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Beck AL, Mora R, Joseph G, Perrin E, Cabana M, Schickedanz A, Fernandez A. A Multimethod Evaluation of the Futuros Fuertes Intervention to Promote Healthy Feeding, Screen Time, and Sleep Practices. Acad Pediatr 2023; 23:1351-1360. [PMID: 37211275 DOI: 10.1016/j.acap.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE 1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action. METHODS Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention. RESULTS There were n = 96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p = 0.05). Breastfeeding rates were higher in intervention participants at 6 months (84% vs 59% p = 0.02) and 9 months (81% vs 51% p = 0.008). Mean daily screen time was lower among intervention participants at 6 months (7 vs 22 min p = 0.003), 12 months (35 vs 52 min p = 0.03), and 15 months (60 vs 73 min p = 0.03). Major qualitative themes include 1) parental trust in intervention messaging 2) changes in feeding and screen time parenting practices, 3) text messages supported behavior change for parents and family members, and 4) varying effectiveness of intervention on different health behaviors. CONCLUSIONS Low-income Latino infants participating in the Futuros Fuertes intervention had modestly healthier feeding and screen time practices compared to control participants.
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Affiliation(s)
- Amy L Beck
- Department of Pediatrics, School of Medicine (AL Beck), University of California San Francisco.
| | - Rosa Mora
- School of Medicine (R Mora), University of California San Francisco
| | - Galen Joseph
- Department of Humanities and Social Medicine, School of Medicine (G Joseph), University of California San Francisco
| | - Eliana Perrin
- Department of Pediatrics, Schools of Medicine and Nursing (E Perrin), Johns Hopkins University, Baltimore, Md
| | - Michael Cabana
- Department of Pediatrics (M Cabana), Albert Einstein College of Medicine, New York, NY
| | - Adam Schickedanz
- Department of Pediatrics (A Schickedanz), University of California Los Angeles
| | - Alicia Fernandez
- Department of Medicine (A Fernandez), University of California San Francisco
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Kay MC, Pankiewicz AR, Schildcrout JS, Wallace S, Wood CT, Shonna Yin H, Rothman RL, Sanders LM, Orr C, Delamater AM, Flower KB, Perrin EM. Early Sweet Tooth: Juice Introduction During Early Infancy is Related to Toddler Juice Intake. Acad Pediatr 2023; 23:1343-1350. [PMID: 37150479 PMCID: PMC10592660 DOI: 10.1016/j.acap.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess if 100% fruit juice intake prior to 6 months is associated with juice and sugar-sweetened beverage (SSB) intake at 24 months and whether this differs by sociodemographic factors. METHODS We used longitudinal data from infants enrolled in the control (no obesity intervention) arm of Greenlight, a cluster randomized trial to prevent childhood obesity which included parent-reported child 100% fruit juice intake at all well child checks between 2 and 24 months. We studied the relationship between the age of juice introduction (before vs after 6 months) and juice and SSB intake at 24 months using negative binomial regression while controlling for baseline sociodemographic factors. RESULTS We report results for 187 participants (43% Hispanic, 39% non-Hispanic Black), more than half (54%) of whom had reported 100% fruit juice intake before 6 months. Average 100% fruit juice intake at 24 months was greater than the recommended amount (of 4 oz) and was 8.2 oz and 5.3 oz for those who had and had not, respectively, been introduced to juice before 6 months. In adjusted models, early introduction of juice was associated with a 43% (95% confidence interval: 5%-96%) increase in juice intake at 24 months. CONCLUSIONS 100% fruit juice intake exceeding recommended levels at 6 and 24 months in this diverse cohort was prevalent. Introducing 100% fruit juice prior to 6 months may put children at greater risk for more juice intake as they age. Further research is necessary to determine if early guidance can reduce juice intake.
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Affiliation(s)
- Melissa C Kay
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Aaron R Pankiewicz
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Jonathan S Schildcrout
- Department of Biostatistics (JS Schildcrout), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Shelby Wallace
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Charles T Wood
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University Grossman School of Medicine.
| | - Russell L Rothman
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Lee M Sanders
- Department of Pediatrics (LM Sanders), Stanford University, Calif.
| | - Colin Orr
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami, Coral Gables, Fla.
| | - Kori B Flower
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Md.
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Martino F, Bassareo PP, Martino E, Romeo F, Calcaterra G, Perrone Filardi P, Indolfi C, Nodari S, Montemurro V, Guccione P, Salvo GD, Chessa M, Pedrinelli R, Mercuro G, Barillà F. Cardiovascular prevention in childhood: a consensus document of the Italian Society of Cardiology Working Group on Congenital Heart Disease and Cardiovascular Prevention in Paediatric Age. J Cardiovasc Med (Hagerstown) 2023; 24:492-505. [PMID: 37409595 DOI: 10.2459/jcm.0000000000001488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Cardiovascular diseases (CVD) may be manifested from a very early age. Genetic and environmental (epigenetic) factors interact to affect development and give rise to an abnormal phenotypical expression of genetic information, although not eliciting changes in the nucleotide sequence of DNA. It has been scientifically proven that increased oxidative stress (OS) caused by disease (overweight, obesity, diabetes), nutritional imbalances, unhealthy lifestyles (smoking, alcohol, substance abuse) in the mother during pregnancy may induce placental dysfunction, intrauterine growth restriction, prematurity, low birth weight, postnatal adiposity rebound, metabolic alterations and consequent onset of traditional cardiovascular risk factors. OS represents the cornerstone in the onset of atherosclerosis and manifestation of CVD following an extended asymptomatic period. OS activates platelets and monocytes eliciting the release of pro-inflammatory, pro-atherogenic and pro-oxidising substances resulting in endothelial dysfunction, decrease in flow-mediated arterial dilatation and increase in carotid intima-media thickness. The prevention of CVD is defined as primordial (aimed at preventing risk factors development), primary (aimed at early identification and treatment of risk factors), secondary (aimed at reducing risk of future events in patients who have already manifested a cardiovascular event), and tertiary (aimed at limiting the complex outcome of disease). Atherosclerosis prevention should be implemented as early as possible. Appropriate screening should be carried out to identify children at high risk who are apparently healthy and implement measures including dietary and lifestyle changes, addition of nutritional supplements and, lastly, pharmacological treatment if risk profiles fail to normalise. Reinstating endothelial function during the reversible stage of atherosclerosis is crucial.
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Affiliation(s)
- Francesco Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Eliana Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | | | | | | | - Ciro Indolfi
- Division of Cardiology, Research Centre for Cardiovascular Diseases, Magna Graecia University, Catanzaro
| | - Savina Nodari
- Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia
| | | | - Paolo Guccione
- Department of Cardiology, Cardiac Surgery, Cardio-pulmonary Transplantation, IRCCS Bambino Gesu'Paediatric Hospital, Rome
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University of Padua, Padua
| | - Massimo Chessa
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Vita Salute San Raffaele University, Milan
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa
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Gorecki MC, Perrin EM, Orr CJ, White MJ, Yin HS, Sanders LM, Rothman RL, Delamater AM, Truong T, Green CL, Flower KB. Feeding, television, and sleep behaviors at one year of age in a diverse sample. OBESITY PILLARS (ONLINE) 2023; 5:100051. [PMID: 37990745 PMCID: PMC10662021 DOI: 10.1016/j.obpill.2022.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 11/23/2023]
Abstract
Background Healthy lifestyle behaviors that can prevent adverse health outcomes, including obesity, are formed in early childhood. This study describes feeding, television, and sleep behaviors among one-year-old infants and examines differences by sociodemographic factors. Methods Caregivers of one-year-olds presenting for well care at two clinics, control sites for the Greenlight Study, were queried about feeding, television time, and sleep. Adjusted associations between sociodemographic factors and behaviors were performed by modified Poisson (binary), multinomial logistic (multi-category), or linear (continuous) regression models. Results Of 235 one-year-olds enrolled, 81% had Medicaid, and 45% were Hispanic, 36% non-Hispanic Black, 19% non-Hispanic White. Common behaviors included 20% exclusive bottle use, 32% put to bed with bottle, mean daily juice intake of 4.1 ± 4.6 ounces, and active television time 45 ± 73 min. In adjusted analyses compared to Hispanic caregivers, non-Hispanic Black caregivers were less likely to report exclusive bottle use (odds ratio: 0.11, 95% confidence interval [CI] 0.03-0.39), reported 2.4 ounces more juice (95% CI 1.0-3.9), 124 min more passive television time (95% CI 60-188), and 37 min more active television time (95% CI 10-64). Increased caregiver education and higher income were associated with 0.4 (95% CI 0.13-0.66) and 0.3 (95% CI 0.06-0.55) more servings of fruits and vegetables per day, respectively. Conclusion In a diverse sample of one-year-olds, caregivers reported few protective behaviors that reduce the risk for adverse health outcomes including obesity. Differences in behavior by race/ethnicity, income, and education can inform future interventions and policies. Future interventions should strive to create culturally effective messaging to address common adverse health behaviors.
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Affiliation(s)
- Michelle C. Gorecki
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Eliana M. Perrin
- Department of Pediatrics, Schools of Medicine and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Colin J. Orr
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle J. White
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University, New York, NY, USA
| | - Lee M. Sanders
- Department of Pediatrics, Center for Health Policy, Stanford University, Stanford, CA, USA
| | - Russell L. Rothman
- Departments of Pediatrics, Internal Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, FL, USA
| | - Tracy Truong
- Department of Biostatistics, Duke University, Durham, NC, USA
| | | | - Kori B. Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hart CN, Phelan S, Coffman DL, Jelalian E, Ventura AK, Hodges EA, Hawley N, Fisher JO, Wing RR. Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions. Appetite 2023; 180:106348. [PMID: 36272545 DOI: 10.1016/j.appet.2022.106348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.
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Affiliation(s)
- C N Hart
- Department of Social and Behavioral Sciences and Center for Obesity Research and Education, College of Public Health, Temple University, USA.
| | - S Phelan
- Department of Kinesiology & Public Health and Center for Health Research, California Polytechnic State University, USA
| | - D L Coffman
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Department of Psychiatry and Human Behavior, USA
| | - E Jelalian
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, USA
| | - A K Ventura
- Department of Kinesiology & Public Health and Center for Health Research, California Polytechnic State University, USA
| | - E A Hodges
- School of Nursing, The University of North Carolina at Chapel Hill, USA
| | - N Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, USA
| | - J O Fisher
- Department of Social and Behavioral Sciences and Center for Obesity Research and Education, College of Public Health, Temple University, USA
| | - R R Wing
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, USA
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6
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e Silva BFV, Sampaio SSS, Moura JR, de Medeiros CEB, de Lima-Alvarez CD, Simão CR, Azevedo IG, Pereira SA. "I Am Afraid of Positioning my Baby in Prone": Beliefs and Knowledge about Tummy Time Practice. Int J Pediatr 2023; 2023:4153523. [PMID: 37124427 PMCID: PMC10132908 DOI: 10.1155/2023/4153523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/08/2023] [Accepted: 04/01/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To identify beliefs and knowledge about tummy time (TT) practice and its repercussions on motor development. Methods Longitudinal study carried out with parents/caregivers of infants older than 30 days of life. Two assessments were performed. A structured interview was conducted, while the babies were between one and six months old to identify beliefs, knowledge about TT, and the motor milestone achievement expected for the age. At six to 12 months, the risk of motor development delay was tracked using the survey of well-being of young infant questionnaire (SWYC). Results 41 families responded to the SWYC questionnaire (21 were allocated to the TT group). 31.70% reported that it was not important to put the infants in a prone position while awake, and 70.70% said they are afraid their babies would become breathless when positioned in a prone position. 85.70% of infants from the TT group showed typical development, while 55% of the control group showed atypical development for their age (p = 0.01). Only three infants from the control group were at risk of delayed motor development (p = 0.10). Conclusions Most of the families feel insecure about proning their babies and fear breathlessness when positioned. Acquisition of motor milestones prevailed in the TT group, suggesting an association between TT practice and motor milestone achievement.
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Affiliation(s)
| | | | - Julia Raffin Moura
- Physiotherapy Department, Federal University of Rio Grande do Norte, Brazil
| | | | | | - Camila Rocha Simão
- Anita Garibaldi Center for Education and Research in Health, Santos Dumont Institute, Brazil
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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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Nieri T, Zimmer A, Vaca JM, Tovar A, Cheney A. A Systematic Review of Research on Non-Maternal Caregivers' Feeding of Children 0-3 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14463. [PMID: 36361342 PMCID: PMC9658782 DOI: 10.3390/ijerph192114463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Although people other than mothers participate in feeding, few interventions include non-maternal caregivers, especially those promoting healthy development among children aged 0-3 years. Understanding the role and influence of non-maternal caregivers is essential for the development and effectiveness of early childhood feeding interventions; yet, no reviews have examined non-maternal caregivers of children aged 0-3 years. This study assessed what is known about non-maternal caregivers' feeding of children aged 0-3. We systematically reviewed 38 empirical quantitative, qualitative, and mixed methods studies, cataloged in PubMed and Web of Science and published between 1/2000-6/2021. The studies showed that non-maternal caregivers engage in child feeding and their attitudes and behaviors affect child outcomes. Like mothers, non-maternal caregivers vary in the extent to which their knowledge and attitudes support recommended feeding practices and the extent to which they exhibit responsive feeding styles and practices. Children of broad ages were included in the studies; future research should include infant/toddler-only samples to allow for better assessment of age-specific feeding constructs. The studies also revealed issues specific to non-maternal caregivers that are unlikely to be addressed in interventions developed for mothers. Thus, the review highlighted features of non-maternal caregiving of children 0-3 years that could be addressed to support feeding and child outcomes.
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Affiliation(s)
- Tanya Nieri
- Department of Sociology, University of California Riverside, Riverside, CA 92521, USA
| | - Arianna Zimmer
- Center for Health Disparities Research, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
| | - Jai Mica Vaca
- Department of Justice Studies, San Jose State University, San Jose, CA 95192, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
| | - Ann Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
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White MJ, Kay MC, Truong T, Green CL, Yin HS, Flower KB, Rothman RL, Sanders LM, Delamater AM, Duke NN, Perrin EM. Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors. Acad Pediatr 2022; 22:1429-1436. [PMID: 35227910 PMCID: PMC10078964 DOI: 10.1016/j.acap.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors. METHODS Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics. RESULTS Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support. CONCLUSIONS Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC.
| | - Melissa C Kay
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC; Duke Global Digital Health Science Center (MC Kay), Duke University, Durham, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Hsiang Shonna Yin
- Departments of Pediatrics and Population Health (HS Yin), New York University Grossman School of Medicine, New York, NY
| | - Kori B Flower
- University of North Carolina at Chapel Hill School of Medicine (KB Flower), Chapel Hill, NC
| | - Russell L Rothman
- Department of Pediatrics (RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn
| | - Lee M Sanders
- Departments of Pediatrics and Health Policy (LM Sanders), Stanford University, Stanford, Calif
| | - Alan M Delamater
- Mailman Center for Child Development (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Naomi N Duke
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins Schools of Medicine and Nursing, Baltimore, Md
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Risica PM, Karpowicz JM, von Ash T, Gans KM, Stowers KC, Tovar A. Feeding and Activity Environments for Infants and Toddlers in Childcare Centers and Family Childcare Homes in Southeastern New England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159702. [PMID: 35955058 PMCID: PMC9367851 DOI: 10.3390/ijerph19159702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 06/01/2023]
Abstract
Few studies have documented the food and physical activity (PA) environments of childcare settings caring for children <24 months of age, although they may be key contributors to developing child PA and diet patterns. We used an adapted Environment and Policy Assessment and Observation tool to assess the food and activity environments for infants and toddlers in childcare centers (n = 21) and family childcare homes (FCCH) (n = 20) and explored differences by childcare type. Many similarities were found between childcare site types; however, centers used more recommended feeding practices than FCCH (e.g., 100% of center providers talked with toddlers about feelings of hunger or fullness compared to 18% of family childcare providers (FCCP), p < 0.01). Differences in non-recommended feeding practices (e.g., spoon feeding, bottle propping and encouraging unhealthy foods) were mixed between childcare types. Toddlers in centers spent more time playing at higher PA levels than those in FCCH (61 vs. 13 min, p < 0.001). Screen time was observed in FCCH, but not in centers. Differences between childcare types may indicate differential influences on infant and toddler feeding and PA behaviors, which could predict disparate obesity risk. Future research should further observe these behaviors in a larger sample of centers and FCCH to inform childcare interventions and policies.
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Affiliation(s)
- Patricia Markham Risica
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | | | - Tayla von Ash
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Kim M. Gans
- Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Kristen Cooksey Stowers
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT 06103, USA
| | - Alison Tovar
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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Wu AJ, Aris IM, Hivert MF, Fiechtner L, Davison KK, Redline S, Taveras EM. Associations of Healthy Infant Feeding Practices and Early Childhood Adiposity in the Rise & SHINE Cohort. J Pediatr Gastroenterol Nutr 2022; 75:e15-e19. [PMID: 35641893 PMCID: PMC9329206 DOI: 10.1097/mpg.0000000000003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We studied healthy infant feeding practices among 308 mother-infant pairs, including exclusive breastmilk, satiety cues, complementary food introduction, sugary beverage intake, and bottle use in bed. We examined associations of individual and cumulative infant feeding practices through 12 months of age with body mass index (BMI) z -score at 2 years. Exclusive breastmilk and avoidance of bottle use in bed were associated with lower BMI z -score (β -0.29 units; 95% CI, -0.56, -0.02 units and β -0.32 units; 95% CI, -0.57, -0.07, respectively), when accounting for maternal pre-pregnancy BMI, household income, infant sex, race, and ethnicity. Adherence to 4--5 practices, compared to ≤ 2 practices, was associated with lower BMI z -score (β -0.84 units; 95% CI, -1.35, -0.34 units). Adherence to healthy infant feeding practices may reduce risk of excessive adiposity in early childhood. Targeting multiple infant feeding practices may be a more effective way to prevent childhood adiposity.
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Affiliation(s)
- Allison J Wu
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Izzuddin M Aris
- the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- the Diabetes Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Lauren Fiechtner
- the Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
- the Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Kirsten K Davison
- the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- the School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Susan Redline
- the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elsie M Taveras
- the Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
- the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Balantekin KN, Moore AM, Ruggiero CF, Savage JS. A synthesis of early antecedents of eating behavior and weight status in girls: The legacy of girls' NEEDS project. Appetite 2022; 175:106052. [PMID: 35483476 PMCID: PMC9913538 DOI: 10.1016/j.appet.2022.106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 01/27/2023]
Abstract
Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the 'thin ideal' got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.
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Affiliation(s)
- Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA; Center for Ingestive Behavior Research, University at Buffalo, 355 Hochstetter Hall, Buffalo, NY, 14260, USA.
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA
| | - Cara F Ruggiero
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA; Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA; Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
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Ramirez A, Tovar A, Garcia G, Nieri T, Hernandez S, Sastre M, Cheney AM. Involvement of Non-Parental Caregivers in Obesity Prevention Interventions among 0-3-Year-Old Children: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084910. [PMID: 35457780 PMCID: PMC9031125 DOI: 10.3390/ijerph19084910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions. METHODS We conducted a scoping review following the Arksey and O'Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded. RESULTS Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions (n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions (n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake (n = 5), parental feeding practices (n = 3), and screen time (n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.
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Affiliation(s)
- Andrea Ramirez
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA;
| | - Gretel Garcia
- Graduate School of Education, University of California Riverside, Riverside, CA 92521, USA;
| | - Tanya Nieri
- Department of Sociology, University of California Riverside, Riverside, CA 92521, USA; (T.N.); (M.S.)
| | - Stephanie Hernandez
- School of Public Policy, University of California Riverside, Riverside, CA 92507, USA;
| | - Myrna Sastre
- Department of Sociology, University of California Riverside, Riverside, CA 92521, USA; (T.N.); (M.S.)
| | - Ann M. Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
- Correspondence:
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McArthur BA, Volkova V, Tomopoulos S, Madigan S. Global Prevalence of Meeting Screen Time Guidelines Among Children 5 Years and Younger: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:373-383. [PMID: 35157028 PMCID: PMC8845032 DOI: 10.1001/jamapediatrics.2021.6386] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives. OBJECTIVE To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time. DATA SOURCES Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020. STUDY SELECTION Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported. DATA EXTRACTION AND SYNTHESIS Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates. MAIN OUTCOMES AND MEASURES Prevalence of meeting screen time guidelines. RESULTS From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.
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Affiliation(s)
- Brae Anne McArthur
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Valeriya Volkova
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine–Bellevue Hospital Center, New York
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
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Zachry AH, Woods L. Using the Theoretical Domains Framework and the Behavior Change Wheel to Design a Tummy Time Intervention. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2022. [DOI: 10.1080/19411243.2022.2048429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anne H. Zachry
- Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lauren Woods
- Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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16
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Demographic Correlates of Movement Behaviors in Infants: A Longitudinal Study. J Phys Act Health 2022; 19:177-185. [PMID: 35135898 DOI: 10.1123/jpah.2021-0570] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Demographic correlates of movement behaviors in infants are unclear. This study examined the longitudinal associations between demographic correlates and movement behaviors in infants. METHODS Participants were 411 parents of infants from the Early Movers project in Edmonton, Canada. Movement behaviors, infant and parental age, and nonparental care time were assessed using a parental questionnaire at 2, 4, and 6 months of age. Other infant and parental demographic variables were assessed at 2 months of age. Linear and generalized linear mixed models were conducted. RESULTS Infant age was associated with all movement behaviors except for restrained time. White infants and those with older parents had less tummy time but increased odds of having reading time. Infants of the most educated parents also had lower tummy time. Higher parental education and more siblings were associated with no screen time and longer infant sleep time. Infants with immigrant parent(s) were less likely to have reading time. No associations were found for infant sex, time spent in nonparental care, and parental marital status. CONCLUSION Since no single demographic group demonstrated healthy patterns for all movement behaviors, promotion of a healthy balance of movement behaviors may be needed universally for all infants.
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von Ash T, Alikhani A, Lebron C, Risica PM. Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum. Public Health Nutr 2022; 25:1-10. [PMID: 35029142 PMCID: PMC9991812 DOI: 10.1017/s1368980021005073] [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: 03/01/2021] [Revised: 11/04/2021] [Accepted: 12/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women. DESIGN Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders. SETTING Participants were recruited from prenatal clinics. PARTICIPANTS 343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other). RESULTS Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0·032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0·019), allow their infant to eat whenever he/she wanted (P = 0·023) and only allow their infant to eat at set times (P < 0·001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors. CONCLUSIONS Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum.
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
- Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Anna Alikhani
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
| | - Cynthia Lebron
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
- Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, RI, USA
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Hish AJ, Wood CT, Howard JB, Flower KB, Yin HS, Rothman RL, Delamater AM, Sanders LM, Bian A, Schildcrout JS, Perrin EM. Infant Television Watching Predicts Toddler Television Watching in a Low-Income Population. Acad Pediatr 2021; 21:988-995. [PMID: 33161116 PMCID: PMC8096856 DOI: 10.1016/j.acap.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study examines the development of active television (TV) watching behaviors across the first 2 years of life in a racially and ethnically diverse, low-income cohort and identifies caregiver and child predictors of early TV watching. METHODS We used longitudinal data from infants enrolled in the active control group (N = 235; 39% Latino; 29% Black; 15% White) of Greenlight, a cluster randomized multisite trial to prevent childhood obesity. At preventive health visits from 2 months to 2 years, caregivers were asked: "How much time does [child's first name] spend watching television each day?" Proportional odds models and linear regression analyses were used to assess associations among TV introduction age, active TV watching amount at 2 years, and sociodemographic factors. RESULTS Sixty-eight percent of children watched TV by 6 months, and 88% by 2 years. Age of TV introduction predicted amount of daily active TV watching at 2 years, with a mean time of 93 minutes if starting at 2 months; 64 minutes if starting at 4 or 6 months; and 42 minutes if starting after 6 months. Factors predicting earlier introduction included lower income, fewer children in household, care away from home, male sex, and non-Latino ethnicity of child. CONCLUSIONS Many caregivers report that their infants actively watch TV in the first 6 months of life. Earlier TV watching is related to sociodemographic factors yet predicts more daily TV watching at 2 years even controlling those factors. Interventions to limit early TV watching should be initiated in infancy.
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Affiliation(s)
| | - Charles T Wood
- Department of Pediatrics, Duke University (CT Wood, JB Howard, and EM Perrin), Vienna, Austria; Duke Center for Childhood Obesity Research, Duke University School of Medicine (CT Wood, JB Howard, and EM Perrin), Durham, NC
| | - Janna B Howard
- Department of Pediatrics, Duke University (CT Wood, JB Howard, and EM Perrin), Vienna, Austria; Duke Center for Childhood Obesity Research, Duke University School of Medicine (CT Wood, JB Howard, and EM Perrin), Durham, NC
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine (KB Flower)
| | - H Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University (HS Yin), New York, NY
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center (RL Rothman), Nashville, Tenn
| | - Alan M Delamater
- University of Miami School of Medicine (AM Delamater), Miami, Fla
| | - Lee M Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University (LM Sanders), Stanford, Calif
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University School of Medicine (A Bian and JS Schildcrout), Nashville, Tenn
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University School of Medicine (A Bian and JS Schildcrout), Nashville, Tenn
| | - Eliana M Perrin
- Department of Pediatrics, Duke University (CT Wood, JB Howard, and EM Perrin), Vienna, Austria; Duke Center for Childhood Obesity Research, Duke University School of Medicine (CT Wood, JB Howard, and EM Perrin), Durham, NC.
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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Sanders LM, Perrin EM, Yin HS, Delamater AM, Flower KB, Bian A, Schildcrout JS, Rothman RL. A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-049866. [PMID: 33911032 PMCID: PMC8086006 DOI: 10.1542/peds.2020-049866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months. METHODS In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score). RESULTS A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively. CONCLUSIONS The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
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Affiliation(s)
- Lee M. Sanders
- Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California
| | - Eliana M. Perrin
- Division of Primary Care and Duke Center for Childhood Obesity Research, Department of Pediatrics, Medical Center, Duke University, Durham, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University and Department of Pediatrics, Bellevue Hospital Center, New York City, New York
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, Florida
| | | | - Aihua Bian
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan S. Schildcrout
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Lebron CN, Agosto Y, Guzman T, Sutton D, Stoutenberg M, Messiah SE, George SMS. A qualitative study of cognitive, behavioral, and environmental influences on Hispanic mothers' early childhood feeding practices. Appetite 2021; 164:105268. [PMID: 33864860 DOI: 10.1016/j.appet.2021.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Young children's lifestyle behaviors are largely shaped by their parents. There are socioeconomic risk factors particular to Hispanic populations that influence the way parents feed their children. As obesity continues to be a public health issue with substantial inequities across race and ethnicity, it is critical to understand Hispanic parents' food choices and feeding practices. The objective of this qualitative study is to identify the behavioral, environmental, and cognitive factors that influence the parental food choices and feeding behaviors of Hispanic mothers of children ages 0-5 years. Snowball sampling was used to recruit participants from the community (n = 30) who were 1) female; 2) Hispanic; 3) over the age of 18; and 4) a mother to child(ren) between the ages zero and five. Each interview consisted of a brief demographic survey and a set of open-ended questions based on Social Cognitive Theory constructs. A thematic analysis using a combined deductive and inductive approach was used to analyze transcriptions. Results indicated that mothers' attitudes around breastfeeding were connected with their challenges, while their attitudes around solid foods were expressed in their feeding strategies. Mothers used strategies of modeling, repeated exposure, and practices of "sneaking" in healthy foods and bribing to promote healthy eating. Mothers were most likely to seek out information from (1) pediatricians, (2) female family members, and (3) the internet. Hispanic mothers actively seek out information from many different sources that impact how they feed their young children. Understanding their trusted sources and how it influences the SCT constructs is an important step in preventing early childhood obesity.
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Affiliation(s)
- Cynthia N Lebron
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Yaray Agosto
- Florida International University, Robert Stempel College of Public Health & Social Work, Miami, FL, USA
| | - Tamisha Guzman
- Florida International University, Robert Stempel College of Public Health & Social Work, Miami, FL, USA
| | - Danielle Sutton
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark Stoutenberg
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Sarah E Messiah
- University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas, TX, USA; Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Costa AD, Tagliaferro EPDS, Costa ED, Ambrosano GMB, Possobon RDF. Expectation of parental control and the maintenance of bottle-feeding in childhood. J Pediatr (Rio J) 2021; 97:225-232. [PMID: 32387579 PMCID: PMC9432026 DOI: 10.1016/j.jped.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/22/2020] [Accepted: 03/17/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate association between parental locus of control (belief of individuals about what or who has control of the events of their lives) and bottle feeding habits among children from 3 to 5 years of age. METHODOLOGY Parental locus of control validated in Brazil, and semi-structured questionnaire to obtain sociodemographic, health, and oral habit behaviors was applied to mothers of 992 preschool children. Outcome variable "use of feeding bottle" was studied according to the time of its use (≤36 months and >36 months). Simple logistic regression models were adjusted and raw odds ratios were estimated for variables of distal blocks, which contemplated parental locus of control, socioeconomic characteristics of family, and maternal habits. In the intermediate block, the variables for conditions of the child's birth and place of health care attendance during the prenatal period and early childhood were included. In the proximal block, the time of breastfeeding and pacifier use were reported. Variables were analyzed from the distal to the proximal block, and the individual analyses that presented p≤0.20 remained in each model; included in the subsequent block were the variables with p≤0.10, because this was a study of prevention. RESULTS Longer time of feeding bottle use was associated with the internal parental locus of control, mothers older than 31 years of age, white race, premature children, who used pacifiers and are treated in the private health system. CONCLUSIONS Children who maintained the habit of feeding bottle use for a longer time were those whose mother presented an internal locus of control.
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Affiliation(s)
- Adriana Dantas Costa
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Odontologia Social, Piracicaba, SP, Brazil.
| | - Elaine Pereira da Silva Tagliaferro
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Odontologia de Piracicaba, Departamento de Odontologia Social, Araraquara, SP, Brazil
| | - Eliana Dantas Costa
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Odontologia de Piracicaba, Departamento de Odontologia Social, Araraquara, SP, Brazil
| | - Glaucia Maria Bovi Ambrosano
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Odontologia Social, Piracicaba, SP, Brazil
| | - Rosana de Fátima Possobon
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Odontologia Social, Piracicaba, SP, Brazil
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23
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Wood CT, Witt WP, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater AM, Flower KB, Kay MC, Perrin EM. Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life. Acad Pediatr 2021; 21:288-296. [PMID: 32961335 PMCID: PMC10910619 DOI: 10.1016/j.acap.2020.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether proportion of breast versus formula feeding and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants. METHODS Using data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2- to 6-month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models. RESULTS Of the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (adjusted odds ratio [aOR] 0.34; 95% confidence interval [CI]: 0.17, 0.69) when compared to infants who were formula-fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96). CONCLUSIONS Feeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.
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Affiliation(s)
- Charles T Wood
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine (CT Wood and EM Perrin), Durham, NC.
| | - Whitney P Witt
- College of Health, Lehigh University, (WP Witt), Bethlehem, PA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Duke Clinical Research Institute (AC Skinner), Durham, NC
| | - Hsiang S Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine/Bellevue Hospital Center (HS Yin), New York, NY
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center (RL Rothman), Nashville, Tenn
| | - Lee M Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University (LM Sanders), Stanford, Calif
| | - Alan M Delamater
- Department of Pediatrics, University of Miami School of Medicine (AM Delamater), Miami, Fla
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine (KB Flower), Chapel Hill, NC
| | - Melissa C Kay
- Duke Center for Childhood Obesity Research and Duke Global Digital Health Science Center, Duke University School of Medicine and Duke Global Health Institute (MC Kay), Durham, NC
| | - Eliana M Perrin
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine (CT Wood and EM Perrin), Durham, NC
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24
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Sirkka O, Hof MH, Vrijkotte T, Abrahamse-Berkeveld M, Halberstadt J, Seidell JC, Olthof MR. Feeding patterns and BMI trajectories during infancy: a multi-ethnic, prospective birth cohort. BMC Pediatr 2021; 21:34. [PMID: 33441111 PMCID: PMC7805191 DOI: 10.1186/s12887-020-02456-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Milk feeding type (exclusive breastfeeding [EBF], formula feeding or mixed feeding) and timing of complementary feeding (CF) have been associated with infant growth. However, studies evaluating their combined role, and the role of ethnicity, are scarce. We examined associations of feeding patterns (milk feeding type combined with timing of CF) with infant body mass index (BMI) trajectories and potential ethnic-specific associations. METHODS Infant feeding and BMI data during the 1st year of life from 3524 children (Dutch n = 2880, Moroccan n = 404 and Turkish n = 240) from the Amsterdam Born Children and their Development (ABCD) cohort were used. Six feeding patterns were defined: EBF/earlyCF, EBF/lateCF (reference), formula/earlyCF, formula/lateCF, mixed/earlyCF and mixed/lateCF. A covariate adjusted latent class mixed model was applied to simultaneously model BMI trajectories and associations with feeding patterns. Potential ethnic differences in the associations were studied in a separate model where interactions between ethnicity and feeding patterns were included. RESULTS Four distinct BMI trajectories (low, mid-low, mid-high and high) were identified. Feeding pattern of formula/earlyCF was associated with lower odds for low (OR: 0.43; 95% CI: 0.25, 0.76) or mid-high (0.28; 0.16, 0.51) (ref: high) trajectory compared with EBF/lateCF pattern (ref). An ethnic-specific model revealed that among Dutch infants, formula/earlyCF pattern was associated with lower odds for low trajectory (0.46; 0.24, 0.87), whereas among Turkish/Moroccan infants almost all feeding patterns were associated with lower odds for the low trajectory (ref: high). CONCLUSION Infant feeding patterns are associated with early BMI trajectories with specific ethnic differences. Future studies should take the role of ethnicity into account in the associations between infant feeding and growth.
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Affiliation(s)
- Outi Sirkka
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands. .,Danone Nutricia Research, Utrecht, the Netherlands.
| | - Michel H Hof
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tanja Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
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25
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Messiah SE, Atem F, Lebron C, Ofori A, Mathew MS, Chang C, Natale RA. Comparison of Early Life Obesity-Related Risk and Protective Factors in Non-Hispanic Black Subgroups. Matern Child Health J 2020; 24:1130-1137. [PMID: 32632842 PMCID: PMC7423728 DOI: 10.1007/s10995-020-02979-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children. METHODS Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced. RESULTS Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6 lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced. CONCLUSIONS Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child's development.
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Affiliation(s)
- Sarah E Messiah
- University of Texas Health Science Center School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, Children's Health System of Texas and University of Texas Health Science Center School of Public Health, Dallas, USA.
| | - Folefac Atem
- University of Texas Health Science Center School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and University of Texas Health Science Center School of Public Health, Dallas, USA
| | - Cynthia Lebron
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Ashley Ofori
- University of Texas Health Science Center School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and University of Texas Health Science Center School of Public Health, Dallas, USA
| | - M Sunil Mathew
- University of Texas Health Science Center School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and University of Texas Health Science Center School of Public Health, Dallas, USA
| | | | - Ruby A Natale
- Department of Pediatrics, University of Miami, Miami, FL, USA
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26
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Felzer-Kim IT, Erickson K, Adkins C, Hauck JL. Wakeful Prone "Tummy Time" During Infancy: How Can We Help Parents? Phys Occup Ther Pediatr 2020; 40:651-668. [PMID: 32192403 DOI: 10.1080/01942638.2020.1742847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS This study's purpose is to present facilitators and barriers for wakeful prone positioning or "tummy time" during infancy by exploring the personal perspectives of infant caregivers attempting to provide daily tummy time. METHODS The study was qualitative in design, using thematic analysis to identify major and minor themes from semi-structured interviews. The Capability, Opportunity, Motivation - Behavior Model provided a conceptual framework for the interview guide and categorization of major themes. RESULTS Within capability, opportunity, and motivation, the major themes of self-efficacy, scheduling, variations, siblings, committed adult help, social responses of acquaintances, and caregiver enjoyment could be barriers or facilitators, depending on the context. Optimized physical circumstances, caregiver interest, perceived benefits to the infant, pride and accomplishment, and obligation were identified as facilitators only. Barriers included negative infant affect. CONCLUSIONS These results offer preliminary guidance in a knowledge gap: tummy time support that addresses the self-identified concerns of infant caregivers.
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Affiliation(s)
| | - Karl Erickson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Chelsea Adkins
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Janet L Hauck
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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27
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O'Connor TG, Williams J, Blair C, Gatzke-Kopp LM, Francis L, Willoughby MT. Predictors of Developmental Patterns of Obesity in Young Children. Front Pediatr 2020; 8:109. [PMID: 32266187 PMCID: PMC7105829 DOI: 10.3389/fped.2020.00109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction: The current study characterizes longitudinal patterns in obesity in young children and their prediction from developmental programming and social determinant hypotheses. Materials and Methods: The data are based on the Family Life Project, a prospective longitudinal study of 1,292 families recruited from low-income, racially diverse, rural communities in Pennsylvania, and North Carolina. Pre-natal, peri-natal, and post-natal risks for childhood obesity were collected from 2 months of age; in-person assessments of child growth were used to identity obesity on multiple occasions from 24 to 90 months of age. Results: Two major novel findings emerged. First, longitudinal analyses identified four distinct obesity development profiles: stable obesity, later-onset obesity, moderate/declining obesity, and non-obese; these groups had distinct risk profiles. Second, prediction analyses favored developmental programming explanations for obesity, including evidence even in early childhood that both low- and high birth weight was associated with stable obesity. There was no indication that pre- and peri-natal and post-natal factors predicted obesity differently in non-minority and minority children. Discussion: Factors derived from the developmental programming model of obesity overlapped with, but predicted early onset obesity independently from, risks associated with social determinant models of obesity.
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Affiliation(s)
- Thomas G O'Connor
- Department of Psychiatry, University of Rochester, Rochester, NY, United States.,Department of Psychology, University of Rochester, Rochester, NY, United States.,Department of Neuroscience, University of Rochester, Rochester, NY, United States.,Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, United States.,Wynne Center for Family Research, University of Rochester, Rochester, NY, United States
| | - Jason Williams
- RTI International, Research Triangle Park, Durham, NC, United States
| | - Clancy Blair
- Department of Population Health, New York University, New York, NY, United States
| | - Lisa M Gatzke-Kopp
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, United States
| | - Lori Francis
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, United States
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28
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Czepiel KS, Perez NP, Campoverde Reyes KJ, Sabharwal S, Stanford FC. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne) 2020; 11:290. [PMID: 32477270 PMCID: PMC7237714 DOI: 10.3389/fendo.2020.00290] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ~6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m2, respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.
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Affiliation(s)
- Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Kathryn S. Czepiel
| | - Numa P. Perez
- Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shreya Sabharwal
- Department of Bioethics, Harvard Medical School, Boston, MA, United States
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
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29
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Hauck JL, Felzer-Kim IT. Time Spent in Sedentary Activity Is Related to Gross Motor Ability During the Second Year of Life. Percept Mot Skills 2019; 126:753-763. [DOI: 10.1177/0031512519858261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sedentary activity occupies a substantial amount of time during early childhood, with these habits influenced by changing trends in screen time for very young children. Among school-aged children, motor ability is inversely related to sedentary activity. However, the concept of sedentary activity is rarely investigated in toddlers, and thus little is known concerning its relationship with motor development during this rapidly changing and early period of life. Among two groups of toddlers, aged 18 months ( N = 26) and aged 24 months ( N = 16), this study investigated cross-sectional correlations of motor development (Bayley Scales of Infant Development—III) with daily sedentary activity (accelerometers). In both groups, gross motor ability, but not fine motor ability, was inversely correlated with time spent in sedentary activity. At 18 months, gross motor raw scores inversely correlated significantly with time in sedentary activity ( r = −.533, p < .001) but fine motor raw scores did not ( r = .182, p = .441). Also, at 24 months, gross motor raw scores inversely correlated with time in sedentary activity ( r = −.563, p = .029), while fine motor raw scores did not ( r = −.112, p = .425). These findings add important missing knowledge to the empirical literature regarding sedentary activity in toddlers and its relationship to emerging motor development. Future work might investigate best practices for measuring sedentary activity in this age-group and mechanisms behind its relationship with gross motor skills.
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Affiliation(s)
- Janet L. Hauck
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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30
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Cheney AM, Nieri T, Davis E, Prologo J, Valencia E, Anderson AT, Widaman K, Reaves C, Sullivan G. The Sociocultural Factors Underlying Latina Mothers' Infant Feeding Practices. Glob Qual Nurs Res 2019; 6:2333393618825253. [PMID: 30746425 PMCID: PMC6360473 DOI: 10.1177/2333393618825253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
In this study, we examined the sociocultural factors underlying infant feeding practices. We conducted four focus groups with 19 Latina mothers of children 0 to 2 years of age enrolled in Early Head Start programs in the United States over a 1-year period. We found these mothers considered both science- and family-based feeding recommendations. However, advice from family was often inconsistent with science- and nutrition-based recommended feeding practices. In the interest of showing respect and preserving harmonious relationships, some mothers accepted family advice instead of recommended practices while others employed strategies to follow recommended practices without offending. Nutrition educators need to consider the intersection of macro, organizational, and community factors with micro-level processes in shaping the implementation of recommended feeding practices within family systems. Nutrition interventions for Latino families should capitalize on Latina mothers’ strategies for navigating multiple information sources while preserving cultural values and family relationships.
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Affiliation(s)
- Ann M Cheney
- University of California, Riverside, Riverside, California, USA
| | - Tanya Nieri
- University of California, Riverside, Riverside, California, USA
| | - Elizabeth Davis
- University of California, Riverside, Riverside, California, USA
| | - Joe Prologo
- Early Head Start, San Bernardino, San Bernardino, California, USA
| | - Esmirna Valencia
- Riverside County Office of Education, Riverside, California, USA
| | | | - Keith Widaman
- University of California, Riverside, Riverside, California, USA
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31
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Wang YC, Chen LC, Tung YC, Lee CC, Tsai SY. Physical activity and objectively assessed sleep in 6-month-old infants in Taiwan. Res Nurs Health 2019; 42:128-135. [PMID: 30620090 DOI: 10.1002/nur.21929] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/24/2018] [Indexed: 12/24/2022]
Abstract
Adequate physical activity is associated with improved sleep in adults. Such associations, however, vary greatly across studies in pediatric populations, with no studies involving infants found in the literature. This prospective observational study was designed, therefore, to examine the association between physical activity and sleep patterns in infants. A total of 183 healthy infants aged 6 months wore an actigraph for 7 days to measure physical activity and sleep. Parents and caregivers completed a sleep-activity diary over the same period documenting the different types of infant activities. Daily mean time spent in screen-time-or-limited physical activity, including screen-based (e.g., watching television or other electronic devices) and non-screen based activity (e.g., quiet play or restricted infant movement when carried by caregivers or seated in high chairs, swings, or bouncer seats), was 6.68 hr (SD = 1.99), which represented 47.50% of daytime waking hours (SD = 13.73). We found that 65 (35.5%) infants engaged in some screen time during the study, with 10 (5.5%) infants having an average daily screen time >30 min. In our multivariate linear regression model, more hours of screen-time-or-limited physical activity per day were significantly associated with a decrease in total daily 24 hr sleep duration (p < 0.01). Findings from our study suggest that reducing screen-time-or-limited physical activity might be an approach for promoting adequate sleep and lengthening infant daily sleep duration.
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Affiliation(s)
- Yi-Ching Wang
- Disease Control Division, Department of Health, New Taipei City Government, Taipei, Taiwan
| | - Li-Chiou Chen
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Yu Tsai
- School of Nursing, National Taiwan University, Taipei, Taiwan
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Koren A, Kahn-D'angelo L, Reece SM, Gore R. Examining Childhood Obesity From Infancy: The Relationship Between Tummy Time, Infant BMI-z, Weight Gain, and Motor Development-An Exploratory Study. J Pediatr Health Care 2019; 33:80-91. [PMID: 30131199 DOI: 10.1016/j.pedhc.2018.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/09/2018] [Accepted: 06/16/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION This exploratory study investigated the infant time spent in tummy time (TT) in relation to body mass index z score (BMI-z), weight gain, and motor development in infants from birth to 4 months. METHOD Mothers and their infants were telephone surveyed at 2 and 4 months. Mother demographics; TT; feeding practices; and infant length, and height, and development were collected each time. RESULTS Results from Cochran-Mantel-Haenszel and single logistic regression showed a significant association between development, level of BMI-z, and time spent in TT at 2 months of age (p < .0001). The threshold model showed there was a decline in BMI-z at 4 months as daily time in TT increases past the threshold value of approximately 12 minutes per day. Mother education and TT at 2 months were significant predictors of BMI-z at 4 months. DISCUSSION Study outcomes suggest that infant positioning and time in TT promote infant motor development and may moderate rapid infant weight gain.
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Affiliation(s)
- Ainat Koren
- Ainat Koren, Associate Professor, Susan and Alan Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA..
| | - Linda Kahn-D'angelo
- Linda Kahn-D'angelo, Professor, Department of Physiotherapy, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA
| | - Susan M Reece
- Susan M. Reece, Professor Emeritus, Susan and Alan Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA
| | - Rebecca Gore
- Rebecca Gore, Senior Biostatistician, School of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Lowell, MA
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Neighborhood Commute to Work Times and Self-Reported Caregiver Health Behaviors and Food Access. Acad Pediatr 2019; 19:74-79. [PMID: 30041009 PMCID: PMC6321776 DOI: 10.1016/j.acap.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Time spent commuting is associated with obesity. The objective of this study was to assess the relationship between neighborhood-level commute to work (CTW) times and self-reported health behaviors and food access. METHODS We conducted a cross-sectional analysis of caregivers with infants as part of the Greenlight Study, a multisite obesity trial in Chapel Hill, New York City, Nashville, and Miami. ZIP code-based commuting estimates were determined using the US Census American Community Survey. Self-reported health behaviors and food access data were collected by directed interview. Logistic and linear regression models were used to determine associations between neighborhood CTW times and health behaviors and food access. RESULTS The average neighborhood CTW time for all ZIP codes was 29 minutes (n = 846). Caregivers in longer CTW time neighborhoods were more likely to endorse fewer food choices (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.15-1.69; P = .001) and difficulty accessing markets with fresh produce (AOR, 1.51; 95% CI, 1.02-2.25; P = .04). Neighborhood CTW time >30 minutes was associated with less caregiver physical activity (AOR, 0.58; 95% CI, 0.34-0.98; P = .044). Neighborhood CTW time was inversely related to infant television time (adjusted mean, 399 minutes/day for ≤30 minutes and 256 minutes/day for >30 minutes; P = .025). New York families in longer CTW neighborhoods were more likely to report difficulty accessing markets with fresh produce (AOR, 1.80; 95% CI, 1.03-3.14; P = .039). CONCLUSIONS Neighborhood CTW time is associated with several self-reported health behaviors and perceived food access among caregivers with children. Neighborhood CTW times may represent city-specific features, including transportation infrastructure, which may impact the health of families.
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Orr CJ, Ben-Davies M, Ravanbakht SN, Yin HS, Sanders LM, Rothman RL, Delamater AM, Wood CT, Perrin EM. Parental Feeding Beliefs and Practices and Household Food Insecurity in Infancy. Acad Pediatr 2019; 19:80-89. [PMID: 30248471 PMCID: PMC6599601 DOI: 10.1016/j.acap.2018.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Food insecurity is associated with childhood obesity possibly mediated through caregiver feeding practices and beliefs. We examined if caregiver feeding practices differed by household food security status in a diverse sample of infants. We hypothesized that feeding practices differ based on food security status. PATIENTS AND METHODS Included in the baseline cross-sectional analysis of data from a randomized controlled trial to prevent obesity were 842 caregivers of 2-month-old infants presenting for well-child care at 4 academic institutions. Food insecurity exposure was based on an affirmative answer to 1 of 2 items in a 2-item validated questionnaire. Chi-square tests examined the association between parent feeding practices and food security status. Logistic regression adjusted for covariates. Differences in caregiver feeding practices by food security status and race/ethnicity were explored with an interaction term (food security status x race/ethnicity). RESULTS Forty-three percent of families screened as food insecure. In adjusted logistic regression, parents from food-insecure households were more likely to endorse that "the best way to make an infant stop crying is to feed him or her" (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.28-2.29) and "when my baby cries, I immediately feed him or her" (aOR, 1.40; 95% CI, 1.06-1.83). Food-insecure caregivers less frequently endorsed paying attention to their baby when he or she is full or hungry (OR, 0.57; 95% CI, 0.34-0.96). Racial/ethnic differences in beliefs and behaviors were observed by food security status. CONCLUSIONS During early infancy, feeding practices differed among caregivers by household food security status. Further research is needed to examine whether these practices are associated with increased risk of obesity and obesity-related morbidity.
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Affiliation(s)
- Colin J Orr
- University of North Carolina at Chapel Hill, 260 MacNider Building, CB#7220, UNC School of Medicine, Chapel Hill NC, 27599; ;
| | - Maureen Ben-Davies
- University of North Carolina at Chapel Hill, 260 MacNider Building, CB#7220, UNC School of Medicine, Chapel Hill NC, 27599; ;
| | - Sophie N. Ravanbakht
- Duke University Medical Center Department of Pediatrics and Duke Center for Childhood Obesity Research 146 Civitan Building, 2213 Elba Street Durham, NC 27705; ; ;
| | - H. Shonna Yin
- New York University School of Medicine, Department of Pediatrics and Population Health NYU School of Medicine/Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, New York 10016;
| | - Lee M Sanders
- Stanford University Department of Pediatrics, Center for Health Policy, 117 Encina Commons, Room 182, Stanford, California 94305;
| | - Russell L. Rothman
- Vanderbilt University Medical Center, 6100 Medical Center East, Vanderbilt University Medical Center, Nashville, TB 37232;
| | - Alan M. Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, University of Miami Miller School of Medicine, PO Box 016820, Miami, FL 33101;
| | - Charles T. Wood
- Duke University Medical Center Department of Pediatrics and Duke Center for Childhood Obesity Research 146 Civitan Building, 2213 Elba Street Durham, NC 27705; ; ;
| | - Eliana M Perrin
- Department of Pediatrics and Duke Center for Childhood Obesity Research (SN Ravanbakht, CT Wood, and EM Perrin), Duke University Medical Center, Durham, NC.
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Pulli EP, Kumpulainen V, Kasurinen JH, Korja R, Merisaari H, Karlsson L, Parkkola R, Saunavaara J, Lähdesmäki T, Scheinin NM, Karlsson H, Tuulari JJ. Prenatal exposures and infant brain: Review of magnetic resonance imaging studies and a population description analysis. Hum Brain Mapp 2018; 40:1987-2000. [PMID: 30451332 DOI: 10.1002/hbm.24480] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Brain development is most rapid during the fetal period and the first years of life. This process can be affected by many in utero factors, such as chemical exposures and maternal health characteristics. The goal of this review is twofold: to review the most recent findings on the effects of these prenatal factors on the developing brain and to qualitatively assess how those factors were generally reported in studies on infants up to 2 years of age. To capture the latest findings in the field, we searched articles from PubMed 2012 onward with search terms referring to magnetic resonance imaging (MRI), brain development, and infancy. We identified 19 MRI studies focusing on the effects of prenatal environment and summarized them to highlight the recent advances in the field. We assessed population descriptions in a representative sample of 67 studies and conclude that prenatal factors that have been shown to affect brain metrics are not generally reported comprehensively. Based on our findings, we propose some improvements for population descriptions to account for plausible confounders and in time enable reliable meta-analyses to be performed. This could help the pediatric neuroimaging field move toward more reliable identification of biomarkers for developmental outcomes and to better decipher the nuances of normal and abnormal brain development.
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Affiliation(s)
- Elmo P Pulli
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Venla Kumpulainen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Jussi H Kasurinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Turku Collegium for Science and Medicine, University of Turku, Turku, Finland
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Hicks J, Morse E, Wyant DK. Barriers and Facilitators of Breastfeeding Reported by Postpartum Women in Methadone Maintenance Therapy. Breastfeed Med 2018; 13:259-265. [PMID: 29595995 DOI: 10.1089/bfm.2017.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study utilized a cross-sectional qualitative and quantitative interview-based survey to capture the infant feeding practices and barriers to exclusive breastfeeding for women in methadone maintenance therapy. Participants were recruited from an opioid dependence treatment center in an urban setting in the Southeastern United States. MATERIALS AND METHODS A convenience sample of women in treatment (n = 30) were interviewed using an adapted instrument designed to capture decisions and intentions to formula feed or breastfeed; support from friends and family; hospital experience; support from healthcare personnel; and maternal knowledge of breastfeeding while taking methadone. RESULTS The majority of women in the sample initiated breastfeeding, but only 10% continued for >1 month. Challenges related to infant hospital stay posed a significant barrier. Two-thirds of infants remained hospitalized after the mother was discharged. Out of the 24 women who initiated breastfeeding, 11 reported that they discontinued because of issues related to infant's neonatal intensive care unit (NICU) stay. Eleven women reported that their healthcare providers did not discuss breastfeeding with them. Women who were encouraged to breastfeed by healthcare staff were more likely to breastfeed for longer durations. CONCLUSIONS Women in treatment for opioid dependence both desire and attempt to establish breastfeeding, but encounter significant challenges, including long NICU stays and lack of support and education, that compromise their success. These findings should inform the development of future programs or interventions geared toward increasing breastfeeding initiation, support, and duration among women who give birth to babies while in treatment for opioid addiction.
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Affiliation(s)
- Jennifer Hicks
- 1 Tennessee Department of Health, Rutherford County Health Department , Murfreesboro, Tennessee
| | - Elizabeth Morse
- 2 College of Health Sciences, Belmont University , Nashville, Tennessee
| | - David K Wyant
- 3 College of Business Administration, Belmont University , Nashville, Tennessee
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Hodges EA, Wasser HM, Colgan BK, Bentley ME. Development of Feeding Cues During Infancy and Toddlerhood. MCN Am J Matern Child Nurs 2018; 41:244-251. [PMID: 27710994 PMCID: PMC5057392 DOI: 10.1097/nmc.0000000000000251] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To enhance responsive feeding, this study aimed to characterize the development of feeding cues during infancy and toddlerhood. STUDY DESIGN AND METHODS A secondary analysis was performed on a dataset of first-time, low-income African American mother-infant pairs assessed at infant age 3, 6, 9, 12, and 18 months. A subsample with the 15 highest, middle, and lowest infant body mass index (BMI) Z-scores at 18 months was selected (n = 45). Using video-recorded home feedings, early, active, and late receptiveness and fullness cues were assessed using the Responsiveness to Child Feeding Cues Scale at each time point. Descriptive statistics were used to characterize development. RESULTS Early receptiveness cues were relatively rare over time, whereas active receptiveness cues were much more common. However, there were changes over time. For example, settling into the feeding decreased from ~50% at 3 and 6 months to 4.8% by 18 months, whereas postural attention and reaching for food increased after 6 months. In the first 6 months, falling asleep and decreasing muscle tone and activity level were the most common early fullness cues. Thereafter, taking interest in surroundings was most prevalent. Active fullness cues became increasingly diverse after 6 months, led by more assertive cues such as pushing or pulling away and communicating "no" verbally or nonverbally. CLINICAL IMPLICATIONS These findings provide an empirical description of waxing and waning in feeding cues and indicate increasing intentionality of cues over the first 18 months of life. Knowing common cues across development may aid clinicians in enhancing parental feeding responsiveness, avoiding overfeeding, thereby decreasing risk of early childhood obesity.
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Affiliation(s)
- Eric A Hodges
- Eric A. Hodges is an Associate Professor, University of North Carolina-Chapel Hill, School of Nursing, Chapel Hill, N.C. The author can be reached via e-mail at M. Wasser is a Research Assistant Professor, Center for Women's Health Research, University of North Carolina-Chapel Hill, School of Medicine, Chapel Hill, N.C.Brook K. Colgan is Vice President and Director of Training for WISE (Women-Inspired Systems' Enrichment) in Chapel Hill, N.C.Margaret E. Bentley is a Professor, University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, N.C
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Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics 2018; 141:peds.2017-3459. [PMID: 29483202 PMCID: PMC6109602 DOI: 10.1542/peds.2017-3459] [Citation(s) in RCA: 895] [Impact Index Per Article: 149.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide updated prevalence data on obesity trends among US children and adolescents aged 2 to 19 years from a nationally representative sample. METHODS We used the NHANES for years 1999 to 2016. Weight status was determined by using measured height and weight from the physical examination component of the NHANES to calculate age- and sex-specific BMI. We report the prevalence estimates of overweight and obesity (class I, class II, and class III) by 2-year NHANES cycles and compared cycles by using adjusted Wald tests and linear trends by using ordinary least squares regression. RESULTS White and Asian American children have significantly lower rates of obesity than African American children, Hispanic children, or children of other races. We report a positive linear trend for all definitions of overweight and obesity among children 2-19 years old, most prominently among adolescents. Children aged 2 to 5 years showed a sharp increase in obesity prevalence from 2015 to 2016 compared with the previous cycle. CONCLUSIONS Despite previous reports that obesity in children and adolescents has remained stable or decreased in recent years, we found no evidence of a decline in obesity prevalence at any age. In contrast, we report a significant increase in severe obesity among children aged 2 to 5 years since the 2013-2014 cycle, a trend that continued upward for many subgroups.
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Affiliation(s)
- Asheley Cockrell Skinner
- Departments of Population Health Sciences and .,Duke Clinical Research Institute, Durham, North Carolina
| | - Sophie N. Ravanbakht
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | - Joseph A. Skelton
- Division of Public Health Sciences, Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, North Carolina,Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina,Brenner Families In Training Program, Brenner Children’s Hospital, Winston-Salem, North Carolina
| | - Eliana M. Perrin
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | - Sarah C. Armstrong
- Duke Clinical Research Institute, Durham, North Carolina,Department of Pediatrics, Duke University, Durham, North Carolina,Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
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Horodynski MA, Pierce SJ, Reyes-Gastelum D, Olson B, Shattuck M. Feeding Practices and Infant Growth: Quantifying the Effects of Breastfeeding Termination and Complementary Food Introduction on BMI z-Score Growth Velocity through Growth Curve Models. Child Obes 2017; 13:490-498. [PMID: 28767287 DOI: 10.1089/chi.2017.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infant feeding practices are a focus of early obesity prevention. We tested whether infant growth velocity increased after breastfeeding termination and complementary food introduction. METHODS Our secondary analysis included a sample of 547 mother-infant dyads from a longitudinal randomized controlled trial conducted in Michigan and Colorado. Infant anthropometrics at birth, baseline, and 6- and 12-month follow-up were standardized to BMI-for-age z-score (ZBMI) according to World Health Organization (WHO) growth charts. We used growth curve models with time-varying predictors to quantify effects of breastfeeding termination and timing of complementary food introduction on growth velocity. RESULTS Median breastfeeding duration was 2.0 months [confidence interval (CI) = 2.0-2.5]; median introduction of complementary foods occurred at 3.0 months (CI = 2.8-3.2). Breastfed infants not yet introduced to complementary foods had an average ZBMI growth velocity of 0.050 (CI = -0.013 to 0.113) z-score units per month [zpm], not significantly faster than WHO growth trajectory (p = 0.118) defined as 0 zpm. Breastfeeding termination had negligible effect on ZBMI growth velocity (γ11 = 0.001, CI = -0.027 to 0.030, p = 0.927). Introduction of complementary foods increased ZBMI growth velocity relative to an average child in the sample, but not significantly (γ12 = 0.033, CI = -0.034 to 0.100, p = 0.334). Growth velocities for infants receiving complementary foods both before and after breastfeeding termination were significantly faster than the WHO growth trajectory (0.083 zpm, CI = 0.052-0.114, and 0.084 zpm, CI = 0.064-0.105, respectively, p's < 0.001). CONCLUSIONS Average postcomplementary food introduction growth velocity was significantly higher than WHO growth trajectory, but did not differ from the sample's initial average trajectory. Growth curve models can accurately estimate effects of feeding practices on infant growth to direct obesity prevention efforts.
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Affiliation(s)
| | - Steven J Pierce
- 2 Center for Statistical Training and Consulting, Michigan State University , East Lansing, MI
| | - David Reyes-Gastelum
- 4 Department of Counseling, Educational Psychology, and Special Education, Michigan State University , East Lansing, MI
| | - Beth Olson
- 3 Department of Nutritional Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison , Madison, WI
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Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race. Matern Child Health J 2017; 20:1971-9. [PMID: 27178429 DOI: 10.1007/s10995-016-2015-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2 months of age; outcome was BMI Z-score and BMI ≥ 85th percentile (overweight and obese) at 4 years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE = 0.048) and a decreased odds of a BMI ≥ 85th percentile (0.832; 95 % CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p = 0.0002) and BMI ≥ 85th percentile (p < 0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p = 0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.
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Alghamdi S, Horodynski M, Stommel M. Racial and ethnic differences in breastfeeding, maternal knowledge, and self-efficacy among low-income mothers. Appl Nurs Res 2017; 37:24-27. [PMID: 28985916 DOI: 10.1016/j.apnr.2017.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/22/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to examine racial and ethnic differences in the propensity to engage in breastfeeding, maternal knowledge, and self-efficacy in infant feeding among three groups of low-income mothers: non-Hispanic (NH) White, NH African American, and Hispanic. BACKGROUND While racial and ethnic differences in infant feeding practices are substantial, these differences have not been broadly examined in relation to breastfeeding, maternal knowledge, and self-efficacy in infant feeding among low-income mothers. METHODS This secondary analysis used baseline data from a randomized clinical trial with a sample of 540 low-income, mother-infant dyads from Michigan and Colorado. All data were collected when infants were approximately one month old via self-report questionnaires. RESULTS After adjusting for mothers' age, education, marital and working status, the odds of engaging in any form of breastfeeding among Hispanic mothers remained significantly higher than among NH African-American mothers (OR=2.5, 95% CI:1.59-3.96) and NH White mothers (OR=1.7, 95% CI:1.08-2.81). However, Hispanic mothers had significantly lower maternal knowledge and self-efficacy in infant feeding than the other two groups. No significant correlations were found between maternal knowledge, self-efficacy in infant feeding, and the propensity to breastfeed. CONCLUSIONS Racial and ethnic variations were evident in the propensity to breastfeed, maternal knowledge, and self-efficacy in infant feeding suggesting the importance of tailoring breastfeeding programs to improve breastfeeding, and associated positive health outcomes. Further investigation is needed to find a better way to address breastfeeding disparity in relation to race and ethnicity, maternal knowledge, and self-efficacy in infant feeding.
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Affiliation(s)
- Salmah Alghamdi
- College of Nursing, Michigan State University, East Lansing, MI, USA; College of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | | | - Manfred Stommel
- College of Nursing, Michigan State University, East Lansing, MI, USA
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Whaley SE, Koleilat M, Leonard S, Whaley M. Breastfeeding Is Associated With Reduced Obesity in Hispanic 2- to 5-Year-Olds Served by WIC. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:S144-S150.e1. [PMID: 28689551 DOI: 10.1016/j.jneb.2017.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/24/2017] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the relationship between breastfeeding (BF) and odds of childhood obesity in a large, primarily Hispanic Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population. SETTING A large urban WIC program in California. PARTICIPANTS Infants enrolled in WIC born between 2004 and 2007 and observed to age 5 years (N = 39,801; 88.6% Hispanic). INTERVENTION Level of BF: fully BF, fully formula feeding, or combination feeding. MAIN OUTCOME MEASURE Obesity at age 2-5 years, measured by body mass index (BMI) ≥ 95th percentile. ANALYSIS Logistic regression analyses to evaluate the association between initiation, duration, and exclusivity of BF and odds of obesity at age 2-5 years, controlling for ethnicity, preferred language, family size, poverty level, and maternal BMI. RESULTS Infants exclusively formula fed at birth were significantly more likely than fully breastfed infants to be obese at age 2-5 years (χ2 [2, N = 39,801] = 123.31; P < .001). For every additional month of any BF, obesity risk at age 2-5 years decreased by 1%. Every additional month of full BF conferred a 3% decrease in obesity risk. Ethnicity, preferred language, family size, poverty level, and maternal BMI were also significantly related to obesity risk. CONCLUSIONS AND IMPLICATIONS Breastfeeding may have a role in the attenuation of obesity in early childhood among Hispanic children. The BF promotion and support offered at WIC may have a significant role in reducing rates of early childhood obesity.
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Affiliation(s)
- Shannon E Whaley
- Division of Research and Evaluation, Public Health Foundation Enterprises Special Supplemental Nutrition Program for Women, Infants, and Children, Irwindale, CA.
| | - Maria Koleilat
- Department of Health Science, California State University, Fullerton, Fullerton, CA
| | - Stephanie Leonard
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA
| | - Mike Whaley
- Division of Research and Evaluation, Public Health Foundation Enterprises Special Supplemental Nutrition Program for Women, Infants, and Children, Irwindale, CA
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Gross RS, Mendelsohn AL, Yin HS, Tomopoulos S, Gross MB, Scheinmann R, Messito MJ. Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time. Obesity (Silver Spring) 2017; 25:920-927. [PMID: 28332324 PMCID: PMC5404992 DOI: 10.1002/oby.21779] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/01/2016] [Accepted: 12/31/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families. METHODS This study was a randomized controlled trial (n = 533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving "Starting Early," with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement-restricting devices). Health literacy was assessed using the Newest Vital Sign. RESULTS Four hundred fifty-six mothers completed 3-month assessments. Infant activity results were: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported ≥1 h/d in movement-restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44-3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14-2.49) compared to controls. No difference in the time spent in movement-restricting devices was found. CONCLUSIONS Tummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.
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Affiliation(s)
- Rachel S. Gross
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental - Behavioral Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
- Department of Population Health, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - H. Shonna Yin
- Department of Population Health, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Suzy Tomopoulos
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Michelle B. Gross
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Roberta Scheinmann
- Research and Evaluation Unit, Public Health Solutions, New York, NY, USA
| | - Mary Jo Messito
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
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Musaad SMA, Speirs KE, Hayes JT, Mobley AR, Fitzgerald N, Jones BL, VanBrackle A, Sigman-Grant M. The impact of environmental, parental and child factors on health-related behaviors among low-income children. Appetite 2017; 112:260-271. [PMID: 28159663 DOI: 10.1016/j.appet.2017.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/19/2022]
Abstract
Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S. SAMPLE This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (β: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (β: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (β: -0.19, 95% CI: -0.29; -0.10). More parental covert control (β: 0.44, 95% CI: 0.35; 0.54), more parental overt control (β: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (β: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.
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Affiliation(s)
- Salma M A Musaad
- Family Resiliency Center, Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, 2031 Doris Kelley Christopher Hall, 904 W. Nevada, Urbana, IL 61801, USA.
| | - Katherine E Speirs
- Department of Family Studies and Human Development, Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, 315-L McClelland Park, Tucson, AZ, 85721-0078, USA.
| | - Jenna T Hayes
- University of Nevada, Reno, Human Development and Family Studies, 1664 N. Virginia St./Mail Stop 0140, Reno, NV 89557, USA.
| | - Amy R Mobley
- Department of Nutritional Sciences, University of Connecticut, 3624 Horsebarn Road Extension Unit 4017, Storrs, CT 06269-4017, USA.
| | - Nurgul Fitzgerald
- Department of Nutritional Sciences, Rutgers, The State University of New Jersey, 26 Nichol Avenue, Room 229A, New Brunswick, NJ 08901, USA.
| | - Blake L Jones
- Department of Human Development and Family Studies, Purdue University, 1202 W. State St., West Lafayette, IN 47907-2055, USA.
| | - Angela VanBrackle
- University of Nevada, Reno Cooperative Extension, 8050 Paradise Rd., Suite 100, Las Vegas, NV 89123, USA.
| | - Madeleine Sigman-Grant
- University of Nevada, Reno Cooperative Extension, 8050 Paradise Rd., Suite 100, Las Vegas, NV 89123, USA.
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Perrin AJ, Caren N, Skinner AC, Odulana A, Perrin EM. The unbuilt environment: culture moderates the built environment for physical activity. BMC Public Health 2016; 16:1227. [PMID: 27919241 PMCID: PMC5139009 DOI: 10.1186/s12889-016-3866-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022] Open
Abstract
Background While research has demonstrated a link between the built environment and obesity, much variation remains unexplained. Physical features are necessary, but not sufficient, for physical activity: residents must choose to use these features in health-promoting ways. This article reveals a role for local culture in tempering the effect of the physical environment on physical activity behaviors. Methods We developed Systematic Cultural Observation (SCO) to observe place-based, health-related culture in Lenoir County, NC (population ~60,000). Photographs (N = 6450) were taken systematically from 150 most-used road segments and geocoded. Coders assessed physical activity (PA) opportunities (e.g., public or private activity spaces, pedestrian-friendly features) and presence of people in each photograph. Results 28.7% of photographs contained some PA feature. Most were private or pedestrian; 3.1% contained public PA space. Only 1.5% of photographs with any PA features (2% of those with public PA space, 0.7% of those with private) depicted people despite appropriate weather and daylight conditions. Conclusions Even when PA opportunities existed in this rural county, they were rarely used. This may be the result of culture (“unbuilt environment”) that disfavors physical activity even in the presence of features that allow it. Policies promoting built environments designed for healthy lifestyles should consider local culture (shared styles, skills, habits, and beliefs) to maximize positive outcomes.
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Affiliation(s)
- Andrew J Perrin
- Department of Sociology, College of Arts and Sciences, University of North Carolina, CB#3210, 155 Hamilton Hall, Chapel Hill, NC, 27599-3210, USA.
| | - Neal Caren
- Department of Sociology, College of Arts and Sciences, University of North Carolina, CB#3210, 155 Hamilton Hall, Chapel Hill, NC, 27599-3210, USA
| | - Asheley C Skinner
- The Duke Clinical Research Institute, 2400 Pratt Street, Office 8047, Durham, NC, 27705, USA
| | - Adebowale Odulana
- Medical University of South Carolina, 165 Ashley Avenue, MSC 561, Charleston, SC, 29425, USA
| | - Eliana M Perrin
- Department of Pediatrics, School of Medicine, University of North Carolina, 231 MacNider, CB#7225, Chapel Hill, NC, 27599-7225, USA
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Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age. Eur J Clin Nutr 2016; 71:25-32. [PMID: 27827398 DOI: 10.1038/ejcn.2016.206] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 07/27/2016] [Accepted: 09/18/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors. SUBJECTS/METHODS Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors. RESULTS Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children's sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls.SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order. CONCLUSIONS Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order.
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Gonzalez G. Primary Care Interventions to Reduce Childhood Obesity in Latino Families. J Pediatr Health Care 2016; 30:471-9. [PMID: 26677979 DOI: 10.1016/j.pedhc.2015.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/30/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Increasing rates of obesity in Latino children call for culturally sensitive primary care interventions. Despite recent efforts to address this growing disparity, little is known about cultural variables that influence obesity management programs in Latino children. METHODS A literature search was conducted using CINHAL, Scopus, PubMed, and PsycINFO to review the state of the science regarding primary care interventions to decrease obesity in Latino children. The author analyzed the effects of several cultural practices on obesity and made recommendations based on their clinical implications for weight reduction management programs. RESULTS Obesity in Latino children is a multifactorial problem influenced by family behaviors, cultural perceptions of weight and health, traditional dietary norms, and socioeconomic status. Current practice lags behind national obesity management recommendations and is further hindered by a lack of consideration of the roles of key cultural differences in Latino families. DISCUSSION It is imperative to recognize the importance of family preferences and culture when developing weight reduction programs so as to foster long-term behavior changes. More research assessing the efficacy of culturally competent interventions is necessary to guide national efforts to address this increasing disparity.
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Aldrich H, Gance-Cleveland B. Comparing Weight-for-Length Status of Young Children in Two Infant Feeding Programs. Matern Child Health J 2016; 20:2518-2526. [PMID: 27485490 DOI: 10.1007/s10995-016-2077-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives A cross-sectional study comparing weight-for-length status of children 6-24 months old who participated in Nurse-Family Partnership (NFP) or Special Supplemental Program for Women, Infants, and Children (WIC). Methods Secondary analysis of NFP (n = 44,980) and WIC (n = 31,294) national datasets was conducted to evaluate infant and toddler growth trajectories. Weight-for-length status was calculated at 6, 12, 18, and 24 months based on World Health Organization criteria. Demographics and breastfeeding rates were also evaluated. Binary logistic regression was used to calculate odds ratios for high weight-for-length (≥97.7 percentile) at each time point. Results At 6 months, approximately 10 % of WIC and NFP children were classified as high weight-for-length. High weight-for-length rates increased for both groups similarly until 24 months. At 24 months, NFP children had significantly lower rates of excess weight (P = 0.03) than WIC children, 15.5 and 17.5 % respectively. At all time points, non-Hispanic white children had lower rates of high-weight for length than Hispanic and non-Hispanic black children. NFP infants were also found to have higher rates of ever being breastfed than WIC infants (P < 0.0001). Conclusions for Practice Infant and toddler populations served by NFP or WIC were found to be at increased risk for high weight-for-length. This study found NFP participation was associated with a small, but significant, protective impact on weight-for-length status at 24 months. Continued efforts need to be made in addressing weight-related racial/ethnic and socioeconomic disparities during early childhood.
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Affiliation(s)
- Heather Aldrich
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 E. 19th Avenue, Aurora, CO, 80045, USA
| | - Bonnie Gance-Cleveland
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 E. 19th Avenue, Aurora, CO, 80045, USA.
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Abstract
OBJECTIVE Child sleep problems are prevalent and have been linked to poor behavior, worse school performance, and obesity. Low health literacy (HL) is associated with suboptimal parenting practices and worse health outcomes, but the relationship between parent HL and child sleep-related issues is not known. We examined the association between parent HL and child sleep-related issues. METHODS This was a cross-sectional analysis of data from caregivers enrolled in a cluster randomized trial of a primary care-based child obesity prevention program in 4 pediatric clinics. Parent HL was assessed using the Short Test of Functional Health Literacy in Adults. At the 9-month well-child visit, sleep-related factors were assessed: presence of TV in room where child sleeps, regular naptimes and bedtimes (≥5 days/wk), low daytime and nighttime sleep duration (>1 SD below mean on the basis of national data). Multiple logistic regression analyses were performed. RESULTS We enrolled 557 caregivers of 9-month-old children (49.7% Hispanic, 26.9% black, 56.2% <$20,000 annual income); 49.6% reported having a TV in the room where their child sleeps; 26.6% did not have regular naptimes norbedtimes. Median sleep duration was 2.3 (interquartile range, 1.5-3.0) hours (daytime), and 9.0 (interquartile range, 8.0-10.0) hours (night) (30.2% low daytime; 20.3% low nighttime sleep duration). Children of parents with low HL were more likely to have a bedroom TV (66.7% vs 47.7%, P = .01; adjusted odds ratio, 2.2; 95% confidence interval, 1.1-4.3) and low night-time sleep (37.0% vs 18.5%; P = .002; adjusted odds ratio, 2.4; 95% confidence interval, 1.2-4.8). CONCLUSIONS Low parent HL is associated with TV in the bedroom and low night sleep duration. Additional study is needed to further explore these associations and intervention strategies to address child sleep problems.
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