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Townsend MS, Shilts MK, Lanoue L, Drake C, Díaz Rios LK, Keim NL, Styne DM, Ontai LL. Obesity Risk Assessment for Spanish-Speaking Immigrant Families with Young Children in the United States: Reliability and Validity with Nutrient Values. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050868. [PMID: 37238415 DOI: 10.3390/children10050868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
The purpose is to examine validity and reliability for an obesity risk assessment tool developed in Spanish for immigrant families with children, 3-5 years old using an 8-week cross-sectional design with data collected over 1 year at Head Start and Special Supplemental Nutrition Program for Women, Infants and Children [WIC]. Parent/child dyads (206) provided a child obesity risk assessment, three child modified 24 h dietary recalls, three child 36+ h activity logs and one parent food behavior checklist. Main outcome measures were convergent validity with nutrients, cup equivalents, and diet quality and three assessments of reliability that included item difficulty index, item discrimination index, and coefficient of variation. Validity was demonstrated for assessment tool, named Niños Sanos. Scales were significantly related to variables in direction hypothesized [p ≤ 0.05]: Healthy Eating Index, fruit/vegetable cup equivalents, folate, dairy cup equivalents, vitamins D, β-carotene, fiber, saturated fat, sugar, time at screen/ sleep/physical activity and parent behaviors. Three measures of reliability were acceptable. The addition of nutrient values as an analytical validation approach adds strength and consistency to previously reported Niños Sanos validation results using children's blood biomarkers and body mass index. This tool can be used by health professionals as an assessment of obesity risk in several capacities: (1) screener for counseling in a clinic, (2) large survey, (3) guide for participant goal setting and tailoring interventions, and (4) evaluation.
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Affiliation(s)
| | - Mical K Shilts
- Department of Family and Consumer Sciences, Nutrition, Food & Dietetics Program, California State University, Sacramento, CA 95819, USA
| | - Louise Lanoue
- Department of Nutrition, University of California, Davis, CA 95616, USA
| | - Christiana Drake
- Department of Statistics, University of California, Davis, CA 95616, USA
| | - L Karina Díaz Rios
- Division of Agriculture and Natural Resources, Public Health Department, University of California, Merced, CA 95343, USA
| | - Nancy L Keim
- USDA Western Human Nutrition and Research Center, University of California, Davis, CA 95616, USA
| | - Dennis M Styne
- Department of Pediatrics, University of California Medical Center, Davis, CA 95817, USA
| | - Lenna L Ontai
- Department of Human Ecology, University of California, Davis, CA 95616, USA
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Díaz Rios LK, Ontai LL, Shilts MK, Lanoue L, Townsend MS. Cross-Cultural Adaptation and Initial Validation of Mi Niño: A Tool to Measure Food-Related Parenting Practices of Spanish-Speaking Parents with Young Children. Curr Dev Nutr 2023; 7:100002. [PMID: 37180080 PMCID: PMC10111596 DOI: 10.1016/j.cdnut.2022.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/03/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Accurate measurement of food-related parenting practices is necessary to inform related interventions and program evaluation. Valid tools reflect cultural attributes that affect household food environments and feeding practices. Simple, unidirectional language adaptation approaches are insufficient to capture these attributes in assessment tools. My Child at Mealtime (MCMT) is a 27-item, validated, visually enhanced self-assessment tool to measure food-related parenting practices of low-income English-speaking parents of preschoolers. Objectives The aim of this study was to describe the cross-cultural adaptation of MCMT into its Spanish version Mi Niño a la Hora the Comer (Mi Niño) and to establish its face validity, factor structure, and internal consistency. Methods MCMT was adapted into its Spanish version after an iterative process that triangulated cognitive interviews with verification of conceptual equivalence by content experts to establish face validity and semantic equivalence. The resulting tool underwent confirmatory factor analysis to determine whether internal consistency was equivalent across the 2 versions. Results Four rounds of cognitive interviews (n = 5, n = 6, n = 2, and n = 4, respectively) with Spanish-speaking women caregivers of children aged 3-5 y recruited from Head Start were conducted. Ten items were modified throughout the adaptation process. Modifications included improved clarity (6 items), comprehension (7 items), appropriateness (4 items), suitability (4 items), and usefulness (2 items) of text and/or accompanying visuals. Confirmatory factor analysis with a sample of Spanish-speaking caregivers (n = 243) resulted in 2 reliable factors representing "child-centered" (α = 0.82) and "parent-centered" (α = 0.87) food-related parenting practices. Conclusions Face validity, semantic equivalence, and internal consistency of Mi Niño were established. This tool can be used in community settings to inform program content and measure changes in food-related parenting practices of Spanish-speaking parents and assist in setting food-related parenting goals. The next steps include exploring the correspondence of Mi Nino with mealtime behaviors observed through video recording.
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Affiliation(s)
- L. Karina Díaz Rios
- Division of Agriculture and Natural Resources, University of California–Merced, Merced, CA, USA
| | - Lenna L. Ontai
- Department of Human Ecology, University of California–Davis, Davis, CA, USA
| | - Mical K. Shilts
- Department of Family and Consumer Sciences, California State University–Sacramento, Sacramento, CA, USA
| | - Louise Lanoue
- Department of Nutrition, University of California–Davis, Davis, CA, USA
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Krijger A, ter Borg S, Elstgeest L, van Rossum C, Verkaik-Kloosterman J, Steenbergen E, Raat H, Joosten K. Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review. Nutrients 2022; 14:nu14142899. [PMID: 35889854 PMCID: PMC9325265 DOI: 10.3390/nu14142899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Screening of children’s lifestyle, including nutrition, may contribute to the prevention of lifestyle-related conditions in childhood and later in life. Screening tools can evaluate a wide variety of lifestyle factors, resulting in different (risk) scores and prospects of action. This systematic review aimed to summarise the design, psychometric properties and implementation of lifestyle screening tools for children in community settings. We searched the electronic databases of Embase, Medline (PubMed) and CINAHL to identify articles published between 2004 and July 2020 addressing lifestyle screening tools for children aged 0–18 years in the community setting. Independent screening and selection by two reviewers was followed by data extraction and the qualitative analysis of findings. We identified 41 unique lifestyle screening tools, with the majority addressing dietary and/or lifestyle behaviours and habits related to overweight and obesity. The domains mostly covered were nutrition, physical activity and sedentary behaviour/screen time. Tool validation was limited, and deliberate implementation features, such as the availability of clear prospects of actions following tool outcomes, were lacking. Despite the multitude of existing lifestyle screening tools for children in the community setting, there is a need for a validated easy-to-administer tool that enables risk classification and offers specific prospects of action to prevent children from adverse health outcomes.
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Affiliation(s)
- Anne Krijger
- Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CB Rotterdam, The Netherlands;
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
- Correspondence: ; Tel.: +31(0)6-2461-2722
| | - Sovianne ter Borg
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Liset Elstgeest
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
- Reinier Academy, Reinier de Graaf Hospital, 2600 GA Delft, The Netherlands
| | - Caroline van Rossum
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Janneke Verkaik-Kloosterman
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Elly Steenbergen
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
| | - Koen Joosten
- Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CB Rotterdam, The Netherlands;
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A systematic review of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in young children (aged 0-5 years). Int J Behav Nutr Phys Act 2022; 19:18. [PMID: 35164783 PMCID: PMC8845346 DOI: 10.1186/s12966-022-01251-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Background Accurate proxy-report questionnaires, adapted to the child’s developmental stage, are required to monitor 24-h movement behaviors in young children, especially for large samples and low-resource settings. Objectives This review aimed to summarize available studies evaluating measurement properties of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in children aged 0–5 years. Methods Systematic literature searches were carried out in the PubMed, Embase and SPORTDiscus databases, up to January 2021. For physical activity and sedentary behavior questionnaires this is a review update, whereas for sleep questionnaires we included all relevant studies published up to now. Studies had to evaluate at least one of the measurement properties of a proxy-report questionnaire assessing at least duration and/or frequency of physical activity, sedentary behavior and/or sleep in 0- to 5-year-old children. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to evaluate the quality of evidence. Results Thirty-three studies were included, examining a total of 37 questionnaires. Ten questionnaires were designed for infants, two for toddlers, 11 for preschoolers, and 14 for a broader age range targeting multiple of these age groups. Twenty questionnaires assessed constructs of sleep, four assessed constructs of physical activity, two assessed screen behavior, five assessed constructs of both physical activity and sedentary behavior, and six assessed constructs of all 24-h movement behaviors. Content validity was evaluated for six questionnaires, structural validity for two, internal consistency for three, test-retest reliability for 16, measurement error for one, criterion validity for one, and construct validity for 26 questionnaires. None of the questionnaires were considered sufficiently valid and/or reliable for assessing one or more movement behaviors in 0- to 5-year-old children, and the quality of evidence was mostly low or very low. Conclusions Valid and/or reliable questionnaires assessing 24-h movement behaviors in 0- to 5-year-olds are lacking. High-quality studies are therefore required, to develop proxy-report questionnaires and evaluate their measurement properties. PROSPERO registration number CRD42020169268. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01251-x.
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Weber SJ, Shearer E, Mulvaney SA, Schmidt D, Thompson C, Jones J, Ahmad H, Coe M, Hull PC. Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach. JMIR Form Res 2021; 5:e30450. [PMID: 34328432 PMCID: PMC8367138 DOI: 10.2196/30450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface.
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Affiliation(s)
- Summer J Weber
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Elyse Shearer
- College of Agriculture, Tennessee State University, Nashville, TN, United States
| | | | - Douglas Schmidt
- School of Engineering, Vanderbilt University, Nashville, TN, United States
| | | | - Jessica Jones
- Meharry-Vanderbilt Alliance, Meharry Medical College, Nashville, TN, United States
| | - Haseeb Ahmad
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Martina Coe
- College of Agriculture, Tennessee State University, Nashville, TN, United States
| | - Pamela C Hull
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
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Shilts MK, Diaz Rios LK, Panarella KH, Styne DM, Lanoue LL, Drake CM, Ontai L, Townsend MS. Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention. J Prim Care Community Health 2021; 12:21501327211009695. [PMID: 33845676 PMCID: PMC8047825 DOI: 10.1177/21501327211009695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. Methods: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. Results: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. Conclusion: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.
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Affiliation(s)
- Mical K Shilts
- California State University, Sacramento, Sacramento, CA, USA
| | | | | | - Dennis M Styne
- University of California, Davis Medical Center, Sacramento, CA, USA
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Townsend MS, Shilts MK, Lanoue L, Drake C, Rios LKD, Styne DM, Keim NL, Ontai L. Obesity Risk Assessment Tool for Low-Income Spanish Speaking Immigrant Parents with Young Children: Validity with BMI and Biomarkers of Obesity. Nutrients 2020; 12:E3582. [PMID: 33266497 PMCID: PMC7700341 DOI: 10.3390/nu12113582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022] Open
Abstract
Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.
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Affiliation(s)
| | - Mical K. Shilts
- Department of Family and Consumer Sciences, Nutrition, Food & Dietetics Program, California State University Sacramento, Sacramento, CA 95819, USA;
| | - Louise Lanoue
- Department of Nutrition, University of California, Davis, CA 95616, USA;
| | - Christiana Drake
- Department of Statistics, University of California at Davis, Davis, CA 95616, USA;
| | - L. Karina Díaz Rios
- Division of Agriculture and Natural Resources, Public Health Department, University of California, Merced, CA 95343, USA;
| | - Dennis M. Styne
- Pediatric Endocrinology, Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA 95817, USA;
| | - Nancy L. Keim
- USDA Western Human Nutrition Research Center, University of California, Davis, CA 95616, USA;
| | - Lenna Ontai
- Department of Human Ecology, University of California, Davis, CA 95616, USA;
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MacTavish K, Cistrone A, Kingsnorth S, McPherson AC. Communication tools used in childhood obesity discussions: A scoping review. Child Care Health Dev 2020; 46:651-666. [PMID: 32844408 DOI: 10.1111/cch.12800] [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: 04/03/2020] [Accepted: 07/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Paediatric healthcare professionals (HCPs) play an essential role in the prevention and management of childhood obesity; however, many report considerable barriers to having weight-related conversations, including a lack of confidence. One way to address this is to use communication tools, such as charts, pictures and handouts. This scoping review's objective was to identify the extent and nature of available tools in the published literature that aimed to support HCPs in having positive weight-related conversations with children and families. METHODS CINAHL, Medline and PsycINFO were systematically searched from 2005 to 2019. Articles were selected based on (a) use of an identified communication tool; (b) tool designed for use with children between the ages of 2 and 18 and/or their parents; (c) tool designed to be used in weight-related discussions; and (d) tool designed to be used by HCPs in a formal healthcare setting. RESULTS Of the 3,596 articles yielded after deduplication, 13 unique communication tools were identified. Tools were grouped according to three themes: (a) help communicate child's weight status; (b) provide a communication framework for HCPs; and (c) actively engage children and/or parents in discussions. Many of the tools were recently developed and had not been evaluated in clinical practice. The clinical utility of each tool was evaluated. CONCLUSION This study identified 13 communication tools HCPs could use when having weight-related discussions. However, there was a lack of evaluation and clinical utility. Only one tool had high clinical utility, and not all tools would be recommended for use in practice.
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Affiliation(s)
- Katherine MacTavish
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Cistrone
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Bonuck K, Collins-Anderson A, Ashkinaze J, Karasz A, Schwartz A. Environmental Scan of Sleep Health in Early Childhood Programs. Behav Sleep Med 2020; 18:598-610. [PMID: 31318273 PMCID: PMC6980449 DOI: 10.1080/15402002.2019.1640222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To ascertain how sleep health knowledge is translated to early care and education (ECE) programs, using a multi-component environmental scan. METHODS A website scan identified organizations' sleep content re: recommended practices, developmental effects, and "actionable" ratings (0-2). ECE staff surveys assessed preparedness, practices, and beliefs about addressing sleep health and sleep problems in ECE programs. Semi-structured interviews with stakeholders from the ECE, pediatric and sleep communities assessed awareness, priorities, and practices at their organizations. RESULTS Of 15 websites scanned, half lacked sleep content on links to development, optimal duration, or scientific background. ECE staff (n = 31) were comfortable speaking to parents about healthy sleep, and with incorporating sleep education and guidance into ECE. Stakeholders (n = 15) rated healthy sleep as a high relevance, but lower priority issue. Within ECE settings stakeholders reported that knowledge about specific links to health and development was poor and that sleep health was often obscured by "safe sleep" issues. Their recommendations included: linking sleep health to "hot topics" such as obesity or preschool suspensions and expulsions, integrating it with the teaching of routines, and raising public awareness. CONCLUSION Despite understanding that healthy sleep promotes school readiness, there is insufficiently specific, actionable information in ECE training, programs, or policies. Findings suggest a need for an awareness campaign with clear, actionable messaging, dissemination of turnkey materials, and integration with policy and professional training systems. TRIAL REGISTRATION - ClinicalTrials.Gov: NCT03556462.
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Affiliation(s)
- Karen Bonuck
- Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY, USA
| | | | | | - Alison Karasz
- Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY
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Fox K, Gans K, McCurdy K, Risica PM, Jennings E, Gorin A, Papandonatos GD, Tovar A. Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices. Contemp Clin Trials Commun 2020; 19:100583. [PMID: 32637721 PMCID: PMC7327278 DOI: 10.1016/j.conctc.2020.100583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/28/2022] Open
Abstract
There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.
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Affiliation(s)
- Katelyn Fox
- Department of Nutrition and Food Science, University of Rhode Island, 41 Lower College Road, Room 125, Kingston, RI, 02881, USA
| | - Kim Gans
- Department of Human Development and Family Studies, and Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Karen McCurdy
- Department of Human Development & Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | | | - Alison Tovar
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
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Ontai LL, Sutter C, Sitnick S, Shilts MK, Townsend MS. Parent Food-Related Behaviors and Family-Based Dietary and Activity Environments: Associations with BMI z-Scores in Low-Income Preschoolers. Child Obes 2020; 16:S55-S63. [PMID: 31682151 DOI: 10.1089/chi.2019.0105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: In early childhood, the family dietary and activity environment and parent food-related practices have been found to be important predictors of children's weight. However, few studies account for both of these factors, or the interaction between the 2, when assessing BMI in early childhood. This study aims to examine the association between the family-based dietary and activity environment (including intake, physical activity, and structure) and children's BMI z-scores in the context of parent food-related behaviors in low-income families during the preschool years. Methods: Parents (n = 111) completed questionnaires assessing the family-based dietary and activity environment, including diet, physical activity, screentime and sleep, and their use of parent food-related behaviors including parent-centered (i.e., controlling) and child-centered (i.e., autonomy supportive) practices. Children's BMI z-scores were calculated from researcher-measured height and weight. Results: Parent-centered food-related behaviors were directly related to children's BMI z-scores and moderated the association between the family-based dietary and activity environment and children's BMI z-scores. Family-based behaviors were associated with lower BMI only when parents used fewer parent-centered behaviors. Conclusions: Findings indicate that programs working with low-income families to prevent child obesity should stress both the creation of a healthy home environment and the use of positive parent food-related behaviors with preschool aged children.
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Affiliation(s)
- Lenna L Ontai
- Department of Human Ecology, University of California, Davis, Davis, CA, USA
| | - Carolyn Sutter
- UChicago STEM Education, Outlier Research and Evaluation, University of Chicago, Chicago, IL, USA
| | - Stephanie Sitnick
- School of Psychology and Counseling, Caldwell University, Caldwell, NJ, USA
| | - Mical K Shilts
- Department of Family and Consumer Sciences, California State University, Sacramento, Sacramento, CA, USA
| | - Marilyn S Townsend
- Department of Nutrition, University of California, Davis, Davis, CA, USA
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Townsend MS, Shilts MK, Lanoue L, Drake C, Styne DM, Woodhouse L, Ontai L. Obesity Risk Assessment Tool among 3-5 Year Olds: Validation with Biomarkers of Low-Grade Chronic Inflammation. Child Obes 2020; 16:S23-S32. [PMID: 32857609 DOI: 10.1089/chi.2019.0237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Many families with young children practice nutrition, parenting, and lifestyle behaviors that set their children on trajectories for unhealthful weight gain. Potential adverse health effects of excessive body fat can result in the secretion of proinflammatory molecules and increased risk of inflammation and metabolic diseases. A pediatric obesity risk assessment tool named Healthy Kids (HK), demonstrated validity in a longitudinal study with child's measured BMI and 36-hour diet, screen, sleep, and activity logs. Our objective was to provide additional evidence of validity with low-income families with literacy issues using an inflammation index composed of four proinflammatory biomarkers. Methods: Parent/child pairs (n = 104) from Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided HK, blood samples, and measured heights/weights. Select child inflammatory markers were discretized into two groups of HK scores. Data were analyzed with a mixed model adjusted for children's age and BMI. Results: A significant HK-time interaction effect was shown for the child inflammation index with two data collection points 1 year apart (pdid = 0.039). This index increased over 12 months in children with less healthful behaviors (p = 0.007), but not in children with more healthful profiles (p = 0.58). Conclusions: Children with less healthful HK scores had an elevated inflammation index indicating a low-grade chronic systemic inflammatory state. Taken together with our previously published findings, the HK tool has potential as a rapid and easy-to-administer assessment of the family environment and the child's obesity risk. HK can be useful for federal nutrition programs for evaluation, risk assessment, goal setting, and/or program planning in clinical and community environments.
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Affiliation(s)
| | - Mical K Shilts
- Department of Family and Consumer Sciences, California State University at Sacramento, Sacramento, CA, USA
| | - Louise Lanoue
- Nutrition Department, University of California at Davis, Davis, CA, USA
| | - Christiana Drake
- Statistics Department, University of California at Davis, Davis, CA, USA
| | - Dennis M Styne
- Pediatric Endocrinology, Department of Pediatrics, University of California, Davis Medical School, Sacramento, CA, USA
| | | | - Lenna Ontai
- Family Studies, Human Ecology Department, University of California at Davis, Davis, CA, USA
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Bailey‐Davis L, Kling SMR, Wood GC, Cochran WJ, Mowery JW, Savage JS, Stametz RA, Welk GJ. Feasibility of enhancing well-child visits with family nutrition and physical activity risk assessment on body mass index. Obes Sci Pract 2019; 5:220-230. [PMID: 31275595 PMCID: PMC6587309 DOI: 10.1002/osp4.339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Integration of behavioural risk assessment into well-child visits is recommended by clinical guidelines, but its feasibility and impact is unknown. METHODS A quasi-experimental study evaluated the feasibility and effectiveness of risk assessment on body mass index (BMI) at 1-year follow-up. Children with assessments (intervention) were compared with those who did not complete assessments (non-respondent) and those who received standard care (non-exposed). RESULTS Analyses included 10,647 children aged 2-9 years (2,724 intervention, 3,324 non-respondent and 4,599 non-exposed). Forty-five per cent of parents completed the assessments. Intervention and non-respondent groups differed in change in BMI z-score at 1 year by -0.05 (confidence interval [CI]: -0.08, -0.02; P = 0.0013); no difference was observed with non-exposed children. The intervention group had a smaller increase in BMI z-score (0.07 ± 0.63) than non-respondent group (0.13 ± 0.63). For children with normal weight at baseline, intervention versus non-respondent groups differed in BMI z-score change by -0.06 (CI: -0.10, -0.02; P = 0.0025). However, children with overweight at baseline in the intervention versus the non-exposed group differed in BMI z-score change (0.07 [CI: 0.02, 0.14]; P = 0.016). When analysed by age, results were similar for 2- to 5-year-olds, but no differences were found for 6- to 9-year-olds. CONCLUSION Automating risk assessment in paediatric care is feasible and effective in promoting healthy weight among preschool but not older children.
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Affiliation(s)
- L. Bailey‐Davis
- Geisinger Obesity InstituteGeisingerDanvillePAUSA
- Department of Nutritional SciencesThe Pennsylvania State University, University ParkState CollegePAUSA
| | - S. M. R. Kling
- Department of Nutritional SciencesThe Pennsylvania State University, University ParkState CollegePAUSA
| | - G. C. Wood
- Geisinger Obesity InstituteGeisingerDanvillePAUSA
| | | | - J. W. Mowery
- Geisinger Obesity InstituteGeisingerDanvillePAUSA
| | - J. S. Savage
- Center for Childhood Obesity Research, Department of Nutritional SciencesThe Pennsylvania State University, University ParkState CollegePAUSA
| | - R. A. Stametz
- Steele Institute for Health InnovationGeisingerDanvillePAUSA
| | - G. J. Welk
- Department of KinesiologyIowa State UniversityAmesIAUSA
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Ontai LL, Sutter C, Sitnick S, Shilts MK, Townsend MS. My Child at mealtime parent self-assessment of food related behaviors: Validation with mealtime behaviors. Appetite 2019; 136:62-69. [PMID: 30677466 DOI: 10.1016/j.appet.2019.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 12/17/2018] [Accepted: 01/20/2019] [Indexed: 11/15/2022]
Abstract
My Child at Mealtime (MCMT) is a visually enhanced, self-assessment tool designed to measure parent food related behaviors of low-income caregivers of preschool-aged children. The current study examined the factor structure of MCMT and the correspondence between MCMT parent- and child-centered food related behaviors with observed behaviors during a mealtime with their preschool aged child. Caregivers (N = 175) completed MCMT, and a subsample (n = 60) had a mealtime videotaped in their home. Exploratory and confirmatory factor analysis supported a two-factor structure resulting in parent-centered and child-centered MCMT subscales. There was a significant association between parent-centered MCMT scores and observed parent-centered behaviors at mealtime. Behavioral correspondence of MCMT child-centered behaviors was generally weaker. Overall, the findings suggest that caregivers' MCMT responses provide a valid measure of parent food related behaviors.
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