Engagement, satisfaction, retention and behavioural outcomes of linguistically diverse mothers and infants participating in an Australian early obesity prevention trial.

BACKGROUND: Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. METHODS: Healthy Beginnings is a nurse-led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6- and 12-month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). RESULTS: Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6-month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%-65%) compared to those speaking English (70%-80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. CONCLUSIONS: Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.

Strong support for broad policies to prevent childhood obesity among mothers in New South Wales, Australia.

ISSUE ADDRESSED: Support for broad policies to prevent childhood obesity is not clear. This study aimed to investigate the level of support for state government health promotion policies among mothers with infants and its associated factors. METHODS: This secondary analysis of data from 1155 mothers in NSW assessed approval for six policy options derived from public health approaches to obesity. Descriptive statistics were used to show the extent of policy approval across the cohort. Logistic regression models tested associations between perceived susceptibility and perceived severity of childhood obesity and approval of each policy option. RESULTS: The proportion of mothers who felt these policy options were 'about the right amount' (56%-68%) or 'not going far enough' (24%-36%), collectively represented 89%-95% approval of government intervention. In comparison, 5%-11% felt that these policies were 'going too far'. Factors associated with their levels of support varied between each policy option, based on mothers' characteristics and perceptions of childhood obesity. CONCLUSION: These findings indicate high support for government intervention to prevent obesity among mothers in NSW and support health promotion advocacy in this area. SO WHAT?: Governments should give due consideration to implementing each of the six policy options and prioritise the implementation of restrictions on fast food advertising in publicly owned or controlled areas.

Chinese Public's Attention to the COVID-19 Epidemic on Social Media: Observational Descriptive Study.

BACKGROUND: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. OBJECTIVE: This study aims to investigate and analyze the public's attention to events related to COVID-19 in China at the beginning of the COVID-19 epidemic (December 31, 2019, to February 20, 2020) through the Sina Microblog hot search list. METHODS: We collected topics related to the COVID-19 epidemic on the Sina Microblog hot search list from December 31, 2019, to February 20, 2020, and described the trend of public attention on COVID-19 epidemic-related topics. ROST Content Mining System version 6.0 was used to analyze the collected text for word segmentation, word frequency, and sentiment analysis. We further described the hot topic keywords and sentiment trends of public attention. We used VOSviewer to implement a visual cluster analysis of hot keywords and build a social network of public opinion content. RESULTS: The study has four main findings. First, we analyzed the changing trend of the public's attention to the COVID-19 epidemic, which can be divided into three stages. Second, the hot topic keywords of public attention at each stage were slightly different. Third, the emotional tendency of the public toward the COVID-19 epidemic-related hot topics changed from negative to neutral, with negative emotions weakening and positive emotions increasing as a whole. Fourth, we divided the COVID-19 topics with the most public concern into five categories: the situation of the new cases of COVID-19 and its impact, frontline reporting of the epidemic and the measures of prevention and control, expert interpretation and discussion on the source of infection, medical services on the frontline of the epidemic, and focus on the worldwide epidemic and the search for suspected cases. CONCLUSIONS: Our study found that social media (eg, Sina Microblog) can be used to measure public attention toward public health emergencies. During the epidemic of the novel coronavirus, a large amount of information about the COVID-19 epidemic was disseminated on Sina Microblog and received widespread public attention. We have learned about the hotspots of public concern regarding the COVID-19 epidemic. These findings can help the government and health departments better communicate with the public on health and translate public health needs into practice to create targeted measures to prevent and control the spread of COVID-19.

A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity.

BACKGROUND: With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity. METHODS/DESIGN: We propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions. DISCUSSION: The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children's BMI in the early years of life. If proven to be feasible, effective as well as cost-effective, the trial results will inform a series of recommendations for policy and practice related to promoting healthy infant feeding and physical activity in young children in the first years of life. TRIAL REGISTRATION: The CHAT Trial is registered with the Australian Clinical Trial Registry ( ACTRN12616001470482p ). It was registered on October 21, 2016.

Effectiveness and co-benefits of a telephone-based intervention in reducing obesity risk of children aged 2-4 years: findings from a pragmatic randomised controlled trial during the COVID-19 pandemic in Australia.

BACKGROUND: Evidence of effective early childhood obesity prevention is scarce and mainly derived from face-to-face interventions. However, the COVID-19 pandemic drastically reduced face-to-face health programmes globally. This study assessed effectiveness of a telephone-based intervention in reducing obesity risk of young children. METHODS: We adapted a study protocol (developed before the pandemic) and conducted a pragmatic randomised controlled trial of 662 women with children aged 2 years (mean age 24·06 months [SD 0·69]) during March, 2019, and October, 2021, extending the original planned intervention of 12 months to 24 months. The adapted intervention comprised five telephone-based support sessions plus text messages over a 24-month period (at child ages 24-26 months, 28-30 months, 32-34 months, 36-38 months, and 42-44 months). The intervention group (n=331) received staged telephone plus SMS support regarding healthy eating, physical activity, and information about COVID-19. The control group (n=331) received four staged mail-outs on information not related to the obesity prevention intervention, such as toilet training, language development, and sibling relationships, as a retention strategy. The intervention effects on BMI (primary outcome) and eating habits (secondary outcome), and perceived co-benefits, were evaluated using surveys and qualitative telephone interviews at 12 months and 24 months after baseline (age 2 years). The trial is registered with the Australian Clinical Trial Registry, ACTRN12618001571268. FINDINGS: Of 662 mothers, 537 (81%) completed the follow-up assessments at 3 years, and 491 (74%) completed the follow-up assessment at 4 years. Multiple imputation analysis showed no significant difference in mean BMI between the groups. Among low-income families (ie, annual household income

Association between dietary intake and symptoms of depression and anxiety in pregnant women: Evidence from a community-based observational study.

Dietary intake is considered as a crucial factor affecting mental health symptoms, particularly depression and anxiety symptoms, especially in the case of pregnant women. This study explored the role of dietary intake in depression and anxiety symptoms of pregnant women and provided evidence for primary care interventions. We enrolled 806 pregnant women in their third trimester from 14 communities in Hengyang City, Hunan Province, China, from July 2019 to September 2019. The Chinese version of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder questionnaire-7 (GAD-7) were used to assess depression and anxiety symptoms. Dietary intake, demographic characteristics, BMI, and pregnancy characteristics were collected using a self-designed, structural questionnaire. A covariate-adjusted logistic regression was conducted to examine the relationship between mental health symptoms and dietary intake. The prevalence of anxiety and depression symptoms in our population were 7.7% (95% CI: 5.9%-9.5%) and 9.2% (95% CI: 7.2%-11.2%), respectively. Women consuming eggs and egg products once a week (OR: 3.688, 95% CI: 1.476-9.215) were more likely to have depression symptom than consumed eggs and egg products once or more per day. Consuming green leafy vegetable <2-3 times per month had a significantly greater risk for depression symptoms than consuming the same once or more per day (OR: 3.450, 95% CI: 1.145-10.393). Women who consumed eggs and egg products 2-3 times a week had an increased likelihood of experiencing anxiety symptoms (OR: 2.253, 95% CI: 1.049-4.837). Anxiety symptoms in women consuming green leafy vegetables <2-3 times per month probably increased by 3.988 times (95% CI: 1.327-11.985) compared with women consuming the same once or more per day. Consuming salted and smoked food <2-3 times per month was protective against anxiety symptoms (OR: 0.181, 95% CI: 0.040-0.828) than consuming the same every day. Implementing interventions to promote healthy dietary among pregnant women is crucial due to its association with mental health. However, future researches are warranted to confirm the reliability and causal association obtained in this study.

COVID-19 Containment: Comparisons and Suggestions for Global Response.

BACKGROUND: The 2019-nCoV (COVID-19) is spreading at an alarming rate worldwide. Therefore, it is currently one of the biggest global health challenges. This research review describes the differences in response to the coronavirus epidemic between countries across the world. In addition, an opinion that the experience of China in response against the epidemic would play an important role globally in the battle against the novel coronavirus has been discussed as well as the insufficient and delayed response by other countries. OBJECTIVES: To provide an overview of China's experience in the control and prevention of the COVID-19, and compare it to that of other countries. METHODS: Relevant literature for this review was obtained from the Chinese government website; the World Health Organization website; Johns Hopkins University website; the European Centre for Disease Prevention website; and the PubMed databases. In addition, related news channels were used to obtain information. RESULTS: China's experience in the fight against COVID-19 provides valuable insight into the handling of this epidemic, and suggests that promoting cooperation between countries is imperative for effective control and prevention measures against this global virus pandemic. CONCLUSIONS: China's experience suggests that the following measures were effective in the fight against COVID-19: "social isolation," "medical observation," "social distancing" or "limited contact with people," "self-protection," and combined modern public health intervention measures. These findings could help control outbreaks in other countries and regions across the world.

Participants' Engagement With Telephone Support Interventions to Promote Healthy Feeding Practices and Obesity-Protective Behaviours for Infant Obesity Prevention.

Background: Participant engagement with program interventions is vital to support intended behaviour changes and outcomes. The aim of this research was to investigate participant engagement with the Communicating Healthy Beginnings Advice by Telephone (CHAT) program, an early childhood obesity prevention program that included interventions for promoting healthy infant feeding practices and obesity-protective behaviours via telephone, and whether engagement with the telephone support program varied by participants' sociodemographic characteristics. Methods: This study used de-identified CHAT program data of participants who received the interventions via telephone. Data analysed included 1) participant engagement in telephone support from late pregnancy to 12 months of child's age, 2) demographic characteristics collected at late pregnancy and 3) intervention providers' observations and notes (qualitative data) for 10 participants from each engagement group (low, medium, high) to explore issues discussed during telephone support. Results: Call completion rate by participants was above sixty percent for all six stages of the telephone support program with more than half of the participants (57%) demonstrating high level of engagement. We found that participants' country of birth, employment status and annual household income were predictors of engagement with the telephone support provided in the CHAT program. The odds of participants' engagement with the telephone support program were 1.68 times higher for Australian born (95% CI 1.07 - 2.62), 1.63 times higher for participants who were employed (95% CI 1.01 - 2.66) and 1.63 times higher for participants with annual household income ≥AUD$80,000 (95% CI 1.02 - 2.60). Conclusions: Participant engagement with the program interventions was good. Participants' engagement with the telephone support program was significantly associated with certain socio-demographic characteristics. Australian born participants, and participants associated with higher household income and employment engaged significantly more with the telephone support provided in the CHAT program. Additionally, the program engaged more participants older than 30 years of age and those who spoke English at home. The program provided unintended personal benefits to some participants with high engagement level due to their various psychosocial needs such as domestic violence, mental health and sleep related issues. Although not an intended benefit of the intervention, psychosocial needs of participants were met which was a likely factor for mothers' engagement with the program. This is an important factor that needs to be considered while implementing future programs or scale up of this program.

Economic evaluation of the Communicating Healthy Beginnings Advice by Telephone trial for early childhood obesity prevention.

OBJECTIVE: This study aimed to conduct an economic evaluation of the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial to prevent childhood obesity. METHODS: Cost-effectiveness analyses were conducted for the telephone and short message service (SMS) delivery of Healthy Beginnings advice, compared with usual care, which included child health services unrelated to Healthy Beginnings. Costs were valued in 2018 Australian dollars, and costs and outcomes were discounted at 5% per year. The costs of upscaling both delivery modes to all yearly births in New South Wales, Australia, were estimated and compared with the original Healthy Beginnings home-visiting intervention. RESULTS: At child age 2 years, the SMS delivery was more cost-effective ($5154 per unit BMI and $979 per 0.1 BMI z score units avoided) than the telephone delivery ($10,665 per unit BMI and $2017 per 0.1 BMI z score units avoided). The costs of upscaling the SMS ($7.64 million) and the telephone delivery modes ($37.65 million) were lower than the home-visiting intervention ($108.45 million). CONCLUSIONS: SMS delivery of Healthy Beginnings advice was more cost-effective than telephone delivery but less cost-effective than the original home-visiting approach ($4230 per unit BMI avoided, as calculated in an earlier study). Both the SMS and telephone interventions were more affordable than the home-visiting approach.

An analysis of children's clothing-related injuries cases reported by the media in mainland of China from 2003 to 2017.

BACKGROUND: Numerous reports in the media have suggested that children could be hurt due to their clothing, yet there are few medical reports that discussed children's clothing-related injuries. This study therefore, aimed to describe the epidemiological characteristics of media-reported injury cases related to children's clothing in Mainland of China. METHODS: This study systematically collected a total of 192 cases of children's clothing-related injuries reported in the news reports and medical literatures published by the Chinese media before December 2017. A content analysis of these cases was conducted to obtain information on the characteristics of these injuries. RESULTS: Cases of clothing-related injuries were most common in children aged 3 to 6 years (54.7%); the ratio of the number of boys to the number of girls in the 192 cases was 1.5: 1. In addition, approximately 51% of the cases occurred in the region of East China. The most common location of the incidents was in the home (35%). Furthermore, the zippers are the most common cause of injuries (15.1%), and the most common injured body part was the genital organs (29.2%). Besides, there were 24 cases reported death related to clothing injuries (13%). Moreover, the locations where the injuries occurred, the reasons for the occurrence of the injuries and the injured body parts differed significantly by gender and age (P < .05). CONCLUSIONS: Our findings suggest that future unintentional injuries could be prevented by implementing 2 major initiatives: improving the promotion of the safety of children clothing design in China and educating consumers on the potential risk associated with children's clothing.

Consumer Engagement in Mobile Application (App) Interventions Focused on Supporting Infant Feeding Practices for Early Prevention of Childhood Obesity.

Background and Aims: There has been increasing interest in using mobile applications ("apps") for innovative health service delivery and public health interventions. This paper describes two independent studies investigating mothers' or pregnant women's perceptions of, interest in and experiences with technological devices, apps and websites about infant feeding practices. Methods: Study 1 was a cross-sectional survey conducted with 107 pregnant women in their third trimester in late 2016 and early 2017. Multiple logistic regression analyses were conducted to examine factors associated with their app usage. The second was a qualitative study of 29 mothers of infants aged <1 year conducted in 2014. Thematic network analysis was used to explore the themes from the transcribed interviews. Results: Study 1 found that the use of apps was common among the pregnant women, with 100% having previously downloaded an app on their phone either free or paid. About 60% had used an app for health purposes. The majority reported that they were likely to use an app promoting healthy infant feeding practices, including 30% extremely likely and 53% very likely. Women with university or other tertiary level of education were more likely to use an app for promoting healthy infant feeding practices than those with other levels of education (adjusted odds ratio 3.22, 95% confidence interval 1.28-8.13). The qualitative interviews found that all the mothers were interested in a mobile program to support them with infant feeding practices. Participants felt they would benefit from individualized messages although did not want them to be sent too frequently. Further, participants also expressed the importance of having non-judgmental information and they were interested in receiving information using different modes such as videos, SMS or an app. Conclusions: Both studies suggest that using apps for promoting healthy infant feeding practices is acceptable from the perspective of mothers. There is great potential for health promotion practitioners to be engaged in app development for the purpose of promoting health in early years and health promotion in general.