of infant feeding co-ordinators, rapid literature review, focus groups with service users and peer supporters and interviews with health-care professionals and a Stakeholder Advisory Group. It consisted of face-to-face contact at 48 hours after birth and proactive one-to-one peer support from the Mam-Kind buddy for 2 weeks, followed by mother-led contact for a further 2-6 weeks. MAIN OUTCOME MEASURES Recruitment and retention of Mam-Kind buddies, uptake of Mam-Kind by participants, feasibility of delivering Mam-Kind as specified and of data collection methods, and acceptability of Mam-Kind to mothers, buddies and health-care professionals. RESULTS Nine buddies were recruited to deliver Mam-Kind to 70 participants (61% of eligible women who expressed an interest in taking part in the study). Participants were aged between 19 and 41 years and 94% of participants were white. Intervention uptake was 75% and did not vary according to age or parity. Most contacts (79%) were initiated by the buddy, demonstrating the intended proactive nature of the intervention and 73% (n = 51) of participants received a contact within 48 hours. Follow-up data were available for 78% of participants at 10 days and 64% at 8 weeks. Data collection methods were judged feasible and acceptable. Data completeness was > 80% for almost all variables. Interviews with participants, buddies and health service professionals showed that the intervention was acceptable. Buddies delivered the intervention content with fidelity (93% of intervention objectives were met), and, in some cases, developed certain MI skills to a competency level. However, they reported difficulties in changing from an information-giving role to a collaborative approach. These findings were used to refine the training and intervention specification to emphasise the focus of the intervention on providing mother-centric support. Health-care professionals were satisfied that the intervention could be integrated with existing services. CONCLUSIONS The Mam-Kind intervention was acceptable and feasible to deliver within NHS maternity services and should be tested for effectiveness in a multicentre randomised controlled trial. The feasibility study highlighted the need to strengthen strategies for birth notification and retention of participants, and provided some insights on how this could be achieved in a full trial. LIMITATIONS The response rate to the survey of infant feeding co-ordinators was low (19.5%). In addition, the women who were recruited may not be representative of the study sites. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Lauren Copeland
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Laura Merrett
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Nina Gobat
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Amy Brown
- Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
| | - Sally Tedstone
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Heather Trickey
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, Cardiff, UK
| | - Mike Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
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27
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Gaffney KF, Brito AV, Kitsantas P, Kermer DA, Pereddo G, Ramos KM. Institute of Medicine Early Infant Feeding Recommendations for Childhood Obesity Prevention: Implementation by Immigrant Mothers From Central America. J Pediatr Nurs 2018; 40:27-33. [PMID: 29776476 PMCID: PMC5962027 DOI: 10.1016/j.pedn.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 11/18/2022]
Abstract
PURPOSES Describe implementation of Institute of Medicine (IOM) early infant feeding recommendations for child obesity prevention by immigrant mothers from Central America; examine potential relationships with food insecurity and postpartum depressive symptoms. DESIGN AND METHODS Using a cross-sectional, descriptive design, face-to-face interviews were conducted with 318 mothers of 2month old infants at a large pediatric setting for low income families. Logistic regression models assessed feeding practices, food insecurity and postpartum depressive symptoms. RESULTS Exclusive breastfeeding rates were low (9.4%); most mothers (62.7%) both breastfed and bottle fed their infants. Mothers who bottle fed at moderate and high intensity were twice as likely to affirm that if you give a baby a bottle, you should always make sure s/he finishes it (OR=2.30, 95% CI=1.13, 4.69; OR=2.29, 95% CI=1.26, 4.14). Food insecurity was experienced by 57% of mothers but postpartum depressive symptoms were low (Possible range=0-30; M=2.96, SD =3.6). However, for each increase in the postpartum depressive symptoms score, the likelihood of affirming a controlling feeding style increased by 11-13%. CONCLUSIONS Immigrant mothers from Central America were more likely to both breastfeed and bottle feed (las dos cosas) than implement exclusive breastfeeding. Bottle feeding intensity was associated with a controlling feeding style. PRACTICE IMPLICATIONS Infant well visits provide the ideal context for promoting IOM recommendations for the prevention of obesity among children of immigrant mothers from Central America.
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Affiliation(s)
| | - Albert V Brito
- Inova Cares Clinic for Children, Falls Church, VA, United States.
| | - Panagiota Kitsantas
- Health Administration and Policy Department, George Mason University, Fairfax, VA, United States.
| | - Deborah A Kermer
- University Libraries, Data Services, George Mason University, Fairfax, VA, United States.
| | - Graciela Pereddo
- Global and Community Health Department, George Mason University, Fairfax, VA, United States.
| | - Katya M Ramos
- School of Nursing, George Mason University, Fairfax, VA, United States.
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Haste A, Adamson AJ, McColl E, Araujo-Soares V, Bell R. Problems recruiting and retaining postnatal women to a pilot randomised controlled trial of a web-delivered weight loss intervention. BMC Res Notes 2018; 11:203. [PMID: 29587868 PMCID: PMC5870076 DOI: 10.1186/s13104-018-3305-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/20/2018] [Indexed: 01/17/2023] Open
Abstract
Objective This paper highlights recruitment and retention problems identified during a pilot randomised controlled trial and process evaluation. The pilot trial aimed to evaluate the feasibility and acceptability of a web-delivered weight loss intervention for postnatal women and associated trial protocol. Results General practice database searches revealed low rates of eligible postnatal women per practice. 16 (10%) of the 168 identified women were recruited and randomised, seven to the intervention and nine to the control. 57% (4/7) of the intervention women completed 3 month follow-up measurements in comparison to 56% (5/9) in the control group. By 12 months, retention in the intervention group was 43% (3/7), with 2/7 women active on the website, in comparison to 44% (4/9) of the control group. Interview findings revealed the web as an acceptable method for delivery of the intervention, with the suggestion of an addition of a mobile application. Alternative recruitment strategies, using health visitor appointments, midwifery departments or mother and baby/toddler groups, should be explored. Greater involvement of potential users should enable better recruitment methods to be developed. Trial registration ISRCTN: ISRCTN48086713, Registered 26 October 2012
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Affiliation(s)
- Anna Haste
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. .,Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. .,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
| | - Ashley J Adamson
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.,Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Vera Araujo-Soares
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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29
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Horsch A, Gilbert L, Lanzi S, Gross J, Kayser B, Vial Y, Simeoni U, Hans D, Berney A, Scholz U, Barakat R, Puder JJ. Improving cardiometabolic and mental health in women with gestational diabetes mellitus and their offspring: study protocol for MySweetHeart Trial, a randomised controlled trial. BMJ Open 2018; 8:e020462. [PMID: 29487077 PMCID: PMC5855393 DOI: 10.1136/bmjopen-2017-020462] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) carries prenatal and perinatal risk for the mother and her offspring as well as longer-term risks for both the mother (obesity, diabetes, cardiovascular disease) and her child (obesity, type 2 diabetes). Compared with women without GDM, women with GDM are twice as likely to develop perinatal or postpartum depression. Lifestyle interventions for GDM are generally limited to physical activity and/or nutrition, often focus separately on the mother or the child and take place either during or after pregnancy, while their results are inconsistent. To increase efficacy of intervention, the multifactorial origins of GDM and the tight link between mental and metabolic as well as maternal and child health need to be heeded. This calls for an interdisciplinary transgenerational approach starting in, but continuing beyond pregnancy. METHODS AND ANALYSIS This randomised controlled trial will assess the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention aimed at improving the metabolic and mental health of 200 women with GDM and their offspring. Women with GDM at 24-32 weeks gestational age who understand French or English, and their offspring and partners can participate. The intervention components will be delivered on top of usual care during pregnancy and the first year postpartum. Metabolic and mental health outcomes will be measured at 24-32 weeks of pregnancy, shortly after birth and at 6-8 weeks and 1 year after childbirth. Data will be analysed using intention-to-treat analyses. The MySweetHeart Trial is linked to the MySweetHeart Cohort (clinicaltrials.gov/ct2/show/NCT02872974). ETHICS AND DISSEMINATION We will disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02890693; Pre-results.
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Affiliation(s)
- Antje Horsch
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | - Leah Gilbert
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Service of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Yvan Vial
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHad Laboratory, Pediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Center of Bone Diseases, Rheumatology Service, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Consultation Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Lausanne, Switzerland
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jardena J Puder
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Service of Pediatric Endocrinology, Diabetology and Obesity, Lausanne University Hospital, Lausanne, Switzerland
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30
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Wright C, Mogul M, Acevedo G, Aysola J, Momplaisir F, Schwartz S, Shea J. Preparing for a trial to test a postpartum weight retention intervention among low income women: feasibility of a protocol in a community-based organization. BMC WOMENS HEALTH 2018; 18:27. [PMID: 29370795 PMCID: PMC5785896 DOI: 10.1186/s12905-018-0517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/14/2018] [Indexed: 11/29/2022]
Abstract
Background Postpartum weight retention (PPWR) causes intergenerational harm, negatively affecting a mother’s cardiovascular health and ability to have future healthy pregnancies. Low-income minority women are at highest risk for PPWR with little guidance concerning timeline or strategy to lose weight after delivery. An academic-community partnership conducted observational and focus group work to develop an intervention for PPWR among low-income mothers. This study’s objective is to determine the feasibility of implementing a PPWR intervention trial in partnership with a community-based organization (CBO) serving low-income families with social service support. Methods We analyzed five implementation outcomes in this feasibility study: acceptability, adoption, appropriateness, penetration, and sustainability. Other secondary outcomes were the change in psychosocial and clinical outcomes from baseline to one year following the intervention delivery. Results An academic-community partnership developed and piloted a postpartum weight retention intervention among 17 participants that included 1) six weeks of interactive daily health texting, 2) exercise assistance with baby carrier, home exercise program, and pedometer provision, 3) two live healthy eating and baby feeding workshops, and 4) two 45-min home visits over one year to provide social support and acquire followup data. Implementation outcomes demonstrate an intervention supported by the organization and accepted by end-users, with increased capacity of the CBO to test and deliver an effective intervention. Weight loss was achieved by the majority of participants at one year (Md − 5 pounds (IQR = − 14.5 - 0.3). Conclusion We made protocol enhancements to the developed intervention based on the analysis of this study, and now prepare for a funded randomized controlled trial (RCT) in a community-based setting. Our central hypothesis is that low-income women who participate in a multi-component, low cost-intervention delivered by a CBO will have less postpartum weight retention than those women who do not participate in the program. Trial registration The trial was retrospectively registered, ID NCT02867631, 8/11/16.
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Affiliation(s)
- Charmaine Wright
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
| | - Marjie Mogul
- Maternity Care Coalition, 2000 Hamilton Avenue, Suite 205, Philadelphia, PA, 19130, USA
| | - Glamarys Acevedo
- Maternity Care Coalition, 2000 Hamilton Avenue, Suite 205, Philadelphia, PA, 19130, USA
| | - Jaya Aysola
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Florence Momplaisir
- Drexel School of Medicine, Department of Medicine, Infectious Diseases, Partnership Comprehensive Care Practice, 1427 Vine Street, 2nd Floor, Philadelphia, PA, 19102, USA
| | - Sandy Schwartz
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Judy Shea
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
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31
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Gross TT, Rahman M, M Wright A, M Hirth J, Sarpong KO, Rupp RE, D Barrett A, Berenson AB. Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance. Matern Child Health J 2017; 20:154-163. [PMID: 27316631 DOI: 10.1007/s10995-016-2030-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction The objective of this qualitative study was to assess healthcare providers' acceptability of an ongoing postpartum human papillomavirus (HPV) vaccination program in Southeast Texas and its integration into everyday clinical care. Methods In 2012, the Department of Obstetrics & Gynecology at the University of Texas Medical Branch (UTMB) began offering HPV vaccination as part of standard postpartum care to increase vaccination rates among young women in Galveston County. Initial vaccine doses were offered on the postpartum unit while subsequent doses were coordinated with postpartum and well-baby visits. Thirty months after project initiation, semi-structured interviews of physicians (n = 12) and nurses (n = 6) involved in postpartum and pediatric care at UTMB were conducted. Interview transcripts were analyzed using thematic analysis in Nvivo10. Results Overall, providers demonstrated "pro-vaccine" attitudes and stated the program was an effective strategy for vaccinating hard-to-reach women. Cancer prevention was the main perceived benefit while follow-up compliance was the primary perceived patient barrier. The initial challenges with integrating postpartum HPV vaccination included miscommunication between providers regarding vaccine orders and coordination issues with well-baby visits for follow-up doses. One novel finding was providers' beliefs that women's personal HPV vaccine practices may positively impact their decisions about later vaccinating their children against HPV. Providers' suggestions to improve the program included: enhancing postpartum HPV vaccine education for patients, offering more continuing education for providers, and increasing community awareness of HPV vaccination. Discussion These findings can help providers of postpartum care understand how to integrate postpartum HPV vaccination into their current practices and how to overcome perceived vaccination barriers.
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Affiliation(s)
- Tyra T Gross
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA.,Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, USA
| | - Mahbubur Rahman
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA
| | | | - Jacqueline M Hirth
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA
| | - Kwabena O Sarpong
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard E Rupp
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, USA
| | - Alan D Barrett
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77550-0587, USA.
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Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race. Matern Child Health J 2017; 20:1971-9. [PMID: 27178429 DOI: 10.1007/s10995-016-2015-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2 months of age; outcome was BMI Z-score and BMI ≥ 85th percentile (overweight and obese) at 4 years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE = 0.048) and a decreased odds of a BMI ≥ 85th percentile (0.832; 95 % CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p = 0.0002) and BMI ≥ 85th percentile (p < 0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p = 0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.
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van der Pligt P, Ball K, Hesketh KD, Teychenne M, Crawford D, Morgan PJ, Collins CE, Campbell KJ. A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study. J Hum Nutr Diet 2017; 31:314-328. [PMID: 29034545 DOI: 10.1111/jhn.12521] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour. METHODS A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum. RESULTS Mean PPWR decreased in the (I) group (-1.2 kg) and the C2 group (-1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (-6.4 cm) compared to C1 (-1.1 cm; P = 0.002) and C2 (-3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant. CONCLUSIONS The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.
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Affiliation(s)
- P van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - K D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - M Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - D Crawford
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - P J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, The University of Newcastle, NSW, Australia
| | - C E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - K J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Fiks AG, Gruver RS, Bishop-Gilyard CT, Shults J, Virudachalam S, Suh AW, Gerdes M, Kalra GK, DeRusso PA, Lieberman A, Weng D, Elovitz MA, Berkowitz RI, Power TJ. A Social Media Peer Group for Mothers To Prevent Obesity from Infancy: The Grow2Gether Randomized Trial. Child Obes 2017; 13:356-368. [PMID: 28557558 PMCID: PMC5647509 DOI: 10.1089/chi.2017.0042] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have addressed obesity prevention among low-income families whose infants are at increased obesity risk. We tested a Facebook peer-group intervention for low-income mothers to foster behaviors promoting healthy infant growth. METHODS In this randomized controlled trial, 87 pregnant women (Medicaid insured, BMI ≥25 kg/m2) were randomized to the Grow2Gether intervention or text message appointment reminders. Grow2Gether participants joined a private Facebook group of 9-13 women from 2 months before delivery until infant age 9 months. A psychologist facilitated groups featuring a curriculum of weekly videos addressing feeding, sleep, parenting, and maternal well-being. Feasibility was assessed using the frequency and content of participation, and acceptability using surveys. Maternal beliefs and behaviors and infant growth were assessed at birth, 2, 4, 6, and 9 months. Differences in infant growth between study arms were explored. We conducted intention-to-treat analyses using quasi-least-squares regression. RESULTS Eighty-eight percent (75/85) of intervention participants (42% (36/85) food insecure, 88% (75/85) black) reported the group was helpful. Participants posted 30 times/group/week on average. At 9 months, the intervention group had significant improvement in feeding behaviors (Infant Feeding Style Questionnaire) compared to the control group (p = 0.01, effect size = 0.45). Intervention group mothers were significantly less likely to pressure infants to finish food and, at age 6 months, give cereal in the bottle. Differences were not observed for other outcomes, including maternal feeding beliefs or infant weight-for-length. CONCLUSIONS A social media peer-group intervention was engaging and significantly impacted certain feeding behaviors in families with infants at high risk of obesity.
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Affiliation(s)
- Alexander G. Fiks
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel S. Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chanelle T. Bishop-Gilyard
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Senbagam Virudachalam
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew W. Suh
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marsha Gerdes
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gurpreet K. Kalra
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia A. DeRusso
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexandra Lieberman
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel Weng
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michal A. Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Robert I. Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas J. Power
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Ash T, Taveras EM. Associations of short sleep duration with childhood obesity and weight gain: summary of a presentation to the National Academy of Science's Roundtable on Obesity Solutions. Sleep Health 2017; 3:389-392. [DOI: 10.1016/j.sleh.2017.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/18/2017] [Indexed: 01/25/2023]
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Effectiveness of community-based peer support for mothers to improve their breastfeeding practices: A systematic review and meta-analysis. PLoS One 2017; 12:e0177434. [PMID: 28510603 PMCID: PMC5433692 DOI: 10.1371/journal.pone.0177434] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 04/27/2017] [Indexed: 01/17/2023] Open
Abstract
Breastfeeding is associated with reduced mortality in children aged less than 5 years. We conducted a systematic review and meta-analysis (registered as PROSPERO 2015: CRD42015019105) to examine the effectiveness of community-based peer support for mothers on their breastfeeding practices as compared to mothers who have not received such a support.
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Gross RS, Mendelsohn AL, Yin HS, Tomopoulos S, Gross MB, Scheinmann R, Messito MJ. Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time. Obesity (Silver Spring) 2017; 25:920-927. [PMID: 28332324 PMCID: PMC5404992 DOI: 10.1002/oby.21779] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/01/2016] [Accepted: 12/31/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families. METHODS This study was a randomized controlled trial (n = 533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving "Starting Early," with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement-restricting devices). Health literacy was assessed using the Newest Vital Sign. RESULTS Four hundred fifty-six mothers completed 3-month assessments. Infant activity results were: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported ≥1 h/d in movement-restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44-3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14-2.49) compared to controls. No difference in the time spent in movement-restricting devices was found. CONCLUSIONS Tummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.
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Affiliation(s)
- Rachel S. Gross
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental - Behavioral Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
- Department of Population Health, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - H. Shonna Yin
- Department of Population Health, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Suzy Tomopoulos
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Michelle B. Gross
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Roberta Scheinmann
- Research and Evaluation Unit, Public Health Solutions, New York, NY, USA
| | - Mary Jo Messito
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
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Stoeckel LE, Birch LL, Heatherton T, Mann T, Hunter C, Czajkowski S, Onken L, Berger PK, Savage CR. Psychological and neural contributions to appetite self-regulation. Obesity (Silver Spring) 2017; 25 Suppl 1:S17-S25. [PMID: 28229541 PMCID: PMC5328502 DOI: 10.1002/oby.21789] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This paper reviews the state of the science on psychological and neural contributions to appetite self-regulation in the context of obesity. METHODS Three content areas (neural systems and cognitive functions; parenting and early childhood development; and goal setting and goal striving) served to illustrate different perspectives on the psychological and neural factors that contribute to appetite dysregulation in the context of obesity. Talks were initially delivered at an NIH workshop consisting of experts in these three content areas, and then content areas were further developed through a review of the literature. RESULTS Self-regulation of appetite involves a complex interaction between multiple domains, including cognitive, neural, social, and goal-directed behaviors and decision-making. Self-regulation failures can arise from any of these factors, and the resulting implications for obesity should be considered in light of each domain. In some cases, self-regulation is amenable to intervention; however, this does not appear to be universally true, which has implications for both prevention and intervention efforts. CONCLUSIONS Appetite regulation is a complex, multifactorial construct. When considering its role in the obesity epidemic, it is advisable to consider its various dimensions together to best inform prevention and treatment efforts.
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Affiliation(s)
- Luke E. Stoeckel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
| | - Todd Heatherton
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH
| | - Traci Mann
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Christine Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Lisa Onken
- National Institute on Aging, Bethesda, MD
| | - Paige K. Berger
- Department of Foods and Nutrition, University of Georgia, Athens, GA
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Lumeng JC, Kaciroti N, Retzloff L, Rosenblum K, Miller AL. Longitudinal associations between maternal feeding and overweight in low-income toddlers. Appetite 2017; 113:23-29. [PMID: 28212827 DOI: 10.1016/j.appet.2017.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 11/16/2022]
Abstract
Maternal feeding is a frequent intervention target for the prevention of early childhood obesity but longitudinal associations between feeding and child overweight are poorly understood. This observational cohort study sought to examine the cross-lagged associations between maternal feeding and overweight across ages 21, 27, and 33 months. Feeding was measured by maternal self-report (n = 222) at each age. Child weight and length were measured. Cross-lagged analysis was used to evaluate longitudinal associations between feeding and overweight, adjusting for infant birth weight, maternal body mass index, maternal education, and maternal depressive symptoms. The sample was 50.5% white, 52.3% male and 37.8% of mothers had a high school education or less. A total of 30.6%, 29.2%, and 26.3% of the sample was overweight at each age, respectively. Pressuring to Finish, Restrictive with regard to Amount, Restrictive with regard to Diet Quality, Laissez-Faire with regard to Diet Quality, Responsiveness to Satiety, Indulgent Permissive, Indulgent Coaxing, Indulgent Soothing, and Indulgent Pampering each tracked strongly across toddlerhood. There were no significant associations between maternal feeding and child overweight either in cross-sectional or cross-lagged associations. Our results do not support a strong causal role for feeding in childhood overweight. Future work longitudinal work should consider alternative approaches to conceptualizing feeding and alternative measurement approaches.
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Affiliation(s)
- Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lauren Retzloff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Rosenblum
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Santos IS, Bassani DG, Matijasevich A, Halal CS, Del-Ponte B, da Cruz SH, Anselmi L, Albernaz E, Fernandes M, Tovo-Rodrigues L, Silveira MF, Hallal PC. Infant sleep hygiene counseling (sleep trial): protocol of a randomized controlled trial. BMC Psychiatry 2016; 16:307. [PMID: 27590170 PMCID: PMC5010682 DOI: 10.1186/s12888-016-1016-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep problems in childhood have been found to be associated with memory and learning impairments, irritability, difficulties in mood modulation, attention and behavioral problems, hyperactivity and impulsivity. Short sleep duration has been found to be associated with overweight and obesity in childhood. This paper describes the protocol of a behavioral intervention planned to promote healthier sleep in infants. METHODS The study is a 1:1 parallel group single-blinded randomized controlled trial enrolling a total of 552 infants at 3 months of age. The main eligibility criterion is maternal report of the infant's sleep lasting on average less than 15 h per 24 h (daytime and nighttime sleep). Following block randomization, trained fieldworkers conduct home visits of the intervention group mothers and provide standardized advice on general practices that promote infant's self-regulated sleep. A booklet with the intervention content to aid the mother in implementing the intervention was developed and is given to the mothers in the intervention arm. In the two days following the home visit the intervention mothers receive daily telephone calls for intervention reinforcement and at day 3 the fieldworkers conduct a reinforcement visit to support mothers' compliance with the intervention. The main outcome assessed is the between group difference in average nighttime self-regulated sleep duration (the maximum amount of time the child stays asleep or awake without awakening the parents), at ages 6, 12 and 24 months, evaluated by means of actigraphy, activity diary records and questionnaires. The secondary outcomes are conditional linear growth between age 3-12 and 12-24 months and neurocognitive development at ages 12 and 24 months. DISCUSSION The negative impact of inadequate and insufficient sleep on children's physical and mental health are unquestionable, as well as its impact on cognitive function, academic performance and behavior, all of these being factors to which children in low- and middle-income countries are at higher risk. Behavioral interventions targeting mothers and young children that can be delivered inexpensively and not requiring specialized training can help prevent future issues by reducing the risk to which these children are exposed. TRIAL REGISTRATION ClinicalTrial.gov NCT02788630 registered on 14 June 2016 (retrospectively registered).
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Affiliation(s)
- Ina S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Diego G. Bassani
- Centre for Global Child Health, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alicia Matijasevich
- Department of Preventive Medicine, School of Medicine, University of Sao Paulo, São Paulo, SP Brazil
| | - Camila S. Halal
- Hospital da Criança Conceição – Ministry of Health, Porto Alegre, RS Brazil
| | - Bianca Del-Ponte
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Suélen Henriques da Cruz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Luciana Anselmi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Elaine Albernaz
- Department of Maternal and Child Health, Faculty of Medicine, Federal University of Pelotas, Pelotas, RS Brazil
| | - Michelle Fernandes
- Oxford Maternal and Perinatal Health Institute International Research Fellow, Nuffield Department of Obstetrics and Gynaecology, The John Radcliffe Hospital, University of Oxford, Toronto, UK ,Core Clinical Fellow in Paediatrics, Department of Paediatrics, Southampton General Hospital and Southampton University, Southampton, UK
| | - Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Mariangela F. Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
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Uesugi KH, Dattilo AM, Black MM, Saavedra JM. Design of a Digital-Based, Multicomponent Nutrition Guidance System for Prevention of Early Childhood Obesity. J Obes 2016; 2016:5067421. [PMID: 27635257 PMCID: PMC5007363 DOI: 10.1155/2016/5067421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/21/2016] [Accepted: 07/17/2016] [Indexed: 12/02/2022] Open
Abstract
Interventions targeting parenting focused modifiable factors to prevent obesity and promote healthy growth in the first 1000 days of life are needed. Scale-up of interventions to global populations is necessary to reverse trends in weight status among infants and toddlers, and large scale dissemination will require understanding of effective strategies. Utilizing nutrition education theories, this paper describes the design of a digital-based nutrition guidance system targeted to first-time mothers to prevent obesity during the first two years. The multicomponent system consists of scientifically substantiated content, tools, and telephone-based professional support delivered in an anticipatory and sequential manner via the internet, email, and text messages, focusing on educational modules addressing the modifiable factors associated with childhood obesity. Digital delivery formats leverage consumer media trends and provide the opportunity for scale-up, unavailable to previous interventions reliant on resource heavy clinic and home-based counseling. Designed initially for use in the United States, this system's core features are applicable to all contexts and constitute an approach fostering healthy growth, not just obesity prevention. The multicomponent features, combined with a global concern for optimal growth and positive trends in mobile internet use, represent this system's future potential to affect change in nutrition practice in developing countries.
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Affiliation(s)
| | - Anne M. Dattilo
- Nestlé Nutrition, 12 Vreeland Road, Florham Park, NJ 07932, USA
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard Street No. 161, Baltimore, MD 21201, USA
- RTI International, East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
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Gruver RS, Bishop-Gilyard CT, Lieberman A, Gerdes M, Virudachalam S, Suh AW, Kalra GK, Magge SN, Shults J, Schreiner MS, Power TJ, Berkowitz RI, Fiks AG. A Social Media Peer Group Intervention for Mothers to Prevent Obesity and Promote Healthy Growth from Infancy: Development and Pilot Trial. JMIR Res Protoc 2016; 5:e159. [PMID: 27485934 PMCID: PMC4987492 DOI: 10.2196/resprot.5276] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evidence increasingly indicates that childhood obesity prevention efforts should begin as early as infancy. However, few interventions meet the needs of families whose infants are at increased obesity risk due to factors including income and maternal body mass index (BMI). Social media peer groups may offer a promising new way to provide these families with the knowledge, strategies, and support they need to adopt obesity prevention behaviors. OBJECTIVE The aim of this study is to develop and pilot test a Facebook-based peer group intervention for mothers, designed to prevent pediatric obesity and promote health beginning in infancy. METHODS We conducted in-depth semi-structured interviews with 29 mothers of infants and focus groups with 30 pediatric clinicians, to inform the development of a theory-based intervention. We then conducted a single-group pilot trial with 8 mothers to assess its feasibility and acceptability. All participants were recruited offline at pediatric primary care practices. Participants in the pilot trial joined a private Facebook group, moderated by a psychologist, with a weekly video-based curriculum, and also had the option to meet at a face-to-face event. Within the Facebook group, mothers were encouraged to chat, ask questions, and share photos and videos of themselves and babies practicing healthy behaviors. Consistent with the literature on obesity prevention, the curriculum addressed infant feeding, sleep, activity, and maternal well-being. Feasibility was assessed using the frequency and content of group participation by mothers, and acceptability was measured using online surveys and phone interviews. RESULTS Based on preferences of mothers interviewed (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 27, all Black), we designed the intervention to include frequent posts with new information, videos showing parents of infants demonstrating healthy behaviors, and an optional face-to-face meeting. We developed a privacy and safety plan that met the needs of participants as well as the requirements of the local institutional review board (IRB), which included use of a "secret" group and frequent screening of participant posts. Clinicians, 97% (29/30) women and 87% (26/30) pediatricians, preferred no direct involvement in the intervention, but were supportive of their patients' participation. In our 8-week, single group pilot trial, all participants (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 28, all Black) viewed every weekly video post, and interacted frequently, with a weekly average of 4.4 posts/comments from each participant. All participant posts were related to parenting topics. Participants initiated conversations about behaviors related to healthy infant growth including solid food introduction, feeding volume, and managing stress. All 8 pilot group participants reported that they found the group helpful and would recommend it to others. CONCLUSIONS Our methodology was feasible and acceptable to low-income mothers of infants at high risk of obesity, and could be adapted to implement peer groups through social media for underserved populations in varied settings. CLINICALTRIAL ClinicalTrials.gov NCT01977105; https://clinicaltrials.gov/ct2/show/NCT01977105 (Archived by WebCite at http://www.webcitation.org/6iMFfOBat).
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Affiliation(s)
- Rachel S Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Azevedo LB, Ling J, Soos I, Robalino S, Ells L. The effectiveness of sedentary behaviour interventions for reducing body mass index in children and adolescents: systematic review and meta-analysis. Obes Rev 2016; 17:623-35. [PMID: 27098454 DOI: 10.1111/obr.12414] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/25/2016] [Accepted: 03/12/2016] [Indexed: 12/24/2022]
Abstract
Intervention studies have been undertaken to reduce sedentary behaviour (SB) and thereby potentially ameliorate unhealthy weight gain in children and adolescents. We synthesised evidence and quantified the effects of SB interventions (single or multiple components) on body mass index (BMI) or BMI z-score in this population. Publications up to March 2015 were located through electronic searches. Inclusion criteria were interventions targeting SB in children that had a control group and objective measures of weight and height. Mean change in BMI or BMI z-score from baseline to post-intervention were quantified for intervention and control groups and meta-analyzed using a random effects model. The pooled mean reduction in BMI and BMI z-score was significant but very small (standardized mean difference = -0.060, 95% confidence interval: -0.098 to -0.022). However, the pooled estimate was substantially greater for an overweight or obese population (standardized mean difference = -0.255, 95% confidence interval: -0.400 to -0.109). Multicomponent interventions (SB and other behaviours) delivered to children from 5 to 12 years old in a non-educational setting appear to favour BMI reduction. In summary, SB interventions are associated with very small improvement in BMI in mixed-weight populations. However, SB interventions should be part of multicomponent interventions for treating obese children. © 2016 World Obesity.
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Affiliation(s)
- Liane B Azevedo
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Jonathan Ling
- Department of Pharmacy Health and Well-being, University of Sunderland, Sunderland, UK
| | - Istvan Soos
- Department of Sports and Exercise Sciences, University of Sunderland, Sunderland, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Louisa Ells
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
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Gross RS, Mendelsohn AL, Gross MB, Scheinmann R, Messito MJ. Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices. J Pediatr 2016; 174:171-177.e2. [PMID: 27113376 PMCID: PMC4925185 DOI: 10.1016/j.jpeds.2016.03.060] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/16/2016] [Accepted: 03/23/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families. STUDY DESIGN The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall. RESULTS A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P = .004). CONCLUSIONS Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT01541761.
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Affiliation(s)
- Rachel S. Gross
- Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental - Behavioral Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY
| | - Michelle B. Gross
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY
| | | | - Mary Jo Messito
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY
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Machuca H, Arevalo S, Hackley B, Applebaum J, Mishkin A, Heo M, Shapiro A. Well Baby Group Care: Evaluation of a Promising Intervention for Primary Obesity Prevention in Toddlers. Child Obes 2016; 12:171-8. [PMID: 27035857 DOI: 10.1089/chi.2015.0212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nationally, approximately 24% of preschool children are overweight or obese, with low-income communities disproportionately affected. Few interventions to prevent obesity in children at greatest risk have demonstrated positive results. Therefore, we evaluated the effectiveness of a novel group well-child care intervention for primary obesity prevention at age 2 years. METHODS Well Baby Group (WBG) is an alternative to traditional well-child care offered at a federally qualified health center in the South Bronx. Facilitated by a pediatrician and nutritionist, WBG fosters positive dietary behaviors, responsive parenting and feeding practices, and peer support during the first 18 months of life. Multivariable logistic regression was conducted to test the effect of WBG on rates of overweight/obesity at 2 years (BMI-for-age ≥85th percentile) using a nonrandomized comparison group of children receiving traditional care at our center over the same period. RESULTS Characteristics of mothers and infants were comparable between intervention (n = 47) and comparison (n = 140) groups. Children enrolled in WBG were significantly less likely to be overweight/obese at 2 years than children receiving traditional well-child care (2.1% vs. 15.0%; OR 0.12; 95% CI 0.02-0.94; p = 0.02). In multivariable regression analysis, WBG remained a significant independent protective factor (OR 0.12; 95% CI 0.02-0.93; p = 0.04), adjusting for birthweight and parity. CONCLUSIONS WBG, a replicable model integrated into primary care visits, affords a unique opportunity to intervene consistently and early, providing families in at-risk communities with increased provider time, intensive education, and ongoing support. Further study of group well-child care for primary obesity prevention is warranted to confirm the effectiveness of the model.
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Affiliation(s)
- Hildred Machuca
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Sandra Arevalo
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Barbara Hackley
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Jo Applebaum
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Arielle Mishkin
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Moonseong Heo
- 2 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, NY
| | - Alan Shapiro
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
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Wood CT, Perreira KM, Perrin EM, Yin HS, Rothman RL, Sanders LM, Delamater AM, Bentley ME, Bronaugh AB, Thompson AL. Confirmatory factor analysis of the Infant Feeding Styles Questionnaire in Latino families. Appetite 2016; 100:118-25. [PMID: 26876910 PMCID: PMC4799737 DOI: 10.1016/j.appet.2016.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/25/2016] [Accepted: 02/09/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Parent feeding practices affect risk of obesity in children. Latino children are at higher risk of obesity than the general population, yet valid measure of feeding practices, one of which is the Infant Feeding Styles Questionnaire (IFSQ), have not been formally validated in Spanish. OBJECTIVE To validate the IFSQ among Latino families, we conducted confirmatory factor analysis of pressuring, restrictive, and responsive feeding constructs from the IFSQ. DESIGN/METHODS The IFSQ was administered at the 12-month visit in the Greenlight study, a multi-center cluster randomized trial to prevent obesity. Parents were included if they were of Latino origin (n = 303) and completed an English or Spanish language modified IFSQ (without the indulgence construct). Scores from nine sub-constructs of the IFSQ were compared between English and Spanish language versions. We tested reliability with Cronbach's alpha coefficients and performed confirmatory factor analysis to examine factor loadings and goodness of fit characteristics, modifying constructs to achieve best fit. RESULTS Of 303 parents completing the IFSQ, 84% were born outside the US, and 74% completed the IFSQ in Spanish. Reliability coefficients ranged from 0.28 to 0.61 for the laissez-faire sub-constructs and from 0.58 to 0.83 for the pressuring, restrictive, and responsive sub-constructs. Results for all coefficients were similar between participants responding to an English and Spanish version of the IFSQ. Goodness of fit indices ranged from CFI 0.82-1 and RMSEA 0.00-0.31, and the model performed best in pressuring-soothing (CFI 1.0, RMSEA 0.00) and restrictive-amount (CFI 0.98, RMSEA 0.1) sub-constructs. CONCLUSIONS In a sample of Latino families, pressuring, restrictive, and responsive constructs performed well. The modified IFSQ in both English and Spanish-speaking Latino families may be used to assess parenting behaviors related to early obesity risk in this at-risk population.
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Affiliation(s)
- Charles T Wood
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Krista M Perreira
- Carolina Population Center, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, USA
| | - Eliana M Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - H Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, New York, NY, USA
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lee M Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami School of Medicine, Miami, FL, USA
| | - Margaret E Bentley
- Carolina Population Center, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, USA
| | - Andrea B Bronaugh
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Thompson
- Carolina Population Center, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, USA
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Sinha B, Chowdhury R, Sankar MJ, Martines J, Taneja S, Mazumder S, Rollins N, Bahl R, Bhandari N. Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104:114-34. [PMID: 26183031 DOI: 10.1111/apa.13127] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/12/2015] [Accepted: 06/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To provide comprehensive evidence of the effect of interventions on early initiation, exclusive, continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above. METHODS Of 23977 titles identified through a systematic literature search in PUBMED, Cochrane and CABI, 195 articles relevant to our objective, were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity, we explored its causes by subgroup analysis and meta-regression and applied random effects model. RESULTS Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding rates, were seen when counselling or education were provided concurrently in home and community, health systems and community, health systems and home settings, respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding. CONCLUSION To promote breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.
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Affiliation(s)
- Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - M Jeeva Sankar
- Department of Pediatrics; Newborn Health Knowledge Centre; ICMR Center for Advanced Research in Newborn Health; All India Institute of Medical Sciences; New Delhi India
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health; Centre for International Health; University of Bergen; Bergen Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - Nigel Rollins
- Department of Maternal; Newborn, Child and Adolescent Health; World Health Organization; Geneva Switzerland
| | - Rajiv Bahl
- Department of Maternal; Newborn, Child and Adolescent Health; World Health Organization; Geneva Switzerland
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
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Rapid infant weight gain and early childhood obesity in low-income Latinos and non-Latinos. Public Health Nutr 2015; 19:1777-84. [DOI: 10.1017/s1368980015003201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractObjectiveTo examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity.DesignWeight and height measurements were extracted from all visits for a sample of 0–4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity.SettingBaltimore, MD, USA.SubjectsLatino (n 210) and non-Latino (n 253) children, born in 2003–2004.ResultsAn increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth.ConclusionsAn increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.
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Lim S, O'Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev 2015; 16:972-87. [PMID: 26313354 DOI: 10.1111/obr.12312] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/14/2015] [Accepted: 07/17/2015] [Indexed: 12/31/2022]
Abstract
Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.
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Affiliation(s)
- S Lim
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Hamilton, Vic., Australia
| | - S O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Vic., Australia
| | - H Behrens
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - T Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, NT, Australia
| | - I Ellis
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - J A Dunbar
- Deakin Population Health Strategic Research Centre, Deakin University, Warrnambool, Victoria, Australia
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Bauer NS, Szczepaniak D, Sullivan PD, Mooneyham G, Pottenger A, Johnson CS, Downs SM. Group Visits to Improve Pediatric Attention-Deficit Hyperactivity Disorder Chronic Care Management. J Dev Behav Pediatr 2015; 36:553-61. [PMID: 26414089 DOI: 10.1097/dbp.0000000000000207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with attention-deficit hyperactivity disorder (ADHD) may experience continued impairment at home and school even after medication initiation. Group visits offer a way for pediatricians to provide more time to address ongoing needs. A pilot study was undertaken to examine whether a group visit model improved ADHD management in the pediatric medical home. METHODS Parents and children aged 6 to 18 years with ADHD were recruited and randomized to group visits or a usual care control. Data included attendance at ADHD follow-up visits, parent-rated ADHD symptoms, adaptive functioning, and quality of life. Longitudinal linear mixed models (continuous variables) and generalized linear mixed models (binary outcomes) were used to compare groups. In our statistical models, child and family were random effects; study assignment was a fixed effect. RESULTS Twenty families representing 29 children participated (intervention: 9 parents/13 children and control: 11 parents/16 children). Aside from race, baseline characteristics of participants were similar. None of the intervention families missed the expected 5 ADHD follow-up visits over 1 year; control families missed 1 or more visits over the same period. Intervention families reported an improved level of adaptive functioning at 12 months compared with control (mean severity score: 3.7 vs 4.4, p = .003). All families reported greater limitations and poorer quality of life compared with national norms. CONCLUSION Group visits in the pediatric medical home can improve adherence, and preliminary results show a variety of improvements for the family.
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Affiliation(s)
- Nerissa S Bauer
- *Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; †Section of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; ‡Regenstrief Institute, Inc., Indianapolis, IN; §Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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