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Abstract
This JAMA Pediatrics Patient Page describes the benefits of eating family meals together at home.
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Affiliation(s)
- Callie L Brown
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Melissa C Kay
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Lindsay A Thompson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Patel P, Samant A, Del Rosario K, Vitolins MZ, Skelton JA, Ip EH, Lucas CB, Brown CL. Differences in maternal and paternal pressure to eat and perception of household responsibilities. PLoS One 2024; 19:e0302331. [PMID: 38662729 PMCID: PMC11045048 DOI: 10.1371/journal.pone.0302331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Controlling feeding practices, such as pressure to eat, are associated with a child's disinhibited eating and extremes in bodyweight. We aimed to explore which factors are associated with parent dyads' pressuring feeding practices, including how mothers and fathers perceive the sharing of household tasks such as mealtime and child feeding responsibilities. In this cross-sectional study, parent dyads (mother and father) of healthy preschool-aged children completed an identical questionnaire consisting of measures of picky eating (food fussiness subscale of Child Eating Behavior Questionnaire), parental concern for undereating, and pressure to eat (Child Feeding Questionnaire). We used separate multivariable linear regression models for mothers and fathers to assess correlates associated with pressure to eat subscale score, including slowness of eating and enjoyment of food, child BMI z-score and race/ethnicity, and household income. Separate unadjusted linear regression models for mothers and fathers were used to report the association of pressure to eat with household responsibilities. Parents (N = 88) had similar mean picky eating, concern for undereating, and pressure to eat scores; more fathers had high pressure to eat scores (36% vs 27%). Higher pressure to eat was significantly associated with lower income, non-Hispanic Black or Black race/ethnicity, slow eating, and lower enjoyment of food. Pressure was not associated with household responsibilities. While there were similar maternal and paternal perceptions of child eating behaviors, more fathers reported pressuring their child to eat. Identifying differences in parental feeding practices may assist in intervention development to improve feeding practices.
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Affiliation(s)
- Paula Patel
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Anusha Samant
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest University, Winston-Salem, NC, United States of America
| | - Kychelle Del Rosario
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Mara Z. Vitolins
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Joseph A. Skelton
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Edward H. Ip
- Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Caroline B. Lucas
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Callie L. Brown
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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Omoruyi EA, Brown CL, Orr CJ, Montez K. Examining Full-Time Academic General Pediatric Faculty Compensation by Gender, Race, and Ethnicity: 2020-2021. Acad Pediatr 2024; 24:309-317. [PMID: 37285912 DOI: 10.1016/j.acap.2023.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In medicine, women have lower lifetime earnings than men. To our knowledge, an in-depth examination of academic general pediatric faculty compensation by gender, race, and ethnicity has not been conducted. We aimed to 1) explore full-time academic general pediatric faculty salary differences by race and ethnicity; 2) explore these differences among all full-time pediatric faculty. METHODS We performed a cross-sectional study using data on median full-time academic general pediatric faculty compensation for the academic year of 2020-2021 from the Association of American Medical Colleges Medical School Faculty Salary Survey report. Pearson's chi-square tests were used to evaluate the association of faculty rank with gender, race, ethnicity, and degree. We used hierarchical generalize linear models with a log link and a gamma distribution to model to assess the association of median salary with faculty race and ethnicity, adjusting for degree, rank, and gender. RESULTS Men academic general pediatric faculty consistently had higher median salaries than women faculty even after adjusting for degree, rank, race, and ethnicity. Underrepresented in medicine academic general pediatric faculty had a lower median salary when compared to White faculty, and this was similar when adjusted for degree, rank, race, and ethnicity. CONCLUSIONS Our results demonstrated broad disparities in general academic pediatric compensation by both gender and race and ethnicity. Academic medical centers must identify, acknowledge, and address inequities in compensation models.
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Affiliation(s)
- Emma A Omoruyi
- Department of Pediatrics (EA Omoruyi), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex.
| | - Callie L Brown
- Department of Pediatrics, Department of Epidemiology and Prevention (CL Brown), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Colin J Orr
- Department of Pediatrics (CJ Orr), University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Kimberly Montez
- Department of Pediatrics, Department of Social Sciences and Health Policy (K Montez), Wake Forest University School of Medicine, Winston-Salem, NC.
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Cohen GM, Brown CL, Skelton JA. What Parents Should Expect From the New AAP Obesity Guidelines. JAMA Pediatr 2024; 178:100. [PMID: 38010664 DOI: 10.1001/jamapediatrics.2023.4852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
This JAMA Pediatrics Patient Page describes pediatric weight management according to the obesity guidelines recently published by the American Academy of Pediatrics (AAP).
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Affiliation(s)
- Gail M Cohen
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Callie L Brown
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Joseph A Skelton
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Wood CT, Churchill ML, McGrath M, Aschner J, Brunwasser SM, Geiger S, Gogcu S, Hartert TV, Hipwell AE, Lee-Sarwar K, Lyall K, Moog NK, O'Connor TG, O'Shea TM, Smith PB, Wright RJ, Zhang X, Zimmerman E, Huddleston KC, Brown CL. Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program. Pediatr Res 2023; 94:2085-2091. [PMID: 37479746 PMCID: PMC10938641 DOI: 10.1038/s41390-023-02750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND We aimed to understand the association between maternal stress in the first year of life and childhood body mass index (BMI) from 2 to 4 years of age in a large, prospective United States-based consortium of cohorts. METHODS We used data from the Environmental influences on Child Health Outcomes program. The main exposure was maternal stress in the first year of life measured with the Perceived Stress Scale (PSS). The main outcome was the first childhood BMI percentile after age 2 until age 4 years. We used an adjusted linear mixed effects model to examine associations between BMI and PSS quartile. RESULTS The mean BMI percentile in children was 59.8 (SD 30) measured at 3.0 years (SD 1) on average. In both crude models and models adjusted for maternal BMI, age, race, ethnicity, infant birthweight, and health insurance status, no linear associations were observed between maternal stress and child BMI. CONCLUSIONS Among 1694 maternal-infant dyads, we found no statistically significant relationships between maternal perceived stress in the first year of life and child BMI after 2 through 4 years. IMPACT Although existing literature suggests relationships between parental stress and childhood BMI, we found no linear associations between maternal stress in the first year of life and childhood BMI at 2-4 years of age among participants in ECHO cohorts. Higher maternal stress was significantly associated with Hispanic ethnicity, Black race, and public health insurance. Our analysis of a large, nationally representative sample challenges assumptions that maternal stress in the first year of life, as measured by a widely used scale, is associated with offspring BMI.
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Affiliation(s)
- Charles T Wood
- Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
| | - Marie L Churchill
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven M Brunwasser
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Geiger
- Department of Kinesiology and Community Health, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Tina V Hartert
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen Lee-Sarwar
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Nora K Moog
- Department of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas G O'Connor
- Department of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - T Michael O'Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Rosalind J Wright
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xueying Zhang
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | | | - Callie L Brown
- Division of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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McCarthy M, Vitolins MZ, Skelton JA, Ip EH, Brown CL. A Pilot Study Examining the Association of Parental Stress and Household Food Insecurity with Dietary Quality in Pre-School-Aged Children. Nutrients 2023; 15:3154. [PMID: 37513572 PMCID: PMC10383475 DOI: 10.3390/nu15143154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Adequate dietary quality is necessary for children's appropriate development and may be influenced by family factors. This study with 24 healthy 3-5-year-old children assessed the associations of parental stress and household food insecurity (HFI) with a child's dietary quality. Parents completed three 24 h dietary recalls, and the Healthy Eating Index was calculated to assess dietary quality. Parents also completed a questionnaire, including The Perceived Stress Scale (assessing overall parental stress) and the Hunger Vital Sign screen (assessing HFI). Children's height/weight were measured, and BMIz was calculated. Separate multivariable linear regression models assessed the association of dietary quality components with HFI and parental stress, adjusting for household income, child sex, and child BMI z-score. In bivariate analyses, children with HFI consumed more added sugars, and parental stress was associated with the child's greens/beans intake. In multivariable analysis, HFI was associated with lower total protein scores and higher added sugar intake, while parental stress was associated with lower greens/beans intake. Higher household income was associated with higher total vegetable and sodium intake, and children with a higher BMIz had a lower total protein intake. Parental stress and HFI can impact a child's dietary quality; providers should counsel families on strategies to improve diet quality.
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Affiliation(s)
- Madison McCarthy
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Edward H Ip
- Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Pham SB, Skelton JA, Pratt K, Lewis KH, Brown CL. Examining the effect of parent participation in an adult weight management program on changes in children's weight. Clin Obes 2023; 13:e12583. [PMID: 36759742 PMCID: PMC9992107 DOI: 10.1111/cob.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Children of parents participating in weight management programs (WMPs) are more likely to adopt their parents' weight control practices. Little is known about the weight outcomes of children who have a parent participating in a WMP. This study aimed to assess this relationship. Children 2-17 years of age with a parent who participated in a WMP were included in the study. Multilevel linear mixed-effects regression models were used, stratified by child weight status at the time of parental WMP participation (healthy weight, overweight/obesity) to determine change in children's BMIz from before to after parents WMP participation, including covariates of parent BMI and parental feeding practices. Parents (N = 77) were mostly white (76%) and female (84%). Children (N = 114) had a mean age of 10.5 ± 4.6; 47% had overweight or obesity. Children with overweight or obesity prior to their parent's WMP had a decrease in BMIz (-0.68) after the WMP while children with a healthy weight had no significant change. Children with overweight or obesity had a decrease in BMIz from before to after parent's participation in a WMP. Further research is needed to understand changes in family eating practices that occur during and after parent WMP participation.
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Affiliation(s)
- Stephanie B Pham
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Brenner FIT, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Keeley Pratt
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Kristina Henderson Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Palakshappa D, Brown CL, Skelton JA, Goodpasture M, Albertini LW, Montez K. Social Risk Screening and Interventions in Healthcare Settings: Opportunities, Challenges, and Future Research. Acad Pediatr 2022; 22:1278-1280. [PMID: 35970506 PMCID: PMC10154944 DOI: 10.1016/j.acap.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine (D Palakshappa), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC; Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Callie L Brown
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC; Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph A Skelton
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC; Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Meggan Goodpasture
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Laurie W Albertini
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
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Brown CL, Skinner AC, Steiner MJ, Truong T, Green CL, Wood CT. Prevalence of High Weight Status in Children Under 2 Years in NHANES and Statewide Electronic Health Records Data in North Carolina and South Carolina. Acad Pediatr 2022; 22:1353-1359. [PMID: 35342033 PMCID: PMC9508281 DOI: 10.1016/j.acap.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We evaluated the prevalence of high weight status in children ages 0 to 24 months (m) using data from electronic health records (EHR) and NHANES. We also examined relationships between weight status during infancy and obesity at 24 months of age. METHODS EHR data from 4 institutions in North and South Carolina included patients born January 1, 2013-October 10, 2017 (N = 147,290). NHANES data included study waves from 1999 to 2018 (unweighted N = 5121). We calculated weight-for-length (WFL), weight-for-age (WFA), and body mass index (BMI), excluding implausible values, and categorized weight status (<85th, 85th to <95th, or ≥95th percentile), assessing prevalence at birth, 6, 12, 18, and 24 months. Utilizing individual, longitudinal EHR data, we used separate regression models to assess obesity risk at 24 months based on anthropometrics at birth, 6, 12, and 18 months, adjusting for sex, race/ethnicity, insurance, and health system. RESULTS Prevalence of BMI ≥95th percentile in EHR data at 6, 12, 18, and 24 months were 9.7%, 15.7%, 19.6%, and 20.5%, respectively. With NHANES the prevalence was 11.6%, 15.0%, 16.0%, and 8.4%. For both, the prevalence of high weight status was higher in Hispanic children. In EHR data, high weight status at 6, 12, and 18 months was associated with obesity at 24 months, with stronger associations as BMI category increased and as age increased. CONCLUSIONS High weight status is common in infants and young children, although lower at 24 months in NHANES than EHR data. In EHR data, high BMI at 6, 12, and 18 months was associated with increased risk of obesity at 24 months.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine (CL Brown), Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine (CL Brown), Winston-Salem, NC.
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University (AC Skinner), Durham, NC
| | - Michael J Steiner
- Department of Pediatrics, University of North Carolina at Chapel Hill (MJ Steiner), Chapel Hill, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine (T Truong, CL Green), Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine (T Truong, CL Green), Durham, NC
| | - Charles T Wood
- Department of Pediatrics, Duke University (CT Wood), Durham, NC
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Brown CL, Ip EH, Skelton J, Lucas C, Vitolins MZ. Parental concerns about picky eating and undereating, feeding practices, and child's weight. Obes Res Clin Pract 2022; 16:373-378. [PMID: 36097260 DOI: 10.1016/j.orcp.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/29/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Parents' concerns about their child's feeding may lead parents to pressure their child to eat, which may lead to a greater risk for obesity. We aimed to assess if parental concerns for picky eating and undereating are associated with pressure to eat and increased child BMI z-score (BMIz). METHODS We performed a cross-sectional study of 328 parents of healthy preschoolers assessing parent concerns about picky eating (Child Eating Behavior Questionnaire) and child undereating ("Are you concerned …doesn't eat enough?"), parent pressure to eat (Child Feeding Questionnaire), and covariates. Dyads' heights and weights were measured. Structural equation modeling (SEM) was performed to examine the relationships between parental concerns, pressure to eat, and child BMIz. Measurement models were tested and refined, and the structural model was tested. Model fit was determined using multiple goodness-of-fit indices. RESULTS Dyads were racially and socioeconomically diverse. The SEM model demonstrated good goodness-of-fit. Children who were perceived as not eating enough had significantly higher picky eating scores (β 0.756; p < 0.001). Parents had higher pressure to eat scores if children were more picky (β 0.148; p = 0.02) or were perceived as not eating enough (β 0.654; p < 0.001). Parental pressure to eat was not associated with the child's BMIz. CONCLUSIONS In a cohort of diverse preschoolers, parent concerns about eating were associated with increased pressure to eat, but pressure to eat was not associated with BMIz. Identifying these relationships is important to develop effective interventions to improve feeding practices in young children.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Epidemiology and Prevention, Wake Forest School of Medicine, United States.
| | - Edward H Ip
- Department of Biostatistics, Wake Forest School of Medicine, United States
| | - Joseph Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Epidemiology and Prevention, Wake Forest School of Medicine, United States
| | - Caroline Lucas
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, United States
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Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Acad Pediatr 2022; 22:1105-1114. [PMID: 35577282 PMCID: PMC10153634 DOI: 10.1016/j.acap.2022.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/07/2022] [Accepted: 04/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially. OBJECTIVE To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies. RESULTS We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity. LIMITATIONS Most studies were cross-sectional and many were medium- or high-risk for bias or confounding. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.
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Affiliation(s)
- Kathryn S Cain
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephanie C Meyer
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Elaina Cummer
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Kishan K Patel
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas J Casacchia
- Clinical and Translational Science Institute (NJ Casacchia), Wake Forest University, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Deepak Palakshappa
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine (D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention (D Palakshappa, CL Brown), Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics (KS Cain, SC Meyer, E Cummer, KK Patel, K Montez, D Palakshappa, and CL Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention (D Palakshappa, CL Brown), Wake Forest School of Medicine, Winston-Salem, NC.
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Meyer SC, Montez K, McClung R, Michael L, Namak S, Brown CL. Growth of Pediatric Refugees after Resettlement to the Southeastern United States. Acad Pediatr 2022; 22:777-781. [PMID: 34637931 PMCID: PMC8993936 DOI: 10.1016/j.acap.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare weight status and body mass index z-scores (BMIz) of refugee children upon arrival to the Southeastern US and after resettlement with age- and sex-matched controls of nonrefugee children. METHODS We identified refugee children resettled between July 2014 and June 2018 to Forsyth County, NC. Refugees were assigned age- and sex-matched controls (3 controls:1 refugee) who received care at the same health care site, were Medicaid insured, and had height and weight recorded at time of their matched refugee's resettlement plus at least 2 additional visits. BMI and BMIz were calculated. Pearson chi-square test assessed differences in weight status at the time of refugee resettlement and at the last measured time point. Multilevel linear mixed-effects regression models assessed change in BMIz by refugee status, adjusting for sex, race/ethnicity, age, and time since resettlement. RESULTS This study examined 139 pediatric refugees and 417 nonrefugee controls; 46% were female. At the time of resettlement, refugees had a higher rate of underweight (3.3% vs 1.9%), higher rate of healthy weight (68.9% vs 48.2%), and lower rate of overweight/obesity (27.8% vs 50%), compared to controls P < .001. At the last available time point, compared to controls, refugees had higher rates of underweight (3.3% vs 3.0%) and healthy weight (69.5% vs 54.2%) and lower rates of overweight/obesity (27.2% vs 42.7%), P = .005. Refugees had a lower predicted BMIz compared with controls (adjusted β: -0.78; 95% confidence interval -0.91, -0.66). CONCLUSIONS Resettled pediatric refugees were found to have significantly lower predicted BMIz than their age- and sex-matched nonrefugee controls.
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Affiliation(s)
- Stephanie C Meyer
- Department of Student Affairs (SC Meyer), Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (K Montez and CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Rachel McClung
- Novant Health, Robinhood Pediatrics (R McClung), Winston-Salem, NC
| | - Lemaat Michael
- Department of Student Affairs (L Michael), Wake Forest School of Medicine, Winston-Salem, NC
| | - Shahla Namak
- Department of Family and Community Medicine (S Namak), Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics (K Montez and CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC; Department of Epidemiology and Prevention (CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC.
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13
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Brown CL, Dornan LM, Muldoon MJ, Hembre RT, Stevenson PJ, Manesiotis P. Comparison of three stationary phases in the separation of polyphenyls by liquid chromatography. J Chromatogr A 2022; 1671:462992. [PMID: 35395451 DOI: 10.1016/j.chroma.2022.462992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
We present herein new analytical protocols for the separation and structural elucidation of polyphenyls. Three commercially available chromatographic stationary phases are compared in the separation of these non-polar, unfunctionalized, positional isomers. Baseline separation of nine terphenyl and quaterphenyl isomers is achieved in under ten minutes using a rapid gradient elution HPLC method. Complete separation of these, and a further five polyphenyls, is demonstrated. We finally present a linear correlation between solvent accessible surface area and the retention times of these closely related compounds.
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Affiliation(s)
- C L Brown
- School of Chemistry and Chemical Engineering, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland
| | - L M Dornan
- School of Chemistry and Chemical Engineering, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland
| | - M J Muldoon
- School of Chemistry and Chemical Engineering, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland.
| | - R T Hembre
- Eastman Chemical Company, Kingsport, Tennessee, United States
| | - P J Stevenson
- School of Chemistry and Chemical Engineering, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland.
| | - P Manesiotis
- School of Chemistry and Chemical Engineering, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland.
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14
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Brown CL, Palakshappa D. Let's Not Settle for Getting Back to "Normal" - Addressing ACEs and Health Behaviors in the Wake of the COVID-19 Pandemic. Acad Pediatr 2021; 21:1307-1308. [PMID: 34216804 PMCID: PMC8572150 DOI: 10.1016/j.acap.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Callie L Brown
- Department of Pediatrics (CL Brown, D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention (CL Brown, D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC.
| | - Deepak Palakshappa
- Department of Pediatrics (CL Brown, D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention (CL Brown, D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine (D Palakshappa), Wake Forest School of Medicine, Winston-Salem, NC
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15
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Schramm PJ, Brown CL, Saha S, Conlon KC, Manangan AP, Bell JE, Hess JJ. A systematic review of the effects of temperature and precipitation on pollen concentrations and season timing, and implications for human health. Int J Biometeorol 2021; 65:1615-1628. [PMID: 33877430 PMCID: PMC9016682 DOI: 10.1007/s00484-021-02128-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/22/2021] [Accepted: 04/04/2021] [Indexed: 05/19/2023]
Abstract
Climate and weather directly impact plant phenology, affecting airborne pollen. The objective of this systematic review is to examine the impacts of meteorological variables on airborne pollen concentrations and pollen season timing. Using PRISMA methodology, we reviewed literature that assessed whether there was a relationship between local temperature and precipitation and measured airborne pollen. The search strategy included terms related to pollen, trends or measurements, and season timing. For inclusion, studies must have conducted a correlation analysis of at least 5 years of airborne pollen data to local meteorological data and report quantitative results. Data from peer-reviewed articles were extracted on the correlations between seven pollen indicators (main pollen season start date, end date, peak date, and length, annual pollen integral, average daily pollen concentration, and peak pollen concentration), and two meteorological variables (temperature and precipitation). Ninety-three articles were included in the analysis out of 9,679 articles screened. Overall, warmer temperatures correlated with earlier and longer pollen seasons and higher pollen concentrations. Precipitation had varying effects on pollen concentration and pollen season timing indicators. Increased precipitation may have a short-term effect causing low pollen concentrations potentially due to "wash out" effect. Long-term effects of precipitation varied for trees and weeds and had a positive correlation with grass pollen levels. With increases in temperature due to climate change, pollen seasons for some taxa in some regions may start earlier, last longer, and be more intense, which may be associated with adverse health impacts, as pollen exposure has well-known health effects in sensitized individuals.
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Affiliation(s)
- P J Schramm
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA.
| | - C L Brown
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA
| | - S Saha
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA
| | - K C Conlon
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA
| | - A P Manangan
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S106-6, Atlanta, GA, 30341, USA
| | - J E Bell
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - J J Hess
- Departments of Emergency Medicine, Environmental and Occupational Health Sciences, and Global Health, and the Center for Health and the Global Environment, Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA
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16
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Montez K, Brown CL, Garg A, Rhodes SD, Song EY, Taxter AJ, Skelton JA, Albertini LW, Palakshappa D. Trends in food insecurity rates at an academic primary care clinic: a retrospective cohort study. BMC Pediatr 2021; 21:364. [PMID: 34452604 PMCID: PMC8390339 DOI: 10.1186/s12887-021-02829-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Healthcare organizations are increasingly screening and addressing food insecurity (FI); yet, limited data exists from clinic-based settings on how FI rates change over time. The objective of this study was to evaluate household FI trends over a two-year period at a clinic that implemented a FI screening and referral program. METHODS In this retrospective cohort study, data were extracted for all visits at one academic primary care clinic for all children aged 0-18 years whose parents/guardians had been screened for FI at least once between February 1, 2018 to February 28, 2019 (Year 1) and screened at least once between March 1, 2019 to February 28, 2020 (Year 2). Bivariate analyses tested for differences in FI and demographics using chi-square tests. Mixed effects logistic regression was used to assess change in FI between Years 1 and 2 with random intercept for participants controlling for covariates. The interaction between year and all covariates was evaluated to determine differences in FI change by demographics. RESULTS Of 6182 patients seen in Year 1, 3691 (59.7%) were seen at least once in Year 2 and included in this study. In Year 1, 19.6% of participants reported household FI, compared to 14.1% in Year 2. Of those with FI in Year 1, 40% had FI in Year 2. Of those with food security in Year 1, 92.3% continued with food security in Year 2. Compared to Hispanic/Latinx participants, African American/Black (OR: 3.53, 95% CI: 2.33, 5.34; p < 0.001) and White (OR: 1.88, 95% CI: 1.06, 3.36; p = 0.03) participants had higher odds of reporting FI. African American/Black participants had the largest decrease in FI between Years 1 and 2 (- 7.9, 95% CI: - 11.7, - 4.1%; p < 0.0001). CONCLUSIONS Because FI is transitional, particularly for racial/ethnic minorities, screening repeatedly can identify families situationally experiencing FI.
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Affiliation(s)
- Kimberly Montez
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Callie L. Brown
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
| | - Eunyoung Y. Song
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
- Health Quality Partners, Doyleston, PA USA
| | - Alysha J. Taxter
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Joseph A. Skelton
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
| | - Laurie W. Albertini
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Deepak Palakshappa
- Departments of Pediatrics and Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
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17
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Brown CL, Montez K, Amati JB, Simeonsson K, Townsend JD, Orr CJ, Palakshappa D. Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas. Int J Environ Res Public Health 2021; 18:ijerph18115734. [PMID: 34071783 PMCID: PMC8199093 DOI: 10.3390/ijerph18115734] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0–18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Correspondence: ; Tel.: +1-(336)-716-4987
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Jane Blakely Amati
- Department of Pediatrics, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA;
| | - Kristina Simeonsson
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA; (K.S.); (J.D.T.)
| | - John D. Townsend
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA; (K.S.); (J.D.T.)
| | - Colin J. Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Deepak Palakshappa
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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18
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Brown CL, Skelton JA, Palakshappa D, Pratt KJ. High Prevalence of Food Insecurity in Participants Attending Weight Management and Bariatric Surgery Programs. Obes Surg 2021; 30:3634-3637. [PMID: 32363554 DOI: 10.1007/s11695-020-04645-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated the prevalence and correlates of household food insecurity (HFI) in participants attending weight management and bariatric surgery programs (WMP). We surveyed participants (N = 298) residing with a child and romantic partner from two WMP offering bariatric surgery and medical weight management. We assessed HFI using the Hunger Vital Sign and conducted multivariate logistic regression to assess correlates of HFI. HFI was present in 29.2% of participants. There were increased odds of HFI in participants with lower income and those with three or more children living at home. There was no association with sex, race, program type, education, or BMI. HFI is highly prevalent among participants of WMP. WMP should screen all participants for food insecurity to address this potential barrier to a healthy lifestyle.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA. .,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Keeley J Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA.,Deparment of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
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19
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Masler IV, Palakshappa D, Skinner AC, Skelton JA, Brown CL. Food insecurity is associated with increased weight loss attempts in children and adolescents. Pediatr Obes 2021; 16:e12691. [PMID: 32558334 PMCID: PMC8396069 DOI: 10.1111/ijpo.12691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Household food insecurity (HFI) has been associated with adverse childhood outcomes and shares many common risk factors with obesity. Half of adolescents with overweight or obesity are actively attempting to lose weight. We aim to evaluate whether HFI is associated with weight loss attempts and unhealthy weight loss control practices in children. We examined cross-sectional data of children ages 8 to 15 years old from the National Health and Nutrition Examination Survey. Attempted weight loss was more common among children with very low food security (OR 1.50, 95% CI 1.09, 2.07). Children with a healthy weight with very low food security had increased odds of attempting weight loss (OR 1.51, 95% CI 1.00, 2.26) but there was no association in children with overweight or obesity. Very low food security was also associated with unhealthy weight control practices (OR: 1.42, 95% CI: 1.04, 1.93). Physicians should counsel all children and adolescents on healthy and unhealthy weight loss behaviours, regardless of weight or food security status.
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Affiliation(s)
- Isabella V. Masler
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC;,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University, Durham, NC.,Duke Clinical Research Institute, Duke University, Durham, NC
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC;,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC;,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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20
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Wirth SH, Palakshappa D, Brown CL. Association of household food insecurity and childhood weight status in a low-income population. Clin Obes 2020; 10:e12401. [PMID: 32915524 PMCID: PMC8405045 DOI: 10.1111/cob.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
One in seven US households with children are food insecure. The health effects of household food insecurity (HFI) are well documented, but its association with childhood weight status remains unclear. We aimed to assess this association and to describe correlates of HFI in children. We conducted a cross-sectional study of 3019 low-income children aged 2 to 17 years. Data were extracted via chart review. HFI was assessed using the hunger vital sign screener. Body mass index (BMI) was calculated from documented clinical measurements. We used adjusted linear and logistic regression to assess the association of HFI with BMI z-score (BMIz) and weight status. We used logistic regression to examine correlates of HFI including age, race/ethnicity, tobacco exposure, number of parents and siblings living at home, weight status, and census-tract poverty rate and food access. Of participants whose HFI status was documented, 91% were food secure and 9% were food insecure. The mean (SD) BMIz was 0.81 (1.11). Fifty five percentage of children were healthy weight, 18% overweight, and 26% obese. In adjusted analyses, HFI was not associated with BMIz but was associated with decreased odds of obesity (OR 0.56; 95% CI 0.36-0.87). Tobacco exposure (1.63; 1.10-2.44), additional siblings (1.16; 1.04-1.30), and residence census tract with high poverty rate (1.02; 1.01-1.03) were all associated with HFI. We concluded that food-insecure children were less likely to have obesity and had differences in household makeup, exposures, and residential location compared to food-secure children. Clinicians should understand these relationships when counselling families about weight status and food insecurity.
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Affiliation(s)
- Scott H Wirth
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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21
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Palakshappa D, Lenoir K, Brown CL, Skelton JA, Block JP, Taveras EM, Lewis KH. Identifying geographic differences in children's sugar-sweetened beverage and 100% fruit juice intake using health system data. Pediatr Obes 2020; 15:e12663. [PMID: 32558331 PMCID: PMC8445093 DOI: 10.1111/ijpo.12663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Identifying areas with higher sugar-sweetened beverage intake could help tailor policy and public health efforts intended to reduce sugary beverage consumption. OBJECTIVE Demonstrate the feasibility of using health system data to examine the geographic distribution of sugar-sweetened beverage intake and evaluate neighbourhood characteristics associated with intake. METHODS We extracted electronic health record data from a sugar-sweetened beverage and 100% fruit juice screener used for children ages 1 to 17 years in eight pediatric practices in North Carolina (March 2017-2018) and dichotomized intake to high (≥3 sugar-sweetened beverages/day) vs not. We geocoded address and mapped the proportion of consumers in each census tract. We combined electronic health record data with US census data and evaluated associations of census tract income and race/ethnicity with intake. We used multivariable models to evaluate the association between geographic concentrations of income and race/ethnicity and sugar-sweetened beverage intake, controlling for demographics extracted from the electronic health record and clustering by tract. RESULTS Of 19 451 patients, 4579 (23.5%) reported consuming ≥3 sugar-sweetened beverages/day. In multivariable models, children living in tracts with high concentrations of low-income (OR: 1.45, 95% CI: 1.26, 1.68) and non-white residents (OR: 1.44, 95% CI: 1.21, 1.71) were more likely to consume ≥3 sugar-sweetened beverages/day than children in tracts with a high concentration of high-income and white residents. CONCLUSION We demonstrate how health system data could be used to characterize geographic variation in sugar-sweetened beverage and 100% fruit juice consumption. This approach could help target public health efforts and monitor the effects of community-level interventions.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kristin Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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22
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Abstract
Background: Family-oriented therapies are the gold standard of childhood obesity treatment, yet little is known about if or how information gathered by one parent from a health care provider is translated to the home. We assessed how families of children and adolescents with overweight and obesity communicate weight-related information received from their provider to family members not present at the visit. Methods: Parents and children (9-18 years old, N = 112) completed the McMaster's Family Assessment Device Communication Subscale (FADc) and investigator-derived questions describing weight-related communication practices with family members. We used descriptive statistics to describe communication practices and separate logistic regression models to assess associations of communication practices with parent-reported FADc, child BMI z-score, child sex, parent BMI, household income, and site. Results: Most parents discuss with other family members: their child's weight (60.4%) or weight management discussions with the child's provider (57.9%). Median parent FADc score was 2.0 (IQR 0.5). The most common facilitator to weight-related conversations was understanding what the provider said (95.1%). Higher FADc score (worse communication) was associated with whether parents ask other family members' opinions about weight information received from their child's provider [odds ratio 0.22 (95% confidence interval 0.05-0.99)]. Higher income was associated with many healthy communication practices. Conclusions: Slightly more than half of parents discuss with family members what their provider said regarding their child's weight. More effort must be placed on aiding parents in relaying information from the provider to other family members in the home to encourage family lifestyle changes and alleviate childhood obesity.
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Affiliation(s)
- Kathryn S. Cain
- Wake Forest School of Medicine, Bowman Gray Center, Winston-Salem, NC, USA
| | - Gail M. Cohen
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren V. Crawford
- Wake Forest School of Medicine, Bowman Gray Center, Winston-Salem, NC, USA
| | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Khalsa AS, Copeland KA, Misik L, Brown CL, Kharofa RY, Ollberding NJ. Maternal Body Dissatisfaction and Accuracy of Infant Weight Perception in Families From Low-Income Backgrounds. Acad Pediatr 2020; 20:793-800. [PMID: 32247669 DOI: 10.1016/j.acap.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between maternal body dissatisfaction and mother's (mis)perception of their infant's weight classification among families from low-income households. METHODS Mother-infant dyads were recruited during well-child visits from 2 urban primary care clinics. Maternal body dissatisfaction was measured using the Stunkard Figure Rating Scale. Perception of infant weight was assessed using a 5-point Likert scale. Infant weight-for-length percentiles were calculated using World Health Organization growth charts. Associations between maternal body dissatisfaction score and mother's (mis)perception of their infant's weight classification were examined using logistic regression allowing for nonlinear associations via restricted cubic splines. RESULTS Mothers (n = 180) were 26.6 ± 5.1 years old and 72% Black; infants were 8.8 ± 2.1 months old. Mean infant weight-for-length percentile was 64 ± 26. On average, mothers wanted to be one body figure smaller than their perceived current body size. Most mothers (82%) accurately perceived their infant's weight classification while few overestimated (7%) or underestimated (11%) their child's weight category. The probability of mothers misperceiving their infant's weight classification increased as maternal body dissatisfaction increased in either extreme in unadjusted (P < .05) and adjusted analysis (P = .06). CONCLUSIONS Increased maternal body dissatisfaction may be associated with mother's misperception of infant weight classification. Future studies should examine this relationship in a heterogeneous population.
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Affiliation(s)
- Amrik Singh Khalsa
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (AS Khalsa), Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine (AS Khalsa), Columbus, Ohio.
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (KA Copeland), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (KA Copeland, RY Kharofa, and NJ Ollberding), Cincinnati, Ohio
| | - Lauren Misik
- Northeast Ohio Medical University, College of Medicine (L Misik), Rootstown, Ohio
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University School of Medicine (CL Brown), Winston-Salem, NC
| | - Roohi Y Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine (KA Copeland, RY Kharofa, and NJ Ollberding), Cincinnati, Ohio; The Heart Institute, Cincinnati Children's Hospital Medical Center (RY Kharofa), Cincinnati, Ohio
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine (KA Copeland, RY Kharofa, and NJ Ollberding), Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center (NJ Ollberding), Cincinnati, Ohio
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Brown CL, Howard JB, Perrin EM. A randomized controlled trial examining an exam room poster to prompt communication about weight. Pediatr Obes 2020; 15:e12625. [PMID: 32072772 PMCID: PMC8394047 DOI: 10.1111/ijpo.12625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/19/2019] [Accepted: 01/20/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recognition of childhood weight status is important to the adoption of healthy lifestyle behaviours. OBJECTIVES We assessed whether an exam room educational poster addressing weight and healthy lifestyle behaviours was acceptable to parents, prompted parent-provider communication or improved parental weight perception accuracy. METHODS In this multi-site randomized controlled trial, exam rooms were randomized to display the posters (English and Spanish) or not. Children ages 3 to 8 years (N = 965) attending well visits were weighed and roomed per usual clinic protocol. After the visit, parents completed a questionnaire assessing demographics, child weight status perceptions and whether they discussed weight status with provider or were shown growth charts. We used separate logistic regression analyses to examine associations between intervention status and: asking provider about child weight, being shown growth charts, and accuracy of weight perception, adjusting for covariates and clustering by exam room. RESULTS Of the parents who saw the poster, 97% liked seeing it and reported greater understanding of weight status visualization (96%) and healthy lifestyle behaviours (94%). Parents who saw the poster were more likely to report being shown a growth chart (OR 1.87, 95% 1.06, 3.30) but were not more likely to ask about their child's weight status nor accurately report their child's weight status. CONCLUSIONS An educational exam room poster about healthy weight was well-received by parents and prompted providers to show the child's growth chart but did not prompt parent-initiated conversations about weight status nor improve parental weight perception accuracy.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Janna B. Howard
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | - Eliana M. Perrin
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
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Abstract
Background: Little is known about factors that affect a family's ability to engage in pediatric weight management clinics (PWMCs). We aimed at comparing child and family characteristics of patients referred to a PWMC by participants' attendance at orientation, attendance at intake, or completing the program. Methods: We performed a retrospective study of patients ages 2-18 years referred to a PWMC between 2014 and 2017. We extracted data from electronic medical records and clinic databases, including age, sex, race/ethnicity, language, referral year, address, and insurance. We performed t-tests and chi-square tests to examine the association of engagement outcomes with covariates. We used separate multivariate logistic regression models to assess the predictors of engagement outcomes, including significant covariates from bivariate analyses. Results: Participants (N = 2020 referred) had a mean age of 11.5 ± 3.5 years; 72% had Medicaid, and 34% lived in city limits. Participants were 39% white, 30% black, and 27% Hispanic. Of those referred, 41% attended orientation, 14% attended intake, and 9% completed. Significant predictors of attending orientation were age [odds ratio (OR): 0.93, 95% confidence interval (CI): 0.91-0.96], male sex (OR: 0.74, 95% CI: 0.60-0.91), Hispanic ethnicity (OR: 1.69, 95% CI: 1.26-2.26), living in city limits (OR: 1.39, 95% CI: 1.11-1.75), and Medicaid (OR: 0.77, 95% CI: 0.60-0.98). Significant predictors of attending intake were age (OR: 0.93, 95% CI: 0.90-0.96), Medicaid (OR: 0.61, 95% CI: 0.46-0.81), and 2017 referral year (OR: 0.21, 95% CI: 0.12-0.35). Hispanic ethnicity was associated with twice the odds of completion (OR: 2.07, 95% CI: 1.10-3.91). Conclusions: Child and family characteristics more strongly predicted initial engagement with a PWMC than completion. Future research should examine how targeting these predictors (e.g., referring at younger age) can improve PWMC engagement.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Address correspondence to: Callie L. Brown, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jaclyn Dovico
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dara Garner-Edwards
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Melissa Moses
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
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McLaurin-Jiang S, Cohen GM, Brown CL, Edwards P, Albertini LW. Integrated Mental Health Training Relates to Pediatric Residents' Confidence with Child Mental Health Disorders. Acad Psychiatry 2020; 44:299-304. [PMID: 31965516 DOI: 10.1007/s40596-020-01182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the association of an integrated mental health training model on pediatric residents' use of (1) secondary screens, (2) mental health referrals, (3) psychotropic medications, and (4) follow-up appointments for mental health concerns. The secondary aim was to determine resident confidence managing mental health conditions. METHODS Visits of children ages 6-18 years old with either a positive primary mental health screen or a mental health diagnosis in pre- and post-intervention years (N = 113 and N = 251, respectively) at a single-site continuity clinic were included. Authors also surveyed alumni from pre- and post- intervention years (N = 46) about their confidence with managing mental health disorders. The authors used chi-squared and t-tests to compare visit characteristics between years and multivariable logistic regression to determine correlates of mental health management. RESULTS Post-intervention residents more often used secondary screening tools (adjusted odds ratio 5.61, 95% confidence interval 2.08-15.17). There were no differences in referrals, prescribing psychotropic medications, or follow-up visits. Post-intervention graduates reported higher confidence with diagnosis, screening, medication management, and follow-up for mental health disorders. CONCLUSIONS After transitioning to an integrated mental health model, residents were more likely to use secondary screens and post-intervention graduates reported higher confidence with managing mental health disorders.
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Affiliation(s)
- Skyler McLaurin-Jiang
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Gail M Cohen
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Pratt KJ, Skelton JA, Lewis KH, Taylor CA, Spees C, Brown CL. Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children. J Nutr Educ Behav 2020; 52:579-587. [PMID: 32527416 PMCID: PMC10173866 DOI: 10.1016/j.jneb.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children. DESIGN Cross-sectional survey. SETTING Two US weight management centers. PARTICIPANTS 259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2-18 years) MAIN OUTCOME MEASURE(S): Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation. ANALYSIS Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates. RESULTS Patients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021). CONCLUSIONS AND IMPLICATIONS Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.
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Affiliation(s)
- Keeley J Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH; Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, OH.
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston Salem, NC; Department of Epidemiology and Prevention, Wake Forest University, Winston Salem, NC
| | - Kristina H Lewis
- Department of Epidemiology and Prevention, Wake Forest University, Winston Salem, NC
| | - Christopher A Taylor
- Medical Dietetics Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Colleen Spees
- Medical Dietetics Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University, Winston Salem, NC
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Albright CA, Pratt KJ, Martin SB, Hulshult H, Brown CL, Lewis KH, Skelton JA. Family members' experiences with adult participation in weight management programs: Triadic perspectives from patients, partners and children. Clin Obes 2020; 10:e12354. [PMID: 31965733 PMCID: PMC9107074 DOI: 10.1111/cob.12354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Spouses are known to influence the outcomes of an individual's attempt at weight loss, but little is known about the broader influence of, and on, the family. The objectives were to explore: (a) the effects of an adult weight management program on the family and (b) family factors that help or hinder patient weight loss. METHODS A qualitative design was employed to explore triadic family members' experiences of patient participation in a weight management program. Semi-structured interviews were conducted with patients, partners and children (ages 7-18). Questions included support for patient participation and weight loss, dietary choices, meal preparation, physical activity routines, the home-food environment, communication about health and family dynamics. Thematic analysis was used, where codes and categories of codes were then grouped together to create themes and subthemes. RESULTS Nineteen triadic interviews were conducted (57 total). Seven themes emerged, including four related to Outcomes (objective 1): (a) shift in family dynamics, (b) family behaviour change, (c) child observations of family change, (d) indirect benefit to partner; and three related to Process (objective 2): (e) level of accountability, (f) patient perception of support and (g) support is essential and flexible. CONCLUSIONS Future research and clinical applications from these themes should seek to determine the positive behaviour change that was evident in the families that were interviewed, where the culmination of family interactions, expectations and concurrent partner weight loss indicates the potential longevity of weight management programs beyond patients' own participation.
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Affiliation(s)
| | - Keeley J. Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Sarah B. Martin
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Palakshappa D, Goodpasture M, Albertini L, Brown CL, Montez K, Skelton JA. Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic. Acad Pediatr 2020; 20:203-207. [PMID: 31629943 PMCID: PMC7036321 DOI: 10.1016/j.acap.2019.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Clinics are increasingly interested in identifying food insecurity (FI), but there are limited data on how to implement FI screening. Our objective was to determine the difference in FI disclosure rates by parents/guardians screened by a written questionnaire compared to verbally. METHODS The study occurred in 1 pediatric primary care clinic in which we screened for FI using the 2-item Hunger Vital Sign. We used interrupted time series to evaluate the effect of changing from the clinician verbal screening to a written questionnaire. Screening results were extracted for all well-child visits from 4/2017 to 10/2018 for children age 0 to 18 years. The outcome was the proportion who screened positive for FI 9 months before and 9 months after the implementation of the written questionnaire. We estimated the difference in the level and trend of positive screens using ordinary least squares regression using Newey-West standard errors and adjusting for autocorrelation. RESULTS In 7996 well-child visits, 1141 patients (14.3%) screened positive. In bivariate analysis, there was a significant difference in the FI disclosure rates between patients screened by written questionnaire compared to verbally (16.3% vs 10.4%, P < .001). In interrupted time series, changing to the written questionnaire was associated with a significant increase in FI disclosure rates (β = .04, 95% confidence interval: 0.01, 0.07; P = .02). There was no significant change in the trend in disclosure rates. DISCUSSION Multiple barriers exist to effectively implementing FI screening in clinical care. Changing from a verbal to a written questionnaire resulted in an immediate and significant increase in the number of parents/guardians who reported FI.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine (D Palakshappa), Winston-Salem, NC; Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC.
| | - Meggan Goodpasture
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC
| | - Laurie Albertini
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC
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Dovico JM, Palmer RJ, Perrin EM, Brown CL. Food Insecurity Associated With Underestimation of Weight Status in Children With a Healthy Weight. Acad Pediatr 2020; 20:188-192. [PMID: 31029740 PMCID: PMC8404410 DOI: 10.1016/j.acap.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/12/2019] [Accepted: 04/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Accurate parental weight perception of one's child is an important step in addressing healthy behaviors, but its associations with socioeconomic status (SES) and household food insecurity (HFI) are unclear. We aimed to assess the association of parental weight perception with HFI. METHODS This was a secondary data analysis of a cross-sectional study of 284 children ages 2 to 8 years whose parents completed surveys about weight perception, SES, and HFI. Height and weight were measured to determine the children's body mass index scores and were self-reported by parents. We performed chi-square tests to compare HFI and accuracy of parental weight perception and used logistic regression to assess accuracy, adjusting for significant covariates and stratifying by child weight category. RESULTS Approximately two thirds of children had healthy weight, 18% had overweight, and 15% had obesity. About one third of parents inaccurately identified their child's weight category, almost always underestimating weight status. Twenty-eight percent of the families were food insecure. HFI was not associated with parental weight perception in bivariate analysis. When stratified by weight status, food insecure families with children at healthy weight had 0.16 times the odds of accurately perceiving their children's weight status. There was no association between HFI and accuracy of weight perception in children with overweight or obesity. CONCLUSIONS Food insecurity was associated with a decrease in the accuracy of parental weight perceptions in children with healthy weight. Pediatricians should clearly communicate about weight status, as families with HFI may adopt unhealthy eating behaviors under the incorrect assumption that their child is underweight.
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Affiliation(s)
- Jaclyn M Dovico
- Department of Pediatrics (JM Dovico and RJ Palmer), Wake Forest School of Medicine, Winston-Salem, NC
| | - Rebecca J Palmer
- Department of Pediatrics (JM Dovico and RJ Palmer), Wake Forest School of Medicine, Winston-Salem, NC
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin and CL Brown), University of North Carolina at Chapel Hill; EM Perrin is now with the Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC
| | - Callie L Brown
- Department of Pediatrics (EM Perrin and CL Brown), University of North Carolina at Chapel Hill; CL Brown is now with the Departments of Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
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Bishop AM, Dubel AK, Sattler R, Brown CL, Horning M. Wanted dead or alive: characterizing likelihood of juvenile Steller sea lion predation from diving and space use patterns. ENDANGER SPECIES RES 2019. [DOI: 10.3354/esr00999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nixon PA, Shaltout HA, South AM, Jensen ET, O'Shea TM, Brown CL, Washburn LK. Antenatal Steroid Exposure, Aerobic Fitness, and Physical Activity in Adolescents Born Preterm with Very Low Birth Weight. J Pediatr 2019; 215:98-106.e2. [PMID: 31604627 PMCID: PMC6920012 DOI: 10.1016/j.jpeds.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether antenatal corticosteroid exposure is associated with aerobic fitness or physical activity participation in adolescents born preterm with very low birth weight (VLBW). STUDY DESIGN Observational cohort study of 14-year-old adolescents (n = 173) born with VLBW between 1992 and 1996 at a regional perinatal center with 91 exposed to antenatal corticosteroids. Aerobic fitness was determined from peak oxygen uptake (V˙O2peak) obtained via maximal exercise testing on a cycle ergometer. Physical activity levels for the past year and past 2 months were estimated from a questionnaire. Between-group comparisons for continuous variables were evaluated using independent t tests or Mann-Whitney U tests. Generalized linear models were used to compare differences in fitness and physical activity between those exposed to antenatal corticosteroids and not exposed to antenatal corticosteroids, with race and sex in models. RESULTS Regression analysis revealed an antenatal corticosteroids × sex × race interaction for V˙O2peak (P ≤ .001). Nonblack male adolescents exposed to antenatal corticosteroids had significantly greater V˙O2peak than nonblack male adolescents not exposed to antenatal corticosteroids expressed relative to body mass (mean difference [95% CI]; 8.5 [2.1-15.0] mL·kg-1·min-1) and lean body mass (9.0 [1.1-16.9] mL·kglean body mass-1·min-1). No antenatal corticosteroid group differences in V˙O2peak were evident in black male adolescents, or black and nonblack female adolescents. Male adolescents exposed to antenatal corticosteroids reported participating in significantly more total physical activity (medians: 14.6 vs 8.5) and vigorous physical activity (3.0 vs 0.95) per week for the past 2 months than male adolescents not exposed to antenatal corticosteroids. CONCLUSIONS Exposure to antenatal corticosteroids was associated with greater physical activity participation and aerobic fitness in adolescents with VLBW, particularly in nonblack male adolescents, which may confer health benefits in this at-risk population.
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Affiliation(s)
- Patricia A Nixon
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC; Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC.
| | - Hossam A Shaltout
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston Salem, NC; Department of Pharmacology and Toxicology, School of Pharmacy, University of Alexandria, Alexandria, Egypt
| | - Andrew M South
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC
| | - Lisa K Washburn
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC
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Eagleton SG, Brown CL, Moses MJ, Skelton JA. Restrictive feeding and excessive hunger in young children with obesity: A case series. Clin Case Rep 2019; 7:1962-1967. [PMID: 31624618 PMCID: PMC6787779 DOI: 10.1002/ccr3.2411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/03/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
Treatment recommendations for childhood obesity include guidance to reduce portions and the consumption of high-energy-dense foods. These messages may unintentionally promote restrictive feeding among parents of children with obesity with excessive hunger. Clinical guidance may benefit from framing treatment messages to parents in the context of a nonrestrictive feeding style.
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Affiliation(s)
- Sally G. Eagleton
- Center for Childhood Obesity ResearchPenn State College of Health and Human DevelopmentUniversity ParkPA
- Department of Nutritional SciencesPenn State College of Health and Human DevelopmentUniversity ParkPA
| | - Callie L. Brown
- Department of PediatricsWake Forest School of MedicineWinston‐SalemNC
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNC
| | - Melissa J. Moses
- Brenner FIT (Families In Training) ProgramBrenner Children's HospitalWake Forest Baptist HealthWinston‐SalemNC
| | - Joseph A. Skelton
- Department of PediatricsWake Forest School of MedicineWinston‐SalemNC
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNC
- Brenner FIT (Families In Training) ProgramBrenner Children's HospitalWake Forest Baptist HealthWinston‐SalemNC
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Abstract
Background: Family members influence the behaviors and weight loss of adults in weight management programs (WMPs). Less is known about the weight control practices of children who have a parent participating in a WMP. Thus, we aimed to explore weight control practices in children of parents in WMPs. Methods: We recruited participants who were parents of least one child aged 2-18 living at home from two institution's adult WMPs. Parents reported weight control practices for themselves and their child. We used separate logistic regression models to assess the association of each child weight control practice with parent weight control practice; child age, race, sex, and BMI z-score (BMIz); parent education; and household income. Results: Parents (N = 300) had a mean age of 41 ± 7 and 85% were female. Children (N = 295) had a mean age of 9.3 ± 4.9; 20% had overweight or obesity. Parents reported their child used the following weight control practices in the past year: 12% dieted, 12% ate very little food, 7% used food substitutes, 10% skipped meals, 29% increased fruit and vegetables, 25% reduced calories, 22% reduced snacking, 21% reduced fat intake, and 45% exercised. Children were more likely to utilize weight control practices if their parent utilized the same weight control practice and if children had obesity and were older. Conclusions: Children of parents attending WMPs commonly utilize weight control practices, especially older children with higher BMIz. Adult WMPs should offer guidance to parents on ways to incorporate new healthy dietary practices into their family.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
- Address correspondence to: Callie L. Brown, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157
| | - Keeley Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH
| | - Sarah Martin
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hannah Hulshult
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
- Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC
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Pratt KJ, Ferriby M, Brown CL, Noria S, Needleman B, Skelton JA. Adult weight management patients' perceptions of family dynamics and weight status. Clin Obes 2019; 9:e12326. [PMID: 31232524 PMCID: PMC10179550 DOI: 10.1111/cob.12326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 01/26/2023]
Abstract
Our overall objective was to describe the parent-child, romantic, and family dynamics of adult weight management program (WMP) patients, and associations with children's and partners' weight status. First, we determined if family functioning mediated the effect between parent-child feeding practices and perceived child weight status, and romantic relationship anxiety and avoidance and perceived partner weight status. Second, we assessed if perceived child and partner weight status moderated the associations between family functioning and parent-child feeding practices and romantic relationship anxiety and avoidance, respectively. Patients (N=203) who resided with a child and partner from two WMPs completed assessments of parent-child feeding practices (Child Feeding Questionnaire), romantic relationship anxiety and avoidance (Relationship Structures Questionnaire), family functioning (Family Assessment Device General Functioning Scale), and perceived child and partner weight status. Bivariate analyses determined differences in weight status and relationship dynamics and family functioning, and mediation and moderation analyses were conducted to answer the two research questions. Family functioning was not a mediator between romantic relationship dynamics and partner weight status or parent-child dynamics and child weight status. Lower family functioning was associated with higher parent-child restrictive feeding practices, only among children with overweight/obesity. Similarly, lower family functioning was associated with higher anxiety and avoidance in romantic relationships, only for partners with overweight/obesity. Patients with children and/or partners with overweight/obesity reported more impaired family dynamics and functioning, compared to patients with children and/or partners with a healthy weight status.
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Affiliation(s)
- Keeley J Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
- Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Megan Ferriby
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University, Winston Salem, North Carolina
| | - Sabrena Noria
- Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Bradley Needleman
- Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston Salem, North Carolina
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South AM, Palakshappa D, Brown CL. Relationship between food insecurity and high blood pressure in a national sample of children and adolescents. Pediatr Nephrol 2019; 34:1583-1590. [PMID: 31025108 PMCID: PMC6660989 DOI: 10.1007/s00467-019-04253-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine the relationship between food insecurity (FI) and high blood pressure (BP) in a national cohort of children and adolescents. METHODS A cross-sectional analysis of children aged 8-17 years in the 2007-2014 National Health and Nutrition Examination Survey (NHANES; unweighted N = 7125). FI over the preceding 12 months was assessed using the USDA Household Food Security Scale in NHANES. We defined high BP as (i) systolic or diastolic BP ≥ 90% for age < 13 years or ≥ 120/80 mmHg for age ≥ 13 years measured at one visit or (ii) reported hypertension diagnosis or current antihypertensive medication use. We used multivariable logistic regression to determine the association between household and child-specific FI and high BP, controlling for age, sex, race, and household income, accounting for the complex NHANES survey design. RESULTS The study population was 14.4% black, 21.3% Hispanic, and 49.4% female with a mean age of 12.6 years (SD 2.9). 20.3% had FI and 12.8% had high BP. High BP was more common in household FI vs. food-secure subjects (15.3% vs. 12.1%, p = 0.003). Adjusted analysis confirmed that household FI and child FI were associated with high BP (OR 1.26, 95% CI 1.04-1.54; OR 1.42, 95% CI 1.03-1.96, respectively). CONCLUSIONS Household and child FI were associated with an increased likelihood of high BP in a large nationally representative cohort of children and adolescents. FI may have a significant impact on cardiovascular health during childhood. Further research is warranted to better define how FI contributes to health disparities.
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Affiliation(s)
- Andrew M. South
- Department of Pediatrics, Wake Forest School of Medicine,Department of Epidemiology and Prevention, Wake Forest School of Medicine,Cardiovascular Sciences Center, Wake Forest School of Medicine
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine,Department of Epidemiology and Prevention, Wake Forest School of Medicine,Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine,Department of Epidemiology and Prevention, Wake Forest School of Medicine
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Abstract
We assessed the individual constructs that comprise "picky eaters" and determined the relationship of each construct to parental perception of their child's weight status, parental pressure-to-eat, and the child's body mass index z-score (BMIz). We developed a questionnaire including 7 commonly used measures of picky eating, which was completed by parents of 2-8 year-olds in pediatric clinics. We performed exploratory factor analysis, confirmatory factor analysis, and model fit. Regression models assessed the association of each picky eating factor to weight perception, pressure-to-eat, and BMIz. We identified three distinct picky eating factors: trying new foods, eating sufficient quantity, and desire for specific food preparation. Each factor had Cronbach's alpha > 0.7 and acceptable model fit. No factors were associated with weight perception. Parents who were more concerned their child did not eat enough were more likely to pressure-to-eat, and these children had lower BMIz. These components of picky eating should be addressed by primary care providers.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Eliana M Perrin
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
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Wood CT, Skinner AC, Brown JD, Brown CL, Howard JB, Steiner MJ, Perrin AJ, Levine C, Ravanbakht SN, Perrin EM. Concordance of Child and Parent Reports of Children's Screen Media Use. Acad Pediatr 2019; 19:529-533. [PMID: 30981024 PMCID: PMC6612580 DOI: 10.1016/j.acap.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 04/06/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Little is known about the concordance of parent and child reports of children's media consumption, even though parents are often asked to report for their children in clinical care settings. Our objective was to understand how parent and child reports of children's media consumption differ in an era of changing screen media consumption via personal devices. METHODS As part of a larger study about the reception of health-related cues from children's media, children ages 9 to 11 years (N = 114) and their parents independently completed identical questionnaires about specific media use and health behaviors. To examine concordance between child and parent reports of children's screen media use, we calculated the mean number of minutes per day and proportions reported by the child and parent and assessed concordance with t-tests and chi-square tests. RESULTS On a typical day, children reported nearly an hour each of video and app game use, computer use, and television exposure. Overall, child and parent reports were similar, usually within 10 minutes of each other; however, among 3 measures of TV use, parents consistently reported less TV exposure than children. There was significant discordance in the percentages of parents and children reporting the presence of a TV in the child's room. CONCLUSIONS Parent and child reports of children's media use were generally concordant; however, there were important disagreements, such as TV use in the child's room and during meals. We discuss possible causes of discrepancies and implications.
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Affiliation(s)
- Charles T Wood
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics (CT Wood, JB Howard, and EM Perrin),; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (CT Wood, CL Brown, JB Howard, MJ Steiner, and EM Perrin),.
| | - Asheley Cockrell Skinner
- Department of Population Health Sciences (AC Skinner), Duke University School of Medicine; Duke Clinical Research Institute (AC Skinner), Durham, NC
| | | | - Callie L Brown
- School of Media and Journalism (JD Brown),; Department of Pediatrics (CL Brown), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Janna B Howard
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics (CT Wood, JB Howard, and EM Perrin),; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (CT Wood, CL Brown, JB Howard, MJ Steiner, and EM Perrin)
| | - Michael J Steiner
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (CT Wood, CL Brown, JB Howard, MJ Steiner, and EM Perrin)
| | | | - Cary Levine
- Department of Art and Art History (C Levine)
| | - Sophie N Ravanbakht
- Department of Health Policy and Management, Gillings School of Global Public Health (SN Ravanbakht), University of North Carolina at Chapel Hill
| | - Eliana M Perrin
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics (CT Wood, JB Howard, and EM Perrin),; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (CT Wood, CL Brown, JB Howard, MJ Steiner, and EM Perrin)
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Marsh MC, Supples S, McLaurin-Jiang S, Brown CL, Linton JM. Introducing the Concepts of Advocacy and Social Determinants of Health Within the Pediatric Clerkship. MedEdPORTAL 2019; 15:10798. [PMID: 30800998 PMCID: PMC6376941 DOI: 10.15766/mep_2374-8265.10798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/14/2018] [Indexed: 05/30/2023]
Abstract
Introduction Although advocacy and social determinants of health (SDH) are fundamental components of pediatrics and other areas of health care, medical education often lacks formal training about these topics and the role of health care professionals as advocates. SDH are common targets of advocacy initiatives; however, little is known about optimal ways to incorporate this content into medical education curricula. Methods We developed a lecture and assessment for third-year medical students that included interactive discussion of advocacy, SDH issues specific to children, and opportunities for learners to engage in advocacy. Learners attended the lecture during the pediatric clerkship. Over the course of a year, questionnaires assessing knowledge of advocacy, SDH, and incorporation of advocacy into practice were administered to 75 students before the lecture and as the clerkship ended. We used chi-square and Fisher's exact tests to compare knowledge before and after the lecture. Results Students showed significant improvement on most individual questions and overall passing rates. Learners provided positive feedback on the quality of the lecture material and demonstrated interest in engaging in current advocacy projects to address SDH. Discussion As recognition of the importance of advocacy and SDH increases, the development of educational tools for teaching this information is critical. Our lecture produced significant improvement in knowledge of these topics and was well received by students. Early introduction to advocacy and SDH during relevant clinical rotations emphasizes the importance of these topics and may establish a foundation of advocacy as fundamental to health care.
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Affiliation(s)
- Melanie C. Marsh
- Pediatric Resident, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Sarah Supples
- Pediatric Resident, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Skyler McLaurin-Jiang
- Instructor, Department of Pediatrics, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Callie L. Brown
- Assistant Professor, Department of Pediatrics, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
- Assistant Professor, Department of Epidemiology and Prevention, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Julie M. Linton
- Assistant Professor, Department of Pediatrics, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
- Associate Director, Integrating Special Populations Program, Maya Angelou Center for Health Equity
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40
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Abstract
Despite extensive public health and clinical interventions, obesity rates remain high, and evidence-based preventive strategies are elusive. Many consensus guidelines suggest that providers should screen all children after age 2 years for obesity by measuring height and weight, calculating body mass index (BMI), and sensitively communicating weight status in the context of health to the family at each visit. However, preventive counseling should begin in infancy and focus on healthy feeding, activity, and family lifestyle behaviors. For children with overweight or obesity, the American Academy of Pediatrics outlines 4 stages of treatment: 1) Primary care providers should offer "prevention plus," the use of motivational interviewing to achieve healthy lifestyle modifications in family behaviors or environments; 2) children requiring the next level of obesity treatment, structured weight management, need additional support beyond the primary care provider (such as a dietitian, physical therapist, or mental health counselor) and more structured goal setting with the team, including providers adept at weight management counseling; 3) children with severe obesity and motivated families may benefit from referral to a comprehensive multidisciplinary intervention, such as an obesity treatment clinic; and 4) tertiary care interventions are provided in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols for evaluation of interventions, including medications and surgery. Although it is certainly a challenge for providers to fit in all the desired prevention and treatment counseling during preventive health visits, by beginning to provide anticipatory guidance at birth, providers can respond to parents' questions, add to parents' knowledge base, and partner with parents and children and adolescents to help them grow up healthy. This is especially important in an increasingly toxic food environment with numerous incentives and messages to eat unhealthfully, barriers to appropriate physical activity, and concomitant stigma about obesity. Focusing on key nutrition and physical activity habits and establishing these healthy behaviors at an early age will allow children to develop a healthy growth trajectory. However, much more work is needed to determine the best evidence-based practices for providers to counsel families on improving target behaviors, environmental modifications, and parenting skills and to decrease abundant disparities in obesity prevalence and treatment.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC.
| | - Eliana M Perrin
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC
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Oseledchyk A, Leitao MM, Konner J, O'Cearbhaill RE, Zamarin D, Sonoda Y, Gardner GJ, Long Roche K, Aghajanian CA, Grisham RN, Brown CL, Snyder A, Chi DS, Soslow RA, Abu-Rustum NR, Zivanovic O. Adjuvant chemotherapy in patients with stage I endometrioid or clear cell ovarian cancer in the platinum era: a Surveillance, Epidemiology, and End Results Cohort Study, 2000-2013. Ann Oncol 2018; 28:2985-2993. [PMID: 28950307 DOI: 10.1093/annonc/mdx525] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background We sought to evaluate the impact of adjuvant chemotherapy on overall survival (OS) in patients with stage I endometrioid epithelial ovarian cancer (EEOC) or ovarian clear cell cancer (OCCC) using a national database. Patients and methods The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I EEOC or OCCC from 2000 to 2013. We sought to identify predictors of chemotherapy use and to assess the impact of chemotherapy on OS in these patients. OS was compared using the log-rank test and the Cox proportional hazards model. Results In all, 3552 patients with FIGO stage I EEOC and 1995 patients with stage I OCCC were identified. Of the 1600 patients (45%) with EEOC who underwent adjuvant chemotherapy, the 5-year OS rate was 90%, compared with 89% for those who did not undergo adjuvant chemotherapy (P = 0.807). Of the 1374 (69%) patients with OCCC who underwent adjuvant chemotherapy, the 5-year OS rate was 85%, compared with 83% (P = 0.439) for those who did not undergo adjuvant chemotherapy. Chemotherapy use was associated with younger age, higher substage, and more recent year of diagnosis for both the EEOC and OCCC groups. Only in the subgroup of patients with FIGO substage IC, grade 3 EEOC (n = 282) was chemotherapy associated with an improved 5-year OS-81% compared with 62% (P = 0.003) in untreated patients (HR: 0.583; 95% CI: 0.359-0.949; P = 0.030). In patients with OCCC, there was no significant effect of adjuvant chemotherapy on OS in any substage. Conclusions Adjuvant chemotherapy was associated with improved OS only in patients with substage IC, grade 3 EEOC. In stage I OCCC, adjuvant chemotherapy was not associated with improved OS.
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Affiliation(s)
- A Oseledchyk
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - M M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - J Konner
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, New York
| | - R E O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, New York
| | - D Zamarin
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, New York
| | - Y Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - G J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - K Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - C A Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, New York
| | - R N Grisham
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, New York
| | - C L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - A Snyder
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, New York
| | - D S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - R A Soslow
- Gynecologic Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - N R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
| | - O Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.,Department of OB/GYN, Weill Cornell Medical College, New York
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Brown CL, Perrin EM, Peterson KE, Brophy Herb HE, Horodynski MA, Contreras D, Miller AL, Appugliese DP, Ball SC, Lumeng JC. Association of Picky Eating With Weight Status and Dietary Quality Among Low-Income Preschoolers. Acad Pediatr 2018; 18:334-341. [PMID: 28887030 PMCID: PMC5837907 DOI: 10.1016/j.acap.2017.08.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake. METHODS This was a cross-sectional analysis of baseline data from a randomized controlled trial to prevent obesity among 506 preschoolers attending Head Start. Parents completed questionnaires to assess picky eating and child temperament. Three 24-hour dietary recalls were collected to assess dietary intake. Multivariate regression models assessed child, parent, and family predictors of picky eating; additional models tested adjusted associations of picky eating with child BMIz, dietary quality (measured using the Healthy Eating Index-2010), and micronutrient intake. RESULTS Picky eating was predicted by male sex, older child age, and more difficult temperament but not race/ethnicity, maternal body mass index, maternal depressive symptoms, household food insecurity, or single parent home. Picky eating was not associated with child BMIz or micronutrient deficiencies; it was inversely associated with total Healthy Eating Index-2010 score and servings of whole fruit, total vegetables, greens and beans, and total protein foods. CONCLUSIONS Pediatric providers should support parents in expanding the number of healthy foods the child eats to improve dietary quality, but reassure parents that picky eating is not associated with children's weight status or micronutrient deficiencies.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Eliana M Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine
| | - Karen E Peterson
- Center for Human Growth and Development, University of Michigan; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor; Department of Nutrition, Harvard W.T. Chan School of Public Health, Boston, Mass
| | - Holly E Brophy Herb
- Department of Human Development and Family Studies, Michigan State University, East Lansing
| | | | - Dawn Contreras
- Department of Human Development and Family Studies, Michigan State University, East Lansing; Health and Nutrition Institute, Michigan State University Extension, East Lansing
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | | | - Sarah C Ball
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor; Department of Pediatrics, University of Michigan Medical School, Ann Arbor
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Jenkins BJ, Newell MS, Goode AW, Boucher BJ, Monson JP, Brown CL. Impact of Conventional and Three-Dimensional Thallium-Technetium Scans on Surgery for Primary Hyperparathyroidism. J R Soc Med 2018; 83:427-9. [PMID: 2168488 PMCID: PMC1292729 DOI: 10.1177/014107689008300705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Twenty-nine patients with primary hyperparathyroidism underwent double-tracer subtraction scanning after injection of 201Tl as thallous chloride for thyroid and parathyroid images followed by 99mtechnetium as sodium pertechnetate for thyroid images prior to surgical exploration of the neck. The operative findings were correlated with the scans. All 23 adenomas (100%) and 13 of 18 (72%) hyperplastic glands were correctly localized. The ability of the scan to identify abnormal parathyroids was determined by the gland mass rather than whether the tissue was adenomatous or hyperplastic as all 32 (100%) abnormal glands weighing more than 180 mg were successfully localized in contrast to four of nine (44%) glands weighing less than 180 mg. An additional technique, in which emission tomography was carried out after subtraction scintigraphy, was used on 11 patients in the series. In all 11, the site of a single abnormal gland was predicted by the conventional subtraction scan: in nine of these patients, emission tomography provided additional localization of the gland in the anteroposterior plane.
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Jonas DE, Amick HR, Wallace IF, Feltner C, Vander Schaaf EB, Brown CL, Baker C. Vision Screening in Children Aged 6 Months to 5 Years: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2017; 318:845-858. [PMID: 28873167 DOI: 10.1001/jama.2017.9900] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Preschool vision screening could allow detection and treatment of vision abnormalities during a critical developmental stage, preserving function and quality of life. OBJECTIVE To review the evidence on screening for and treatment of amblyopia, its risk factors, and refractive error in children aged 6 months to 5 years to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, Cochrane Library, CINAHL, and trial registries through June 2016; references; and experts, with surveillance of the literature through June 7, 2017. STUDY SELECTION English-language randomized clinical trials (RCTs) or prospective cohort studies that evaluated screening, studies evaluating test accuracy, RCTs of treatment vs inactive controls, and cohort studies or case-control studies assessing harms. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Studies were not quantitatively pooled because of clinical and methodological heterogeneity. MAIN OUTCOMES AND MEASURES Visual acuity, amblyopia, school performance, functioning, quality of life, test accuracy, testability, and harms. RESULTS Forty studies were included (N = 34 709); 34 evaluated test accuracy. No RCTs compared screening with no screening, and no studies evaluated school performance, function, or quality of life. Studies directly assessing earlier or more intensive screening were limited by high attrition. Positive likelihood ratios were between 5 and 10 for amblyopia risk factors or nonamblyogenic refractive error in most studies of test accuracy and were greater than 10 in most studies evaluating combinations of clinical tests. Inability to cooperate may limit use of some tests in children younger than 3 years. Studies with low prevalence (<10%) of vision abnormalities showed high false-positive rates (usually >75%). Among children with amblyopia risk factors (eg, strabismus or anisometropia), patching improved visual acuity of the amblyopic eye by a mean of less than 1 line on a standard chart after 5 to 12 weeks for children pretreated with glasses (2 RCTs, 240 participants); more children treated with patching than with no patching experienced improvement of at least 2 lines (45% vs 21%; P = .003; 1 RCT, 180 participants). Patching plus glasses improved visual acuity by about 1 line after 1 year (0.11 logMAR [95% CI, 0.05-0.17]) for children not pretreated with glasses (1 RCT, 177 participants). Glasses alone improved visual acuity by less than 1 line after 1 year (0.08 logMAR [95% CI, 0.02-0.15], 1 RCT, 177 participants). CONCLUSIONS AND RELEVANCE Studies directly evaluating the effectiveness of screening were limited and do not establish whether vision screening in preschool children is better than no screening. Indirect evidence supports the utility of multiple screening tests for identifying preschool children at higher risk for vision problems and the effectiveness of some treatments for improving visual acuity outcomes.
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Affiliation(s)
- Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC)
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | | | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC)
- RTI International, Research Triangle Park, North Carolina
| | - Cynthia Feltner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC)
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | | | - Callie L Brown
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Claire Baker
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC)
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
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Brown CL, Skelton JA. Opportunities and Cautions in the Use of Commercially Delivered Weight-Management Programs for Children and Adolescents. J Pediatr 2017; 185:12-14. [PMID: 28318528 DOI: 10.1016/j.jpeds.2017.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Callie L Brown
- Department of Pediatrics Department of Epidemiology and Prevention Wake Forest School of Medicine; Brenner FIT (Families In Training) Program Brenner Children's Hospital Winston-Salem, North Carolina.
| | - Joseph A Skelton
- Department of Pediatrics Department of Epidemiology and Prevention Wake Forest School of Medicine; Brenner FIT (Families In Training) Program Brenner Children's Hospital Winston-Salem, North Carolina
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Abstract
BACKGROUND Picky eating and food neophobia are common during childhood. Childhood eating behaviors are often predictive of adult eating behaviors. OBJECTIVES Determine if childhood picky eating or food neophobia is associated with childhood weight status, or with becoming underweight, overweight, or obese later in childhood. DATA SOURCES We identified relevant studies from searches of PubMed, PsycINFO, and NEOHAL, as well as citations from identified studies. Study Eligibility Criteria and Participants: Inclusion criteria were original research articles examining a relationship between picky eating and/or food neophobia with childhood weight status. We summarized definitions and prevalence of picky eating or food neophobia and association with weight status. STUDY APPRAISAL Two independent investigators assessed bias and confounding using the Agency for Healthcare Research and Quality's RTI Item Bank. RESULTS Forty-one studies met inclusion criteria. Picky eating was defined inconsistently, and a large variation in prevalence was found (5.8%-59%). Food neophobia was consistently defined as an unwillingness to try new foods, with a prevalence between 40% and 60%. No association existed between childhood weight status and food neophobia, and results were unclear for picky eating. LIMITATIONS Risk of bias and confounding were moderate. Parental report was commonly used to assess picky eating, height, and weight and parental weight, feeding styles, and community characteristics were infrequently considered. CONCLUSIONS AND IMPLICATIONS Heterogeneous definitions used for picky eating led to a wide range of reported prevalence and an unclear relationship with weight. Consistent definitions and an improved understanding of such a relationship could help clinicians provide appropriate anticipatory guidance.
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Affiliation(s)
- Callie L. Brown
- Department of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily B. Vander Schaaf
- Department of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gail M. Cohen
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC.,Brenner FIT Program, Brenner Children's Hospital, Winston-Salem, NC
| | - Megan B. Irby
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC.,Brenner FIT Program, Brenner Children's Hospital, Winston-Salem, NC
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC.,Brenner FIT Program, Brenner Children's Hospital, Winston-Salem, NC.,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Brown CL, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater AM, Ravanbakht SN, Perrin EM. Parental Perceptions of Weight During the First Year of Life. Acad Pediatr 2016; 16:558-64. [PMID: 27002214 PMCID: PMC4976024 DOI: 10.1016/j.acap.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND More than half of parents underestimate their overweight child's weight; however, previous research focuses on children older than 2 years of age. The objective of this study was to assess whether parents of 2- to 12-month-old infants are able to accurately perceive their children's weight status. METHODS We performed a cross-sectional analysis of data collected from the Greenlight study, a cluster randomized obesity prevention trial, at 4 pediatric clinics serving diverse and low-income populations. Infants' length and weight were measured at well-child checks, and parents completed questionnaires including demographic characteristics and perception of their children's weight. Weight-for-length (WFL) percentile at the fifth to ≤95 was considered healthy weight and WFL percentile >95th was considered overweight. We used chi-squared tests to compare accuracy according to weight category and performed logistic regression analysis to assess accuracy at each time point. RESULTS Approximately 85% to 90% of infants (n = 853 at 2 months, n = 563 at 12 months) were at a healthy WFL at all measurement times, and parents of these infants were more likely to have an accurate perception of their child's weight (accuracy 89%-95%) than overweight children (accuracy 7%-26%; P < .001 across time points). Approximately 10% of healthy weight infants were perceived as underweight by their parents at all time points. At 12 months, mothers who were overweight were significantly more likely to underestimate their child's weight status (P = .008). CONCLUSIONS In our diverse and low-income sample, parents of overweight infants infrequently know that their infants are overweight. Future studies should examine how perception is related to feeding habits and weight status over time.
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Affiliation(s)
- Callie L. Brown
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Asheley C. Skinner
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - H. Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, New York, NY
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Lee M. Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA
| | - Alan M. Delamater
- Department of Pediatrics, University of Miami School of Medicine, Miami, FL
| | - Sophie N. Ravanbakht
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Abstract
Objective: To evaluate the effect of rigid foot orthoses on balance parameters in participants with clinically diagnosed excessively pronated feet. Design: Randomized clinical trial. Setting: University biomechanics laboratory. Participants: Thirty female and 20 male healthy participants (mean 23.89 ± 2.2 years old) with excessively pronated feet, according to a validated foot classification system were randomly assigned to either a control or intervention group. Interventions: Balance testing was performed using the Balance Performance Monitor with an over-the-counter rigid foot orthoses. Main outcome measures: Standing balance in the form of mean balance (measures the participants ability to stand with an even load), medial–lateral sway and anterior–posterior sway. All participants were measured while standing bipedally. Results: There was no significant mean difference in balance scores between the control and intervention group at baseline. After four weeks the results demonstrated no significant differences between mean) balance ( p > 0.05) and anterior–posterior sway ( p > 0.05). However, there was a reduction with the intervention group in medial–lateral sway ( p > 0.02). Conclusion: The use of foot orthoses in the current study may have improved postural control by stabilizing the rear foot and thus maintaining balance. By the same argument, the benefits of limiting excessive foot pronation may contribute to effective control of internal rotation of the tibia and thereby reduce counter-rotatory motion at the knee and lower leg and maintain balance.
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Affiliation(s)
- K Rome
- University of Teesside, School of Health and Social Care, Centre for Rehabilitation Sciences, Middlesbrough, UK.
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Affiliation(s)
- Callie L Brown
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Brown CL, Pesch MH, Perrin EM, Appugliese DP, Miller AL, Rosenblum K, Lumeng JC. Maternal Concern for Child Undereating. Acad Pediatr 2016; 16:777-782. [PMID: 27354196 PMCID: PMC5077664 DOI: 10.1016/j.acap.2016.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/02/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices. METHODS This was a cross-sectional analysis of an observational study with 286 mother-child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates. RESULTS Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43-0.77) and picky eating (OR = 2.41; 95% CI, 1.26-4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55-2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50-4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08-3.36) during mealtimes. CONCLUSIONS Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children.
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Affiliation(s)
- Callie L. Brown
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Megan H. Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - Alison L. Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julie C. Lumeng
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
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