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Aleid AM, Sabi NM, Alharbi GS, Alharthi AA, Alshuqayfi SM, Alnefiae NS, Ismail GM, Allhybi AK, Alrasheeday AM, Alshammari B, Alabbasi Y, Al Mutair A. The Impact of Parental Involvement in the Prevention and Management of Obesity in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2024; 11:739. [PMID: 38929318 PMCID: PMC11201836 DOI: 10.3390/children11060739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/11/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Obesity in children is a critical public health issue in developed countries and developing countries. The establishment of health-related behaviors in childhood, significantly influenced by parental involvement, underscores the need for effective intervention measures. AIM This original research is a systematic review and meta-analysis that aimed to investigate the impact of parental involvement on the prevention and management of childhood obesity, focusing on outcomes such as BMI z-score, exercise levels, screen time, dietary self-efficacy, and percentage body fat. METHODS Adhering to the PRISMA guidelines, we conducted a systematic review and meta-analysis of 12 randomized controlled trials (RCTs) identified through comprehensive searches of PubMed, Scopus, Web of Science, and the Cochrane Library, including RCTs involving children aged 2-18 years with parental or caregiver participation, reporting on the specified outcomes. Data analysis was performed using RevMan 5.3, employing a random effects model. RESULTS A total of 5573 participants were included. The meta-analysis revealed a significant reduction in BMI z-score (MD = -0.06, 95% CI: -0.09 to -0.02, p = 0.005, I2 = 58%), a non-significant increase in exercise levels (SMD = 0.26, 95% CI: -0.01 to 0.52, p = 0.05, I2 = 52%), and a significant reduction in screen time (MD = -0.36 h per day, 95% CI: -0.61 to -0.11, p = 0.005, I2 = 0%). Dietary self-efficacy also improved significantly (MD = 0.59, 95% CI: 0.12 to 1.05, p = 0.01, I2 = 0%). However, changes in percentage body fat did not reach statistical significance (MD = -1.19%, 95% CI: -2.8% to 0.41%, p = 0.15, I2 = 0%). CONCLUSION Parental involvement in childhood obesity interventions significantly impacts BMI z-score, exercise levels, screen time, and dietary self-efficacy but not percentage body fat. These findings highlight the importance of engaging parents in obesity prevention and management strategies.
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Affiliation(s)
- Abdulsalam M. Aleid
- Department of Surgery, Medical College, King Faisal University, Hofuf 31982, Saudi Arabia
| | - Noor M. Sabi
- Department of Medicine, Medical College, Umm Al-Qura University, Makkah 31982, Saudi Arabia
| | | | | | - Sarah M. Alshuqayfi
- Department of Medicine, Medical College, Umm Al-Qura University, Makkah 31982, Saudi Arabia
| | - Nirmeen S. Alnefiae
- Department of Medicine, Medical College, Umm Al-Qura University, Makkah 31982, Saudi Arabia
| | | | - Abdulaziz K. Allhybi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21561, Saudi Arabia
| | - Awatif M. Alrasheeday
- Nursing Administration Department, College of Nursing, University of Hail, Hail 21424, Saudi Arabia
| | - Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
| | - Yasmine Alabbasi
- Department of Maternity and Pediatric Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Abbas Al Mutair
- Department of Medical-Surgical Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Fukkink RG, Booij YS, Leistra LHM, van Verseveld MDA. Profiles of Cultural Adaptation and Parenting Approach for Childhood Obesity in Lifestyle Interventions for Families With Young Children: A Systematic Review. FAMILY & COMMUNITY HEALTH 2024; 47:95-107. [PMID: 38372327 PMCID: PMC10916755 DOI: 10.1097/fch.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND OBJECTIVES Various interventions aim to reduce obesity and promote healthy lifestyles among different cultural groups. METHODS We have conducted a systematic literature review, following PRISMA guidelines (registered at https://doi.org/10.17605/OSF.IO/HB9AX), to explore profiles of cultural adaptation and parenting approach of lifestyle interventions for families with young children (1-4 years). RESULTS Our search (in CINAHL, ERIC, PsycINFO, PubMed, Scopus, and SSCI) yielded 41 studies reporting 31 interventions. Drawing on Intervention Mapping, we applied a newly developed framework with various indicators of cultural adaptation and a parenting approach to analyze interventions. Our review shows clear differences in the level of cultural adaptation. A categorical principal component analysis revealed 6 different empirical profiles of cultural adaptation. CONCLUSIONS Based on our profiles, we discuss how cultural adaptation can be strengthened in the design of future early interventions aimed at promoting a healthy lifestyle.
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Affiliation(s)
- Ruben G. Fukkink
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands (Dr Fukkink and Ms Leistra); Centre of Expertise Urban Education, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Dr Fukkink); Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Ms Booij); and Norwegian University of Science and Technology, Trondheim, Norway (Dr van Verseveld)
| | - Yvonne S. Booij
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands (Dr Fukkink and Ms Leistra); Centre of Expertise Urban Education, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Dr Fukkink); Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Ms Booij); and Norwegian University of Science and Technology, Trondheim, Norway (Dr van Verseveld)
| | - Loes H. M. Leistra
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands (Dr Fukkink and Ms Leistra); Centre of Expertise Urban Education, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Dr Fukkink); Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Ms Booij); and Norwegian University of Science and Technology, Trondheim, Norway (Dr van Verseveld)
| | - Marloes D. A. van Verseveld
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands (Dr Fukkink and Ms Leistra); Centre of Expertise Urban Education, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Dr Fukkink); Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands (Ms Booij); and Norwegian University of Science and Technology, Trondheim, Norway (Dr van Verseveld)
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Delaney T, Jackson J, Lecathelinais C, Clinton-McHarg T, Lamont H, Yoong SL, Wolfenden L, Sutherland R, Wyse R. Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial. J Med Internet Res 2024; 26:e51108. [PMID: 38502177 PMCID: PMC10988364 DOI: 10.2196/51108] [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: 07/21/2023] [Revised: 10/01/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems ("online canteens") are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online. OBJECTIVE This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up. METHODS A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either "everyday," "occasional," or "should not be sold." Primary outcomes were the average proportion of "everyday," "occasional," and "should not be sold" items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen. RESULTS From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more "everyday" items (+11.5%, 95% CI 7.3% to 15.6%; P<.001), and significantly fewer "occasional" (-5.4%, 95% CI -9.4% to -1.5%; P=.007) and "should not be sold" items (-6%, 95% CI -9.1% to -2.9%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders. CONCLUSIONS Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students. TRIAL REGISTRATION Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546 ; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/.
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Affiliation(s)
- Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christophe Lecathelinais
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Tara Clinton-McHarg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Hannah Lamont
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sze Lin Yoong
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Wallsend, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Sequí-Domínguez I, Cavero-Redondo I, Álvarez-Bueno C, López-Gil JF, Martínez-Vizcaíno V, Pascual-Morena C. Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e41649. [PMID: 38381490 PMCID: PMC10918549 DOI: 10.2196/41649] [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: 08/03/2022] [Revised: 05/30/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. OBJECTIVE This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. METHODS The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD -16.11 counts, 95% CI -122.76 to 90.53; k=3; n=402; I2=69%; favoring control), steps per day (MD 593.46 steps, 95% CI -2102.27 to 3289.19; k=2; n=152; I2=0%; favoring intervention [FI]), moderate to vigorous PA (MD -1.99 min/d, 95% CI -8.95 to 4.96; k=14; n=2336; I2=86%; favoring control), light PA (MD 3.28 min/d, 95% CI -15.48 to 22.04; k=5; n=355; I2=67%; FI), screen time (MD -31.48 min/d, 95% CI -68.62 to 5.65; k=5; n=904; I2=0%; FI), and sedentary time (MD -33.12 min/d, 95% CI -57.27 to -8.97; k=8; n=819; I2=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. CONCLUSIONS We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. TRIAL REGISTRATION PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020.
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Affiliation(s)
- Irene Sequí-Domínguez
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion, Cuenca, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
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Zhou P, Li Y, Lau PWC, Yan L, Song H, Shi TL. Effectiveness of parent-based electronic health ( eHealth) intervention on physical activity, dietary behaviors, and sleep in preschoolers: A systematic review. J Exerc Sci Fit 2024; 22:1-13. [PMID: 38021206 PMCID: PMC10663681 DOI: 10.1016/j.jesf.2023.10.004] [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: 06/14/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background The lifestyles of preschoolers have become physically inactive and sedentary, their eating habits unhealthy, and their sleep routines increasingly disturbed. Parental involvement appears crucial to combat the unhealthy lifestyle of preschoolers. Because of the recognized barriers to traditional face-to-face interventions, easy access and lower costs make electronic health (eHealth) interventions appealing. However, whether parent-based eHealth intervention may be harnessed to improve the aforementioned lifestyle behaviors of preschoolers is currently unclear, a gap that this systematic review intends to address. This study aims to systematically review the current literature concerning the effectiveness of parent-based eHealth intervention on the physical activity, dietary behaviors, and sleep of preschoolers. Method This systematic review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Six databases (EMBASE, PubMed, MEDLINE, Web of Science, SPORTDiscus, and PsycINFO) were retrieved for the period from January 2000 to December 2022. Studies were eligible if 1 they were quantitative study design; 2 eHealth interventions in which parents were the change agents targeted children aged 3-6 years; 3 interventions examined the effectiveness of eHealth or incorporated eHealth as one of the intervention modalities; 4 at least one variable included in either primary or secondary outcome had to concentrate on the physical activity, diet, and sleep of preschoolers; 5 publication type was limited to the English language and peer-reviewed journal articles; 6 study settings were confined to family- or parent-based ones. The risk of bias was assessed, based upon Version 2 of the Cochrane risk-of-tool for randomized trials (RoB2). Results Twelve studies were screened. No significant group-by-time improvement in physical activity was found in studies related to physical activity outcomes. Two studies reported a significant difference between groups concerning motor ability, with one study indicating improved object control with the other reporting improvement in both object control and locomotor skills. Of the studies related to dietary behavior outcomes, six studies reported a significant difference at the posttest compared to the control group, in terms of vegetable and fruit intake, sugar-sweetened drinks, reduced candy consumption, and improved non-core food. Three studies reported a significant difference between groups in sleep duration at the end of the posttest, with the result of one study limited to preference-only participants. None of the reviewed studies found a significant difference between groups for sleep problems. Conclusion Parent-based eHealth interventions were not significantly effective in improving physical activity and reducing sleep problems in preschoolers, but the majority of studies have found that this type of intervention significantly improves the dietary behaviors and sleep duration of preschoolers. High-quality, robustly designed studies to balance the intervention dosage and sequence are needed to investigate the effectiveness of parent-based eHealth intervention on physical activity, dietary behaviors, and sleep in preschoolers, particularly those raised in other cultural background, which may significantly impact their lifestyle. Trial registration International Prospective Register of Systematic Review (PROSPERO): CRD42023418861.
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Affiliation(s)
- Peng Zhou
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Yin Li
- Department of Physical Education, Sun Yat-sen University, China
| | - Patrick WC. Lau
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Liang Yan
- Department of Physical Education, China Women's University, Beijing, China
| | - Huiqi Song
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Tony Lei Shi
- Beijing Normal University-Hong Kong Baptist University United International College, China
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Salam RA, Khan MH, Meerza SSA, Das JK, Lewis-Watts L, Bhutta ZA. An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents. Nat Med 2024; 30:290-301. [PMID: 38195753 DOI: 10.1038/s41591-023-02737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.
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Affiliation(s)
- Rehana A Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Maryam Hameed Khan
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Saqlain Ali Meerza
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
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Ad G, Dc G, Nj J, Se W, Tr B, Slusser W, Pj C. A Hybrid Mobile Phone Feasibility Study Focusing on Latino Mothers, Fathers, and Grandmothers to Prevent Obesity in Preschoolers. Matern Child Health J 2023; 27:1621-1631. [PMID: 37347374 PMCID: PMC10359399 DOI: 10.1007/s10995-023-03700-w] [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] [Accepted: 05/20/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To pilot the feasibility of a mobile phone childhood obesity intervention for family caregivers of Latino preschool-aged children. METHODS An evidence-based early childhood obesity intervention was adapted to have cultural relevance and a shorter-length curriculum for mothers, fathers, and grandmothers of 2- to 5-year-old Latino children. Traditional in-person group sessions (four weeks) were combined with eight weeks of mobile phone content to support parenting skills and evidence-based and age-appropriate nutritional practices in either English or Spanish. A convenience sample of Latino families were recruited from WIC and Early Education Centers in East Los Angeles. Feasibility measures were collected. Child and caregiver height and weight were measured, and caregiver surveys of child dietary intake were collected at baseline, 1- and 6-month post-baseline. Changes in child's dietary intake and BMI, as well as caregiver BMI, were examined using a mixed effects linear regression model with family random intercept and nested random slope for time period of measurement. RESULTS The program was delivered to 64 low-income Latino families (46 mothers, 34 fathers, 16 grandmothers, and 48 children). Children had a reduction in raw BMI, BMI percentile, and BMI z-scores at 6-months post-baseline compared to baseline measurements. The study also demonstrated stable BMI outcomes among all caregivers. CONCLUSION The pilot study shows promise in preventing childhood obesity, and having a multi-generational impact on weight outcomes. Leveraging the high-use of mobile phones has the potential to shorten in-person interventions, and engage fathers and grandmothers who play an important role in shaping healthy weight practices in young children.
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Affiliation(s)
- Guerrero Ad
- UCLA Department of Pediatrics and Children's Discovery and Innovation Institute, Los Angeles, CA, USA.
| | - Glik Dc
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jackson Nj
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA
| | - Whaley Se
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC, Irwindale, CA, USA
| | - Belin Tr
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Slusser
- UCLA Department of Pediatrics and Children's Discovery and Innovation Institute, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Semel Healthy Campus Initiative Center, Los Angeles, CA, USA
| | - Chung Pj
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Francis LA, Nix RL, BeLue R, Keller KL, Kugler KC, Rollins BY, Savage JS. Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project. Clin Trials 2023; 20:434-446. [PMID: 37077032 PMCID: PMC10338696 DOI: 10.1177/17407745231167115] [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] [Indexed: 04/21/2023]
Abstract
BACKGROUND/AIMS Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.
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Affiliation(s)
- Lori A Francis
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Robert L Nix
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Rhonda BeLue
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Kathleen L Keller
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Kari C Kugler
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Brandi Y Rollins
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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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.
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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.
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10
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Enö Persson J, Leo Swenne C, von Essen L, Bohman B, Rasmussen F, Ghaderi A. Experiences of nurses and coordinators in a childhood obesity prevention trial based on motivational interviewing within Swedish child health services. Int J Qual Stud Health Well-being 2022; 17:2096123. [PMID: 35838058 PMCID: PMC9291662 DOI: 10.1080/17482631.2022.2096123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity. Methods Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis. Results Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses’ commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended. Conclusions Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints. .
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Affiliation(s)
- Johanna Enö Persson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and eHealth, Department of Women and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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11
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Heerman WJ, Perrin EM, Yin HS, Schildcrout JS, Delamater AM, Flower KB, Sanders L, Wood C, Kay MC, Adams LE, Rothman RL. The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemp Clin Trials 2022; 123:106987. [PMID: 36323344 DOI: 10.1016/j.cct.2022.106987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. METHODS This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. CONCLUSIONS By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
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Affiliation(s)
- William J Heerman
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Eliana M Perrin
- Johns Hopkins University, Department of Pediatrics, Schools of Medicine and Nursing, 200 N. Wolfe St, Rubenstein Building-2071, Baltimore, MD 21287, United States of America.
| | - H Shonna Yin
- New York University School of Medicine, Departments of Pediatrics and Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Jonathan S Schildcrout
- Vanderbilt University Medical Center, Department of Biostatistics, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave., Miami, FL 33136, United States of America.
| | - Kori B Flower
- University of North Carolina at Chapel Hill, Division of General Pediatrics and Adolescent Medicine, 231 MacNider Building, CB# 7225, 321 S. Columbia Street, UNC School of Medicine, Chapel Hill, NC 27599-7225, United States of America.
| | - Lee Sanders
- Stanford University School of Medicine, United States of America.
| | - Charles Wood
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Melissa C Kay
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Russell L Rothman
- Vanderbilt University Medical Center, Institute of Medicine and Public Health, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
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Ghofranipour F, Hamzavi Zarghani N, Mohammadi E, Mehrizi AAH, Tavousi M, De Craemer M, Cardon G. An internet-based educational intervention for mothers targeting preschoolers' weight management promotion (PWMP): a pilot study. BMC Public Health 2022; 22:2220. [PMID: 36447163 PMCID: PMC9707417 DOI: 10.1186/s12889-022-14543-5] [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: 12/28/2021] [Accepted: 11/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of overweight and obesity among children has raised public health concerns. This study aimed to design and evaluate a behaviour change intervention program to promote weight management among Tehranian preschoolers. METHODS The PRECEDE-PROCEED model is one of the most popular models in health education used to develop and evaluate most educational interventions. In this one-group pre and post-pilot study, 13 mothers of preschoolers were recruited from preschools in Tehran (the capital of Iran), in August 2020. Mothers received a six-week educational intervention, including text messages and educational videos via WhatsApp, to increase their self-efficacy to overcome barriers changing their children's lifestyle. Mothers reported preschoolers' height and weight to assess Body Mass Index and filled out the Food Frequency Questionnaire, the Persian version of the children's health-related quality of life questionnaire, and demographic features. The "Children's physical activity and sedentary behaviors checklist," newly designed by the researchers, was also filled out by mothers. These behaviors were measured according to the minutes that children were involved in these activities in a day, and the days they spent in a week for them. All variables were measured at baseline, immediately after the intervention and three months later. Data analysis was performed using SPSS IBM statistics version 22. Friedman test was used to evaluate changes over time. RESULTS The findings demonstrated that the mean BMI z-score stayed steady between baseline, immediately after the intervention and after three months (P = 0.60). Besides, after three months, the intervention programme led to a decrease in soft drink consumption (P = 0.001), and an increase in parental perception of their child's general health (P = 0.05), the parental concern regarding their child's emotional and physical health (P = 0.002) and minutes of physical activity per day (P = 0.02). However, fruit intake decreased (P = 0.01), and simple sugar, such as cube, increased (P = 0.03). CONCLUSION Results from this study are promising but should be interpreted with caution and should be replicated on a larger scale and compared with a control group to evaluate whether effects are maintained in a larger sample.
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Affiliation(s)
- Fazlollah Ghofranipour
- grid.412266.50000 0001 1781 3962Department of Health Education and Health Promotion, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Najmeh Hamzavi Zarghani
- grid.412266.50000 0001 1781 3962Department of Health Education and Health Promotion, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohammadi
- grid.412266.50000 0001 1781 3962Department of Nursing, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Ali Asghar Haeri Mehrizi
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Mahmoud Tavousi
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Marieke De Craemer
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- grid.5342.00000 0001 2069 7798Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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13
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Baltaci A, Hurtado Choque GA, Davey C, Reyes Peralta A, Alvarez de Davila S, Zhang Y, Gold A, Larson N, Reicks M. Padres Preparados, Jóvenes Saludables: intervention impact of a randomized controlled trial on Latino father and adolescent energy balance-related behaviors. BMC Public Health 2022; 22:1932. [PMID: 36258168 PMCID: PMC9578196 DOI: 10.1186/s12889-022-14284-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 09/27/2022] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Studies have shown associations among food and activity behaviors and body weight of Latino fathers and adolescents. However, few Latino father-focused interventions have been designed to improve energy balance-related behaviors (EBRBs) and weight status among early adolescents. Thus, this efficacy study aims to evaluate the Padres Preparados, Jóvenes Saludables (Padres) youth obesity prevention program for positive changes in EBRBs (fruit, vegetable, sugar-sweetened beverage (SSB), sweet/salty snack, and fast-food consumption, physical activity, and screen time) and weight status among low-income Latino fathers and adolescents (10-14 years). METHODS A two-arm (treatment versus delayed-treatment control group) randomized controlled trial was conducted to evaluate the efficacy of 8 weekly experiential learning sessions (2.5 hours each) based on social cognitive theory. The sessions included food preparation, parenting skills, nutrition, and physical activity. The program was delivered to father-adolescent dyads (mothers were encouraged to attend) in trusted community-based settings in a Midwest metropolitan area between 2017 and 2019. In March 2020, in-person implementation was discontinued due to COVID-19 pandemic restrictions, which limited the sample size. Father/adolescent dyads were randomized to treatment or control group within each site. Surveys and measurements were completed by fathers and adolescents to assess changes in food and activity behaviors from baseline to post-intervention. Adolescents also completed 24-hour dietary recall interviews at baseline and post-intervention. Intervention effects were assessed using linear regression mixed models adjusted for covariates and accounting for clustering of participants within sites. RESULTS Data from 147 father/adolescent dyads who completed at least the baseline data collection were used. No significant differences were observed for baseline to post-intervention changes in adolescents' and fathers' EBRBs or weight status between treatment and control groups. Fathers' SSB and fast food intakes were not statistically significant (p = 0.067 and p = 0.090, respectively). CONCLUSIONS The Padres program resulted in no significant improvements in adolescent and father EBRBs and weight status. Additional Latino father-focused interventions are needed to examine intervention effects on EBRBs among Latino adolescents. TRIAL REGISTRATION The Padres Preparados, Jóvenes Saludables study is registered with the U.S. National Library of Medicine, ClinicalTrials.gov Identifier: NCT03469752 (19/03/2018).
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Affiliation(s)
- A. Baltaci
- grid.17635.360000000419368657Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454 USA
| | - G. A. Hurtado Choque
- grid.164295.d0000 0001 0941 7177School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD 20742 USA
| | - C. Davey
- grid.17635.360000000419368657Clinical and Translational Science Institute, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414 USA
| | - A. Reyes Peralta
- grid.17635.360000000419368657Center for Family Development, University of Minnesota Extension, 1420 Eckles Ave, St. Paul, MN 55108 USA
| | - S. Alvarez de Davila
- grid.17635.360000000419368657Center for Family Development, University of Minnesota Extension, Robert J. Jones Urban Research and Outreach-Engagement Center, 2001 Plymouth Ave N, Minneapolis, MN 55411 USA
| | - Y. Zhang
- grid.263761.70000 0001 0198 0694Department of Child and Adolescent Health and Social Medicine, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Building 401, Room 1411, Suzhou, 215123 Jiangsu China
| | - A. Gold
- grid.17635.360000000419368657Center for Family Development, University of Minnesota Extension, 1420 Eckles Ave, St. Paul, MN 55108 USA
| | - N. Larson
- grid.17635.360000000419368657Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454 USA
| | - M. Reicks
- grid.17635.360000000419368657Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave, St. Paul, MN 55108 USA
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Chakraborty D, Bailey BA, Seidler AL, Yoong S, Hunter KE, Hodder RK, Webster AC, Johnson BJ. Exploring the application of behaviour change technique taxonomies in childhood obesity prevention interventions: A systematic scoping review. Prev Med Rep 2022; 29:101928. [PMID: 35928597 PMCID: PMC9344347 DOI: 10.1016/j.pmedr.2022.101928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Novel critique of BCT taxonomy applications in childhood obesity prevention trials. Large variation in BCT methods and reporting of BCT-related methods and results. Scarce detail reported in selection of BCTs in prospective taxonomy applications. Need for guidance to standardise processes and reporting of taxonomy applications.
Behaviour change technique (BCT) taxonomies provide one approach to unpack the complexity of childhood obesity prevention interventions. This scoping review sought to examine how BCT taxonomies have been applied to understand childhood obesity prevention interventions targeting children aged 12 years or under and/or their caregivers. A systematic search was conducted in Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL and PROSPERO, to capture all eligible research up to February 2021. No limits were placed on country, language, publication dates, or full text availability. Eligible studies included any study design that applied a BCT taxonomy and evaluated behavioural childhood obesity prevention interventions targeting children aged 12 years or under and/or their parents or caregivers. Sixty-three records, describing 54 discrete studies were included; 32 applied a BCT taxonomy prospectively (i.e., to design interventions) and 23 retrospectively (i.e., to assess interventions), 1 study did both. There was substantial variation in the methods used to apply BCT taxonomies and to report BCT-related methods and results. There was a paucity of detail reported in how BCTs were selected in studies applying BCT taxonomies prospectively. Our review provides important insight into the application of BCT taxonomies in childhood obesity prevention and several ongoing challenges, pointing to the need for best practice reporting guidance.
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Seidler AL, Hunter KE, Baur L, Espinoza D, Taylor RW, Wen LM, Hesketh KD, Campbell K, Daniels L, Mihrshahi S, Rissel C, Taylor B, Askie LM. Examining the sustainability of effects of early childhood obesity prevention interventions: Follow-up of the EPOCH individual participant data prospective meta-analysis. Pediatr Obes 2022; 17:e12919. [PMID: 35396815 PMCID: PMC9541553 DOI: 10.1111/ijpo.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although early childhood obesity prevention has become an important issue internationally, little evidence exists regarding longer term effects (i.e., sustainability) of early interventions. OBJECTIVE To determine whether intervention benefits at 2 years of age were sustained at 3.5 and 5 years. METHODS Follow-up of the Early Prevention of Obesity in Children (EPOCH) individual participant data prospective meta-analysis of four randomized controlled trials including 2196 mother-child dyads at baseline. Interventions were home- or community-based, commenced within 6 months of birth, ended by 2 years of age, and comprised multiple sessions. Controls received standard care. BMI z-score (primary outcome), other anthropometric measures and weight-related behaviours were initially measured at 1.5-2 years and followed up at 3.5 and 5 years. RESULTS Positive intervention effects on BMI z-scores at 1.5-2 years of age were not apparent by 3.5 years (-0.04 adjusted mean difference; 95% CI:-0.14, 0.06; p = 0.424), and 5 years (0.03; 95% CI: -0.08, 0.14; p = 0.60). While prolonged intervention benefits were detected for a few, but not the majority of, weight-related behaviours at 3.5 years, these effects diminished over time. CONCLUSION This meta-analysis found that initial positive effects of childhood obesity interventions faded out after interventions ended, pointing toward the importance of a suite of interventions implemented at multiple stages across childhood.
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Affiliation(s)
- Anna Lene Seidler
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kylie E. Hunter
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Louise Baur
- Specialty of Child and Adolescent HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - David Espinoza
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | | | - Li Ming Wen
- Health Promotion Unit, Sydney Local Health District, School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kylie D. Hesketh
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Karen Campbell
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Lynne Daniels
- Centre Child Health Research, School Exercise Nutrition SciencesQueensland University TechnologyBrisbaneQueenslandAustralia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human SciencesMacquarie UniversityNew South WalesAustralia
| | - Chris Rissel
- Sydney School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Barry Taylor
- Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
| | - Lisa M. Askie
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
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16
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Lyons ER, Nekkanti AK, Funderburk BW, Skowron EA. Parent-Child Interaction Therapy Supports Healthy Eating Behavior in Child Welfare-Involved Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10535. [PMID: 36078247 PMCID: PMC9518458 DOI: 10.3390/ijerph191710535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We tested the efficacy of standard Parent-Child Interaction Therapy (PCIT), a live-coached, behavioral parent-training program, for modifying problematic eating behaviors in a larger effectiveness trial of PCIT for children involved in the child welfare system. METHOD Children ages 3-7 years and their parents were randomly assigned to PCIT intervention (n = 120) or services as the usual control (SAU; n = 84) groups in a randomized clinical trial. Children's eating behaviors were assessed pre- and post-intervention via the Child Eating Behaviors Questionnaire (CEBQ). Intention-to-treat analyses were conducted, followed by per-protocol analyses, on treatment-engaging families only. RESULTS PCIT led to reductions in child welfare-involved children's food responsiveness, speed of food consumption, and tendency to engage in emotional overeating relative to children in the services-as-usual control condition. Standard PCIT may be an effective intervention to promote healthy child eating behaviors in families involved with child welfare, even when food-related behaviors are not directly targeted by the intervention. Public Health Significance: This clinical trial provides evidence that child welfare-involved children who received PCIT experienced significant reductions in maladaptive eating-related behaviors, namely food responsiveness, emotional overeating, and speed of eating. These findings were observed in relation to children in a comparison control group who had access to child welfare services-as-usual.
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Affiliation(s)
- Emma R. Lyons
- Pediatric Mental Health Institute, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Akhila K. Nekkanti
- Center for Innovation and Research on Choice-Filled Lives, Choice-Filled Lives, Inc., Atlanta, GA 30305, USA
| | - Beverly W. Funderburk
- Department of Developmental and Behavioral Pediatrics, Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Kravets M, Sullivan JA, Parrott A, Zvara BJ, Andridge R, Anderson SE, Keim SA. Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:745-752. [PMID: 35668000 PMCID: PMC9378445 DOI: 10.1016/j.jneb.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity. DESIGN Longitudinal cohort. SETTING A large US children's hospital. PARTICIPANTS Caregiver-child dyads (n = 288 with complete data at 2 time points) were sampled in 2017-2019 from those who received care at Nationwide Children's Hospital. MAIN OUTCOME MEASURE(S) Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m2], overweight [BMI ≥ 25 and < 30 kg/m2], or obese [BMI ≥ 30 kg/m2]). ANALYSIS Log-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers' eating competence and weight status. RESULTS Eating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30-3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence. CONCLUSIONS AND IMPLICATIONS Although child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers' eating competence may translate into healthier behaviors and skills for caregivers and their children long term.
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Affiliation(s)
- Melissa Kravets
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH
| | - Jacqueline A Sullivan
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH
| | - Andria Parrott
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH
| | - Bharathi J Zvara
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Sarah E Anderson
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Sarah A Keim
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH.
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18
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Papamichael MM, Karaglani E, Boutsikou T, Dedousis V, Cardon G, Iotova V, Chakarova N, Usheva N, Wikström K, Imre R, RADÓ ASI, Liatis S, Makrilakis K, Moreno L, Manios Y, Manios Y, Cardon G, Lindström J, Schwarz P, Makrilakis K, Annemans L, Ko W, Manios Y, Karatzi K, Androutsos O, Moschonis G, Kanellakis S, Mavrogianni C, Tsoutsoulopoulou K, Katsarou C, Karaglani E, Qira I, Skoufas E, Maragkopoulou K, Tsiafitsa A, Sotiropoulou I, Tsolakos M, Argyri E, Nikolaou M, Vampouli EA, Filippou C, Apergi K, Filippou A, Katerina G, Dimitriadis E, Lindström J, Laatikainen T, Wikström K, Kivelä J, Valve P, Levälahti E, Virtanen E, Pennanen T, Olli S, Nelimarkka K, Cardon G, Van Stappen V, Huys N, Annemans L, Willems R, Shadid S, Schwarz P, Timpel P, Makrilakis K, Liatis S, Dafoulas G, Lambrinou CP, Giannopoulou A, Ko W, Karuranga E, Moreno L, Civeira F, Bueno G, De Miguel-Etayo P, Mª E, Gonzalez-Gil, Miguel-Berges ML, Giménez-Legarre N, Flores-Barrantes P, Ayala-Marín AM, Seral-Cortés M, Baila-Rueda L, Cenarro A, Jarauta E, Mateo-Gallego R, Iotova V, Tankova T, Usheva N, Tsochev K, Chakarova N, Galcheva S, Dimova R, Bocheva Y, Radkova Z, Marinova V, Bazdarska Y, Stefanova T, Rurik I, Ungvari T, Jancsó Z, Nánási A, Kolozsvári L, Semánova C, Bíró É, Antal E, Radó S, Martinez R, Tong M. HOW DO THE HOME FOOD ENVIRONMENT, PARENTING PRACTICES, HEALTH BELIEFS, AND SCREEN TIME AFFECT THE WEIGHT STATUS OF EUROPEAN CHILDREN?: FEEL4DIABETES-STUDY. Nutrition 2022; 103-104:111834. [DOI: 10.1016/j.nut.2022.111834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
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19
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Wang X, Ammerman A, Orr CJ. Family‐based interventions for preventing overweight or obesity among preschoolers from racial/ethnic minority groups: A scoping review. Obes Sci Pract 2022; 8:371-386. [PMID: 35664252 PMCID: PMC9159561 DOI: 10.1002/osp4.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/11/2022] Open
Abstract
Objective This scoping review aimed to synthesize the published literature on family‐based childhood obesity prevention interventions from 2015 to 2021 that focused on children 2–5 years of age from racial and/or ethnic minority households. Methods A PICOS (population, intervention, comparison, outcome, and setting) framework was used to guide the development of the research question, search strategy, and inclusion/exclusion criteria. To be included, the study must have been a randomized controlled trial or quasi‐experimental trial that enrolled participants 2–5 years of age and their caregivers who identified as being from a racial and/or ethnic minority group in the United States. The study must have also examined a family‐based intervention that incorporated components to prevent childhood obesity (i.e., fruits and vegetable intake, parental responsive feeding, physical activity), be conducted in a remote (i.e., online, text, mail), home, community, primary care setting, or early childhood education institution setting, and report on body mass index (BMI, kg/m2), BMI z‐score, anthropometric measures (weight, waist circumference, fat mass, etc.), changes in health behaviors, or increase in nutritional knowledge. Results Fourteen individual studies were identified. Most interventions used multiple components for promoting nutritional knowledge and behavioral changes among families. Eight interventions included culturally tailored components targeting four aspects: (1) language barriers, (2) food choices, (3) relationships between family members, and (4) rapport building. Conclusions There is limited research in this field focusing on children from racial and/or ethnic minority groups. Future efforts should invest in developing culturally appropriate interventions for these groups.
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Affiliation(s)
- Xiran Wang
- Department of Nutrition University of North Carolina at Chapel Hill Gillings School of Public Health Chapel Hill North Carolina USA
| | - Alice Ammerman
- Health Promotion and Disease Prevention University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Colin J. Orr
- Department of Pediatrics University of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina USA
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20
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Kouvari M, Karipidou M, Tsiampalis T, Mamalaki E, Poulimeneas D, Bathrellou E, Panagiotakos D, Yannakoulia M. Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e30675. [PMID: 35156934 PMCID: PMC8887634 DOI: 10.2196/30675] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Melina Karipidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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21
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The Infant Health Study - Promoting mental health and healthy weight through sensitive parenting to infants with cognitive, emotional, and regulatory vulnerabilities: protocol for a stepped-wedge cluster-randomized trial and a process evaluation within municipality settings. BMC Public Health 2022; 22:194. [PMID: 35090411 PMCID: PMC8796192 DOI: 10.1186/s12889-022-12551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Child mental health problems are a major public health concern associated with poor mental and physical health later in development. The study evaluates a new community-based intervention to promote sensitive parenting and reduce enduring mental health problems and unhealthy weight among vulnerable infants aged 9-24 months. Methods We use a step-wedge cluster randomized controlled trial design conducted within a home visiting program offered by community health nurses to infant families in Denmark. Sixteen municipalities are randomly allocated to implement the intervention starting at three successive time points from May 1, 2022 to January 1, 2023. A total of 900-1000 families will be included. A standardized program, Psykisk Udvikling og Funktion (PUF), is used to identify infants with major problems of eating, sleep, emotional or behavioral regulation or developmental problems. The intervention builds on the Video-Feedback Intervention to Promote Positive Parenting (VIPP) program, adapted to the PUF-context and named the VIPP-PUF. Children will be followed up at ages 18 and 24 months. Primary outcome measure is the Strengths and Difficulties Questionnaire (SDQ) at child age 24 months. The other outcome measures include body mass index z-scores, the Ages and Stages Questionnaire Social-Emotional (ASQ:SE2); the Child Behavior Checklist (CBCL 1½ -5); Eating behavior Questionnaires; the Being a Mother-questionnaire (BaM13); the Parental Stress Scale (PSS); and the WHO-5 well-being index (WHO-5). Data on child and family factors are obtained from National registries and the Child Health Database. Quantitative measures are applied to examine the effectiveness of the VIPP-PUF intervention and the implementation process. Qualitative measures include interviews with CHNs, parents and municipality stakeholders to explore factors that may influence the adherence and effectiveness of the intervention. Discussion The study examines a service-setting based intervention building on the promotion of sensitive parenting to vulnerable infants. We use a mixed methods approach to evaluate the intervention, taking into account the influences of COVID-19 pandemic running since March 2020. Overall, the study has potential to add to the knowledge on the possibilities of prevention within the municipality child health care to reduce the risk of mental health problems and unhealthy weight in early childhood. Trial registration www.ClinicalTrials.gov; IDNCT04601779; Protocol ID 95-110-21307. Registered 25 June 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12551-z.
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22
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Johnson BJ, Hunter KE, Golley RK, Chadwick P, Barba A, Aberoumand M, Libesman S, Askie L, Taylor RW, Robledo KP, Mihrshahi S, O'Connor DA, Hayes AJ, Wolfenden L, Wood CT, Baur LA, Rissel C, Staub LP, Taki S, Smith W, Sue-See M, Marschner IC, Espinoza D, Thomson JL, Larsen JK, Verbestel V, Odar Stough C, Salvy SJ, O'Reilly SL, Karssen LT, Rasmussen FE, Messito MJ, Gross RS, Bryant M, Paul IM, Wen LM, Hesketh KD, González Acero C, Campbell K, Øverby NC, Linares AM, Wasser HM, Joshipura KJ, Palacios C, Maffeis C, Thompson AL, Ghaderi A, Lakshman R, Banna JC, Oken E, Campos Rivera M, Pérez-Expósito AB, Taylor BJ, Savage JS, Røed M, Goran M, de la Haye K, Anzman-Frasca S, Seidler AL. Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol. BMJ Open 2022; 12:e048165. [PMID: 35058255 PMCID: PMC8783827 DOI: 10.1136/bmjopen-2020-048165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. METHODS AND ANALYSIS Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. ETHICS AND DISSEMINATION The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study's findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. PROSPERO REGISTRATION NUMBER CRD42020177408.
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Affiliation(s)
- Brittany J Johnson
- Caring Fututures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca K Golley
- Caring Fututures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Angie Barba
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mason Aberoumand
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Charles T Wood
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Louise A Baur
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lukas P Staub
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Wendy Smith
- Canterbury Community Health Centre, Campsie, New South Wales, Australia
- Consumer Representative, Sydney, New South Wales, Australia
| | | | - Ian C Marschner
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Junilla K Larsen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Cathleen Odar Stough
- Department of Psychology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Levie T Karssen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Finn E Rasmussen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Mary Jo Messito
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Rachel S Gross
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, UK
| | - Ian M Paul
- College of Medicine, Penn State, Hershey, Pennsylvania, USA
| | - Li Ming Wen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Carolina González Acero
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Santo Domingo, Dominican Republic
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nina Cecilie Øverby
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Ana M Linares
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Heather M Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Universita degli Studi di Verona, Verona, Italy
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, UK
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rajalakshmi Lakshman
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jinan C Banna
- Human Nutrition, Food and Animal Sciences, University of Hawaii System, Honolulu, Hawaii, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA
| | | | - Ana B Pérez-Expósito
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Washington DC, District of Columbia, USA
| | - Barry J Taylor
- Better Start National Science Challenge, University of Otago, Dunedin, New Zealand
| | - Jennifer S Savage
- Department of Nutritional Sciences and Center for Childhood Obesity Research, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Margrethe Røed
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Michael Goran
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Kayla de la Haye
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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23
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Wyse R, Delaney T, Stacey F, Lecathelinais C, Ball K, Zoetemeyer R, Lamont H, Sutherland R, Nathan N, Wiggers JH, Wolfenden L. Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e31734. [PMID: 34847063 PMCID: PMC8669584 DOI: 10.2196/31734] [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: 07/01/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. Objective This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. Methods This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. Results In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. Conclusions This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075
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Affiliation(s)
- Rebecca Wyse
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rachel Zoetemeyer
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Hannah Lamont
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - John H Wiggers
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia
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How do young children eat after an obesity intervention? Validation of the Child Eating Behaviour Questionnaire using the Rasch Model in diverse samples from Australia and Sweden. Appetite 2021; 169:105822. [PMID: 34822921 DOI: 10.1016/j.appet.2021.105822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/27/2021] [Accepted: 11/20/2021] [Indexed: 12/11/2022]
Abstract
Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4-6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5-1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.
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A pilot study of a school lunchroom intervention in a predominately Latinx sample. Contemp Clin Trials 2021; 111:106599. [PMID: 34688916 DOI: 10.1016/j.cct.2021.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of the study was to assess the feasibility of an environmental school lunchroom intervention ('Smarter Lunchrooms') and test initial efficacy within a predominately Latinx population. DESIGN We collected baseline and intervention lunchroom food consumption and waste data in a pre-post, single group design. Meal consumption data was analyzed using Nutrition Data System for Research software to obtain estimates of nutritional content. MAIN OUTCOME MEASURES Feasibility. SECONDARY MEASURES Plate Waste, Nutrient Intake. RESULTS Participants were 88 1st-4th graders (51% female; 77% Latinx). Our recruitment rate was 45%, we were able to implement 8 Smarter Lunchroom strategies, and we were able to collect 82 baseline plate photos (93%) and 80 intervention photos (90%) of school lunches. On average, students threw away more than half of their meals on both days. Fruit consumption and fiber per 1000 kcal were significantly poorer at intervention compared to baseline. CONCLUSIONS Our findings highlight challenges in collecting consumption data in a real-world setting. We describe directions for future research taking into consideration our "lessons learned" from this formative work.
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Cory M, Loiacono B, Clark Withington M, Herman A, Jagpal A, Buscemi J. Behavioral Economic Approaches to Childhood Obesity Prevention Nutrition Policies: A Social Ecological Perspective. Perspect Behav Sci 2021; 44:317-332. [PMID: 34632280 PMCID: PMC8476712 DOI: 10.1007/s40614-021-00294-y] [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: 05/03/2021] [Indexed: 10/21/2022] Open
Abstract
Childhood obesity is a significant public health concern associated with the development of the leading causes of death. Dietary factors largely contribute to childhood obesity, but prevention interventions targeting these factors have reported relatively small effect sizes. One potential explanation for the ineffectiveness of prevention efforts is lack of theoretical grounding. Behavioral economic (BE) theory describes how people choose to allocate their resources and posits that some children place higher value on palatable foods (relative reinforcing value of food) and have difficulty delaying food rewards (delay discounting). These seemingly individual-level decision making processes are influenced by higher-level variables (e.g., environment/policy) as described by the social ecological model. The purpose of this manuscript is to provide a theoretical review of policy-level childhood obesity prevention nutrition initiatives informed by BE. We reviewed two policy-level approaches: (1) incentives-/price manipulation-based policies (e.g., sugary drink tax, SNAP pilot) and (2) healthful choices as defaults (Healthy Hunger Free Kids Act/National School Lunch Program, advertising regulations, default items). We review current literature as well as its limitations and future directions. Exploration of BE theory applications for nutrition policies may help to inform future theoretically grounded policy-level public health interventions.
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Affiliation(s)
- Molly Cory
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
| | | | | | - Annie Herman
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
| | - Anjana Jagpal
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
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Topham GL, Washburn IJ, Hubbs-Tait L, Kennedy TS, Rutledge JM, Page MC, Swindle T, Shriver LH, Harrist AW. The Families and Schools for Health Project: A Longitudinal Cluster Randomized Controlled Trial Targeting Children with Overweight and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8744. [PMID: 34444492 PMCID: PMC8393339 DOI: 10.3390/ijerph18168744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity; Family Dynamics (FD) added parenting and healthy emotion management. A third Peer Group (PG) intervention taught social acceptance to children. Crossing interventions yielded four conditions: FL, FL + PG, FL + FD, and FL + FD + PG-compared with the control. Longitudinal BMI data were collected to determine if family- and peer-based psychosocial components enhanced the Family Lifestyle approach. Participants were 1st graders with BMI%ile >75 (n = 538: 278 boys, 260 girls). Schools were randomly assigned to condition after stratifying for community size and percent American Indian. Anthropometric data were collected pre- and post-intervention in 1st grade and annually through 4th grade. Using a two-level random intercept growth model, intervention status predicted differences in growth in BMI or BMI-M% over three years. Children with obesity who received the FL + FD + PG intervention had lower BMI gains compared to controls for both raw BMI (B = -0.05) and BMI-M% (B = -2.36). Interventions to simultaneously improve parent, child, and peer-group behaviors related to physical and socioemotional health offer promise for long-term positive impact on child obesity.
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Affiliation(s)
- Glade L. Topham
- Department of Applied Human Sciences, Kansas State University, Manhattan, KS 66506, USA
| | - Isaac J. Washburn
- Department of Human Development & Family Science, Oklahoma State University, Stillwater, OK 74078, USA; (I.J.W.); (L.H.-T.); (A.W.H.)
| | - Laura Hubbs-Tait
- Department of Human Development & Family Science, Oklahoma State University, Stillwater, OK 74078, USA; (I.J.W.); (L.H.-T.); (A.W.H.)
| | - Tay S. Kennedy
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Julie M. Rutledge
- School of Human Ecology, Louisiana Tech University, Ruston, LA 71272, USA;
| | - Melanie C. Page
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA;
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Lenka H. Shriver
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC 27412, USA;
| | - Amanda W. Harrist
- Department of Human Development & Family Science, Oklahoma State University, Stillwater, OK 74078, USA; (I.J.W.); (L.H.-T.); (A.W.H.)
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Cepni AB, Taylor A, Crumbley C, Thompson D, Moran NE, Olvera N, O’Connor DP, Arlinghaus KR, Johnston CA, Ledoux TA. Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157828. [PMID: 34360118 PMCID: PMC8345510 DOI: 10.3390/ijerph18157828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12–36-month-old) diet and activity behaviors. Parent–toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA; accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children’s health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p < 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.
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Affiliation(s)
- Aliye B. Cepni
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Ashley Taylor
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA;
| | - Christine Crumbley
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center and Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (D.T.); (N.E.M.)
| | - Nancy E. Moran
- USDA/ARS Children’s Nutrition Research Center and Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (D.T.); (N.E.M.)
| | - Norma Olvera
- Department of Psychological, Latino Health Disparities Lab, University of Houston, Houston, TX 77204, USA;
| | - Daniel P. O’Connor
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Katherine R. Arlinghaus
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA;
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Tracey A. Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
- Correspondence: ; Tel.: +1-713-743-1870
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Derwig M, Tiberg I, Björk J, Hallström I. Child-Centred Health Dialogue for primary prevention of obesity in Child Health Services - a feasibility study. Scand J Public Health 2021; 49:384-392. [PMID: 31854251 PMCID: PMC8135234 DOI: 10.1177/1403494819891025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/04/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022]
Abstract
Aims: The aim of this study was to test a Child-Centred Health Dialogue model for primary prevention of obesity for 4-year-old children in Child Health Services, for its feasibility and the responsiveness of its outcomes. Methods: A feasibility study was set up with a non-randomised quasi-experimental cluster design comparing usual care with a structured multicomponent Child-Centred Health Dialogue consisting of two parts: (1) a universal part directed to all children and (2) a targeted part for families where the child is identified with overweight. Results: In total, 203 children participated in Child-Centred Health Dialogue while 582 children received usual care. Nurses trained in the model were able to execute both the universal health dialogue and the targeted part of the intervention. Tutorship enabled the nurses to reflect on and discuss their experiences, which strengthened their confidence and security. One year after the intervention fewer normal-weight 4-year-olds in the intervention group had developed overweight at the age of five compared with the control group, and none had developed obesity. The difference in overweight prevalence at follow-up did not reach statistical significance. Conclusions: This study demonstrates that a child-centred, multicomponent, interactive intervention for the promotion of healthy lifestyles and primary prevention of obesity for all 4-year-old children participating in Child Health Services is feasible on a small scale. As almost all caregivers make use of Child Health Services in Sweden, the findings should be confirmed in a randomised controlled trial before the intervention can be implemented on a larger scale.
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Affiliation(s)
- Mariette Derwig
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Irén Tiberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Prochnow T, Umstattd Meyer MR, Johnson C, Delgado H, Gómez L, Sharkey J. The Development and Pilot Testing of the ¡Haz Espacio Para Papi! Program Physical Activity Curriculum for Mexican-heritage Fathers and Children. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1902888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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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.
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Røed M, Medin AC, Vik FN, Hillesund ER, Van Lippevelde W, Campbell K, Øverby NC. Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial. J Med Internet Res 2021; 23:e18311. [PMID: 33591279 PMCID: PMC7925157 DOI: 10.2196/18311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet. Objective In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment. Methods The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420
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Affiliation(s)
- Margrethe Røed
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Anine C Medin
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Frøydis N Vik
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Elisabet R Hillesund
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Wendy Van Lippevelde
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway.,Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Nina C Øverby
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
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Variation in outcomes of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) according to maternal education and age 2 and 3·5 years post-intervention. Public Health Nutr 2021; 24:1460-1468. [PMID: 33427160 DOI: 10.1017/s1368980021000045] [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: 01/01/2023]
Abstract
OBJECTIVE This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age. DESIGN Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children's BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years). SETTING Population based. PARTICIPANTS Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old. RESULTS At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively. CONCLUSIONS Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother's education level or age, which is important in community-based interventions.
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5-Year Follow-Up of a Telephone Intervention to Increase Fruit and Vegetable Consumption in Preschoolers: The ' Healthy Habits' Cluster Randomised Trial. Nutrients 2020; 12:nu12123702. [PMID: 33266039 PMCID: PMC7760630 DOI: 10.3390/nu12123702] [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: 10/15/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
Little is known about the long-term impact of telephone-based interventions to improve child diet. This trial aimed to assess the long-term effectiveness (after 5 years) of a telephone-based parent intervention in increasing children's fruit and vegetable consumption. Parents of 3-5 year olds were recruited from 30 Australian preschools to participate in a cluster randomised controlled trial. Intervention parents received four, weekly, 30-min support calls aimed at modifying the home food environment. Control parents received printed materials. Consumption was assessed using the Fruit and Vegetable subscale of the Children's Dietary Questionnaire (F&V-CDQ) (children) and daily servings of fruit and vegetables (children and parents) via parent telephone interview. Of the 394 parents who completed baseline, 57% (99 intervention, 127 control) completed follow-up. After 5-years, higher intervention F&V-CDQ scores, bordering on significance, were found in complete-case (+1.1, p = 0.06) and sensitivity analyses (+1.1, p = 0.06). There was no difference in parent or child consumption of daily fruit servings. Complete-case analysis indicated significantly higher consumption of child vegetable servings (+0.5 servings; p = 0.02), which was not significant in sensitivity analysis (+0.5 servings; p = 0.10). This telephone-based parent intervention targeting the family food environment may yield promising improvements in child fruit and vegetable consumption over a 5-year period.
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PCIT-Health: Preventing Childhood Obesity by Strengthening the Parent–Child Relationship. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hyman A, Stewart K, Jamin AM, Novak Lauscher H, Stacy E, Kasten G, Ho K. Testing a school-based program to promote digital health literacy and healthy lifestyle behaviours in intermediate elementary students: The Learning for Life program. Prev Med Rep 2020; 19:101149. [PMID: 32670779 PMCID: PMC7347644 DOI: 10.1016/j.pmedr.2020.101149] [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: 01/20/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/22/2022] Open
Abstract
Promoting digital health literacy and healthy lifestyle behaviours in children can lead to positive long-term health outcomes and prevent chronic diseases. However, there are few school-based interventions promoting this education to intermediate elementary students. The objective of this study was to test the effectiveness of a novel intervention to increase students' digital health literacy and health knowledge. Learning for Life is a classroom-based education program, developed for grade 4-7 students and delivered by teachers over six weeks. Three Canadian schools were recruited to deliver the intervention in 2018. This study had a pre-post design and no control group. Students' self-reported digital health literacy and healthy lifestyle behaviours were measured at pre-intervention (n = 126), post-intervention (n = 119), and two-month follow-up (n = 104). Students at pre-intervention had a mean (SD) age of 10.98 (0.56) years (57.1% females). Almost all (97%) students had unsupervised access to the Internet through a computer or smartphone. From pre- to post-intervention, students' digital health literacy increased (p = 0.009), but decreased from post-intervention to follow-up (p < 0.001). Post-intervention, the majority of students could identify at least one healthy behaviour (e.g., exercising one hour/day) and reported making at least one healthy change in their lives (e.g., eating more fruits/vegetables). This study demonstrated that the Learning for Life intervention can improve intermediate elementary students' digital health literacy over the short-term and help them learn and retain healthy lifestyle knowledge and behaviours. These findings affirm the need for interventions promoting digital healthy literacy and healthy lifestyle behaviours for this age group.
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Affiliation(s)
- Antonia Hyman
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Kurtis Stewart
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Anne-Marie Jamin
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Helen Novak Lauscher
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Elizabeth Stacy
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Gerry Kasten
- Community Nutrition Services, Squamish Community Health Centre, Vancouver Coastal Health, PO Box 220 1140 Hunter Place, Squamish, BC V8B 0A2, Canada
| | - Kendall Ho
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
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Vlasblom E, van Grieken A, Beltman M, L’Hoir MP, Raat H, Boere-Boonekamp MM. Parenting support to prevent overweight during regular well-child visits in 0-3 year old children (BBOFT+ program), a cluster randomized trial on the effectiveness on child BMI and health behaviors and parenting. PLoS One 2020; 15:e0237564. [PMID: 32810194 PMCID: PMC7437453 DOI: 10.1371/journal.pone.0237564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 07/28/2020] [Indexed: 01/22/2023] Open
Abstract
Background Prevention of overweight during early childhood seems promising. Objective To evaluate the effectiveness of the parenting-based BBOFT+ overweight prevention program on child BMI, child health behavior and parenting behavior among 0–36 month old children. BBOFT+ is an acronym for the key healthy lifestyle behaviors that are targeted in the BBOFT+ intervention: breastfeeding (B), daily breakfast (B), daily going outdoors (O), limiting sweet beverages (in Dutch, F) and minimal TV or computer time (T), complemented with healthy sleep behavior and improvement of parenting skills (+). Methods A cluster randomized controlled trial in newborn children visiting well-baby clinics, comparing the BBOFT+ intervention (N = 901) with care as usual (CAU) (N = 1094). In both groups, parents received regular well-child visits (±11 visits in the first 3 years). In the intervention group, care was supplemented with the BBOFT+ program, which focuses on improving parenting skills from birth onwards to increase healthy behavior. Questionnaires were filled in at child's age 2–4 weeks, 6, 14 and 36 months. In multivariate analyses we corrected for child’s birthweight, age, ethnic background, mother’s educational level and BMI. Results No differences were found in weight status at 36 months between intervention and control group children. At 6 months, BBOFT+ parents reported their child drinking less sweet beverages than control parents (48% vs 54%;p = .027), and going outdoors daily with their child less often (57% vs 62%;p = .03). At 14 months, more BBOFT+ parents than control parents reported to have breastfed for six months or longer (32% vs 29%;p = .022). At 36 months, more BBOFT+ parents than control parents reported their child going outside daily (78% vs 72%;p = .011) and having less TV/computer time on week- (38% vs 46%;p = .001) and weekend days (48% vs 56%;p = .002). Also, BBOFT+ parents reported having more parental control than control parents (3.92 vs 3.89;p = .02). No significant differences were found for daily breakfast, sleep duration and parenting practices in adjusted analyses. Conclusion The BBOFT+ overweight prevention program showed small improvements in parent-reported child health behaviors, compared to care as usual; no effect was observed on child BMI. The identified modifiable elements are potentially relevant for interventions that aim to prevent overweight.
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Affiliation(s)
- Eline Vlasblom
- Department of Child Health, TNO, Leiden, The Netherlands
- * E-mail:
| | - Amy van Grieken
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maaike Beltman
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Monique P. L’Hoir
- Department of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Department of Public Health Services of North- and East-Gelderland (GGDNOG), Warnsveld, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Magda M. Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Emley E, Dial L, Koerten H, Musher-Eizenman D. Variation in School District Nutrition Policies and Practices: Community Context Matters. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1795753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
OBJECTIVE To examine the relationship between maternal cognitions related to promoting a healthy lifestyle in their child, maternal feeding practices, children's eating styles, and child weight status in children aged 4 to 6 years. METHODS Cross-sectional questionnaire data were collected in 251 Dutch mothers of preschoolers. Structural equation modeling was used to test the fit of a model that assumed maternal health cognitions would predict maternal feeding practices, which in turn would predict children's eating styles and child weight status. Explorative analyses were conducted to examine child characteristics as predictors of maternal health cognitions and feeding practices. RESULTS Mothers with higher self-efficacy used fewer pressure-to-eat feeding techniques, which in turn was related to less avoidant eating styles in children. In addition, mothers who perceived more benefits of a healthy lifestyle used more restriction techniques, which in turn predicted a more approach-oriented eating style in children, which was also related to higher child standard deviation scores body mass index. Finally, children with an avoidant eating style had mothers who perceived more barriers and reported less self-efficacy. CONCLUSION Self-efficacy and perceived benefits relate to maternal feeding practices and eating styles of the child. However, more perceived benefits of a healthy lifestyle were associated with inadequate feeding practices. Therefore, interventions targeted at mothers to reduce child overweight should focus not only on reinforcing perceived benefits of a healthy lifestyle but also on how the mother can translate her attitudes into adaptive parenting to achieve the desired health outcomes.
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Landgren K, Quaye AA, Hallström E, Tiberg I. Family-based prevention of overweight and obesity in children aged 2–6 years: a systematic review and narrative analysis of randomized controlled trials. CHILD AND ADOLESCENT OBESITY 2020. [DOI: 10.1080/2574254x.2020.1752596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Kajsa Landgren
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Angela A. Quaye
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elinor Hallström
- Research Institute of Sweden, Department of Agriculture and Food, Lund, Sweden
| | - Irén Tiberg
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
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Morgan EH, Schoonees A, Sriram U, Faure M, Seguin‐Fowler RA. Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors. Cochrane Database Syst Rev 2020; 1:CD012547. [PMID: 31902132 PMCID: PMC6956675 DOI: 10.1002/14651858.cd012547.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Poor diet and insufficient physical activity are major risk factors for non-communicable diseases. Developing healthy diet and physical activity behaviors early in life is important as these behaviors track between childhood and adulthood. Parents and other adult caregivers have important influences on children's health behaviors, but whether their involvement in children's nutrition and physical activity interventions contributes to intervention effectiveness is not known. OBJECTIVES • To assess effects of caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors, including those intended to prevent overweight and obesity • To describe intervention content and behavior change techniques employed, drawing from a behavior change technique taxonomy developed and advanced by Abraham, Michie, and colleagues (Abraham 2008; Michie 2011; Michie 2013; Michie 2015) • To identify content and techniques related to reported outcomes when such information was reported in included studies SEARCH METHODS: In January 2019, we searched CENTRAL, MEDLINE, Embase, 11 other databases, and three trials registers. We also searched the references lists of relevant reports and systematic reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of interventions to improve children's dietary intake or physical activity behavior, or both, with children aged 2 to 18 years as active participants and at least one component involving caregivers versus the same interventions but without the caregiver component(s). We excluded interventions meant as treatment or targeting children with pre-existing conditions, as well as caregiver-child units residing in orphanages and school hostel environments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures outlined by Cochrane. MAIN RESULTS We included 23 trials with approximately 12,192 children in eligible intervention arms. With the exception of two studies, all were conducted in high-income countries, with more than half performed in North America. Most studies were school-based and involved the addition of healthy eating or physical education classes, or both, sometimes in tandem with other changes to the school environment. The specific intervention strategies used were not always reported completely. However, based on available reports, the behavior change techniques used most commonly in the child-only arm were "shaping knowledge," "comparison of behavior," "feedback and monitoring," and "repetition and substitution." In the child + caregiver arm, the strategies used most commonly included additional "shaping knowledge" or "feedback and monitoring" techniques, as well as "social support" and "natural consequences." We considered all trials to be at high risk of bias for at least one design factor. Seven trials did not contribute any data to analyses. The quality of reporting of intervention content varied between studies, and there was limited scope for meta-analysis. Both validated and non-validated instruments were used to measure outcomes of interest. Outcomes measured and reported differed between studies, with 16 studies contributing data to the meta-analyses. About three-quarters of studies reported their funding sources; no studies reported industry funding. We assessed the quality of evidence to be low or very low. Dietary behavior change interventions with a caregiver component versus interventions without a caregiver component Seven studies compared dietary behavior change interventions with and without a caregiver component. At the end of the intervention, we did not detect a difference between intervention arms in children's percentage of total energy intake from saturated fat (mean difference [MD] -0.42%, 95% confidence interval [CI] -1.25 to 0.41, 1 study, n = 207; low-quality evidence) or from sodium intake (MD -0.12 g/d, 95% CI -0.36 to 0.12, 1 study, n = 207; low-quality evidence). No trial in this comparison reported data for children's combined fruit and vegetable intake, sugar-sweetened beverage (SSB) intake, or physical activity levels, nor for adverse effects of interventions. Physical activity interventions with a caregiver component versus interventions without a caregiver component Six studies compared physical activity interventions with and without a caregiver component. At the end of the intervention, we did not detect a difference between intervention arms in children's total physical activity (MD 0.20 min/h, 95% CI -1.19 to 1.59, 1 study, n = 54; low-quality evidence) or moderate to vigorous physical activity (MVPA) (standard mean difference [SMD] 0.04, 95% CI -0.41 to 0.49, 2 studies, n = 80; moderate-quality evidence). No trial in this comparison reported data for percentage of children's total energy intake from saturated fat, sodium intake, fruit and vegetable intake, or SSB intake, nor for adverse effects of interventions. Combined dietary and physical activity interventions with a caregiver component versus interventions without a caregiver component Ten studies compared dietary and physical activity interventions with and without a caregiver component. At the end of the intervention, we detected a small positive impact of a caregiver component on children's SSB intake (SMD -0.28, 95% CI -0.44 to -0.12, 3 studies, n = 651; moderate-quality evidence). We did not detect a difference between intervention arms in children's percentage of total energy intake from saturated fat (MD 0.06%, 95% CI -0.67 to 0.80, 2 studies, n = 216; very low-quality evidence), sodium intake (MD 35.94 mg/d, 95% CI -322.60 to 394.47, 2 studies, n = 315; very low-quality evidence), fruit and vegetable intake (MD 0.38 servings/d, 95% CI -0.51 to 1.27, 1 study, n = 134; very low-quality evidence), total physical activity (MD 1.81 min/d, 95% CI -15.18 to 18.80, 2 studies, n = 573; low-quality evidence), or MVPA (MD -0.05 min/d, 95% CI -18.57 to 18.47, 1 study, n = 622; very low-quality evidence). One trial indicated that no adverse events were reported by study participants but did not provide data. AUTHORS' CONCLUSIONS Current evidence is insufficient to support the inclusion of caregiver involvement in interventions to improve children's dietary intake or physical activity behavior, or both. For most outcomes, the quality of the evidence is adversely impacted by the small number of studies with available data, limited effective sample sizes, risk of bias, and imprecision. To establish the value of caregiver involvement, additional studies measuring clinically important outcomes using valid and reliable measures, employing appropriate design and power, and following established reporting guidelines are needed, as is evidence on how such interventions might contribute to health equity.
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Affiliation(s)
- Emily H Morgan
- University of VermontDepartment of Nutrition and Food Sciences225B Marsh Life Science109 Carrigan DriveBurlingtonVTUSA05405
| | - Anel Schoonees
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownWestern CapeSouth Africa7505
| | - Urshila Sriram
- Cornell UniversityDivision of Nutritional Sciences2250 N Triphammer Rd, Apt E8IthacaNew YorkUSA14850
- Texas A&M AgriLife ResearchCollege StationTXUSA
| | - Marlyn Faure
- Stellenbosch UniversityDean's Division, Faculty of Medicine and Health SciencesFrancie van Zijl Drive, ParowCape TownWestern CapeSouth Africa14853
| | - Rebecca A Seguin‐Fowler
- Texas A&M AgriLife ResearchCollege StationTXUSA
- Texas A&M UniversityDepartment of Nutrition and Food Science, College of Agriculture and Life SciencesAgriculture and Life Sciences Building600 John Kimbrough Boulevard, Suite 512College StationTXUSA77843‐2142
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Hennessy M, Heary C, Laws R, van Rhoon L, Toomey E, Wolstenholme H, Byrne M. The effectiveness of health professional-delivered interventions during the first 1000 days to prevent overweight/obesity in children: A systematic review. Obes Rev 2019; 20:1691-1707. [PMID: 31478333 DOI: 10.1111/obr.12924] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022]
Abstract
Childhood obesity is a global public health challenge. Early prevention, particularly during the first 1000 days, is advocated. Health professionals have a role to play in obesity prevention efforts, in part due to the multiple routine contacts they have with parents. We synthesized the evidence for the effectiveness of obesity prevention interventions delivered by health professionals during this time period, as reviews to date have not examined effectiveness by intervention provider. We also explored what behaviour change theories and/or techniques were associated with more effective intervention outcomes. Eleven electronic databases and three trial registers were searched from inception to 04 April 2019. A total of 180 studies, describing 39 trials involving 46 intervention arms, were included. While the number of interventions has grown considerably, we found some evidence for the effectiveness of health professional-delivered interventions during the first 1000 days. Only four interventions were effective on a primary (adiposity/weight) and secondary (behavioural) outcome measure. Twenty-two were effective on a behavioural outcome only. Several methodological limitations were noted, impacting on efforts to establish the active ingredients of interventions. Future work should focus on the conduct and reporting of interventions.
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Affiliation(s)
- Marita Hennessy
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Luke van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hazel Wolstenholme
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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Jang M, Owen B, Lauver DR. Different types of parental stress and childhood obesity: A systematic review of observational studies. Obes Rev 2019; 20:1740-1758. [PMID: 31475448 DOI: 10.1111/obr.12930] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/23/2019] [Accepted: 07/10/2019] [Indexed: 12/11/2022]
Abstract
Different types of parental stress may influence children's health behaviors and weight. The aim of this review was to systematically examine the relationships between parental stress and child obesity. We reviewed 27 studies published through December 2018 and classified parental stress as parents' general stress, parenting role stress, and life event stress. There were positive relationships of parents' general stress and parenting role stress with child obesity among families with younger children and in longitudinal studies. The relationship between life event stress and child obesity differed by measures. We found that parenting role stress may be associated with unhealthy parenting practices. Contextual factors such as children's and parents' sex, race or ethnicity, socioeconomic status, and family structure appeared to play a moderating role in the relationship between parents' stress and child obesity, which warrant cautious interpretation. Our recommendations for future research include clarifying further the types of parental stress that influence child obesity, evaluating long-term relationship between parental stress and child obesity, and identifying possible mediating factors to support the relationship between parents' stress and child obesity. Researchers may also consider developing stress management programs for parents to address child obesity.
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Affiliation(s)
- Myoungock Jang
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
| | - Brenda Owen
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
| | - Diane R Lauver
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
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Helle C, Hillesund ER, Wills AK, Øverby NC. Examining the effects of an eHealth intervention from infant age 6 to 12 months on child eating behaviors and maternal feeding practices one year after cessation: The Norwegian randomized controlled trial Early Food for Future Health. PLoS One 2019; 14:e0220437. [PMID: 31442241 PMCID: PMC6707582 DOI: 10.1371/journal.pone.0220437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The Norwegian randomized controlled trial Early Food for Future Health provided parental anticipatory guidance on early protective feeding practices from child age 6 to 12 months through an eHealth intervention. Previously published outcomes at child age 12 months indicated that the eHealth intervention increased daily vegetable/fruit intake and promoted more beneficial mealtime routines. The objective of the current paper is to evaluate the effects of the intervention at child age 24 months, one year after cessation. METHODS Parents of infants aged 3-5 months were recruited via social media and child health clinics during spring 2016. At child age 5.5 months, 715 mothers were randomized to either control (n = 358) or intervention (n = 360) arm. Primary study-outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. Secondary outcome was child anthropometry. RESULTS In total 295 mothers (41%) completed the follow-up questionnaire at child age 24 months. Regarding fruit intake, 54.3% in the intervention group had a high score compared with 48.3% of the control group (p = 0.29). For intake of vegetables, 54.5% in the intervention group had a high score compared with 50.7% in the control group (p = 0.49). A total of 65.7% of the children in the intervention group were eating breakfast together with family ≥ 4 times per week, compared with 57.3% of the children in the control group (p = 0.12). There was no difference between the groups for child anthropometric outcomes at child age 24 months. CONCLUSIONS At child age 24 months, we found no evidence of sustained intervention-effects. Although dietary patterns and mealtime routines at child age 24 months were reasonably consistent and in the same directions as at child age 12 months, the between-group differences were not significant. The large loss to follow-up may have limited power and validity and makes it difficult to draw overall conclusions. Future research is needed to improve knowledge of how short-time effects could be retained over longer term, taking into account that larger samples are necessary when planning longer-term follow-up studies. TRIAL REGISTRATION ISRCTN, ISRCTN13601567.
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Affiliation(s)
- Christine Helle
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | - Elisabet R. Hillesund
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | - Andrew K. Wills
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Nina C. Øverby
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
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Arlinghaus KR, Truong C, Johnston CA, Hernandez DC. An Intergenerational Approach to Break the Cycle of Malnutrition. Curr Nutr Rep 2019; 7:259-267. [PMID: 30324333 DOI: 10.1007/s13668-018-0251-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article examines how nutritional status is treated throughout the lifecycle. In doing so, the review identifies promising life stages during which intervention may improve nutritional status of future generations. RECENT FINDINGS A life course perspective suggests that nutritional changes are most likely to be sustained when they occur during times of developmental transition, such as pregnancy or adolescence. Adolescence is a unique period in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible and individuals seek independence from parents. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women's education.
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Affiliation(s)
- Katherine R Arlinghaus
- Department of Health and Human Performance, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015, USA.
| | - Chelsea Truong
- Department of Health and Human Performance, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015, USA
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015, USA
| | - Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015, USA.,HEALTH Research Institute, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015, USA
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Dial LA, Musher-Eizenman DR. Healthy? Tasty? Children’s evaluative categorization of novel foods. COGNITIVE DEVELOPMENT 2019. [DOI: 10.1016/j.cogdev.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Enö Persson J, Bohman B, Tynelius P, Rasmussen F, Ghaderi A. Prevention of Childhood Obesity in Child Health Services: Follow-Up of the PRIMROSE Trial. Child Obes 2019; 14:99-105. [PMID: 29232526 DOI: 10.1089/chi.2017.0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI). METHODS A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect. RESULTS There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons. CONCLUSIONS A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.
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Affiliation(s)
- Johanna Enö Persson
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - Benjamin Bohman
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,2 Centre for Psychiatry Research , Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Tynelius
- 3 Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden .,4 Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services , Stockholm, Sweden
| | - Finn Rasmussen
- 5 Department of Health Sciences, Lund University , Lund, Sweden
| | - Ata Ghaderi
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
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Beckerman JP, Aftosmes-Tobio A, Kitos N, Jurkowski JM, Lansburg K, Kazik C, Gavarkovs A, Vigilante A, Kalyoncu B, Figueroa R, Klabunde R, Barouch R, Haneuse S, Taveras E, Davison KK. Communities for healthy living (CHL) - A family-centered childhood obesity prevention program integrated into Head Start services: Study protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2019; 78:34-45. [PMID: 30630109 PMCID: PMC6487308 DOI: 10.1016/j.cct.2019.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/15/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is highly prevalent and carries substantial health consequences. Childhood obesity interventions have had mixed results, which may be partially explained by the absence of theory that incorporates broader family context and methods that address implementation challenges in low-resource settings. Communities for Healthy Living (CHL) is an obesity prevention program for Head Start preschools designed with careful focus on theory and implementation. This protocol paper outlines the design, content, implementation, and evaluation of CHL. METHODS/DESIGN CHL integrates a parenting program co-led by Head Start staff and parents, enhanced nutrition support, and a media campaign. CHL content and implementation are informed by the Family Ecological Model, Psychological Empowerment Theory, and Organizational Empowerment Theory. The intervention is directed by community-based participatory research and implementation science principles, such as co‑leadership with parents and staff, and implementation in a real world context. CHL is evaluated in a three-year pragmatic cluster-randomized trial with a stepped wedge design. The primary outcome is change in child Body Mass Index z-score. Secondary outcomes include children's weight-related behaviors (i.e., diet, physical activity, screen use, and sleep), parenting practices targeted at these behaviors (e.g., food parenting), and parent empowerment. The evaluation capitalizes on routine health data collected by Head Start (e.g., child height and weight, diet) coupled with parent surveys completed by subsamples of families. DISCUSSION CHL is an innovative childhood obesity prevention program grounded in theory and implementation science principles. If successful, CHL is positioned for sustained implementation and nationwide Head Start scale-up.
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Affiliation(s)
- Jacob P Beckerman
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Alyssa Aftosmes-Tobio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Janine M Jurkowski
- Department of Health Policy, Management & Behavior, University at Albany School of Public Health, 1 University Place, Rensselaer, NY 12144, United States.
| | - Kindra Lansburg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Action for Boston Community Development, 178 Tremont Street, Boston, MA 02111, United States.
| | - Crystal Kazik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Community Action Agency of Somerville, 66 Union Square, Somerville, MA 02143, United States
| | - Adam Gavarkovs
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Adrienne Vigilante
- Community Action Agency of Somerville, 66 Union Square, Somerville, MA 02143, United States.
| | - Begum Kalyoncu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Roger Figueroa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Rachel Klabunde
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Rachel Barouch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Elsie Taveras
- Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States.
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
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Hammersley ML, Okely AD, Batterham MJ, Jones RA. An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial. J Med Internet Res 2019; 21:e11964. [PMID: 30735139 PMCID: PMC6384541 DOI: 10.2196/11964] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 12/11/2022] Open
Abstract
Background Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children. Objective This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy. Methods The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection. Results A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes. Conclusions The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. Trial Registration Australian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).
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Affiliation(s)
- Megan L Hammersley
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
| | - Marijka J Batterham
- Statistical Consulting Service, National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, Australia
| | - Rachel A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
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50
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Kay MC, Burroughs J, Askew S, Bennett GG, Armstrong S, Steinberg DM. Digital Weight Loss Intervention for Parents of Children Being Treated for Obesity: A Prospective Cohort Feasibility Trial. J Med Internet Res 2018; 20:e11093. [PMID: 30573449 PMCID: PMC6320402 DOI: 10.2196/11093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity continues to increase, and clinic-based treatment options have failed to demonstrate effectiveness. One of the strongest predictors of child weight is parent weight. Parental treatment for weight loss may indirectly reduce obesity in the child. We have previously demonstrated the effectiveness among adults of a fully automated, evidence-based digital weight loss intervention (Track). However, it is unknown if it is feasible to deliver such a treatment directly to parents with obesity who bring their child with obesity to a weight management clinic for treatment. OBJECTIVE The objective of our study was to evaluate the feasibility of and engagement with a digital weight loss intervention among parents of children receiving treatment for obesity. METHODS We conducted a 6-month pre-post feasibility trial among parents or guardians and their children aged 4-16 years presenting for tertiary care obesity treatment. Along with the standard family-based treatment protocol, parents received a 6-month digital weight loss intervention, which included weekly monitoring of personalized behavior change goals via mobile technologies. We examined levels of engagement by tracking completed weeks of self-monitoring and feasibility by assessing change in weight. RESULTS Participants (N=48) were on average 39 years old, mostly female (35/42, 82% ), non-Hispanic Black individuals (21/41, 51%) with obesity (36/48, 75%). Over a quarter had a yearly household income of <US $25,000, and about a third had the equivalent of a high school education. Children were on average 10 years old and had a body mass index of 29.8 kg/m2. The median percentage of weeks participants tracked their behaviors was 77% (18.5/24 total weeks; interquartile range [IQR] 6.3 to 100). The median number of attempts via phone or text message (short message service) required to complete one tracking week was 3.3 (IQR 2.6 to 4.9). Nearly half (23/48, 48%) had high levels of engagement, completing 80% (19/24) or more weeks of tracking. Of the 26 participants with weight measurements reported at 6 months, of which 81% (21/26) were self-reported, there was a median 2.44 kg (IQR -6.5 to 1.0) decrease in weight. CONCLUSIONS It is feasible to deliver an evidence-based digital weight loss intervention to parents or guardians whose children are enrolled in a weight management program. Given the feasibility of this approach, future studies should investigate the effectiveness of digital weight loss interventions for parents on child weight and health outcomes.
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Affiliation(s)
- Melissa C Kay
- Duke Global Digital Health Science Center, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, United States
| | - Jasmine Burroughs
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Sarah Armstrong
- Duke Center for Childhood Obesity Research, Duke Department of Pediatrics, Duke University, Durham, NC, United States
| | - Dori M Steinberg
- Duke Global Digital Health Science Center, Duke School of Nursing, Duke University, Durham, NC, United States
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