'I don't sleep through the night': Qualitative study of sleep in type 1 diabetes.

AIMS: Individuals with type 1 diabetes (T1D) experience greater sleep disturbances than people without diabetes. However, the nature, causes and effects of sleep disruption in individuals with T1D and their family are not well understood. The purpose of this study was to explore and characterise the perspectives of parents, partners and individuals with diabetes about T1D-related sleep issues. METHODS: Participants included 44 youth and adults with T1D (ages 9-69), 24 parents of youth with T1D, and 14 partners of adults with T1D, recruited from diabetes clinics at two academic medical centres in the Southwestern and Midwestern United States. Semi-structured qualitative interviews were transcribed verbatim, coded and analysed using hybrid thematic analysis. RESULTS: We identified two central themes: Emotional Distress and Sleep Disruption. Each theme had multiple subthemes, and the two central themes were related to one another via a shared subtheme, Worry Impacting Sleep. CONCLUSIONS: Complex T1D-related emotional and behavioural factors both contributed to and resulted from sleep difficulties. Diabetes care providers should routinely assess for sleep concerns in people with T1D and their parents and partners. It may be important to consider both diabetes-related causes of sleep disruptions and potential impacts on self management and emotional functioning.

Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities.

BACKGROUND: Preschool-aged children's physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children's PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples - Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA). METHODS: The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children's PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child's ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects. RESULTS: Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children's PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children's PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children's PA and negatively related to ST, while parental promotion of ST was positively associated with children's ST. Correlates of children's PA and ST did not differ by city. CONCLUSIONS: The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children's health-promoting activity levels.

Barriers to and Facilitators of Iron Therapy in Children with Iron Deficiency Anemia.

OBJECTIVE: To characterize barriers to and facilitators of successful iron therapy in young children with iron deficiency anemia (IDA) from an in-depth parental perspective. STUDY DESIGN: Prospective, mixed methods study of children age 9 months to 4 years with a diagnosis of nutritional IDA by clinical history and laboratory criteria and their parents. Clinical data were obtained from the electronic health record. Semistructured interviews focused on knowledge of IDA, clinical effects, experience with iron therapies, and motivation were conducted with the parent who identified as the child's primary caregiver. RESULTS: Twenty patient-parent dyads completed the study; 80% (n = 16) identified as Hispanic/Latino (white). Patients' median age was 23 months (50% male); median initial hemoglobin concentration was 8.2 g/dL and duration of oral iron therapy was 3 months. Parents' median age was 29 years (85% female); 8 interviews (40%) were conducted in Spanish. Barriers included difficulty in administering oral iron owing to side effects and poor taste. Facilitators included provision of specific instructions; support from healthcare providers and additional caregivers at home; motivation to benefit child's health, which was strengthened by strong emotional reactions (ie, stress, anxiety) to therapy and follow-up; and an appreciation of child's improvement with successful completion of therapy. CONCLUSIONS: Our findings support the need for interventions designed to promote oral iron adherence in children with IDA. Rather than focusing on knowledge content related to IDA, interventions should aim to increase parental motivation by emphasizing the health benefits of adhering to iron therapy and avoiding more invasive interventions.

Development of a Nutrition Education Intervention for Food Bank Clients.

The focus of this article is the development of a nutrition education intervention for food bank clients. Formative research using mixed-methods (qualitative and quantitative) and community-based participatory research principles was conducted to assess the nutrition education needs of clients obtaining service from the Houston Food Bank (HFB). Participants were HFB and pantry staff and clients. Interview data were coded and analyzed using grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Data were used to tailor the curriculum to the target population. Six HFB staff, 49 pantry staff from 17 pantries, and 54 clients from 10 pantries participated in interviews and focus groups and completed questionnaires. The participants provided opinion on the current nutrition education provided via the food bank and made suggestions on strategies for development of an intervention. Their feedback was used to develop the six-session intervention curriculum to be delivered over 6 months. This research provides evidence that it is critical for members of the target audience be included in formative research to develop behavior change programs that are relevant and appealing and target their needs and interests.

Psychometrics of the preschooler physical activity parenting practices instrument among a Latino sample.

BACKGROUND: Latino preschoolers (3-5 year old children) have among the highest rates of obesity. Low levels of physical activity (PA) are a risk factor for obesity. Characterizing what Latino parents do to encourage or discourage their preschooler to be physically active can help inform interventions to increase their PA. The objective was therefore to develop and assess the psychometrics of a new instrument: the Preschooler Physical Activity Parenting Practices (PPAPP) among a Latino sample, to assess parenting practices used to encourage or discourage PA among preschool-aged children. METHODS: Cross-sectional study of 240 Latino parents who reported the frequency of using PA parenting practices. 95% of respondents were mothers; 42% had more than a high school education. Child mean age was 4.5 (±0.9) years (52% male). Test-retest reliability was assessed in 20%, 2 weeks later. We assessed the fit of a priori models using Confirmatory factor analyses (CFA). In a separate sub-sample (35%), preschool-aged children wore accelerometers to assess associations with their PA and PPAPP subscales. RESULTS: The a-priori models showed poor fit to the data. A modified factor structure for encouraging PPAPP had one multiple-item scale: engagement (15 items), and two single-items (have outdoor toys; not enroll in sport-reverse coded). The final factor structure for discouraging PPAPP had 4 subscales: promote inactive transport (3 items), promote screen time (3 items), psychological control (4 items) and restricting for safety (4 items). Test-retest reliability (ICC) for the two scales ranged from 0.56-0.85. Cronbach's alphas ranged from 0.5-0.9. Several sub-factors correlated in the expected direction with children's objectively measured PA. CONCLUSION: The final models for encouraging and discouraging PPAPP had moderate to good fit, with moderate to excellent test-retest reliabilities. The PPAPP should be further evaluated to better assess its associations with children's PA and offers a new tool for measuring PPAPP among Latino families with preschool-aged children.

Development of a Peer-Based Intervention Educating Teenagers about Long-Acting Reversible Contraception.

OBJECTIVE: Despite a decrease in teenage pregnancy rates in the United States in the past decades, teen pregnancy continues to be a considerable health issue. In this paper, we outline the development of our novel peer-based intervention, Get It?, that aims to increase awareness of and self-efficacy to use long-active reversible contraceptives (LARCs) among teenagers. METHODS: Peer narrative videos were created from audio recording semi-structured, one-on-one interviews with teenage LARC users. Focus groups of young women 19 years old and younger were conducted to choose the most audience-appropriate videos to be included in the final intervention. Using a thematic content analysis approach, transcripts of the audio recorded focus groups were reviewed and manually coded. RESULTS: The final layout of Get It? included 4 videos that were chosen by participants of the focus groups, as well as supplemental activities that included a basic description of the LARC devices, the ability to anonymously post personal stories about LARCs that can be shared with others, and the opportunity to email the primary investigator questions about LARCs. Thematic analysis of the focus group discussions revealed that when it came to narrative videos, participants desired (1) an authentic narrator, (2) more information on the narrator, and (3) narrators displaying ample emotions. CONCLUSION: Peer narratives play a vital role in influencing a teenager's perspective on their health status; therefore, understanding what constitutes reliable narration from an online format was critical in the development of a peer-based electronic intervention that informs teenagers of the most effective contraceptive available to them.

Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes.

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12-16 years; N = 16) and young adults (18-24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom's role as primary caregiver and dad's role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.

"We are a family with diabetes": Parent perspectives on siblings of youth with type 1 diabetes.

Having a child with type 1 diabetes (T1D) impacts the entire family system. Parental distress and burden have been well studied, but other family members, including siblings, have received little attention. Based on research about family life and sibling experiences in other chronic condition populations (e.g., autism, cancer), we expected parents of youth with T1D would report that siblings participated in T1D management and that T1D had a psychological impact on siblings. As part of a larger qualitative study, parents of youth with T1D age 5-17 (M = 10.8 ± 3.6 years) participated in semistructured interviews about T1D-specific health-related quality of life. For this study, we conducted secondary analyses on transcripts from 20 parents (95% mothers) from households with at least 1 sibling of the child with T1D. Three themes emerged: (a) siblings share the workload and help with T1D management, (b) T1D takes an emotional toll on siblings, and (c) parents feel guilty about prioritizing T1D over siblings' needs and desires. Parents recognized siblings have impactful roles in T1D management and family functioning. Future research into these themes can guide clinical and research efforts to develop sibling-inclusive resources and interventions for families with T1D. Enhancing family-focused interventions to recognize and support the needs of siblings may ultimately improve family T1D-related quality of life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Wearable Activity Tracking Device Use in an Adolescent Weight Management Clinic: A Randomized Controlled Pilot Trial.

Background: The use of physical activity tracker devices has increased within the general population. However, there is limited medical literature studying the efficacy of such devices in adolescents with obesity. In this study, we explored the feasibility of using wearable activity tracking devices as an adjunct intervention on adolescents with obesity. Methods: Randomized controlled pilot trial evaluated the feasibility (attrition ≤50%) of an activity tracking intervention (ATI) and its effects on weight loss in adolescents with obesity enrolled in an adolescent weight management clinic (AWMC). Outcomes included feasibility (attrition rate) and absolute change in BMI. Differences between groups at 6, 12, and 18 weeks were examined. Results: Forty-eight participants were enrolled in the study. Eighteen subjects were randomly assigned to the ATI group and 30 to control. The average age was 14.5 years. Overall, the majority of participants were Hispanic (56%). Sexes were equally distributed. The average baseline BMI was 37.5 kg/m2. At the study conclusion, the overall attrition rate was 52.1%, 44.4% in the ATI group versus 56.6% in the control group, with a differential attrition of 12.2%. The ATI and control groups each showed an absolute decrease in BMI of -0.25 and -2.77, respectively, with no significant differences between the groups. Conclusion: The attrition rate in our study was >50%. Participation in the AWMC by the ATI and control groups resulted in maintenance of BMI and body weight for the study duration. However, the use of an activity tracking device was not associated with greater weight loss. This trial is registered with NCT03004378.

The impact of goal attainment on behavioral and mediating variables among low income women participating in an Expanded Food and Nutrition Education Program intervention study.

This study examined the relationships between participant goal attainment and changes in mediating variables and food choice outcomes from a modified curriculum for the Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthy home food environments and parenting skills related to obesity prevention. EFNEP participants in 54 intervention classes received a goal sheet after each of 6 classes. Participants recorded goal attainment and returned at the next class, Diet and mediating variables were measured at baseline, immediate post, and 4 months later. Mixed model regression analysis over time assessed whether goal attainment was associated with the outcomes at post or follow-up, controlling for baseline assessment. Participants who reported attaining more goals reported greater self-efficacy for planning/encouraging fruit and vegetable consumption and making fruit and vegetables available, menu planning skills, improvement in the food preparation practices and higher home availability for regular vegetables. At post, those who reported attaining more fiber, vegetable, and water goals reported consuming more of these items. Goal attainment was related to some changes in food choice and mediating variables in an at risk population. Further research into the use and efficacy of goal setting and attainment in this population is warranted.

Does the Kids Café Program's Nutrition Education Improve Children's Dietary Intake? A Pilot Evaluation Study.

OBJECTIVE: To evaluate the Kids Café Program (KCP) nutrition education and assess its impact on children's diet quality and body mass index (BMI) percentile. DESIGN: An experimental design consisting of pretest-posttest comparison groups using mixed methods to evaluate a 6-session nutrition education intervention. SETTING: Four Boys and Girls Club sites PARTICIPANTS: A total of 120 9- to 12-year-old children in the KCP (60 intervention and 60 comparison); 89% completed posttest evaluations. INTERVENTION: Trained KCP site staff taught the nutrition education curriculum at intervention sites. MAIN OUTCOME MEASURES: Healthy Eating Index-2010 using 24-hour dietary recall data (primary) and BMI percentile (secondary) ANALYSIS: Repeated-measures mixed-effects modeling RESULTS: Mean age of children was 10.2 years; mean BMI percentile was about 79; 95% were from food-insecure households. The total Healthy Eating Index-2010 score for both groups at baseline and posttest ranged from 50 to 60. At posttest, compared with baseline scores, children from both groups scored significantly lower for total vegetables, and greens and beans; the intervention group children had significantly higher sodium scores. Process evaluation indicated that 60-minute lecture-based sessions were too long after children were in school all day. CONCLUSION: This pilot study suggests that the KCP nutrition education curriculum needs improvement. Further research based on behavioral constructs is needed to refine the curriculum to encourage healthier food choices among children and using the MyPlate and the 2015-2020 Dietary Guidelines for Americans.

Photorealistic Avatar and Teen Physical Activity: Feasibility and Preliminary Efficacy.

OBJECTIVE: Exergames played with a photorealistic avatar may enhance motivation to play, in addition to frequency, duration, and intensity of game-play. This article reports the feasibility and preliminary efficacy of an exergame played with a photorealistic avatar on physical activity (PA) intensity in a laboratory-based study. MATERIALS AND METHODS: Teens (12-14 years old) were recruited from a large, metropolitan area of the southwestern United States. Parents provided written informed consent. Teens completed online data collection, played an exergame with a photorealistic avatar in an observed laboratory setting, and then participated in postassessment data collection that included online questionnaires and a telephone interview. RESULTS: The program was feasible: 42 out of 48 teens recruited (87.5%) completed all data collection activities; game enjoyment was 21.9 ± 8.4 out of possible score of 32; immersion, 49.7 ± 15.6 out of a possible score of 88; avatar identification, 43.9 ± 16.5 out of a possible score of 68; and program satisfaction, 15.6 ± 3.6 out of possible score of 20. Objectively assessed PA indicated that 15.88 minutes of the laboratory-based gameplay session (74.9% of total time) was in vigorous PA; small effect sizes were observed in autonomy (ES = 0.45; P = 0.01) and competence (ES = 0.36; P = 0.03). Little change was observed in relatedness (ES = 0.04; P = 0.82) Qualitative data confirmed participants enjoyed playing the game with a photorealistic avatar and provided suggestions to enhance the gameplay experience. CONCLUSION: Playing an exergame with a photorealistic avatar holds promise as a method for increasing PA among youth. Additional research is needed to further explore its effects on gameplay frequency, intensity, and duration in nonlaboratory setting.

Perspectives on Barriers to Eating Healthy Among Food Pantry Clients.

Objective: To explore perspectives on barriers of eating healthy among food pantry clients. Methods: Food pantry clients participated in focus groups/interviews. Qualitative data were coded and analyzed using content analyses and grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Results: Fifty-four clients from 10 pantries participated in interviews/focus groups and completed questionnaires. Two major themes emerged: concern over obesity and other chronic diseases, and barriers to healthy eating. Several subthemes for barriers to healthy eating were identified: financial uncertainty, cost of healthy foods, lack of time, rationing food within family, lack of transportation, lack of adequate kitchen equipment, lack of nutrition knowledge and skills, and social support network. Conclusions: Issues identified above and those identified by others working with low-income populations need to be systematically addressed and incorporated into programs and nutrition education interventions for this group.

The Role of Family in a Dietary Risk Reduction Intervention for Cardiovascular Disease.

Diet is an essential strategy for the prevention of primary and secondary cardiovascular disease (CVD) events. The objectives were to examine: how families at increased risk of CVD perceived personal risk, their motivations to make dietary changes, their understanding of diet, and the influence of other family members. Individuals (>18 years) who completed an Australian family-based CVD risk reduction program were invited to a semi-structured telephone interview. Responses were recorded, transcribed verbatim and analysed using a systematic deductive approach with coding derived from key concepts developed as part of the interview structure. Seventeen participants from eight families were interviewed (aged 18-70 years, 47% male, five with CVD diagnosis). Key themes indicated both intrinsic and extrinsic motivations to improve heart health, variations in risk perception, recognition of the role diet plays in heart health, and the extent of family influences on eating patterns. Discrepancies between perceived and actual CVD risk perception impacted on perceived "need" to modify current dietary patterns towards heart health recommendations. Therefore, strategies not reliant on risk perception are needed to engage those with low risk perception. This could involve identifying and accessing the family "ringleader" to influence involvement and capitalising on personal accountability to other family members.

Using community insight to understand physical activity adoption in overweight and obese African American and Hispanic women: a qualitative study.

Ecologic models suggest that multiple levels of influencing factors are important for determining physical activity participation and include individual, social, and environmental factors. The purpose of this qualitative study was to use an ecologic framework to gain a deeper understanding of the underlying behavioral mechanisms that influence physical activity adoption among ethnic minority women. Eighteen African American and Hispanic women completed a 1-hour in-depth interview. Verbatim interview transcripts were analyzed for emergent themes using a constant comparison approach. Women were middle-aged (age M = 43.9 ± 7.3 years), obese (body mass index M = 35.0 ± 8.9 kg/m(2)), and of high socioeconomic status (88.9% completed some college or more, 41.2% reported income >$82,600/year). Participants discussed individual factors, including the need for confidence, motivation and time, and emphasized the importance of environmental factors, including their physical neighborhood environments and safety of and accessibility to physical activity resources. Women talked about caretaking for others and social support and how these influenced physical activity behavior. The findings from this study highlight the multilevel, interactive complexities that influence physical activity, emphasizing the need for a more sophisticated, ecologic approach for increasing physical activity adoption and maintenance among ethnic minority women. Community insight gleaned from this study may be used to better understand determinants of physical activity and develop multilevel solutions and programs guided by an ecologic framework to increase physical activity in ethnic minority women.

Feasibility of Recruiting Families into a Heart Disease Prevention Program Based on Dietary Patterns.

Offspring of parents with a history of cardiovascular disease (CVD) inherit a similar genetic profile and share diet and lifestyle behaviors. This study aimed to evaluate the feasibility of recruiting families at risk of CVD to a dietary prevention program, determine the changes in diet achieved, and program acceptability. Families were recruited into a pilot parallel group randomized controlled trial consisting of a three month evidence-based dietary intervention, based on the Mediterranean and Portfolio diets. Feasibility was assessed by recruitment and retention rates, change in diet by food frequency questionnaire, and program acceptability by qualitative interviews and program evaluation. Twenty one families were enrolled over 16 months, with fourteen families (n = 42 individuals) completing the study. Post-program dietary changes in the intervention group included small daily increases in vegetable serves (0.8 ± 1.3) and reduced usage of full-fat milk (-21%), cheese (-12%) and meat products (-17%). Qualitative interviews highlighted beneficial changes in food purchasing habits. Future studies need more effective methods of recruitment to engage families in the intervention. Once engaged, families made small incremental improvements in their diets. Evaluation indicated that feedback on diet and CVD risk factors, dietetic counselling and the resources provided were appropriate for a program of this type.

The Fun, Food, and Fitness Project (FFFP): the Baylor GEMS pilot study.

OBJECTIVE: The Girls health Enrichment Multisite Studies (GEMS) Fun, Food, and Fitness Project (FFFP) was designed to prevent obesity among 8-year-old African-American girls. DESIGN: Twelve-week, two-arm parallel group randomized controlled pilot study. SETTING: Summer day camp and homes in Houston, Texas. PARTICIPANTS: Thirty-five girls and their parents or caregivers were randomly assigned to treatment (N=19) or control groups (N=16). INTERVENTION: Girls in the intervention group attended a special 4-week summer day camp, followed by a special 8-week home Internet intervention for the girls and their parents. Control group girls attended a different 4-week summer day camp, followed by a monthly home Internet intervention, neither of which components included the GEMS-FFFP enhancements. MAIN OUTCOME MEASURES: Body mass index (BMI), consumption of fruit, 100% fruit juice, and vegetables (FJV), physical activity. RESULTS: After adjusting for baseline BMI, there were no significant differences in BMI between treatment and control group girls, either at the end of the 4-week summer day camp, or after the full 12-week intervention. By the end of the summer camp, the subgroup of treatment group girls heavier at baseline exhibited a trend (P<.08) toward lower BMI, compared to their heavier counterparts in the control group. Overall results at the end of the 12-week program demonstrated substantial, although not significant, differences between treatment and control groups in the hypothesized directions. On average, less than half the treatment sample logged onto the Website, which limited intervention dose. CONCLUSIONS: Summer day camp appears to offer promise for initiating health behavior change. Effective methods must be developed and tested to enhance log-on rates among healthy children and their parents before Internet programs can achieve their potential.

Using What's Learned in the Game for Use in Real Life.

A player can learn many things from playing a game for health. Some of these learnings were deliberately designed for the player to use in his or her real life, outside of any game. The effective ways to enable players to generalize what they learn in the game to their real lives (and thereby benefit from playing the game) are not clear. We have convened a group of expert health game designers and researchers to discuss this important issue.