The Families and Schools for Health Project: A Longitudinal Cluster Randomized Controlled Trial Targeting Children with Overweight and Obesity

This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity; Family Dynamics (FD) added parenting and healthy emotion management. A third Peer Group (PG) intervention taught social acceptance to children. Crossing interventions yielded four conditions: FL, FL + PG, FL + FD, and FL + FD + PG—compared with the control. Longitudinal BMI data were collected to determine if family- and peer-based psychosocial components enhanced the Family Lifestyle approach. Participants were 1st graders with BMI%ile >75 (n = 538: 278 boys, 260 girls). Schools were randomly assigned to condition after stratifying for community size and percent American Indian. Anthropometric data were collected pre- and post-intervention in 1st grade and annually through 4th grade. Using a two-level random intercept growth model, intervention status predicted differences in growth in BMI or BMI-M% over three years. Children with obesity who received the FL + FD + PG intervention had lower BMI gains compared to controls for both raw BMI (B = −0.05) and BMI-M% (B = −2.36). Interventions to simultaneously improve parent, child, and peer-group behaviors related to physical and socioemotional health offer promise for long-term positive impact on child obesity.

Beyond Groceries: An Analysis of Referral Needs to Address Underlying Causes of Child Hunger among Households Accessing Food Pantries

Very low food security among children (VLFS-C), often referred to as child hunger, can profoundly hinder child development, family well-being, and community health. Food pantries are important community resources that routinely serve at-risk families. This study investigated the influence of various candidate risk factors for VLFS-C within a food pantry population to inform the development of the "Pantry Assessment Tool against Child Hunger (PATCH)." We collected standardized surveys among a representative sample of households with children accessing food pantry services in Oklahoma (n = 188). Weighted analyses revealed a large majority of households experienced child-level food insecurity (70.6%), with nearly half reporting low food security and nearly one-quarter reporting VLFS-C. We then used logistic regression to identify factors associated with VLFS-C, followed by chi-square automatic interaction detection (CHAID) to assess if, and in what progression, significant risk factors predicted VLFS-C. In unadjusted models, annual household income <$15,000, non-urban residence, lack of health insurance, unstable housing, heavier food pantry reliance, fair or poor adult health, adult anxiety, and adult smoking to reduce hunger pangs were all positively associated with VLFS-C. Receipt of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and higher social support were protective against VLFS-C. However, in adjusted models, only receipt of WIC remained significant. CHAID analysis revealed that access to insurance best differentiated groups with and without VLFS-C. Informed by these analyses, the PATCH tool may be useful for the development of screening programs to identify and address potential root causes of VLFS-C in pantry settings.

Bidirectional Associations between Restrained Eating and Body Mass Index in Middle Childhood

The nature of the association between dietary restraint and weight has been examined in adult samples, but much less is known about this relationship among children. The current study examined the transactional associations among restrained eating behavior and weight among boys and girls during middle childhood. Data for this study came from 263 children participating in the Families and Schools for Health Project (FiSH), a longitudinal study of the psychosocial correlates of childhood obesity. Participants were interviewed by trained researchers in their third- and fourth-grade year when they completed questionnaires and anthropometric assessments. Dietary restraint was assessed using the restrained eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ), and weight was assessed using Body Mass Index z-scores (BMIz). Bidirectional associations between variables were examined using cross-lagged models controlling for children's sex, ethnicity, and weight in first grade. Results indicated that weight in grade 3 was related to greater dietary restraint in grade 4 (B = 0.20, p = 0.001), but dietary restraint in grade 3 was not associated with weight in grade 4 (B = 0.01, p = 0.64). Neither child sex nor race/ethnicity were associated with BMIz or dietary restraint at either time point. Findings from this study advance the existing limited understanding of eating behavior development among children and show that weight predicts increases in children's dietary restraint in middle childhood.

Adolescent social withdrawal, parental psychological control, and parental knowledge across seven years: A developmental cascade model

INTRODUCTION

Social withdrawal can be problematic for adolescents, increasing the risk of poor self-efficacy, self-esteem, and academic achievement, and increased levels of depression and anxiety. This prospective study follows students across adolescence, investigating links between social withdrawal and two types of parenting hypothesized to impact or be reactive to changes in social withdrawal.

METHODS

Adolescent social withdrawal and parenting were assessed across seven years in a U.S. sample, beginning when students were in 6th grade and ending in 12th grade. The sample consisted of 534 adolescents (260 girls and 274 boys, 82% Euro- and 16% African-American). Social withdrawal was assessed in four grades using at least two informants (teachers, mothers, and/or adolescents). Mothers' and fathers' psychological control and monitoring-related knowledge were assessed by adolescents at two time points. A developmental cascade analysis was conducted using structural equation modeling to assess how withdrawal and control-related parenting impact each other transactionally over time. Analyses included a test for gender differences in the model.

RESULTS

The cascade model revealed that, controlling for previous levels of social withdrawal and parenting, earlier social withdrawal positively predicted psychological control and negatively predicted monitoring knowledge, and earlier parental psychological control-but not monitoring knowledge-predicted later social withdrawal. No adolescent gender differences were identified in the associations between social withdrawal and parental knowledge.

CONCLUSIONS

This study offers insight into the mechanisms by which adolescents become more or less withdrawn over time, and suggests psychological control as a point of psychoeducation or intervention for parents.

Are Negative Peer Influences Domain Specific? Examining the Influence of Peers and Parents on Externalizing and Drug Use Behaviors

Most studies tend to characterize peer influences as either positive or negative. In a sample of 1815 youth from 14 different schools in Caracas, Venezuela, we explored how two types of peer affiliations (i.e., deviant and drug-using peers) differentially mediated the paths from positive parenting to youth's externalizing behavior and licit and illicit drug use. We used Zero Inflated Poisson models to test the probability of use and the extent of use during the past 12 months. Results suggested that peer influences are domain specific among Venezuelan youth. That is, deviant peer affiliations mediated the path from positive parenting to youth externalizing behaviors, and peer drug-using affiliations mediated the paths to the drug use outcomes. Mediation effects were partial, suggesting that parenting explained unique variance in the outcomes after accounting for both peer variables, gender, and age. We discuss implications for the development of screening tools and for prevention interventions targeting adolescents from different cultures.

Psychosocial Factors in Children's Obesity: Examples from an Innovative Line of Inquiry

In recent years, researchers and policymakers have recognized that obesity in childhood is not simply a medical problem, but is a complex social and psychological phenomenon. Our research team used an interpersonal and intrapersonal risk model to examine the psychosocial aspects of obesity among rural children. In this article, we describe how the global study of children's obesity has broadened over the last 10 to 15 years, and we present our model of interpersonal and intrapersonal risk factors, which includes complex pathways with many psychosocial variables. We then describe a large prospective longitudinal study of children in grades 1 through 4, and highlight findings from five studies guided by this model. This work illustrates opportunities for developmental scientists and practitioners to join transdisciplinary teams to develop more effective prevention and intervention programs for children.

Encounters with Aggressive Peers in Early Childhood: Frequency, Age Differences, and Correlates of Risk for Behaviour Problems

The primary goal of the present study was to describe the range, types, and quality (in terms of exposure to aggressive peers) of social activity settings in which young children typically have contact with peers. We also examined whether participation in these settings varied as a function of child sex and age, and family demographic characteristics. Subjects were 277 preschoolaged children. On the basis of detailed accounts of their mothers, activity setting measures were derived separately for ages 2-4 years (era 1) and ages 4-5 years (era 2). Each of seven activity settings (e.g. neighbourhood, day care, organised playgroups) was rated for frequency of participation and frequency of exposure to aggressive peers. Children had the greatest amount of peer contact and were exposed to aggressive peers most often in the neighbourhood setting. In contrast, children participated least frequently in structured playgroup settings, and these settings were least likely to contain aggressive peers. Children from lower SES and single-parent families were more likely to be involved in settings (especially neighbourhoods) containing aggressive peers. These findings suggest that one mechanism through which risk for behaviour problems among children in lower SES and single-parent families may operate is increased exposure to activity settings in which aggression occurs regularly.

The Social and Emotional Lives of Overweight, Obese, and Severely Obese Children

This study examines inter- and intrapersonal problems associated with being overweight among one thousand one hundred sixty-four 6- to 7-year-olds (49% boys) in 29 rural schools. Socioemotional data include child self-reports, peer sociometrics, and teacher reports. Results support the hypothesis that children with weight problems struggle socially and emotionally, and extend current understanding of child obesity by demonstrating that problems appear early, are evident in a community sample, can be identified using standard sociometric methods, and are worse among children with severe obesity. Sociometric status difference between levels of obesity were also found. Although obese children were neglected by peers, severely obese children were rejected.

Dynamic changes in parent affect and adolescent cardiac vagal regulation: a real-time analysis

The current study explored the role of parents' negative and positive affect in adolescent respiratory sinus arrhythmia (RSA) reactivity during a parent-adolescent conflict discussion task and the moderating effects of adolescent sex and age. Questionnaire data were collected from 206 adolescents (10-18 years of age; M = 13.37 years) and their primary caregivers (83.3% biological mothers). Electrocardiogram and respiration data were collected from adolescents, and RSA variables were computed. Parent affect was coded during the conflict discussion task. Multilevel modeling was used to distinguish the between- and within-individual effects of parent affect on adolescent RSA. Results indicated that observed within-parent-teen dyad anger was negatively associated with adolescent RSA, controlling for previous-minute RSA level, particularly among adolescents 13 years and older. In addition, observed between-dyad positive affect was positively linked to RSA for both boys and girls when previous-minute RSA level was controlled. Within-dyad positive affect was positively related to girl's RSA only. These findings suggest that expressions of positive affect may be related to better vagal regulation (RSA increases), whereas expressions of anger may be related to poor vagal regulation (RSA decreases) during social engagement.

Adolescent RSA responses during an anger discussion task: Relations to emotion regulation and adjustment

The current study examined associations between adolescent respiratory sinus arrhythmia (RSA) during an angry event discussion task and adolescents' emotion regulation and adjustment. Data were collected from 206 adolescents (10-18 years of age, M age = 13.37). Electrocardiogram (ECG) and respiration data were collected from adolescents, and RSA values and respiration rates were computed. Adolescents reported on their own emotion regulation, prosocial behavior, and aggressive behavior. Multilevel latent growth modeling was employed to capture RSA responses across time (i.e., linear and quadratic changes; time course approach), and adolescent emotion regulation and adjustment variables were included in the model to test their links to RSA responses. Results indicated that high RSA baseline was associated with more adolescent prosocial behavior. A pattern of initial RSA decreases (RSA suppression) in response to angry event recall and subsequent RSA increases (RSA rebound) were related to better anger and sadness regulation and more prosocial behavior. However, RSA was not significantly linked to adolescent aggressive behavior. We also compared the time course approach with the conventional linear approach and found that the time course approach provided more meaningful and rich information. The implications of adaptive RSA change patterns are discussed.

Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children

Prevention of body dissatisfaction development is critical for minimizing adverse effects of poor body esteem on eating behaviors, self-esteem, and overall health. Research has examined body esteem and its correlates largely in pre-adolescents and adolescents; however, important questions remain about factors influencing body esteem of younger children. The main purpose of this study was to test moderation by children's gender and weight status of the relation of maternal controlling feeding practices to 1st graders' body esteem. The Body Esteem Scale (BES) and anthropometric measurements were completed during one-on-one child interviews at school. Mothers completed the Child Feeding Questionnaire (restriction, monitoring, concern, self-assessed maternal weight). A total of 410 mother/child dyads (202 girls) participated. Percent of children classified as overweight (BMI-for-age ≥85th) was: girls - 29%; boys - 27%. Gender moderated the relation between restriction and body esteem (β = -.140, p = .05), with maternal restriction predicting body esteem in girls but not boys. The hypothesized three-way interaction among gender, child weight status, and monitoring was confirmed. Monitoring was significantly inversely related to body esteem only for overweight/obese girls (b = -1.630). The moderating influence of gender or gender and weight status on the link between maternal feeding practices and body esteem suggests the importance of body esteem interventions for girls as early as first grade.

Reciprocal and Complementary Sibling Interactions: Relations with Socialization Outcomes in the Kindergarten Classroom

RESEARCH FINDINGS

To examine associations between sibling interaction patterns and later social outcomes in single- and two-parent families, 113 kindergarteners took part in naturalistic observations at home with siblings, classmates participated in sociometric interviews, and teachers completed behavior ratings. Sibling interactions were coded using a newly-developed 39-item checklist, and proportions of complementary and reciprocal sibling interactions computed. Complementarity occurred more among dyads where kindergartners were with toddler or infant siblings than among kindergartners with older or near-age younger siblings. Higher levels of complementarity predicted lower levels of internalizing but were not related to externalizing problems. Kindergartners' sociometric status in the classroom differed as a function of sibling interaction patterns, with neglected and controversial children experiencing less complementarity/more reciprocity than popular, average, and rejected children. Finally, there was some evidence for differential associations of sibling interaction patterns with social outcomes for children in single- versus two-parent families: regressions testing interaction effects show sibling reciprocity positively associated with kindergartners' social skills only in single-parent families, and complementary sibling interactions positively related to internalizing problems only in two-parent families.

IMPLICATIONS FOR PRACTICE

Those working with divorcing or other single-parent families might consider sibling interactions as a potential target for social skill building.

Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children

Body satisfaction is important for the prevention of disordered eating and body image disturbances. Yet, little is known about body esteem and what influences it among younger children. The purpose of this study was to evaluate body esteem and the relationships between body esteem, weight, gender, and physical activity in elementary school children. A total of 214 third graders in a U.S. Midwestern state participated in this correlational study. The Body Mass Index-for-age, the Body Esteem Scale (BES), BE-Weight, BE-Appearance, and a Physical Activity Checklist were used to examine the relationships between the variables using bivariate correlations and analysis of variance. While children's body esteem did not differ by physical activity, important interactions were identified between weight status and gender in global body esteem and BE-Appearance. It is critical to examine attitudes about weight and appearance and the relationship between body esteem and self-esteem further among middle childhood-aged children.

Weight status, physical activity, and fitness among third-grade rural children

BACKGROUND

Rural children are at a particular high risk for obesity. Given the importance of exercise in obesity and chronic disease prevention, this study evaluated the level and relationship between physical activity and fitness in a sample of rural third graders. The second purpose of the study was to determine potential differences in physical activity and fitness level by weight status in this sample.

METHODS

Twelve schools participating in a multidisciplinary research project were randomly selected for the study. Body mass index-for-age percentile, the modified Self-administered Physical Activity Checklist, and the FITNESSGRAM battery tests were utilized to determine children's weight status, physical activity, and fitness level, respectively.

RESULTS

Thirty-eight percent of the 237 participating children (9.2 ± 0.4 years) were overweight or obese. Nearly 15% were extremely obese. Children spent 91.8 ± 83.8 and 32.2 ± 47.7 minutes in moderate- and vigorous-intensity activities. Obese children spent less time in moderate-intensity activity (p < .01) and combined moderate- and vigorous-intensity activity more than other children (p < .05). Forty-three percent of all children failed to meet the fitness standard for muscular strength and 36% failed to meet it for flexibility.

CONCLUSIONS

Rural children in this sample had higher rates of obesity compared to the national average; they had poor fitness and 30% failed to meet the minimum physical activity recommendations on the previous day. Future interventions should focus on increasing physical activity, especially of moderate-intensity, and improving physical fitness in order to reduce obesity and decrease the risk of future chronic diseases in this high-risk population.

Parenting styles, parental response to child emotion, and family emotional responsiveness are related to child emotional eating

The aim of the present study was to examine the relations of parenting style, parent response to negative child emotion, and family emotional expressiveness and support to child emotional eating. Mothers (N=450) completed questionnaires and their 6-8-year-old children (N=450) were interviewed. Results showed that emotional eating was negatively predicted by authoritative parenting style and family open expression of affection and emotion, and positively predicted by parent minimizing response to child negative emotion. Results suggest the need for early prevention/intervention efforts directed to these parenting and family variables.

Subtypes of social withdrawal in early childhood: sociometric status and social-cognitive differences across four years

From a sample of 567 kindergartners observed during free play, 150 children were classified as socially withdrawn and followed over 4 years. A cluster analysis involving teacher ratings was used to identify subtypes of withdrawn children. Four clusters were identified, 3 fitting profiles found in the literature and labeled unsociable (n = 96), passive-anxious (n = 23), and active-isolate (n = 19), and 1 typically not discussed, labeled sad/depressed (n = 12). Sociometric ratings indicated that unsociable children had elevated rates of sociometric neglect, active-isolates had higher than expected levels of rejection, and sad/depressed children had elevated rates of both neglect and rejection. Subtypes also differed in social information-processing patterns, with active-isolate children displaying the least component skills. The findings that some experience more difficulty than others might account for the ambiguity in extant studies regarding whether or not social withdrawal is a risk factor in psychosocial development, because withdrawal has most often been treated as a unitary construct in the past.