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Dou N, Deitch R, Kowalski AJ, Kuhn A, Lane H, Parker EA, Wang Y, Zafari Z, Black MM, Hager ER. Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study. Contemp Clin Trials 2024; 136:107408. [PMID: 38072192 PMCID: PMC10922699 DOI: 10.1016/j.cct.2023.107408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. METHODS The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. CONCLUSION Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.
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Affiliation(s)
- Nan Dou
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Rachel Deitch
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Alysse J Kowalski
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Ann Kuhn
- Department of Exercise and Nutrition Sciences, University at Buffalo, The State University of New York, 401 Kimball Tower, Buffalo, NY 14214, USA.
| | - Hannah Lane
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701, USA.
| | - Elizabeth A Parker
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, USA.
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC 20052, USA.
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 20 North Pine Street, Baltimore, MD 21201, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, 737 West Lombard Street, Baltimore, MD 21201, USA; RTI International, Research Triangle Park, NC 27709, USA.
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
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2
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Covington LB. Striving to improve sleep health disparities in racial/ethnic minority and socioeconomically disadvantaged families. J Clin Sleep Med 2023; 19:1577-1578. [PMID: 37401772 PMCID: PMC10476035 DOI: 10.5664/jcsm.10716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Lauren B. Covington
- School of Nursing, College of Health Sciences, University of Delaware, Newark, Delaware
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3
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Koivukoski H, Hasanen E, Tolvanen A, Chua T, Chia M, Vehmas H, Sääkslahti A. Meeting the WHO 24-h guidelines among 2-6-year-old children by family socioeconomic status before and during the COVID-19 pandemic: a repeated cross-sectional study. JOURNAL OF ACTIVITY, SEDENTARY AND SLEEP BEHAVIORS 2023; 2:2. [PMID: 38013787 PMCID: PMC9807983 DOI: 10.1186/s44167-022-00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2023]
Abstract
Background The World Health Organization (WHO) has developed guidelines for 24-h physical activity (PA), sedentary behaviour and sleep for young children. Lower socioeconomic status (SES) has been linked to a lower likelihood of meeting these guidelines. The outbreak of the novel coronavirus disease (COVID-19) raised concerns about young children's opportunities to meet the guidelines. The study focused on the prevalence of meeting the WHO's 24-h guidelines on screen time (ST), PA and sleep among 2-6-year-old children, in association with family SES, before COVID-19 outbreak in 2019, and during the pandemic in 2020 and 2021 in Finland. Methods Data were collected at three timepoints by an online survey through day-care centres. Meeting the WHO 24-h guidelines was defined for each behaviour, from a parent-reported seven-day recall of a typical day on weekdays and weekend days and adapted to the national context. Children were considered to meet the ST guideline if they had maximum of 60 min of ST, the PA guideline if they had minimum of 60 min of outdoor PA, and the sleep guidelines if they had minimum of 11/10/9 h (2/3-5/6 years) of good or very good quality sleep. Binary logistic regression models were used to examine the odds ratios of meeting the guidelines. Results The prevalence of meeting the ST guideline was highest before the COVID-19 pandemic in 2019. The PA guideline was most met during the strict pandemic restrictions in 2020. Children from higher SES families were more likely to meet the ST and sleep duration guidelines either on weekdays or weekends. The PA guideline was met more on weekdays by children whose parents had lower education levels at all timepoints. In 2020, sleep quality guideline was less likely met by children with parents with the highest education levels. Conclusion Higher SES may increase the odds of young children meeting the ST and sleep duration guidelines, but the results are more complex regarding PA and SES. The impact of the COVID-19 pandemic on ST, outdoor PA, and sleep of young children varied by family SES, and further research is recommended to identify causality of these relationships. Supplementary Information The online version contains supplementary material available at 10.1186/s44167-022-00010-4.
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Affiliation(s)
- Henriikka Koivukoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Elina Hasanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Asko Tolvanen
- Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Terence Chua
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Michael Chia
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Hanna Vehmas
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Sääkslahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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4
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Gomahr J, Julian V, Thivel D, Maruszczak K, Schneider AM, Weghuber D. Childhood obesity prevention: what can be achieved? Curr Opin Clin Nutr Metab Care 2022; 25:223-231. [PMID: 35256565 DOI: 10.1097/mco.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Childhood obesity is a pandemic generating an enormous individual and socioeconomic burden worldwide. This narrative review summarizes recent evidence on successful and recommended prevention strategies according to age groups and different levels of interventions. RECENT FINDINGS Effective prevention of childhood obesity is feasible and most successful early in life up to preschool age, and it should include a multicomponent approach, integrating individuals, family and society. Trials that improve nutrition and/or enhance physical activity are the cornerstones of childhood obesity prevention on an individual level. However, their efficacy is determined by the combination of interventions for the target age group. Further, improving family support and sleep, as well as reducing screen time, lead to favourable results. Many research gaps remain, including a lack of effective interventions for high-risk groups. SUMMARY As a multifactorial condition, childhood obesity requires a multicomponent approach. Interventions should be developmental stage-specific and adjusted to the setting. Current research gaps need to be targeted by future trials, with a special focus on the benefit of the most vulnerable groups. From a systems response perspective, a paradigm shift from interventions focusing on the individual to approaches that target society as a whole is warranted.
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Affiliation(s)
- Julian Gomahr
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand
| | - David Thivel
- Laboratory AME2P, University of Clermont Auvergne, Aubiere, Franoe
| | - Katharina Maruszczak
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Anna-Maria Schneider
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Weghuber
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
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5
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Lai JS, Blackwell CK, Tucker CA, Jensen SE, Cella D. Measuring PROMIS® Physical Activity and Sleep Problems in Early Childhood. J Pediatr Psychol 2022; 47:534-546. [PMID: 35552434 PMCID: PMC9113359 DOI: 10.1093/jpepsy/jsac028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Physical activity (PA) and sleep are leading health indicators for individuals of all ages. Monitoring young children’s PA and sleep using psychometrically sound instruments could help facilitate timely interventions to promote healthy development. This article describes the development of the PROMIS® Early Childhood (EC) Parent Report Physical Activity (PA) and Sleep Problems (SP) measures for children aged 1–5 years.
Methods
Item pools were generated by interviewing parents, input from content experts, and literature review. Data from a U.S. general population sample were used to determine factor structures of item pools via factor analytic approaches, estimate item parameters via item response theory (IRT) models, and establish norms. Pearson correlations were used to evaluate across-domain associations. Analysis of variance was used and known-groups’ validity of PA and SP by comparing their scores to PROMIS EC Parent Report Global Health: child’s physical, emotional, and mental conditions.
Results
Initial item pools consisted of 19 and 26 items for PA and SP, respectively. Factor analyses’ results supported unidimensionality of 5 and 16 items measuring PA and SP, respectively, which were then calibrated using IRT. Norms were established by centering to a probability-based U.S. general population. Computerized adaptive testing algorithms were established. Some analyses supported initial measure validity.
Conclusions
The PROMIS EC PA calibrated scale and SP item banks are user-friendly and brief, yet produce precise scores. Both measures enable psychometrically sound assessment of PA behavior and sleep problems. Future studies to comprehensively evaluate the validity of these two measures are warranted.
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Affiliation(s)
- Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Institute for Innovations in Developmental Sciences (DevSci), USA
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Institute for Innovations in Developmental Sciences (DevSci), USA
| | - Carole A Tucker
- Department of Nutrition, Metabolic and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, USA
| | - Sally E Jensen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Institute for Innovations in Developmental Sciences (DevSci), USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Institute for Innovations in Developmental Sciences (DevSci), USA
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6
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Reesor-Oyer L, Parker H, Burkart S, Smith MT, Dugger R, von Klinggraeff L, Weaver RG, Beets MW, Armstrong B. Measuring Micro Temporal Processes Underlying Preschoolers Screen Use and Behavioral Health: Protocol for the Tots & Tech Study (Preprint). JMIR Res Protoc 2022; 11:e36240. [PMID: 36169993 PMCID: PMC9557980 DOI: 10.2196/36240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 12/19/2022] Open
Abstract
Background Excessive screen time is associated with poor health and behavioral outcomes in children. However, research on screen time use has been hindered by methodological limitations, including retrospective reports of usual screen time and lack of momentary etiologic processes occurring within each day. Objective This study is designed to assess the feasibility and utility of a comprehensive multibehavior protocol to measure the digital media use and screen time context among a racially and economically diverse sample of preschoolers and their families. This paper describes the recruitment, data collection, and analytical protocols for the Tots and Tech study. Methods The Tots and Tech study is a longitudinal, observational study of 100 dyads: caregivers and their preschool-age children (aged 3-5 years). Both caregivers and children will wear an Axivity AX3 accelerometer (Axivity Ltd) for 30 days to assess their physical activity, sedentary behavior, and sleep. Caregivers will complete ecological momentary assessments (EMAs) for 1 week to measure child behavioral problems, caregiver stress, and child screen time. Results The Tots and Tech study was funded in March 2020. This study maintains rolling recruitment, with each dyad on their own assessment schedule, depending on the time of enrollment. Enrollment was scheduled to take place between September 2020 and May 2022. We aim to enroll 100 caregiver-child dyads. The Tots and Tech outcome paper is expected to be published in 2022. Conclusions The Tots and Tech study attempts to overcome previous methodological limitations by using objective measures of screen time, physical activity, sedentary behavior, and sleep behaviors with contextual factors measured by EMA. The results will be used to evaluate the feasibility and utility of a comprehensive multibehavior protocol using objective measures of mobile screen time and accelerometry in conjunction with EMA among caregiver-child dyads. Future observational and intervention studies will be able to use this study protocol to better measure screen time and its context. International Registered Report Identifier (IRRID) DERR1-10.2196/36240
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Affiliation(s)
- Layton Reesor-Oyer
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Hannah Parker
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Sarah Burkart
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michal T Smith
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Roddrick Dugger
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Lauren von Klinggraeff
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - R Glenn Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michael W Beets
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
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7
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Franchak JM, Scott V, Luo C. A Contactless Method for Measuring Full-Day, Naturalistic Motor Behavior Using Wearable Inertial Sensors. Front Psychol 2021; 12:701343. [PMID: 34744865 PMCID: PMC8570382 DOI: 10.3389/fpsyg.2021.701343] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
How can researchers best measure infants' motor experiences in the home? Body position-whether infants are held, supine, prone, sitting, or upright-is an important developmental experience. However, the standard way of measuring infant body position, video recording by an experimenter in the home, can only capture short instances, may bias measurements, and conflicts with physical distancing guidelines resulting from the COVID-19 pandemic. Here, we introduce and validate an alternative method that uses machine learning algorithms to classify infants' body position from a set of wearable inertial sensors. A laboratory study of 15 infants demonstrated that the method was sufficiently accurate to measure individual differences in the time that infants spent in each body position. Two case studies showed the feasibility of applying this method to testing infants in the home using a contactless equipment drop-off procedure.
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Affiliation(s)
- John M. Franchak
- Perception, Action, and Development Laboratory, Department of Psychology, University of California, Riverside, Riverside, CA, United States
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8
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Ursache A, Robbins R, Chung A, Dawson-McClure S, Kamboukos D, Calzada E, Jean-Louis G, Brotman LM. Sleep, Classroom Behavior, and Achievement Among Children of Color in Historically Disinvested Neighborhoods. Child Dev 2021; 92:1932-1950. [PMID: 34041742 PMCID: PMC9074088 DOI: 10.1111/cdev.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Children of color are more likely to have poor sleep health than White children, placing them at risk for behavioral problems in the classroom and lower academic performance. Few studies, however, have utilized standardized measures of both classroom behavior and achievement. This study examined whether children's sleep (parent and teacher report) in first grade concurrently related to independent observations of classroom behavior and longitudinally predicted achievement test scores in second grade in a sample of primarily Black (86%) children (n = 572; age = 6.8) living in historically disinvested neighborhoods. Higher teacher-reported child sleepiness was associated with lower adaptive behaviors and higher problem behaviors in the classroom, and predicted lower achievement. Parent-reported bedtime resistance and disordered breathing also predicted lower achievement.
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Affiliation(s)
- Alexandra Ursache
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Rebecca Robbins
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
- Department of Sleep and Circadian Disorders, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115
| | - Alicia Chung
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Spring Dawson-McClure
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Dimitra Kamboukos
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Esther Calzada
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712
| | - Girardin Jean-Louis
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Laurie Miller Brotman
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
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9
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Chang Z, Lei W. A Study on the Relationship Between Physical Activity, Sedentary Behavior, and Sleep Duration in Preschool Children. Front Public Health 2021; 9:618962. [PMID: 33898373 PMCID: PMC8059703 DOI: 10.3389/fpubh.2021.618962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Explore the role of physical activity (PA) and sedentary behavior (SB) in the sleep of preschool children. Method: Preschool children (n = 458) from kindergarten were recruited, measures included accelerometer-derived 24 h activity [SB, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), daytime sleep duration (DSP), and nocturnal sleep duration (NSP)]. A self-made questionnaire was used to supplementary survey on different types of SB. The two-layer chi-square test and the Cochran–Mantel–Haenszel test were used and significance set at p < 0.05. Results: PA is mainly a protective factor for DSP, while SB is mainly a risk factor for NSP of preschool children; Screen-type SB including screen viewing SB and video game SB is a risk factor for NSP, while quiet learning SB have no significant correlation with sleep duration in preschool children; Gender and social economic status are important factors affecting the association of PA, SB, and sleep duration in preschool children. Conclusions: The relationship between sleep duration at different periods and PA and SB of preschool children is different. Future educators need to gradually realize the different factors affecting the sleep of preschool children at different stages, clarify the protective factors and risk factors, in order to improve the sleep duration of preschool children.
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Affiliation(s)
- Zhenya Chang
- College of Physical Education and Health, East China Normal University, Shanghai, China.,Preschool Education School, Changsha Normal University, Hunan, China
| | - Wei Lei
- College of Physical Education, Jiangxi Science and Technology Normal University, Jiangxi, China
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10
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Kracht CL, Redman LM, Casey PH, Krukowski RA, Andres A. Association between Home Environment in Infancy and Child Movement Behaviors. Child Obes 2021; 17:100-109. [PMID: 33471594 PMCID: PMC7984654 DOI: 10.1089/chi.2020.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.
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Affiliation(s)
| | | | - Patrick H. Casey
- Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, USA
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aline Andres
- Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, USA.,Address correspondence to: Aline Andres, PhD, RD, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, 15 Children's Way, Slot 512-20B, Little Rock, AR 72202, USA
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11
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Slaton A, Kowalski AJ, Zemanick A, Pulling Kuhn A, Hager ER, Black MM. Motor Competence and Attainment of Global Physical Activity Guidelines among a Statewide Sample of Preschoolers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228546. [PMID: 33217996 PMCID: PMC7698764 DOI: 10.3390/ijerph17228546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
Global physical activity guidelines for preschoolers include 60 min of moderate-to-vigorous physical activity (MVPA) daily. This study, based on the developmental model of motor skill competence, examines how motor competence relates to preschoolers’ likelihood of meeting global guidelines using ankle accelerometry. We measured physical activity using 24-h ankle-placement accelerometry (Actical) for at least two consecutive days (87% with six-seven days), motor competence using the Test of Gross Motor Development-2 (TGMD-2), and BMI-for-age z-scores (BMIz) using anthropometry and age- and sex-specific CDC norms. Caregivers provided demographic characteristics of children’s age, sex, and race. We used multivariable logistic regression to examine how motor competence, BMIz weight status, and demographic characteristics related to meeting global physical activity guidelines. The sample included 588 preschoolers, age 3–5 years; 55% male; 60% white; and 28% overweight/obese; 75% attained the recommended 60 min of MVPA per day. The odds of meeting MVPA guidelines were associated with higher gross motor quotient, higher object control scores, sex (male), age (older), and race (white), but not with BMIz weight status. Findings support the use of 24-h ankle accelerometry among preschoolers and are consistent with the developmental model of motor competence applied to preschoolers, whereby object control competence relates positively to attaining global physical activity guidelines.
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Affiliation(s)
- Anthony Slaton
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY 11549, USA
| | - Alysse J. Kowalski
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
| | - Amy Zemanick
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
| | - Ann Pulling Kuhn
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
| | - Erin R. Hager
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Maureen M. Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
- RTI International, Research Triangle Park, Durham, NC 27709, USA
- Correspondence:
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12
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Covington L, Armstrong B, Trude ACB, Black MM. Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families. Ann Behav Med 2020; 55:653-664. [PMID: 33196078 DOI: 10.1093/abm/kaaa100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families. PURPOSE To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight. METHODS Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score. RESULTS Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score. CONCLUSIONS Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities. TRIAL REGISTRATION NUMBER NCT02615158.
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Affiliation(s)
| | - Bridget Armstrong
- Arnold School of Public Health, Department of Exercise Science, Columbia, SC, USA
| | - Angela C B Trude
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - Maureen M Black
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, Baltimore, MD, USA.,RTI International, Research Triangle Park, NC, USA
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de Lucena Martins CM, Lemos LFGBP, de Souza Filho AN, Bezerra TA, Soares IAA, Mota JG, Bandeira PFR, Mota JAPS, Tassitano RM, Duncan MJ. Adherence to 24-hour movement guidelines in low-income Brazilian preschoolers and associations with demographic correlates. Am J Hum Biol 2020; 33:e23519. [PMID: 33075173 DOI: 10.1002/ajhb.23519] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The importance of movement behaviors for health is well known, although few studies have examined the adherence to movement guidelines in low-income preschoolers from a middle-income country, as Brazil. This study reports the proportion of preschoolers meeting the 24-hour movement guidelines and investigates its associations with demographic correlates in Brazilian low-income preschoolers. METHODS Two hundred and seventy preschoolers (132 boys, means age = 3.97 ± 0.80) provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, screen time, and social correlates were parent-reported. Preschoolers were classified as compliant/not compliant with the 24-hour movement guidelines. Relationships between compliance with movement behaviors guidelines and demographic correlates were calculated using a network analysis (Mplus 8.0; Rstudio). RESULTS Preschoolers were active (273.52 ± 62.08 minutes/day of total PA), though moderate-to-vigorous physical activity (MVPA) time was below the guideline (58.68 ± 22.51 minutes/day); spent more than the recommended 60 minutes/day on screen time (169.91 ± 97.07 minutes/day); and slept less than 10 hours per night (9.44 ± 1.12 hours/day). Only 3% of the sample complied with the guidelines. PA showed the highest compliance (43%), compared to sleep duration (35%) and screen time (15%). Male sex was related to adherence to MVPA recommendations, while female sex, with adherence to total PA recommendations. Child's primary caregiver was the most important centrality indicator in the network. CONCLUSION Only 3% of the assessed preschoolers are compliant with the 24-hour movement behaviors guidelines. Strategies to promote adherence to movement behaviors among low-income preschoolers should consider child's primary caregivers to support movement behaviors.
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Affiliation(s)
| | | | | | - Thaynã Alves Bezerra
- Department of Physical Education, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | | | - Jéssica Gomes Mota
- Department of Physical Education, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | | | | | | | - Michael Joseph Duncan
- Centre for Applied Biological and Exercise Sciences, Coventry University, Coventry, UK
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Kwon S, Honegger K, Mason M. Daily Physical Activity Among Toddlers: Hip and Wrist Accelerometer Assessments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214244. [PMID: 31683776 PMCID: PMC6862284 DOI: 10.3390/ijerph16214244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022]
Abstract
Physical activity (PA) habits seem to track over time from as young as early childhood. For children under age 3 years, wearable sensor-measured PA levels have begun to be investigated. The aims of this study were to evaluate the feasibility of using hip- vs. wrist-worn accelerometers, and to report accelerometer-derived PA metrics among toddlers. A convenience sample of 22 toddlers aged 13 to 35 months and their mothers were recruited for this study. ActiGraph wGT3X-BT accelerometers were attached to wrist bands and waist belts. The mothers were asked to affix a wrist band and a waist belt to their participating children during waking hours for four days. They also completed an acceptability survey. Of the 22 toddlers, 19 (86%) had ≥ 3 valid days of hip data, while only 14 (64%) did so for wrist data (p = 0.16). In terms of acceptability, 18 mothers (82%) responded that the 4-day hip wear was easy, while only 13 (59%) responded that the 4-day wrist wear was easy (p = 0.19). Daily light-intensity PA (LPA) was on average 161 min, and daily moderate- and vigorous-intensity PA (MVPA) was on average 47 min, as determined using published hip accelerometer cut-points. There were no significant differences in LPA or MVPA by age or by sex. In conclusion, this study suggests that hip placement of an ActiGraph accelerometer is more feasible than wrist placement among toddlers.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Kyle Honegger
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Maryann Mason
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
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Armstrong B, Trude ACB, Johnson C, Castelo RJ, Zemanick A, Haber-Sage S, Arbaiza R, Black MM. CHAMP: A cluster randomized-control trial to prevent obesity in child care centers. Contemp Clin Trials 2019; 86:105849. [PMID: 31525490 DOI: 10.1016/j.cct.2019.105849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023]
Abstract
Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.
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Affiliation(s)
- Bridget Armstrong
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Angela C B Trude
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Candace Johnson
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Romulus J Castelo
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Amy Zemanick
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Sophie Haber-Sage
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Raquel Arbaiza
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Maureen M Black
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America; RTI International, Department of Pediatrics, United States of America.
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