Promoting toddlers' self-regulation and healthy eating habits among families living in poverty: A randomized controlled trial of Recipe 4 Success

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21-.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |.16-.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.

Elaboration of parents' schemas of their children: Unique relations to sensitivity and learning support among families living in poverty

This study examined how distinct aspects of parents' schemas of their children are related to caregiving behaviors. It included 242 families with toddlers and young children, most of whom were living in poverty (37% White, 25% Black, 19% Latine, 17% Multiracial, and 2% Asian; child age = 21-39 months; median family income = $1,555 per month). The elaboration and emotional valence of parents' schemas were coded from brief responses to open-ended questions about children's personality; observations of parents' sensitivity and learning support were assessed in structured and unstructured settings. Results of regression equations controlling for multiple family, parent, and child characteristics revealed that both greater elaboration and positive emotional valence were uniquely related to parents' sensitivity (standardized β = .15, p = .05, and β = .13, p = .04, respectively), but only elaboration was uniquely related to learning support (β = .35, p < .001). This study highlights the special importance of the elaboration of parents' schemas in understanding caregiving behaviors among families living in poverty and the potential value of enhancing elaboration in family-focused preventive interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Heterogeneous Effects of Depression on Parenting Competence and Child Behavior Among Families Living in Poverty

This study examined how depression and psychosocial protective factors, such as self-efficacy and conscientiousness, were related to parenting competence and child behavior among families living in poverty. The sample included 238 families (37% White, 25% Black, 19% Latinx, 17% Multiracial, and 2% Asian; 42% of parents reporting clinically significant symptoms of depression) with young children (mean age = 31 months, 51% female). Latent profile analysis identified five distinct subgroups of parents who differed on levels of depression and psychosocial protective factors. A small group of parents who had high levels of depression and low levels of protective factors displayed the least parenting competence and had children with lower levels of adjustment. At the same time, parents in two other profiles had high levels of depression, but moderate or high levels of protective factors, and displayed average parenting competence and had children who displayed average or above average levels of adjustment. In this study, depression appeared less predictive of parenting competence and child behavior than the psychosocial protective factors. This study suggests that many parents, despite having depression and living in poverty, exhibit psychosocial protective factors that are associated with high levels of parenting competence and rear children who are doing well.

Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning

To quantify the impact of the COVID-19 pandemic and public health interventions on parent and child mental health and family relationships, we examined change in individual and family functioning in a sample of parents enrolled in a prevention trial; we examined change before the pandemic (2017-2019) when children were an average of 7 years old to the first months after the imposition of widespread public health interventions in the United States (2020) with paired t tests and HLM models. We examined moderation by parent gender, education, family income, and coparenting conflict. We found large deteriorations from before the pandemic to the first months of the pandemic in child internalizing and externalizing problems and parent depression, and a moderate decline in coparenting quality. Smaller changes were found for parent anxiety and parenting quality. Mothers and families with lower levels of income were at particular risk for deterioration in well-being. Results indicate a need for widespread family support and intervention to prevent potential family "scarring," that is, prolonged, intertwined individual mental health and family relationship problems.

Building long-term family resilience through universal prevention: 10-year parent and child outcomes during the COVID-19 pandemic

As the COVID-19 pandemic has been highly stressful for parents and children, it is clear that strategies that promote long-term family resilience are needed to protect families in future crises. One such strategy, the Family Foundations program, is focused on promoting supportive coparenting at the transition to parenthood. In a randomized trial, we tested the long-term intervention effects of Family Foundations on parent, child, and family well-being one to two months after the imposition of a national shelter-in-place public health intervention in 2020. We used regression models to test intervention impact on outcomes reported on by parents in a standard questionnaire format and a series of 8 days of daily reports. We also tested moderation of intervention impact by parent depression and coparenting relationship quality. Relative to control families, intervention families demonstrated significantly lower levels of individual and family problems (general parent hostility, harsh and aggressive parenting, coparenting conflict, sibling relationship conflict, and children's negative mood and behavior problems), and higher levels of positive family relationship quality (positive parenting, couple relationship quality, sibling relations, and family cohesion). For some outcomes, including coparenting conflict, harsh parenting, and child behavior problems, intervention effects were larger for more vulnerable families-that is, families with higher pre-pandemic levels of parent depression or lower levels of coparenting relationship quality. We conclude that targeted family prevention programming is able to promote healthy parent and child functioning during unforeseen future periods of acute stress. The long-term benefits of a universal approach to family support at the transition to parenthood indicate the need for greater investment in the dissemination of effective approaches.

Promoting parenting in home visiting: A CACE analysis of Family Foundations

This randomized trial tested the impact of an established prevention program for first-time parents, Family Foundations, adapted for low-income mothers and fathers as a series of sessions provided to couples in their homes. To assess program impact, we recruited and randomly assigned a sample of 150 low-income adult mother-father dyads (not necessarily still romantically involved, cohabiting, or married) during pregnancy or shortly after birth. The randomly assigned intervention families participated in Family Foundations Home Visiting (FFHV), consisting of 11 in-home sessions focusing on parental cooperation, collaboration, and conflict management to support children's development. Complier average causal effect (CACE) analysis was used to examine program impact on parental adjustment and parenting for families completing nine or more program sessions. Results indicated significant positive complier effects for mothers' and fathers' reports of depression, Posttraumatic Stress Disorder (PTSD) symptoms, coping with stress, and psychological aggression by fathers toward mothers at post-intervention, controlling for pre-intervention scores. Intervention parents also demonstrated higher levels of affection, engagement, and sensitivity with the infant based on observer coding of videotaped parent-child interactions. These findings indicate that the focus of Family Foundations on enhancing coparenting offers similar benefits for low-income parents and children who are compliers as has the group-format Family Foundations (FF) version in trials with universal samples of cohabiting or married parents. Results are discussed in terms of implications for home visiting, engaging fathers, and optimizing child outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What kind of parenting is associated with early self-control among toddlers living in poverty? The importance of learning support

The present study examined what kind of parenting best supports toddlers' self-control in the context of poverty. Parents and toddlers (52% female; M_age = 2.60 years) in 117 families (35% White, 25% Black, 22% Latinx, 15% Multiracial, and 3% Asian; M family income = $1,845/month) engaged in structured interaction tasks, and toddlers completed a snack delay task concurrently and after 6 months. Latent profile analysis based on eight observed parenting behaviors representing learning support and responsiveness/sensitivity (e.g., teaching, technical scaffolding, teamwork, instructions, choices, language use, specific praise, and warmth) identified four parenting profiles: Lower Learning Support/Lower Responsiveness, Moderate Learning Support/Moderate Responsiveness, High Responsiveness, and High Learning Support. Toddlers with parents in the High Learning Support profile demonstrated the greatest self-control 6 months later, compared with toddlers of parents in the other three profiles, and there were no statistically significant differences in self-control among toddlers of parents in those other three profiles. Results were robust even after controlling for initial levels of self-control, as well as multiple other child, parent, and family characteristics. These study findings highlight the importance of parents' learning support in understanding the early development of toddlers' self-control in the context of poverty and reinforce the need to create and refine preventive interventions in this area. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improving Toddlers' Healthy Eating Habits and Self-regulation: A Randomized Controlled Trial

OBJECTIVES

In this study, we tested whether Recipe 4 Success, a preventive intervention featuring structured food preparation lessons, was successful in improving the following 4 protective factors related to overweight and obesity among families living in poverty: toddlers' healthy eating habits, toddlers' self-regulation, parents' responsive feeding practices, and parents' sensitive scaffolding.

METHODS

This randomized controlled trial was open to families enrolled in Early Head Start home visits and included 73 parents and their toddlers aged 18 to 36 months. Multimethod assessments were conducted at baseline and posttreatment.

RESULTS

Compared with toddlers in usual practice Early Head Start, toddlers in Recipe 4 Success consumed healthier meals and snacks (d = 0.57; P < .03; 95% confidence interval [CI]: 0.08-1.06) and displayed better self-regulation (d = 0.95; P < .001; 95% CI: 0.43-1.45). Compared with parents in usual practice Early Head Start, parents in Recipe 4 Success engaged in more responsive feeding practices (d = 0.87; P < .002; 95% CI: 0.34-1.40) and were better able to sensitively scaffold their toddlers' learning and development (d = 0.58; P < .04; 95% CI: 0.07-1.09).

CONCLUSIONS

This randomized controlled trial revealed medium to large intervention effects on 4 important protective factors that are related to overweight and obesity but are often compromised by living in poverty.

Preventive Effects on Birth Outcomes: Buffering Impact of Maternal Stress, Depression, and Anxiety

OBJECTIVE

Although maternal stress, anxiety, and depression have been linked to negative birth outcomes, few studies have investigated preventive interventions targeting maternal mental health as a means of reducing such problems. This randomized controlled study examines whether Family Foundations (FF)-a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress, depression, and anxiety-can buffer the negative effects of maternal mental health problems.

METHODS

To assess the effects of FF, we used a randomized block design with a sample of 259 expectant mothers assigned to FF or a control condition and analyzed using propensity score models. We examine two-way interactions of condition (intervention vs. control) with maternal mental health problems (financial stress, depression, and anxiety) on birth outcomes (birth weight, days in hospital for mothers and infants). For birth weight, we assess whether intervention effects depend on length of gestation by including a third interaction term.

RESULTS

FF buffered (p < 0.05) the negative impact of maternal mental health problems on birth weight and both mother and infant length of post-partum hospital stay. For birth weight, assignment to FF was associated with higher birth weight for infants born before term.

CONCLUSIONS

These results demonstrate that a psycho-educational program for couples focused on enhancing mutual coparental support, with preventive effects on maternal mental health, can reduce incidence of birth problems among women at elevated risk. Such improvements in birth outcomes could translate into substantial reductions in public and personal healthcare costs. Future work should assess mediating mechanisms of intervention impact and cost-benefit ratio of the intervention.

CLINICAL TRIALS REGISTRATION

The Family Foundations follow-up intervention study is currently registered with www.clinicaltrials.gov . The study identifier is NCT01907412.

Long-term follow-up of a randomized trial of family foundations: effects on children's emotional, behavioral, and school adjustment

This study examines long-term effects of a transition to parenthood program, Family Foundations, designed to enhance child outcomes through a strategic focus on supporting the coparenting relationship. Roughly 5 to 7 years after baseline (pregnancy), parent and teacher reports of internalizing and externalizing problems and school adjustment were collected by mail for 98 children born to couples enrolled in the randomized trial. Teachers reported significantly lower levels of internalizing problems among children in the intervention group compared with children in the control group and, consistent with prior findings at age 3, lower levels of externalizing problems for boys in the intervention group. Baseline level of observed couple negative communication moderated intervention effects for parent and teacher report of child adjustment and teacher report of school adjustment and adaptation. Effect sizes ranged from 0.40 to 0.98. Results indicate that relatively brief preventive programs for couples at the transition to parenthood have the capacity to promote long-term positive benefits for children's adjustment. Although we attended to missing data issues in several ways, high levels of attrition in this long-term follow-up study is a cause for caution.

Costs to implement an effective transition-to-parenthood program for couples: analysis of the Family Foundations program

The transition to parenthood involves many stressors that can have implications for the couple relationship as well as the developmental environment of the child. Scholars and policymakers have recognized the potential for interventions that can help couples navigate these stressors to improve parenting and coparenting strategies. Such evidence-based programs are scarcely available, however, and little is known about the resources necessary to carry out these programs. This study examines the costs and resources necessary to implement Family Foundations, a program that addresses the multifaceted issues facing first-time parents through a series of pre- and post-natal classes. Costs were determined using a 6-step analytic process and are based on the first implementation of the program carried out through a five-year demonstration project. This assessment demonstrates how overall costs change across years as new cohorts of families are introduced, and how cost breakdowns differ by category as needs shift from training group leaders to sustaining program services. Information from this cost analysis helps clarify how the program could be made more efficient in subsequent implementations. We also consider how results may be used in future research examining economic benefits of participation in the program.

Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH

BACKGROUND

Minimally invasive parathyroidectomy (MIP) has become increasingly popular for the treatment of patients with primary hyperparathyroidism (pHPT), and the specific techniques used vary from surgeon to surgeon. This strategy depends on preoperative localization tests, of which the MIBI scan is the most commonly used. This study details one surgeon's MIP experience and examines factors that correlate with the results of sestamibi (MIBI) scans.

STUDY DESIGN

A retrospective review of parathyroidectomies performed between 1996-2006 was performed to create a database including laboratory and imaging results, symptoms, length of stay, and complications. MIBI scans were classified as correct when they showed one area of uptake at the site of a single adenoma (SA) found at exploration. Correlation between patient factors and MIBI scan results were assessed with Spearman correlation and Wilcoxon rank-sum tests.

RESULTS

Of 263 patients having parathyroidectomy for pHPT, 205 had SA, 40 double adenomas, 15 hyperplasia, and 3 negative explorations. Normocalcemia was achieved in 98% of patients at 1 year and 95% by intraoperative parathyroid hormone (PTH) criteria. Factors that were significantly correlated with MIBI scan results in SA patients were preoperative PTH (p = 0.0025) and adenoma weight (p < 0.0001). The median PTH in those with correct scans was 137 versus 101 pg/mL in those with incorrect scans, and the median adenoma weights were 920 and 280 mg, respectively.

CONCLUSIONS

The MIBI scan is a good localization test that made unilateral exploration and MIP possible in 76% of the cases. MIBI scans are more likely to be correct with higher preoperative PTH and larger adenomas.

Inhibition of cholesterol oxidase in a patient with Cushing's syndrome

Serum from a patient with Cushing's syndrome who was being treated with mitotane contained components that interfered with determination of cholesterol in the Du Pont aca. A measured concentration of cholesterol of 4.19 g/L in the undiluted serum increased to a calculated concentration of 9.50 g/L in diluted serum. Adding additional cholesterol oxidase (EC 1.1.3.6) overcame the reaction inhibition in the undiluted sample; adding additional cholesterol esterase (EC 3.1.1.13) had no effect. There is the potential for clinically significant underestimation of cholesterol with the aca in such patients, because the interference may remain undetected. On the other hand, the aca accurately quantified undiluted specimens containing as much as 10 g of cholesterol per liter when mitotane was not present.

Inhibition of cholesterol oxidase in a patient with Cushing's syndrome

Serum from a patient with Cushing's syndrome who was being treated with mitotane contained components that interfered with determination of cholesterol in the Du Pont aca. A measured concentration of cholesterol of 4.19 g/L in the undiluted serum increased to a calculated concentration of 9.50 g/L in diluted serum. Adding additional cholesterol oxidase (EC 1.1.3.6) overcame the reaction inhibition in the undiluted sample; adding additional cholesterol esterase (EC 3.1.1.13) had no effect. There is the potential for clinically significant underestimation of cholesterol with the aca in such patients, because the interference may remain undetected. On the other hand, the aca accurately quantified undiluted specimens containing as much as 10 g of cholesterol per liter when mitotane was not present.

Relationship between arterial and venous bicarbonate values

We determined the clinical efficacy of using the venous CO2 value, as obtained with routine "electrolytes", in acid-base management. Venipuncture samples for venous CO2 content and chloride concentrations were obtained in 336 patients with arterial blood pH, PaO2, PaCO2, and oxygen saturation determinations. The linear correlation between actual calculated arterial HCO3- and the measured venous CO2 was significant (P less than .001). Using venous CO2, chloride, and arterial pH values, we present various prediction equations for estimating arterial HCO3-. We determined the effects of time delay, exposure to air, and acute changes in arterial blood pH and PaCO2 on venous CO2 levels. Venous CO2 determinations should not be substituted for the arterial HCO3 value in the Henderson-Hasselbalch equation to calculate arterial blood pH or PaCO2. Clinically, the venous CO2 value has little direct use, but when venous CO2 content is abnormal, it should alert the clinician to the need for obtaining arterial blood gas and pH values.