1
|
Lebron CN, Atem F, Rana P, Natale R, Messiah SE. Child Care Center Staff Readiness to Change in an Early Childhood Obesity Prevention Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:526-534. [PMID: 38870370 PMCID: PMC11178244 DOI: 10.1097/phh.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
CONTEXT The childcare center (CCC) setting has the potential to be a strong foundation that supports the introduction of sustainable healthy lifestyle behaviors to prevent childhood obesity. It is important to assess barriers and facilitators to healthy weight development initiatives via program evaluation, including measuring CCC staff readiness to change. OBJECTIVE The overall goal of this study was to assess the readiness level over 1 school year among CCC staff who participated in "Healthy Caregivers-Healthy Children" (HC2), a cluster randomized controlled trial that evaluated the effectiveness of a childhood obesity prevention program from 2015 to 2018 in 24 low-income, racially/ethnically diverse centers. A secondary outcome was to assess how a CCC's stage of readiness to change was associated with CCC nutrition and physical activity environment, measured via the Environment and Policy Assessment and Observation (EPAO) tool. DESIGN Mixed-models analysis with the CCC as the random effect assessed the impact of readiness to change over time on EPAO outcomes. PARTICIPANTS Eighty-eight CCC teachers and support staff completed the HC2 readiness to change survey in August 2015 and 68 in August 2016. Only teachers and staff randomized to the treatment arm of the trial were included. MAIN OUTCOME Readiness to change and the EPAO. RESULTS Results showed the majority of CCC staff in advanced stages of readiness to change at both time points. For every increase in readiness to change stage over 1 year (eg, precontemplation to contemplation), there was a 0.28 increase in EPAO nutrition scores (95% confidence interval [CI], 0.04-0.53; P = .02) and a 0.52 increase in PA score (95% CI, 0.09-0.95; P = .02). CONCLUSIONS This analysis highlights the importance between CCC staff readiness to change and the CCC environment to support healthy weight development. Future similar efforts can include consistent support for CCC staff who may not be ready for change to support successful outcomes.
Collapse
Affiliation(s)
| | - Folefac Atem
- University of Texas School of Public Health, Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
| | - Priyanka Rana
- University of Texas School of Public Health, Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
| | - Ruby Natale
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, Florida
| | - Sarah E. Messiah
- University of Texas School of Public Health, Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
- Center for Pediatric Population Health, Children’s Health System of Texas and University of Texas Health Science Center, Dallas, Texas
| |
Collapse
|
2
|
Natale R, Schladant M, Bloyer MH, Hernandez J, Palenzuela J, Agosto Y, Peng Y, Messiah SE. A Randomized Controlled Cluster Trial of an Obesity Prevention Program for Children with Special Health Care Needs: Methods and Implications. Nutrients 2024; 16:1274. [PMID: 38732520 PMCID: PMC11085216 DOI: 10.3390/nu16091274] [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: 03/06/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Children with disabilities have higher prevalence estimates of obesity than typically developing children. The Healthy Caregivers-Healthy Children Phase 3 (HC3) project implemented an obesity prevention program adapted for children with special health care needs (CSHCN) that includes dietary intake and physical activity (PA) components. The primary outcome was a change in dietary intake, PA, and the body mass index (BMI) percentile. Ten childcare centers (CCCs) serving low-resource families with ≥30 2- to 5-year-olds attending were randomized to either the intervention (n = 5) or control (n = 5). The HC3 CCCs received (1) snack, beverage, PA, and screen time policies via weekly technical assistance; (2) adapted lesson plans for CSHCN; and (3) parent curricula. The control CCCs received a behavioral health attention curriculum. HC3 was delivered over three school years, with data collected at five different timepoints. It was delivered weekly for six months in year one. To ensure capacity building, the HC3 tasks were scaled back, with quarterly intervention delivery in year 2 and annually in year 3. Adaptations were made to the curriculum to ensure appropriate access for CSHCN. Given that the program was being delivered during the COVID-19 pandemic, special modifications were made to follow CDC safety standards. The primary outcome measures included the Environment and Policy Assessment and Observation (EPAO) tool, standardized dietary intake and PA assessments, and the child BMI percentile. CCCs are an ideal setting for targeting CSHCN for obesity prevention efforts as they provide an opportunity to address modifiable risk factors.
Collapse
Affiliation(s)
- Ruby Natale
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Michelle Schladant
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Martha H. Bloyer
- Department of Physical Therapy, University of Miami, Coral Gables, FL 33136, USA;
| | - Julieta Hernandez
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Joanne Palenzuela
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Yaray Agosto
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Youmeizi Peng
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Sarah E. Messiah
- University of Texas Health Science Center at Houston School of Public Health, Dallas, TX 75207, USA;
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX 75207, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX 77030, USA
| |
Collapse
|
3
|
Lim H, Lee H. Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea. JMIR Public Health Surveill 2024; 10:e51581. [PMID: 38578687 PMCID: PMC11031700 DOI: 10.2196/51581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/19/2023] [Accepted: 01/23/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Childhood obesity has emerged as a major health issue due to the rapid growth in the prevalence of obesity among young children worldwide. Establishing healthy eating habits and lifestyles in early childhood may help children gain appropriate weight and further improve their health outcomes later in life. OBJECTIVE This study aims to classify clusters of young children according to their eating habits and identify the features of each cluster as they relate to childhood obesity. METHODS A total of 1280 children were selected from the Panel Study on Korean Children. Data on their eating habits (eating speed, mealtime regularity, consistency of food amount, and balanced eating), sleep hours per day, outdoor activity hours per day, and BMI were obtained. We performed a cluster analysis on the children's eating habits using k-means methods. We conducted ANOVA and chi-square analyses to identify differences in the children's BMI, sleep hours, physical activity, and the characteristics of their parents and family by cluster. RESULTS At both ages (ages 5 and 6 years), we identified 4 clusters based on the children's eating habits. Cluster 1 was characterized by a fast eating speed (fast eaters); cluster 2 by a slow eating speed (slow eaters); cluster 3 by irregular eating habits (poor eaters); and cluster 4 by a balanced diet, regular mealtimes, and consistent food amounts (healthy eaters). Slow eaters tended to have the lowest BMI (P<.001), and a low proportion had overweight and obesity at the age of 5 years (P=.03) and 1 year later (P=.005). There was a significant difference in sleep time (P=.01) and mother's education level (P=.03) at the age of 5 years. Moreover, there was a significant difference in sleep time (P=.03) and the father's education level (P=.02) at the age of 6 years. CONCLUSIONS Efforts to establish healthy eating habits in early childhood may contribute to the prevention of obesity in children. Specifically, providing dietary guidance on a child's eating speed can help prevent childhood obesity. This research suggests that lifestyle modification could be a viable target to decrease the risk of childhood obesity and promote the development of healthy children. Additionally, we propose that future studies examine long-term changes in obesity resulting from lifestyle modifications in children from families with low educational levels.
Collapse
Affiliation(s)
- Heemoon Lim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyejung Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
4
|
Niškanović J, Stojisavljević D, Stojisavljević S, Djikanovic B, Manigoda D. Exploring possibilities for the development of healthy eating habits in preschool settings: parent's and teacher's perspectives. Food Sci Nutr 2024; 12:1616-1626. [PMID: 38455201 PMCID: PMC10916589 DOI: 10.1002/fsn3.3853] [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] [Received: 06/15/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 03/09/2024] Open
Abstract
Adoption of eating habits starts early in life, through interaction with family members and alongside preschool settings that offer context for developing healthy lifestyles among children. The aim of this study was to explore the perceptions and practices of teachers and parents related to the development of healthy eating habits among preschool children. Focus groups were conducted with a total sample of 48 parents and teachers (three focus groups among parents and three among teachers) from 15 kindergartens in the Republic of Srpska, Bosnia, and Herzegovina. All of the mentioned kindergartens are part of the "Nutrition friendly preschool/school initiative", a program aimed at creating and developing settings that support and improve children's health. Focus groups were audiotaped, transcribed verbatim, and analyzed according to the Framework Method. Teachers emphasized that good communication and support from parents are important factors for the development of healthy eating habits. During COVID-19, direct communication with parents was restricted, and mutual activities among teachers, children, and parents were reduced. Lack of knowledge, finance, and time are perceived by parents as main obstacles to the improvement of children's healthy eating habits. All participants in the focus groups agreed that more education and informative material are needed so their skills related to good nutrition can be improved and adopted in a culture-sensitive way. Mutual support, education, and dissemination of informative materials are imposed as particularly important needs by all actors involved in the upbringing of children in order to support the development of children's healthy eating habits.
Collapse
Affiliation(s)
- Jelena Niškanović
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
| | - Dragana Stojisavljević
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
- Faculty of MedicineUniversity of Banja LukaBanja LukaBosnia and Herzegovina
| | - Stela Stojisavljević
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
- Faculty of MedicineUniversity of Banja LukaBanja LukaBosnia and Herzegovina
| | - Bosiljka Djikanovic
- Institute of Social Medicine, Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Dijana Manigoda
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
| |
Collapse
|
5
|
Al-walah MA, Donnelly M, Heron N. Barriers, enablers and motivators of the "I'm an active Hero" physical activity intervention for preschool children: a qualitative study. Front Pediatr 2024; 12:1333173. [PMID: 38357506 PMCID: PMC10864600 DOI: 10.3389/fped.2024.1333173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Background Insufficient physical activity (PA) in early childhood is linked to adverse health outcomes and a heightened risk of obesity. Successful PA programmes often require input from key stakeholders, such as parents and educators. However, research on stakeholders' perspectives regarding PA programmes for preschool children is limited, impeding effective programme design and implementation. Objectives This study aims to explore the perspectives of key stakeholders to gain insights into the challenges, facilitators, and motivators that influence the planning, execution, and sustainability of the "I'm an Active Hero (IAAH) intervention component," a preschool-based initiative designed to promote PA among young children. Methods Semi-structured interviews were conducted in Saudi Arabia with individual preschool principals (n = 2), and focus group discussions were held, respectively, with preschool staff members (n = 4, all female) and parents (4 mothers, 5 fathers). Results A thematic analysis identified four main themes: (1) Barriers to parental involvement in preschool PA interventions, such as time constraints, lack of flexibility, limited space, and a shortage of trained staff; (2) Risks and benefits of children's programme participation; (3) Motivators including rewards, non-financial incentives, and concerns about childhood obesity and a sedentary lifestyle; (4) Facilitating factors for overcoming barriers, including staff training, time reallocation, staff coordination, space optimization, non-financial incentives, and sustaining partnerships. Conclusion This study's findings are crucial for childcare professionals, preschools, education authorities, and policymakers, offering valuable insights for future research. However, further collaboration with key stakeholders is essential to enhance individual attitudes and preschool policies for effective intervention implementation.
Collapse
Affiliation(s)
- Mosfer A. Al-walah
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Neil Heron
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Medicine, Keele University, Newcastle-Under-Lyme, Staffordshire, England
| |
Collapse
|
6
|
Grady A, Jackson J, Wolfenden L, Lum M, Yoong SL. Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review. Public Health Nutr 2023; 26:3211-3229. [PMID: 37990443 PMCID: PMC10755435 DOI: 10.1017/s1368980023002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Early childhood education and care (ECEC) is a recommended setting for the delivery of health eating interventions 'at scale' (i.e. to large numbers of childcare services) to improve child public health nutrition. Appraisal of the 'scalability' (suitability for delivery at scale) of interventions is recommended to guide public health decision-making. This study describes the extent to which factors required to assess scalability are reported among ECEC-based healthy eating interventions. DESIGN Studies from a recent Cochrane systematic review assessing the effectiveness of healthy eating interventions delivered in ECEC for improving child dietary intake were included. The reporting of factors of scalability was assessed against domains outlined within the Intervention Scalability Assessment Tool (ISAT). The tool recommends decision makers consider the problem, the intervention, strategic and political context, effectiveness, costs, fidelity and adaptation, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability. Data were extracted by one reviewer and checked by a second reviewer. SETTING ECEC. PARTICIPANTS Children 6 months to 6 years. RESULTS Of thirty-eight included studies, none reported all factors within the ISAT. All studies reported the problem, the intervention, effectiveness and the delivery workforce and setting. The lowest reported domains were intervention costs (13 % of studies) and sustainability (16 % of studies). CONCLUSIONS Findings indicate there is a lack of reporting of some key factors of scalability for ECEC-based healthy eating interventions. Future studies should measure and report such factors to support policy and practice decision makers when selecting interventions to be scaled-up.
Collapse
Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Melanie Lum
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Victoria, Australia
| |
Collapse
|
7
|
Codella R, Lucidi F, Alivernini F, Palombi T, Glad B, Gracia J, Gotti D, La Torre A, Chirico A. "I RUN CLEAN Project"-An Innovative and Self-Sustainable Approach to Develop Clean Sport Behaviours in Grassroots Athletes. Eur J Investig Health Psychol Educ 2023; 13:2561-2573. [PMID: 37998068 PMCID: PMC10670097 DOI: 10.3390/ejihpe13110178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
The phenomenon of doping is a public health issue that poses threats to sport and society. In recent decades, the emphasis on efforts to address the issue and reduce the incidence of doping by young people in sport has shifted from deterrence through testing and punishment to the promotion of clean sport behaviours through values-based education. The "I Run Clean project" sought to develop new and effective tools targeting grassroots athletes and those around them (coaches, medical support personnel, sport leaders, parents). These included sport-specific e-learning and in-person peer-to-peer workshops led by trained volunteer ambassadors. The aim of all "I Run Clean" measures is to go beyond the warnings and provision of factual information about early anti-doping campaigns to a more holistic educational approach that focuses participants on their personal and sport-related values in order to encourage good decision-making and resistance to doping-related behaviours. This study evaluates the efficacy of the peer-to-peer workshops and their impact on selected psycho-social variables. The collaboration of the volunteer ambassadors is shown to effectively transmit the desired reasoning, reduce doping risk factors and enhance protective factors.
Collapse
Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; (R.C.); (D.G.); (A.L.T.)
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, 20138 Milan, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, Sapienza University of Rome, 00185 Rome, Italy; (F.L.); (F.A.); (T.P.)
| | - Fabio Alivernini
- Department of Social and Developmental Psychology, Sapienza University of Rome, 00185 Rome, Italy; (F.L.); (F.A.); (T.P.)
| | - Tommaso Palombi
- Department of Social and Developmental Psychology, Sapienza University of Rome, 00185 Rome, Italy; (F.L.); (F.A.); (T.P.)
| | - Bill Glad
- Agency for the Development of Athletics in Europe, 75013 Paris, France; (B.G.); (J.G.)
| | - Jean Gracia
- Agency for the Development of Athletics in Europe, 75013 Paris, France; (B.G.); (J.G.)
| | - Daniel Gotti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; (R.C.); (D.G.); (A.L.T.)
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; (R.C.); (D.G.); (A.L.T.)
| | - Andrea Chirico
- Department of Social and Developmental Psychology, Sapienza University of Rome, 00185 Rome, Italy; (F.L.); (F.A.); (T.P.)
| |
Collapse
|
8
|
Yoong SL, Lum M, Wolfenden L, Jackson J, Barnes C, Hall AE, McCrabb S, Pearson N, Lane C, Jones JZ, Nolan E, Dinour L, McDonnell T, Booth D, Grady A. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years. Cochrane Database Syst Rev 2023; 8:CD013862. [PMID: 37606067 PMCID: PMC10443896 DOI: 10.1002/14651858.cd013862.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health. OBJECTIVES To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions. SEARCH METHODS We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3). AUTHORS' CONCLUSIONS ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Melanie Lum
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Alix E Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jannah Z Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Lauren Dinour
- College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Therese McDonnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Debbie Booth
- Auchmuty Library, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| |
Collapse
|
9
|
Visier-Alfonso ME, Sánchez-López M, Rodríguez-Martín B, Ruiz-Hermosa A, Bartolomé-Gutiérrez R, Sequí-Domínguez I, Martínez-Vizcaíno V. Parents' Perceptions of Children's and Adolescents' Use of Electronic Devices to Promote Physical Activity: Systematic Review of Qualitative Evidence. JMIR Mhealth Uhealth 2023; 11:e44753. [PMID: 37471127 PMCID: PMC10401398 DOI: 10.2196/44753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/17/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents' perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention. OBJECTIVE The aim of this qualitative systematic review was to improve the understanding of parents' perceptions of the use of electronic devices for PA in children and adolescents. METHODS A systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children's and adolescents' (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity. RESULTS In total, 18 studies with 410 parents, mostly mothers, were included. Parents' perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones. CONCLUSIONS Overall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use. TRIAL REGISTRATION PROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340.
Collapse
Affiliation(s)
| | | | - Beatriz Rodríguez-Martín
- Faculty of Occupational Therapy, Logopedia and Nursing, University of Castilla-La Mancha, Toledo, Talavera de la Reina, Spain
| | - Abel Ruiz-Hermosa
- Department of Didactics of Musical, Plastic and Body Expression, Faculty of Sports and Sciences, University of Extremadura, Cáceres, Spain
| | | | | | - Vicente Martínez-Vizcaíno
- Faculty of Nursing, University of Castilla-La Mancha, Cuenca, Spain
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
| |
Collapse
|
10
|
Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB. Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA 2023; 329:1947-1956. [PMID: 37314275 PMCID: PMC10265310 DOI: 10.1001/jama.2023.8061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023]
Abstract
Importance Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration ClinicalTrials.gov Identifier: NCT02873715.
Collapse
Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Ihuoma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Lew
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Peter Dore
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Rocco A. Paluch
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| |
Collapse
|
11
|
Yoong SL, Lum M, Wolfenden L, Jackson J, Barnes C, Hall AE, McCrabb S, Pearson N, Lane C, Jones JZ, Dinour L, McDonnell T, Booth D, Grady A. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years. Cochrane Database Syst Rev 2023; 6:CD013862. [PMID: 37306513 PMCID: PMC10259732 DOI: 10.1002/14651858.cd013862.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health. OBJECTIVES To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions. SEARCH METHODS We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS: We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3). AUTHORS' CONCLUSIONS ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Melanie Lum
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Alix E Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jannah Z Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Lauren Dinour
- College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Therese McDonnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Debbie Booth
- Auchmuty Library, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| |
Collapse
|
12
|
Nandi N, Charles D, Rivell A, Gore J, Kay C, Gazmararian JA. Examining the Relationship Between Health Behaviors of Adults and Preschool Children. Matern Child Health J 2023:10.1007/s10995-023-03665-w. [PMID: 37191740 DOI: 10.1007/s10995-023-03665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. METHOD Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. RESULTS Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). DISCUSSION The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children.
Collapse
Affiliation(s)
- Nina Nandi
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dannelle Charles
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30033, USA
| | - Aileen Rivell
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Janelle Gore
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30033, USA.
| |
Collapse
|
13
|
Gago C, Aftosmes-Tobio A, Beckerman-Hsu JP, Oddleifson C, Garcia EA, Lansburg K, Figueroa R, Yu X, Kitos N, Torrico M, Leonard J, Jurkowski JK, Mattei J, Kenney EL, Haneuse S, Davison KK. Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children. Int J Behav Nutr Phys Act 2023; 20:4. [PMID: 36631869 PMCID: PMC9832428 DOI: 10.1186/s12966-022-01400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION ClinicalTrials.gov, NCT03334669 , Registered October 2017.
Collapse
Affiliation(s)
- Cristina Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Jacob P Beckerman-Hsu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Evelin A Garcia
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kindra Lansburg
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Xinting Yu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Merieka Torrico
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Jessie Leonard
- Community Action Agency of Somerville (CAAS), Somerville, MA, 02143, USA
| | - Janine K Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA.
| |
Collapse
|
14
|
Natale R, Agosto Y, Bulotsky Shearer RJ, St George SM, Jent J. Designing a virtual mental health consultation program to support and strengthen childcare centers impacted by COVID-19: A randomized controlled trial protocol. Contemp Clin Trials 2023; 124:107022. [PMID: 36442806 PMCID: PMC9694403 DOI: 10.1016/j.cct.2022.107022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had negative psychosocial impacts on young children; teachers in childcare centers continue to be overwhelmed by how to address the downstream psychological effects children are experiencing. This randomized controlled trial will study the role of a community-based, childcare center-support system in improving resilience and mitigating the long-term impacts of COVID-19 on children's development. METHODS This study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID 19 Support (JS + CS) virtual toolkit to childcare centers in Miami-Dade County via a Kubi robot. The toolkit comprises four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. Our first aim will utilize a cluster randomized trial to examine the effectiveness of JS + CS on improving the psychosocial functioning of young children, as compared to an obesity prevention intervention control group. Children will be followed at 6, 12, 18, and 24 months. The second aim will examine the mechanisms that contribute to effective uptake by teachers of the JS + CS support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. CONCLUSION This design will inform the refinement and scaling of JS + CS and generalize impacts to other childcare center interventions in the context of disasters.
Collapse
Affiliation(s)
- Ruby Natale
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| | - Yaray Agosto
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| | - Rebecca J Bulotsky Shearer
- University of Miami, Department of Psychology, 5665 Ponce de Leon Blvd, Coral Gables, Florida 33146, USA.
| | - Sara M St George
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14(th) St, Miami, Florida 33136, USA.
| | - Jason Jent
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| |
Collapse
|
15
|
Violant-Holz V, Rodríguez-Silva C, Rodríguez MJ. Preschool teachers display a flexible pattern of pedagogical actions in promoting healthy habits in children. Front Psychol 2023; 14:1172460. [PMID: 37168422 PMCID: PMC10165009 DOI: 10.3389/fpsyg.2023.1172460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
The school represents the optimal setting for promoting the physical, emotional, and social health of children, especially during the first years of life. Understanding the pedagogical actions of teachers to address health education is an important first step in promoting healthy behaviors in children. We inhere analyzed the pedagogical action patterns in the preschool teaching of healthy habits from a holistic health perspective. We used photography as a strategy for data collection and applied a Chi-square automatic interaction detection (CHAID) classification tree, a data mining procedure, to generate a pattern model. We found that the school space and the learning playfulness strategies for the development of executive functions, classified according to the exercise, symbolic, assembly, rules (ESAR) model, were the main factors that influence the pedagogical actions fostering healthy habits. By contrast, the school and the pedagogical resources of the classroom are factors with a much smaller impact on working with healthy habits. This pedagogical action pattern is flexible, since teachers conduct a multiplicity of pedagogical actions through different strategies, in different school spaces, at any time. In conclusion, our results unmask the interdependent relationships between the different factors that determine the teacher's actions at the preschool. It also contributes to the understanding of the teacher's practices in fostering healthy habits in a healthy learning environment.
Collapse
Affiliation(s)
- Verónica Violant-Holz
- Department of Didactics and Educative Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
- International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
- Research Group and Innovation in Designs (GRID), Technology and Multimedia and Digital Application to Observational Designs, Thematic Core, Hospital Pedagogy, Barcelona, Spain
- *Correspondence: Verónica Violant-Holz,
| | - Carlota Rodríguez-Silva
- Department of Didactics and Educative Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
- International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
- Research Group and Innovation in Designs (GRID), Technology and Multimedia and Digital Application to Observational Designs, Thematic Core, Hospital Pedagogy, Barcelona, Spain
| | - Manuel J. Rodríguez
- Department of Biomedical Sciences, Institute of Neurosciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Manuel J. Rodríguez,
| |
Collapse
|
16
|
Drapeau V, Harvey AA, Jacob R, Provencher V, Panahi S. The impact of a family web-based nutrition intervention to increase fruit, vegetable, and dairy intakes: a single-blinded randomized family clustered intervention. Nutr J 2022; 21:75. [PMID: 36539753 PMCID: PMC9764680 DOI: 10.1186/s12937-022-00825-6] [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] [Received: 01/17/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The importance of adopting healthy eating habits at a young age to prevent obesity and chronic diseases justifies the need for effective interventions. OBJECTIVE This study evaluated the impact of a family web-based nutrition intervention on vegetable and fruit (V/F) and dairy product (DP) consumption, nutrient intakes, diet quality and BMI or BMI z-scores. METHODS Forty-three families with children aged 8-16 years were randomized to either the family web-based intervention, or web-based general nutrition guidelines (control) over 8 weeks. Nutritional variables were assessed with three-day dietary records while anthropometry (body weight and height) was assessed with standardized measures at baseline (PRE), immediately after the intervention (POST 1) and 3-6 months after the intervention (POST 2). Linear mixed models for repeated measures were used to assess the main effects and their interactions followed by post hoc tests. RESULTS The intervention had an effect on DP, total sugar, potassium, magnesium, and calcium in children (Group x Time, P = 0.02 to 0.03) and on DP, V/F juice, carbohydrates, total sugar, saturated fat, protein and calcium in parents (Group x Time, P = 0.01 to 0.03). Post hoc tests revealed children in the intervention group increased their DP intakes immediately after the intervention (POST1) but decreased at follow-up (POST2). No effect of the intervention on V/F, diet quality or BMI was observed. CONCLUSION Compared to general nutrition guidelines, this family web-based nutrition intervention had a modest effect on nutrient intakes, but beneficial effect on DP intakes in the short term. TRIAL REGISTRATION ClinicalTrials.gov , NCT03798808 , Registered 10 january 2019 - Retrospectively registered.
Collapse
Affiliation(s)
- Vicky Drapeau
- grid.23856.3a0000 0004 1936 8390Department of Physical Education, Laval University, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, Quebec, Canada ,grid.421142.00000 0000 8521 1798Quebec Heart and Lung Institute Research Center, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre recherche interuniversitaire sur la formation et la profession enseignante (CRIFPE-Laval), Laval University, Quebec, Canada
| | - Andrée-Anne Harvey
- grid.23856.3a0000 0004 1936 8390Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, Quebec, Canada ,grid.421142.00000 0000 8521 1798Quebec Heart and Lung Institute Research Center, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre recherche interuniversitaire sur la formation et la profession enseignante (CRIFPE-Laval), Laval University, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390School of Nutrition, Laval University, Quebec, Quebec, Canada
| | - Raphaëlle Jacob
- grid.23856.3a0000 0004 1936 8390Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, Quebec, Canada ,grid.421142.00000 0000 8521 1798Quebec Heart and Lung Institute Research Center, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre recherche interuniversitaire sur la formation et la profession enseignante (CRIFPE-Laval), Laval University, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390School of Nutrition, Laval University, Quebec, Quebec, Canada
| | - Véronique Provencher
- grid.23856.3a0000 0004 1936 8390Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390School of Nutrition, Laval University, Quebec, Quebec, Canada
| | - Shirin Panahi
- grid.23856.3a0000 0004 1936 8390Department of Physical Education, Laval University, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, Quebec, Canada ,grid.421142.00000 0000 8521 1798Quebec Heart and Lung Institute Research Center, Quebec, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre recherche interuniversitaire sur la formation et la profession enseignante (CRIFPE-Laval), Laval University, Quebec, Canada
| |
Collapse
|
17
|
Wang D, Ye X, Wu H. Prosocial modelling matters: the association between parent and faculty involvement in fighting COVID-19 with medical students' career commitment. Ann Med 2022; 54:3146-3156. [PMID: 36331292 PMCID: PMC9639478 DOI: 10.1080/07853890.2022.2139410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Role models are essential in medical education, yet empirical research is relatively insufficient on the influence of prosocial modelling on medical students' career commitment. The prosocial behaviour of medical staff involved in the fight against the novel coronavirus disease 2019 (COVID-19) at the beginning of 2020 presents an opportunity to fill the research gap. We explored and compared the different associations of the two most important role models for medical students - parents and faculty- with medical students' career commitment. METHODS The cross-sectional study was conducted with 99,559 undergraduate students majoring in clinical medicine in mainland China. Questions were asked to collect information about participants in the battle against COVID-19, medical students' determination to practice medicine after graduation, as well as students' socio-demographic characteristics. Chi-square tests and hierarchical regressions were performed to examine the associations between parent and faculty involvement and students' career commitment. RESULTS The results showed statistically significant associations between prosocial modelling during the COVID-19 pandemic in China and students' intention to pursue medical careers. The association of faculty involvement (OR = 1.165, p < .001) with students' career commitment was greater than that of parents (OR = 0.970, p > .05). For faculty involvement, the association was stronger among male students (OR = 1.323, p < .001) and students who were already determined to be doctors (OR = 1.219, p < .001) before the pandemic. CONCLUSIONS Our study provides new evidence on the potential roles of parents and faculty in shaping medical students' career commitment. Encouraging faculty to act as positive role models could help medical students increase their intention to become doctors.KEY MESSAGESProsocial modelling could enhance students' intention to pursue medical careers.The association of prosocial behaviour of faculty is larger than that of parents on medical students.Those who have prior medical career commitment are much more likely to persist in the medical profession, and prosocial modelling of faculty is positively associated with their medical career commitment.
Collapse
Affiliation(s)
- Dan Wang
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Xiaoyang Ye
- Annenberg Institute for School Reform, Brown University, Providence, USA
| | - Hongbin Wu
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
| |
Collapse
|
18
|
Bellows LL, Lou Y, Nelson R, Reyes LI, Brown RC, Mena NZ, Boles RE. A Narrative Review of Dietary Assessment Tools for Preschool-Aged Children in the Home Environment. Nutrients 2022; 14:nu14224793. [PMID: 36432478 PMCID: PMC9694043 DOI: 10.3390/nu14224793] [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: 10/16/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Preschool-aged children in the U.S. have suboptimal diets. Interventions to improve child nutrition focus on parents and their role in shaping social and physical home environments, which influence children's eating behaviors. Dietary assessment tools selected to measure intervention objectives, and how results are interpreted in key findings, are essential when examining children's diets. The objectives of this review were to (1) describe dietary assessment tools used in intervention studies in young children focused within the home environment; and (2) examine how the application of these dietary assessment tools addressed intervention objectives. PubMed and Web of Science were searched for English-language nutrition intervention studies that included children aged 2-5 years, had a home environment component, used a dietary assessment tool, and reported on diet-related outcomes. Seventeen studies were included. Intervention objectives focused on overall diet, specific food groups, eating occasions, and obesity prevention/treatment. Concordance of key findings with intervention objectives, type of tool used, and multiple tools within the same study varied with 8 studies aligning in objective and tool, 1 discordant in both, and 8 partially concordant or too broad to determine. This review highlights current challenges in measuring dietary intake in preschoolers and provides recommendations for alternative applications and strategies.
Collapse
Affiliation(s)
- Laura L. Bellows
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Correspondence:
| | - Yuanying Lou
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Rachel Nelson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Ligia I. Reyes
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Renae C. Brown
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Noereem Z. Mena
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Department of Agriculture, Nutrition and Food Systems, University of New Hampshire, Durham, NH 03842, USA
| | - Richard E. Boles
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| |
Collapse
|
19
|
Yin Z, Liang Y, Howard JT, Errisuriz V, Estrada VM, Martinez C, Li S, Ullevig S, Sosa E, Olmstead T, Small S, Ward DS, Parra-Medina D. ¡Míranos! a Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: One-year Results of a Clustered Randomized Controlled Trial. Public Health Nutr 2022; 26:1-26. [PMID: 36357340 PMCID: PMC10172390 DOI: 10.1017/s1368980022002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children. DESIGN A three-group clustered randomized controlled trial. SETTING Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home. STUDY OUTCOMES The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl). PARTICIPANTS Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29). RESULTS Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group. CONCLUSIONS There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.
Collapse
Affiliation(s)
- Zenong Yin
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Yuanyuan Liang
- The University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, USA
| | - Jeffrey T. Howard
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Vanessa Errisuriz
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
| | - Vanessa Marie Estrada
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Cristina Martinez
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Shiyu Li
- UT Health San Antonio, School of Nursing, San Antonio, Texas, USA
| | - Sarah Ullevig
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Erica Sosa
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Todd Olmstead
- The University of Texas at Austin, LBJ School of Public Affairs, Texas, USA
| | - Sharon Small
- Parent/Child Incorporated of San Antonio and Bexar County, San Antonio, Texas, USA
| | - Dianne Stanton Ward
- Department of Nutrition Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Deborah Parra-Medina
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
| |
Collapse
|
20
|
Masento NA, Dulay KM, Harvey K, Bulgarelli D, Caputi M, Cerrato G, Molina P, Wojtkowska K, Pruszczak D, Barlińska J, Messer D, Houston-Price C. Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers. Front Nutr 2022; 9:958245. [PMID: 36337641 PMCID: PMC9633668 DOI: 10.3389/fnut.2022.958245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.
Collapse
Affiliation(s)
- Natalie A. Masento
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Katrina May Dulay
- Department of Psychology, City, University of London, London, United Kingdom
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Marcella Caputi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Paola Molina
- Department of Regional & Urban Studies and Planning, University of Turin, Turin, Italy
| | | | | | | | - David Messer
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, United Kingdom
| | - Carmel Houston-Price
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| |
Collapse
|
21
|
Kim T, Kwon EH. Investigating socioecological obesogenic factors in children with Autism Spectrum Disorder. Front Public Health 2022; 10:867456. [PMID: 36276345 PMCID: PMC9582449 DOI: 10.3389/fpubh.2022.867456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/21/2022] [Indexed: 01/21/2023] Open
Abstract
Obesity-related information in children with Autism Spectrum Disorder (ASD) is limited, and research findings are contradictory. Thus, this study aimed to use a nationwide non-clinical sample to examine the association of sociological factors with overweight status in children with ASD and reveal the degree of differences in the risk factors for overweight in children with and without ASD. The data for this cross-sectional study, based on the modified ecological system theory model, were obtained from the 2019 National Survey of Children's Health. The weighted logistic regressions were performed to determine the factors associated with overweight status in children with ASD, controlling for demographics, physical activity-related behaviors, and family and environmental conditions. A total of 529 children were identified (mean age 13.78 years, 83.21% boys). Two-parent households, less healthy parents and households, households with smokers, poor sleep quality, and greater participation in organized activities were associated with a higher likelihood of overweight in children with ASD (all P < 0.05). The determinants of obesity among children with ASD go beyond the individual level; family and community support are important. Therefore, greater attention should be directed toward the families of children with ASD and community-level administrative policies to improve quality of life by preventing or reducing obesity in children with ASD.
Collapse
Affiliation(s)
- TaeEung Kim
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Eun Hye Kwon
- Department of Counseling, Health & Kinesiology, Texas A&M University-San Antonio, San Antonio, TX, United States
| |
Collapse
|
22
|
Thompson HG, Brady P, Delger P, Kersten S, Evans S, Daly E, Boudreau H, Baymon E, Kim Y, Askelson NM. How Home Child Care Providers Purchase, Prepare, and Serve Healthy Foods: In-Depth Interviews with Child and Adult Care Food Program Participants. Child Obes 2022; 18:507-513. [PMID: 35213249 DOI: 10.1089/chi.2021.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Child care settings can enhance children's access and exposure to healthy foods through participation in The Child and Adult Care Food Program (CACFP), which reimburses child care providers for purchasing healthy foods. To identify challenges and facilitators to CACFP participation, we carried out in-depth interviews with CACFP-participating home child care providers to discuss purchasing, preparing, and serving food under CACFP guidelines. Methods: We carried out 20 in-depth telephone interviews with CACFP-participating home child care providers. Transcribed interviews were coded to develop themes using a deductive approach. Results: Interviews indicated that food costs still burden CACFP-participating child care providers despite reimbursements. CACFP-participating providers who described prioritizing healthy foods and nutrition showed a greater inclination toward purchasing, preparing, and serving healthy foods to children. Conclusions: We offer recommendations for how to effectively support CACFP-participating providers in offering healthy food to their children within a food choice framework, a multilevel categorization of factors that influence food choice. Recommendations include increased reimbursement rates for food purchases under CACFP and support for peer-to-peer mentoring and health promotion programs targeting child care provider health.
Collapse
Affiliation(s)
- Helaina G Thompson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Patrick Brady
- Division of Epidemiology and Community Health at the University of Minnesota, MN, USA
| | - Patti Delger
- Team Nutrition, Iowa Department of Education, Des Moines, Des Moines, IA, USA
| | - Sarah Kersten
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Sydney Evans
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Hailey Boudreau
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Essence Baymon
- Winship Discovery Team in Clinical Research, Emory Winship Cancer Institute, Atlanta, GA, USA
| | - Yeaseul Kim
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA.,Health Policy Research Program, University of Iowa Public Policy Center, Iowa City, IA, USA
| |
Collapse
|
23
|
Dev DA, Padasas I, Hillburn C, Stage VC, Dzewaltowski DA. Ecological Approach to Family-Style, Multilevel Child Care Intervention: Formative Evaluation Using RE-AIM Framework. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:728-744. [PMID: 35768329 DOI: 10.1016/j.jneb.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Conduct formative evaluation of Ecological Approach to Family-Style Dining (EAT) Intervention. DESIGN Qualitative semistructured interviews and demographic surveys. SETTING Early care and education (ECE) centers in Nebraska. PARTICIPANTS Cooperative Extension coaches (n = 9), ECE administrators (n = 8), and teachers (n = 17) caring for children aged 3-5 years. INTERVENTION The EAT intervention (a 16-week, 7-lesson, evidence-based online responsive feeding ECE model) uses a multilevel improvement system of 5 implementation strategies. Early care and education administrators and teachers completed 1 lesson/wk followed by a coaching session. MAIN OUTCOME MEASURES The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework includes 5 evaluative dimensions. ANALYSIS Thematic analysis. RESULTS Overall, 77% of children aged 3-5 years (n = 216) participated from targeted Child and Adult Care Food Program ECEs (Reach). All perceived EAT improved children's nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches found professional development incentives important, whereas administrators/teachers valued inservice hours (Adoption). Teachers reported successful implementation of responsive feeding, and administrators supported the teachers (Implementation). All reported they intended to continue using EAT, and administrators and teachers discussed incorporating EAT practices into the handbook/school policy (Maintenance). CONCLUSION AND IMPLICATIONS The EAT was valued by all stakeholders for its perceived effectiveness to positively impact children's nutritional outcomes. Furthermore, stakeholders valued the provided incentives and multilevel design with coaching, ECE administrators, and teachers. Future research is needed on how to use Extension coaches in ECE interventions.
Collapse
Affiliation(s)
- Dipti A Dev
- Department of Child Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE.
| | - Irene Padasas
- Department of Child Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE
| | - Carly Hillburn
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE
| | - Virginia C Stage
- Department of Nutrition Science, East Carolina University, Greenville, NC
| | - David A Dzewaltowski
- Buffett Early Childhood Institute, Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
24
|
Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Longitudinal effect of prenatal polydrug use and birthweight status on pediatric growth. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2078826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sitara M. Weerakoon
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX, USA
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX, USA
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| |
Collapse
|
25
|
Hammersley ML, Wyse RJ, Jones RA, Okely AD, Wolfenden L, Eckermann S, Xu J, Green A, Stacey F, Yoong SL, Jackson J, Innes-Hughes C, Li V, Rissel C. Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial. J Med Internet Res 2022; 24:e35771. [PMID: 35616994 PMCID: PMC9185338 DOI: 10.2196/35771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few translational trials have provided detailed reports of process evaluation results. Objective This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Methods Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Results Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. Conclusions This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
Collapse
Affiliation(s)
- Megan L Hammersley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel A Jones
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Anthony D Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Simon Eckermann
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Joe Xu
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, Australia
| | - Amanda Green
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Christine Innes-Hughes
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, Australia
| | - Vincy Li
- Health Consult, Sydney, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Darwin, Australia
| |
Collapse
|
26
|
Systematic review of parental influences on Hispanic children's nutritional and physical health. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01713-3] [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] Open
|
27
|
Violant-Holz V, Rodríguez-Silva C, Carol M, Rodríguez MJ. Impact of cocreation training capsules for preschool teachers on children's healthy habits: a pilot study conducted in Barcelona, Spain. BMC Public Health 2021; 21:2089. [PMID: 34774028 PMCID: PMC8590630 DOI: 10.1186/s12889-021-12160-2] [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: 04/30/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Healthy habits are essential for preschoolers to have a healthy lifestyle. The promotion of these healthy habits from a holistic approach by preschool teachers guarantees a better quality of life and a healthier society. Using cocreation, we designed training for healthy habit promotion for preschool teachers (all@once). Then, we implemented the training and evaluated its impact on classroom teaching strategies. Methods This study presents the all@once training design and its implementation and evaluation during 2019. The cocreation process involved 8 parents, 9 preschool teachers and 9 health professionals (selected by a nonprobabilistic sampling system according to quotas) to design training from a holistic perspective. To evaluate the all@once impact in classroom practice, a pilot study was undertaken in four public schools in Barcelona (Spain). All@once was implemented with 16 volunteer teachers selected by convenience sampling and 328 children. A mixed methods approach was chosen to collect data based on direct nonparticipating naturalist systematic observations in June and October 2019. After qualitative data categorization, changes in health routines and actions at school were assessed by either contingency table analysis of frequency distributions or nonparametric comparisons of two related samples. Results The cocreation process provided training organized into online capsules with a holistic view of health in four main dimensions (nutrition, hygiene, physical activity and emotional health). Of these dimensions, the emotional health dimension comprised half of the training content. Pilot testing of the impact of all@once on classroom health-related activities evidenced an increase in the likelihood of observing fruit consumption by children, healthy habit promotion and hand washing. The most significant all@once-induced changes that we observed were related to teaching strategies concerning the emotional health dimension of the training. Conclusions This pilot study provides evidence of cocreation being a productive way to design training for preschool teachers regarding inclusive education in integral health. This approach collects the needs of the school community, provides training with a holistic concept of health and effectively impacts classroom routines and family health habits in the short term.
Collapse
Affiliation(s)
- Verónica Violant-Holz
- Department of Didactic and Educational Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain.,International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
| | - Carlota Rodríguez-Silva
- Department of Didactic and Educational Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
| | - María Carol
- Institute for Lifelong Learning Foundation (IL3-UB), Universitat de Barcelona, Barcelona, Spain.,Current address: Academic Area, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Manuel J Rodríguez
- Department Biomedical Sciences, Institute of Neurosciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, c/Casanova 143, E-08036, Barcelona, Spain. .,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Networked Biomedical Research Centre for Neurodegenerative Disorders (CIBERNED), Barcelona, Spain.
| |
Collapse
|
28
|
McManus KE, Bertrand A, Snelling AM, Cotter EW. In Their Own Words: Parents and Key Informants' Views on Nutrition Education and Family Health Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8155. [PMID: 34360448 PMCID: PMC8346135 DOI: 10.3390/ijerph18158155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children's risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family's health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22; 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents' gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.
Collapse
Affiliation(s)
| | - Adrian Bertrand
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| | - Anastasia M. Snelling
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| | - Elizabeth W. Cotter
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Associations between Community Built Environments with Early Care and Education Classroom Physical Activity Practices and Barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126524. [PMID: 34204363 PMCID: PMC8296338 DOI: 10.3390/ijerph18126524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 01/05/2023]
Abstract
The influence of community-built environments on physical activity (PA) support in Early Childhood Education settings (ECEs) is unknown. The purpose of this cross-sectional study was to determine associations between community PA environments and ECE classroom PA practices. We included licensed Oklahoma ECE directors serving 3-to-5-year-old children. Parks and playground locations were exported from Google Earth. National Walkability Index was derived from 2010 US Census data. ArcMap 10.6 was used to geocode ECE locations, which were within an Activity Desert if no parks/playgrounds were located within a 1-mile radius or if Walkability Index was 10.5 or below. Classroom PA practices were determined by using the Nutrition and PA Self-Assessment tool (NAP SACC). Barriers to implementing practices were reported. Most Head Starts (n = 41; 80.3%), center-based childcare settings (CBC; n = 135; 87.0%), and family childcare homes (FCCHs; n = 153; 96.4%) were in an Activity Desert. Parks/playgrounds within a 10-mile buffer were correlated with classroom PA practices in FCCHs only (p < 0.001). Activity Desert status was not related to classroom PA practices for any ECE context (p > 0.029). While FCCHs may be the most vulnerable to lack of park and playground access, overall findings suggest ECEs provide a healthful micro-environment protective of the typical influence of community-built environments.
Collapse
|
31
|
Guo X, Ahmad Hatib NA, Chew CSE. Preventing obesity from early childhood. Singapore Med J 2021; 62:167-172. [PMID: 33948667 DOI: 10.11622/smedj.2021037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Xiaoxuan Guo
- SingHealth Polyclinics - Punggol, Singapore.,Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Nur Adila Ahmad Hatib
- General Paediatrics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Chu Shan Elaine Chew
- Adolescent Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
32
|
Relationships Between the Home Learning Environment, Weight Status, and Dietary Intake: Results From a Cross-Sectional Study of Preschool-Aged Children in New South Wales, Australia. J Prim Prev 2021; 42:239-256. [PMID: 33742388 PMCID: PMC7979452 DOI: 10.1007/s10935-021-00628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
The home learning environment is a potential correlate of childhood obesity and obesity-related factors. We examined relationships between the home learning environment and weight status and the home learning environment and dietary intake, in a sample of 303 preschool-aged children from Australia. We measured their height and weight, and their parents completed a questionnaire that included questions related to demographics, dietary intake, and the home learning environment. Parents reported their children’s usual consumption of foods from each food group, the frequency of their discretionary food intake, and the frequency of home activities that might support cognitive stimulation. We analysed relationships using regression, adjusting for parents’ education level, and household income. We found no significant associations between the home learning environment and BMI or weight category. We found a significant inverse relationship between the overall home learning environment and discretionary food intake scores, but when stratified by income, this result was significant for children from lower-income families only. Regarding specific elements of the home learning environment, we found significant inverse relationships between discretionary food intake and both reading to children, and teaching them the alphabet. While reading was significant across all income levels, teaching the alphabet was only significant in children from higher-income families. We also found significant inverse relationships between discretionary food intake and: visiting a library, teaching numbers or counting, and teaching songs, poems and nursery rhymes in lower-income families only. There was no association between the home learning environment and meeting individual dietary guidelines. This area requires further research to explore broader home environment factors that may influence these relationships. We also suggest that interventions explore the use of strategies to improve the home learning environment to determine its efficacy in improving healthy eating behaviors.
Collapse
|
33
|
Kanellopoulou A, Katelari A, Notara V, Antonogeorgos G, Rojas-Gil AP, Kornilaki EN, Kosti RI, Lagiou A, Panagiotakos DB. Parental health status in relation to the nutrition literacy level of their children: Results from an epidemiological study in 1728 Greek students. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2021. [DOI: 10.3233/mnm-200470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Children’s dietary behaviors seem tract into adulthood and as a result preventing strategies to establish healthy behaviors from early stages of life are needed. Nutrition knowledge is essential for behavioral change. OBJECTIVE: To examine whether the status of parental health related to their children’s nutrition literacy level through their perceptions mainly of healthy eating attitudes METHODS: A cross-sectional survey was conducted in Greece among 1,728 schoolchildren aged 10–12 years old. The sample was collected in the school setting during the school years of 2014–2016. Children completed anonymously a self-administered questionnaire about their knowledge and perceptions of a healthy diet while their parents completed another suitable questionnaire about family health status. RESULTS: Paternal BMI status and hypertension were inversely associated with the level of nutrition literacy of their children by b = –0.043 (95%CI: (–0.082, –0.003; p = 0.036) and by b = –0.600 (95%CI: –1.181, –0.019; p = 0.043), respectively. Parental health status, specifically, paternal diabetes and maternal dyslipidemia were associated with children’s higher level of nutrition literacy by b = 0.729 (95%CI: 0.002, 1.456; p = 0.049) and by b = 0.730 (95%CI: 0.086, 1.374; p = 0.026), respectively. CONCLUSIONS: Parental health status partially affects, either negatively or positively, the level of nutrition literacy of their children. This impact depends on whether parents follow nutritional recommendations to improve their health.
Collapse
Affiliation(s)
- Aikaterini Kanellopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Angeliki Katelari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Venetia Notara
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Andrea Paola Rojas-Gil
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
| | - Ekaterina N. Kornilaki
- Department of Preschool Education, School of Education, University of Crete, Rethymnon, Greece
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, Trikala, Greece
| | - Areti Lagiou
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, ACT, Australia
| |
Collapse
|
34
|
Do B, Wang SD, Naya CH, Dunton GF, Mason TB. Momentary and personal characteristics predicting maternal fruit and vegetable preparation for children using ecological momentary assessment. Eat Behav 2021; 41:101492. [PMID: 33677396 PMCID: PMC8131213 DOI: 10.1016/j.eatbeh.2021.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/02/2020] [Accepted: 02/13/2021] [Indexed: 11/20/2022]
Abstract
A large body of literature on child-focused research regarding healthy eating within the family context has focused on behavioral management strategies, such as reinforcement, or parental modeling through personal intake or encouragement. However, food preparation behaviors among mothers have been understudied. Also unknown is how maternal food preparation behaviors vary across population subgroups and contexts. The study objective was to elucidate momentary characteristics (i.e., time of day, weekday, and family meals) and personal characteristics (i.e., ethnicity, working status, household characteristics, body mass index, income, and child's age) associated with maternal fruit and vegetable (F/V) preparation through ecological momentary assessment (EMA). 186 mothers (Mage = 40.81) of children (Mage = 9.61, 49.5% female) completed six semi-annual waves, each lasting seven days. Mothers completed up to eight EMA surveys a day, which assessed family meals and F/V preparation, and reported personal characteristics through paper questionnaires. Multilevel generalized estimating equations examined the likelihood of F/V preparation. Momentary, within-day characteristics (i.e., occurrence of family meals, weekdays, afternoons) were associated with greater likelihood of mothers' fresh F/V preparation (ps < 0.05). Additionally, personal characteristics such as non-Hispanic ethnicity, not working full-time, having a child aged six months to five years in the household, and lower child BMI-z were associated with greater fresh F/V preparation among mothers (ps < 0.05). Findings may inform family-based obesity and nutrition intervention programs by understanding which families and in what contexts mothers are more likely to prepare F/Vs.
Collapse
Affiliation(s)
- Bridgette Do
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Shirlene D Wang
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine H Naya
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Genevieve F Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA; Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
35
|
Natale RA, Atem F, Weerakoon S, Lebron C, Mathew MS, Sardinas K, Chang C, Shelnutt KP, Spector R, Altare F, Messiah SE. An Implementation Approach Comparison of a Child Care Center-Based Obesity Prevention Program. J Dev Behav Pediatr 2021; 42:135-145. [PMID: 32947578 PMCID: PMC9336224 DOI: 10.1097/dbp.0000000000000861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the effectiveness of the Healthy Caregivers-Healthy Children (HC2) phase 1 (2011-2014) and 2 (2015-2018) child care center (CCC)-based obesity prevention intervention(s) on child dietary practices and body mass index percentile (PBMI) outcomes over 2 years. Phase 1 was implemented via a university-based research team, and phase 2 was delivered via a train-the-trainers approach (university-based research team trains preschool-based coaches, who in turn train CCC teachers to implement and disseminate HC2). METHODS Phase 1 and 2 were both cluster randomized controlled trials of the HC2 obesity prevention intervention. Phase 1 was composed of 1224 children in 28 CCCs (12 intervention and 16 control). Phase 2 was composed of 825 children in 24 CCCs (12 intervention and 12 control). Both phases included CCCs serving low-resource, predominantly ethnic minority families. RESULTS The mean rate of weekly fruit consumption significantly increased (β = 0.16, p = 0.001) in phase 1, whereas vegetable intake significantly increased (β = 0.16, p = 0.002) in phase 2 intervention CCCs. Fried (β = -0.36, p < 0.001), fast (β = -0.16, p = 0.001), and other unhealthy food (β = -0.57, p < 0.001) consumption significantly decreased in phase 1 only. The mean rate of snack food consumption significantly decreased in phase 2 (β = -0.97, p < 0.001). Mean child PBMI remained in the healthy range over 2 years for all groups in both study phases. CONCLUSION A university-based research team implementation and dissemination approach seemed to be more effective than a train-the-trainers implementation method in improving dietary intake patterns. This finding suggests that CCCs may need robust educational support beyond their existing internal resources for long-term positive dietary intake pattern changes.
Collapse
Affiliation(s)
- Ruby A. Natale
- Department of Pediatrics, University of Miami, Miami, FL
| | - Folefac Atem
- Department of Biostatistics, University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas TX
| | - Sitara Weerakoon
- Department of Biostatistics, University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas TX
| | - Cynthia Lebron
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - M. Sunil Mathew
- Department of Biostatistics, University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas TX
| | | | - Catherina Chang
- Ron and Kathy Assaf College of Nursing, Nova Southeastern University, Davie, FL
| | - Karla P. Shelnutt
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL
| | | | | | - Sarah E. Messiah
- Department of Pediatrics, University of Miami, Miami, FL
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
- Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas, TX
| |
Collapse
|
36
|
Kanellopoulou A, Notara V, Antonogeorgos G, Chrissini M, Rojas-Gil AP, Kornilaki EN, Lagiou A, Panagiotakos DB. Inverse Association Between Health Literacy and Obesity Among Children in Greece: A School-Based, Cross-Sectional Epidemiological Study. HEALTH EDUCATION & BEHAVIOR 2021; 49:54-65. [PMID: 33451250 DOI: 10.1177/1090198120982944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children's health literacy is a crucial pillar of health. This study is aimed to examine the association between health literacy and weight status among Greek schoolchildren aged 10 to 12 years old. A population-based, cross-sectional observational study enrolling 1,728 students (795 boys), aged 10 to 12 years old, was conducted during school years 2014-2016. A health literacy index (range 0-100) was created through an item response theory hybrid model, by combining a variety of beliefs and perceptions of children about health. The mean health literacy score was 70.4 (±18.7). The majority of children (63.8%) had a "high" level (i.e., >67/100) of health literacy, 30.5% had a "medium" level (i.e., 34-66/100) of health literacy, while a small proportion of children (5.7%) had a "low" level (i.e., <33/100). Girls exhibited a higher level of health literacy than boys (71.7 ± 18.3 vs. 68.8 ± 19.1, p < .01). Regarding body weight status, 21.7% of children was overweight and 5.0% was obese. Linear regression models showed that the health literacy score was inversely associated with children's body mass index (regression coefficient [95% CI]: -0.010 [-0.018, -0.001]), after adjusting for dietary habits, physical activity levels, and other potential confounders. Health literacy seems to be a dominant characteristic of children's weight status; therefore, school planning, as well as public health policy actions should emphasize on the ability of children's capacity to obtain, process, and understand basic health information.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Demosthenes B Panagiotakos
- Harokopio University, Athens, Greece.,University of Canberra, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
37
|
Huye HF, Connell CL, Dufrene BA, Mohn RS, Newkirk C, Tannehill J, Sutton V. Development of the Impact of a Preschool Obesity Prevention Intervention Enhanced With Positive Behavioral Supports for Mississippi Head Start Centers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1148-1159. [PMID: 33308516 DOI: 10.1016/j.jneb.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the methodology of the Impact of a Preschool Obesity Prevention intervention enhanced with positive behavioral supports. DESIGN The social ecological model serves as the conceptual framework for this study, which has a within- and between-subjects design with an intervention group and a delayed intervention control group. This 3-year project will use formative methods to pretest materials in Year 1, collect data pre- and postintervention with a follow-up at 4 months in Years 2 and 3, and conduct summative and process evaluation in Year 3. SETTING Head Start centers in Southern and East-Central Mississippi counties. PARTICIPANTS Three hundred parents with 3-year-old children enrolled in 9 Head Start centers (53 classrooms) and 75 Head Start teachers. INTERVENTIONS During Year 2, Hip Hop to Health Jr., Parent-Child Interaction Therapy, and Positive Behavior Interventions and Supports will be implemented. MAIN OUTCOME MEASURES Primary outcomes include changes in parenting and teacher practices. Secondary outcomes include parent feeding styles as well as weight status and dietary intake. Variables will be measured using anthropometrics and validated surveys. ANALYSIS The primary analysis will be a multilevel 2 × 3 mixed ANOVA.
Collapse
Affiliation(s)
- Holly F Huye
- School of Kinesiology and Nutrition, College of Education and Human Sciences, The University of Southern Mississippi, Hattiesburg, MS.
| | - Carol L Connell
- School of Kinesiology and Nutrition, College of Education and Human Sciences, The University of Southern Mississippi, Hattiesburg, MS
| | - Brad A Dufrene
- School of Psychology, College of Education and Human Sciences, The University of Southern Mississippi, Hattiesburg, MS
| | - Richard S Mohn
- School of Education, College of Education and Human Sciences, The University of Southern Mississippi, Hattiesburg, MS
| | | | - Jennifer Tannehill
- School of Psychology, College of Education and Human Sciences, The University of Southern Mississippi, Hattiesburg, MS
| | | |
Collapse
|
38
|
Keech JJ, Hatzis D, Kavanagh DJ, White KM, Hamilton K. Parents' role constructions for facilitating physical activity‐related behaviours in their young children. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jacob J. Keech
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia,
| | - Denise Hatzis
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia,
| | - David J. Kavanagh
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia,
| | - Katherine M. White
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, QLD, Australia,
| | - Kyra Hamilton
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia,
| |
Collapse
|
39
|
Natale R, Weerakoon S, Woody MT, Kolomeyer E, Pena K, Schladant M, Bulotsky-Shearer RJ, Messiah SE. Parent concerns regarding paediatric obesity in community-based programmes serving children with developmental disabilities. Child Care Health Dev 2020; 46:733-740. [PMID: 32803796 DOI: 10.1111/cch.12803] [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: 05/06/2020] [Revised: 07/18/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies show a higher prevalence of obesity among preschool-age children with developmental disabilities (DDs) versus children who are typically developing (TD). Little is known about parent concerns about obesity in young children with DD. The purpose of this study was to examine concerns regarding paediatric obesity among parents who had a preschool-age child with DD compared with parents with a child who is TD. METHODS A cross-sectional analysis occurred at baseline entry into one of three community-based programmes. Parents of a child with DD (n = 815) or TD (n = 563) were asked obesity-related questions about their child and in general. Multinomial and logistic regression unadjusted and adjusted models were run to generate the odds of obesity concerns based on disability status. RESULTS The average child age was 38 months. Parent concerns about paediatric obesity differed by disability status. Unadjusted odds of parents 'doing anything to control their child's weight' was 38% lower among parents of a child with DD versus TD (OR: 0.62, 95% CI: 0.48, 0.82). The adjusted odds of perceiving that their child was underweight was 83% higher among parents of a child with DD compared with parents of a child who is TD (aOR: 1.83, 95% CI: 1.27, 2.64). Parents of a child with DD were 179% more likely to believe that childhood obesity is a public health problem (aOR: 2.79, 95% CI: 1.88, 3.96). The models were adjusted for age, sex and race/ethnicity. CONCLUSIONS Findings indicate that parents of preschool-age children with DD are more likely to acknowledge that obesity is a public health concern. Because some parents of children with DD are concerned about their child's weight, families of preschool-age children with DD may be receptive to the delivery of healthy weight strategies in community-based programs.
Collapse
Affiliation(s)
- Ruby Natale
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sitara Weerakoon
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Malaika T Woody
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ellen Kolomeyer
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kristyna Pena
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | | | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| |
Collapse
|
40
|
Kanellopoulou A, Giannakopoulou SP, Notara V, Antonogeorgos G, Rojas-Gil AP, Kornilaki EN, Konstantinou E, Lagiou A, Panagiotakos DB. The association between adherence to the Mediterranean diet and childhood obesity; the role of family structure: Results from an epidemiological study in 1728 Greek students. Nutr Health 2020; 27:39-47. [PMID: 33073650 DOI: 10.1177/0260106020952600] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Childhood obesity is among the leading public health challenges, worldwide. AIM To examine the association between children's adherence to the Mediterranean diet (MD) and weight status taking into account family structure and related behaviors. METHODS 1728 primary-school Greek students (46% males), from Athens metropolitan area, island of Crete, and the Peloponnese region, were enroled during school years 2014-2016. Children and their parents completed questionnaires which, among others, recorded family structure (i.e., married/cohabited, divorced, single parent, and widowed), dietary and lifestyle habits. Adherence to the MD was assessed through the KIDMED score (range - 4 to 12). Children's body mass index was calculated and classified as normal, overweight/obese, according to the International Obesity Task Force classification. The working sample was 1142 children (44% males) with a recorded family structure. RESULTS The prevalence of overweight was 21.7% and obesity was 5.0%; overweight/obesity prevalence was higher among males than females (32.4% vs. 23.3%; p < 0.001). Overweight/obese children had a lower KIDMED score compared to normal weight (median (range): 4 (-2, 11) vs. 5 (-1, 10), p = 0.05). An inverse association between KIDMED score and children's weight status (odds ratio (OR) (95% confidence interval (CI)): 0.95 (0.89-0.99)) was observed. Interaction between family structure and KIDMED was observed (p < 0.001); stratified analysis revealed that in children from nuclear families the KIDMED score was inversely associated with the likelihood of overweight/obesity (OR (95% CI): 0.95 (0.88-1.00)), whereas in children from single-parent families it was not (OR (95% CI): 0.94 (0.79-1.12)). CONCLUSION Adherence to the MD plays a protective role against childhood overweight/obesity, particularly among children living in nuclear families.
Collapse
|
41
|
Ronto R, Carins J, Ball L, Pendergast D, Harris N. Adolescents' views on high school food environments. Health Promot J Austr 2020; 32:458-466. [PMID: 32619026 DOI: 10.1002/hpja.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED This study explored adolescents' views on high school food environments and potential strategies to help them to make informed food choices. METHODS Fifteen focus groups were conducted with 131 adolescents aged 12-17 years from three high schools in South East Queensland, Australia. Adolescents were asked how their school food environment (dis)encouraged them to eat healthy and what schools could do to help them eat healthier. All focus groups were audio recorded. Data were analysed using content and thematic data analysis methods. RESULTS Four major themes emerged: food availability and affordability; food related policy and regulations; nutrition education; and attitudes, preferences and practices. Adolescents stated that nutrition education within the school curriculum and positive role modelling by peers and school staff in healthy eating were the major factors in helping them to make informed food choices. In contrast, high availability, affordability, fundraising, peer pressure, positive attitudes and negative role modelling towards unhealthy foods impacted unhealthy dietary behaviours. CONCLUSIONS Emerging results indicate that adolescents do not perceive the current high school food environments as helping them to make healthy food choices. Adolescents suggested limiting unhealthy foods in high schools by implementing strict food and beverage policies, compulsory nutrition education classes and changing attitudes towards healthy foods as strategies to improve high school food environments. SO WHAT?: This study highlights the importance of high school food environments in impacting adolescents' food choices. Strategies identified by adolescents inform public health practitioners and school authorities on how high school food environments could be tailored to help them in making better food choices.
Collapse
Affiliation(s)
- Rimante Ronto
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia
| | - Julia Carins
- Defence Science and Technology Group, Scottsdale, TAS, Australia.,Social Marketing @ Griffith, Griffith University, Nathan, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Donna Pendergast
- School of Education and Professional Studies, Griffith University, Nathan, QLD, Australia
| | - Neil Harris
- School of Medicine, Griffith University, Nathan, QLD, Australia
| |
Collapse
|
42
|
Lai AYK, Lam EYW, Fabrizo C, Lee DPK, Wan ANT, Tsang JSY, Ho LM, Stewart SM, Lam TH. A Community-Based Lifestyle-Integrated Physical Activity Intervention to Enhance Physical Activity, Positive Family Communication, and Perceived Health in Deprived Families: A Cluster Randomized Controlled Trial. Front Public Health 2020; 8:434. [PMID: 33042934 PMCID: PMC7522171 DOI: 10.3389/fpubh.2020.00434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Zero-time exercise (ZTEx) is an approach integrating simple strength- and stamina-enhancing physical activity into daily life. The study evaluated the effectiveness of a community-based lifestyle-integrated physical activity intervention using ZTEx to enhance participants' physical activity, family communication, perceived health and happiness, and family harmony. Methods: A parallel group, cluster randomized controlled trial was conducted in a sample of 673 participants from eight Integrated Family Service Centers in Hong Kong. The experimental group (n = 316) received a physical activity intervention. The control group (n = 357) received information on healthy eating. Both groups received three face-to-face intervention sessions (totalling 6 h and 30 min) and 16 text messages. The primary outcome was the change in days spent engaged in ZTEx. Secondary outcomes included changes in sitting time, days engaged in moderate or vigorous physical activities, family communication (encouraging and engaging family members in ZTEx), dietary habits, perceived health and happiness, and family harmony. Self-administered questionnaires were used at baseline and at 3, 6, and 12 months. Mixed effects models with intention-to-treat analysis was used. Results: Compared with the control group at 3 months, the experimental group showed significantly greater increases of 1.3 days spent doing ZTEx (Cohen's d: 0.60), 0.3 days spent doing moderate physical activity (Cohen's d: 0.08), 0.3 days encouraging family members to do ZTEx (Cohen's d: 0.16), and 0.7 days doing ZTEx with family members (Cohen's d: 0.39) during the 7 days prior. At 3 months, the experimental group also showed a significantly greater improvement in perceived health, by a score of 0.2 (Cohen's d: 0.14). The effect sizes ranged from small to medium, with similar intervention effects at the 6-month and 1-year assessments. Compared with the experimental group, the control group showed a significantly greater reduction of 0.4 days on which sweetened beverages were consumed (95% CI: 0.01, 0.9, p < 0.05, Cohen's d: 0.28). The qualitative results supported the quantitative findings. Conclusions: Our findings show that a community-based lifestyle-integrated physical activity (PA) intervention can enhance physical activity, family communication, and perceived health in deprived families in Hong Kong. Trial registration: The research protocol was retrospectively registered at the National Institutes of Health (identifier number: NCT02601534) on November 10, 2015.
Collapse
Affiliation(s)
- Agnes Y K Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Cecilia Fabrizo
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Alice N T Wan
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sunita M Stewart
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
43
|
Scott-Sheldon LAJ, Hedges LV, Cyr C, Young-Hyman D, Khan LK, Magnus M, King H, Arteaga S, Cawley J, Economos CD, Haire-Joshu D, Hunter CM, Lee BY, Kumanyika SK, Ritchie LD, Robinson TN, Schwartz MB. Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019. Child Obes 2020; 16:S221-S248. [PMID: 32936038 PMCID: PMC7482126 DOI: 10.1089/chi.2020.0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.
Collapse
Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Larry V Hedges
- Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Chris Cyr
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - 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
| | | | - Heather King
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Sonia Arteaga
- Office of the Director, National Institutes of Health, National Institutes of Health, Bethesda, MD, USA
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
- Department of Economics, Cornell University, Ithaca, NY, USA
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University, Saint Louis, MO, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Y Lee
- CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley, CA, USA
| | - Thomas N Robinson
- Departments of Pediatrics and Medicine, Stanford Solutions Science Lab, Stanford University, Stanford, CA, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| |
Collapse
|
44
|
Hammersley ML, Okely AD, Batterham MJ, Jones RA. Can Parental Engagement in Social Media Enhance Outcomes of an Online Healthy Lifestyle Program for Preschool-Aged Children? HEALTH COMMUNICATION 2020; 35:1162-1171. [PMID: 31131621 DOI: 10.1080/10410236.2019.1620423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study explored parental engagement, child BMI and secondary outcomes from the social media component of an online healthy lifestyle program for parents of preschool-aged children. Intervention group participants received access to an online program and Facebook group. Data were collected at baseline and 3- and 6-months follow-up. Facebook usage data on comments and posts were used to determine total active engagement. There was a high level of Facebook group membership and most parents actively engaged at least once. Although there were varying levels of engagement between modules and cohorts, it was modest overall. User acceptability of the Facebook group was lower than expected. Children of parents in the intervention who engaged more in the Facebook group (by posting and commenting) demonstrated greater sleep duration over time (estimate 1.79, 95% CI 0.42 to 3.17, p = .01) Children of parents who engaged more in the Facebook group also participated in less moderate- to vigorous-intensity physical activity (estimate -0.14, 95% CI -0.26 to -0.01, p = .03). This study is one of the first parent-focussed healthy lifestyle interventions to include a social media component. Further research is recommended with larger sample sizes and longer duration to further explore the potential of social media in childhood obesity interventions.
Collapse
Affiliation(s)
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong
| | - Marijka J Batterham
- Statistical Consulting Service, National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong
| | - Rachel A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong
| |
Collapse
|
45
|
Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| |
Collapse
|
46
|
Hammersley ML, Wyse RJ, Jones RA, Wolfenden L, Yoong S, Stacey F, Eckermann S, Okely AD, Innes-Hughes C, Li V, Green A, May C, Xu J, Rissel C. Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial). BMC Public Health 2020; 20:636. [PMID: 32381052 PMCID: PMC7204000 DOI: 10.1186/s12889-020-08526-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background Parents are key decision makers and role models in establishing and maintaining healthy behaviours in their children. Interventions involving parents have been shown to be more effective than those that do not, but there are barriers to participation. Efficacy trials have previously been conducted on two such parent-focussed healthy eating and active living interventions with the potential to overcome these barriers - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine the effectiveness of these interventions in a real-world context. The Time for Healthy Habits study is a 3-arm partially randomised preference trial which aims to evaluate the effectiveness and cost-effectiveness of two theory-based programs to promote healthy eating and appropriate levels of movement behaviours (physical activity, sedentary behaviour and sleep) for parents of 2- to 6-year-old children (Healthy Habits Plus telephone-based program and Time2bHealthy online program), when compared to a comparison group receiving written materials. Methods Participants will be recruited across five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide if they wish to be randomised or opt to select their preferred intervention and has been recommended for use to test effectiveness in a real-world setting. Both interventions incorporate multiple behaviour change techniques and support parents to improve their children’s healthy eating, and movement behaviours (physical activity, sedentary behaviour and sleep) and run for 12 weeks, followed by a 3-month and 9-month post-baseline follow-up. Participants will also be asked to complete a process evaluation questionnaire at the completion of the intervention (3-months post-baseline). Outcomes include fruit and vegetable intake (primary outcome), non-core food intake, weight status, physical activity, sedentary behaviour, and sleep habits. Discussion To our knowledge, this is the first translational research trial evaluating the effectiveness and cost-effectiveness of a healthy eating and active living intervention in the 2- to 6-years age group. The results will build the evidence base in regard to translation of effective childhood obesity prevention interventions and inform the implementation and delivery of community based childhood obesity prevention programs. Trial registration UTN: U1111–1228-9748, ACTRN: 12619000396123p.
Collapse
Affiliation(s)
- Megan L Hammersley
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia.
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rachel A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Simon Eckermann
- Australian Health Services Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Christine Innes-Hughes
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Vincy Li
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Amanda Green
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Christine May
- Formerly Murrumbidgee Local Health District, Cootamundra Health Service, McKay St, Cootamundra, NSW, Australia
| | - Joe Xu
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
47
|
Wafa SW, Ghazalli R. Association between the school environment and children's body mass index in Terengganu: A cross sectional study. PLoS One 2020; 15:e0232000. [PMID: 32330177 PMCID: PMC7182194 DOI: 10.1371/journal.pone.0232000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/26/2020] [Indexed: 12/01/2022] Open
Abstract
With the on-going interest in implementing school policies to address the problem of childhood obesity in Malaysia, there is urgent need for information about the association between school environment and children’s weight status. This study aims to investigate the association between school environmental factors (physical, economic, political and sociocultural) with BMI of school children in Terengganu. The school environment factors were assessed using a set of validated whole-school environmental mapping questionnaires, consisting of 76 criteria with four domains; physical environment (41 criteria), economic environment (nine criteria), political environment (nine criteria) and sociocultural environment (17 criteria). This involved face-to-face interview sessions with 32 teachers from 16 schools (eight rural and eight urban). In addition, 400 school children aged between 9 and 11 years of the selected schools were assessed for BMI (WHO 2007 reference chart), dietary intake (food frequency questionnaire (FFQ)) and physical activity level (physical activity questionnaire for children (PAQ-C)). Multiple regression was used to examine the association between school environment factors and BMI of the school children. Seven school environment criteria were found to be associated with BMI of school children when it was adjusted for calorie intake and physical activity level. About 33.4% of the variation in BMI of school children was explained by health professional involvement, simple exercise before class, encouragement to walk/ride bicycle to/from school, no high-calorie food sold, healthy options of foods and drinks at tuck shop, availability of policy on physical activity and training teacher as a role model. Policy makers should make urgent actions to address the obesogenic features of school environments. It should strive towards setting up healthy school environment and improving school curricula to promote healthy behaviours among the school children.
Collapse
Affiliation(s)
- Sharifah Wajihah Wafa
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu, Malaysia
- * E-mail:
| | - Rasyidah Ghazalli
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu, Malaysia
| |
Collapse
|
48
|
Crumbley CA, Ledoux TA, Johnston CA. Physical Activity During Early Childhood: The Importance of Parental Modeling. Am J Lifestyle Med 2020; 14:32-35. [PMID: 31903077 PMCID: PMC6933558 DOI: 10.1177/1559827619880513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Increasing physical activity (PA) is a critical issue in improving overall health. Prior attempts by public health campaigns to promote PA through health-focused messaging have faced challenges. As PA and sedentary behaviors are developed during the early childhood period (ages 0 to 5 years), this stage represents a unique opportunity for clinicians to encourage activity at the family level. Clinicians should discuss the holistic benefits of PA, including the development of social skills and relationships, motor skills that could be applicable to sports later in life, and cognitive skills that could translate to academic achievements in school. For PA to occur in children, parents should also be engaged in and model the PA behaviors, increasing the likelihood of young children learning to be physically active.
Collapse
Affiliation(s)
- Christine A. Crumbley
- University of Houston, Houston, Texas (CAC,
TAL)
- Department of Human Health and Performance,
University of Houston, Houston, Texas (CAJ)
| | - Tracey A. Ledoux
- University of Houston, Houston, Texas (CAC,
TAL)
- Department of Human Health and Performance,
University of Houston, Houston, Texas (CAJ)
| | - Craig A. Johnston
- Craig A. Johnston, Associate Professor,
Department of Human Health and Performance, University of Houston, Houston, TX
77030; e-mail:
| |
Collapse
|
49
|
Mena NZ, Risica PM, Gans KM, Lofgren IE, Gorman K, Tobar FK, Tovar A. Communication With Family Child Care Providers and Feeding Preschool-Aged Children: Parental Perspectives. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:10-20. [PMID: 31929040 PMCID: PMC6961812 DOI: 10.1016/j.jneb.2019.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe parent communication about child nutrition-related topics with family child care providers (FCCPs). DESIGN Five focus groups conducted from December, 2016 to July, 2017. PARTICIPANTS Parents (n = 25) of 2- to 5-year-old children attending family child care homes in Rhode Island. PHENOMENON OF INTEREST How and what parents communicate about with FCCPs related to feeding young children. ANALYSIS Recordings were transcribed verbatim. Two independent coders employed content analysis to analyze transcripts. Reflections, emerging themes, and final themes were discussed. RESULTS Participants were recruited through FCCPs and were mostly Hispanic and female. Parents mainly communicated with FCCPs in person. Communication with FCCPs related to how and what children were fed did not occur frequently, and parents usually inquired about how much children ate. CONCLUSIONS AND IMPLICATIONS Parents did not engage in frequent child nutrition-related communication with their FCCP. However, parents trusted FCCPs to provide healthy and sufficient food to children. More research is needed to identify effective strategies that facilitate child nutrition communication between parents and FCCPs.
Collapse
Affiliation(s)
- Noereem Z Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI.
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI; Department of Human Development and Family Studies, and Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, CT
| | - Ingrid E Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Kathleen Gorman
- Department of Psychology, University of Rhode Island, Kingston, RI
| | - Fatima K Tobar
- Supplemental Nutrition Assistance Program-Education, University of Rhode Island, Providence, RI
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| |
Collapse
|
50
|
ATEŞ-ŞAHİNKAYA N, ACAR-TEK N, DIGÜZEL E. The association between maternal features and nutritional problems in children with autism spectrum disorder. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective In the literature, there is almost no data on the relationship between autistic children’s nutritional problems and their mothers’ demographic and nutritional characteristics. Therefore, this study aimed to evaluate whether there was a relationship between maternal features and nutritional problems in autistic children. Methods This study was conducted with the participation of 58 autistic children (6-19 years) and their mothers. Descriptive data were obtained with a general questionnaire. For the evaluation of children’s nutritional status, anthropometric measurements and 24-hour dietary recall were used. Also, the Brief Autism Mealtime Behavior Inventory and ORTO-15 questionnaires were used to evaluate the meal behavior of children and orthorexia tendency of mothers, respectively. Results No significant correlation was found between the Brief Autism Mealtime Behavior Inventory scores in children of mothers with high and low orthorexia tendency. There were also no statistically significant differences between the children of mothers with high and low educational level in terms of Brief Autism Mealtime Behavior Inventory scores. Only the dietary vitamin B6 intake was significantly higher in the children of mothers with high educational level. Maternal age was associated with the dietary energy and protein intake, unlike, maternal orthorexia tendency was not associated with the nutritional status and meal behavior of children. The abdominal pain experience in the last one month was found to be significantly higher in the children of employed mothers than children of unemployed mothers. Conclusion It is thought that the maternal characteristics are not effective on meal behavior in children and also maternal age and educational status have a very limited effect on the nutritional status of children.
Collapse
|