Health status of childcare center providers in a COVID-19 hotspot.

BACKGROUND: Childcare center providers in Miami-Dade County, Florida a COVID-19 hotspot, are made up almost entirely of ethnic minority women. This is a critical frontline staff that is now encountering the triple threat of respiratory illnesses from respiratory syncytial virus (RSV), influenza viruses (or the seasonal flu), and COVID-19. OBJECTIVE: To examine sociodemographic characteristics, anthropometrics, and health behaviors that were collected from a sample of CCC teachers in Miami Dade County, a COVID-19 hotspot. METHODS: Cross-sectional data were used from Healthy Caregivers, Healthy Children (HC2), a randomized controlled intervention trial (#NCT02697565) for healthy weight maintenance among children 2-to-5 years old, conducted in 24 subsidized childcare centers in MDC in 2015-2018. Prevalence was determined by frequency or mean/standard deviation of each variable. Chi-squared analyses were performed to test for differences in BMI categories. RESULTS: In this sample of childcare center providers (n = 255), the majority (61%) had an elevated body mass index. Positive health behaviors such as regular exercise and eating fruits and vegetables were only reported in about a third of the sample. CONCLUSION: It is vital that we encourage the uptake of regular vaccination schedules as a means to protect our community, especially the critical frontline workers that have been caring for our young children.

Latinas and Maternal and Child Health: Research, Policy, and Representation.

Over the last 50 years, the Latino population in the US has grown and changed. Latinos are the nation's largest minority group and among this group, there is incredible diversity. Much of Latino health research and outcomes have been treated interchangeably with immigrant health, but as the US Latino population evolves so should the focus of Latino health research. We contend that as maternal and child health (MCH) outcomes are an utmost important indicator of a country's health, and as Latinos make up 18% of the US's population, it is imperative that we move past dated research frameworks to a more nuanced understanding of the health of Latina women and children. We summarize how acculturation has been used to describe differences in MCH outcomes, discuss how the umbrella term "Latino" masks subgroups differences, explore Afro-Latinidad in MCH, examine the effects of the sociopolitical climate on the health of families, and demonstrate the limited representation of Latinos in MCH research. We conclude that a deeper understanding of Latino health is necessary to achieve health equity for Latina women and their children.

What is already known on the subject? The Hispanic Health Paradox, the phenomenon that Latinos have better health outcomes than their socioeconomic status would predict, breaks down when empirical studies extended beyond descriptive research and examined Latino subgroups. Substantial heterogeneity within Latinos is observed is health outcomes, especially in maternal and child health.What this article adds to the literature? We provide a comprehensive demonstration of the varied determinants of maternal and child health in Latinas such as acculturation, the Latino monolith, race, policies, and representation.

The Role of Intervention Fidelity, Culture, and Individual-Level Factors on Health-Related Outcomes Among Hispanic Adolescents with Unhealthy Weight: Findings from a Longitudinal Intervention Trial.

Previous studies have suggested the impact of intervention fidelity on the management and prevention of chronic diseases; however, little is known about the effect of the contributing determinants (at multiple levels of influence) that can impact health-related interventions intending to improve the health status of Hispanic adolescents with overweight or obesity. The current study aimed to assess whether fidelity (i.e., dosage and quality of the program delivery), acculturation (i.e., orientation to the American culture, retention of Hispanic cultural values), and individual-level socio-demographic characteristics (i.e., income, education) predict changes in family processes (e.g., parent control), which in turn may affect adolescent health-related outcomes including body mass index (BMI), physical activity, dietary intake, and adolescents' health-related quality of life. A pathway analysis model was utilized to explore the study variables among 140 Hispanic parent-adolescent dyads randomized to Familias Unidas Health and Wellness (FUHW) intervention. Results indicated that fidelity was significantly associated with changes in parent-adolescent communication, parent monitoring, limit-setting, and control. Parents' education was associated with changes in parent limit-setting, and parent Hispanicism was associated with changes in parent limit-setting and discipline. The examination between family processes and adolescent health outcomes revealed that parents' higher discipline and improved communication with their adolescents were significantly associated with improved adolescents' quality of life, and parent control was positively associated with physical activity and negatively associated with BMI in adolescents. Our findings demonstrated the significant contribution of intervention fidelity and participants' characteristics in parenting strategies leading to adolescents' health outcomes to prevent obesity-related chronic diseases. Future research is needed to investigate the effect of environmental and organizational factors on the delivery of the intervention materials.

"Ganja Mamas": Online discussions about cannabis use in pregnancy.

BACKGROUND: Nearly 5 % of pregnant women in the United States use cannabis. However, expecting mothers often do not seek counsel from their healthcare providers about prenatal cannabis use due to stigma and legal ramifications. Instead, cannabis-using pregnant women turn to each other to learn. Online message boards have become a safe place for parents to seek answers anonymously in real-time. The objective of this study was to examine the information-seeking/giving behaviors of cannabis-using pregnant women on an online community forum. METHODS: We extracted 151 original messages and 1260 corresponding comments posted over a 7-day period from Whattoexpect.com's "Ganja Mamas" forum. We iteratively developed a codebook with 16 categories to reflect information-seeking behavior. N = 131 unique forum members posted questions for comment. RESULTS: Approximately half, 46.56 %, reported their geographic location (24 states), and 40.46 % reported gestational age. The top topics for which members sought out information were testing, state-specific questions, postpartum, child protective services (CPS), hospital-specific questions, birth announcements, methods of cannabis use, quitting, breastfeeding/pumping, pregnancy symptoms, mental health, general health and pregnancy, and quantity of cannabis use. The second phase of analysis was based on members' responses. Clustered codes indicated how the respondents were using the forum: (1) interviewing and geographic location, (2) knowledge, experience, and reassurance, (3) congratulations and relief, and (4) concealing cannabis use and symptoms. CONCLUSIONS: Our results demonstrate that mothers on an online cannabis forum are seeking information about location-specific experiences pertaining mostly to testing and child protective services. Additionally, mothers are responding by geographic-specific interviewing, and are expressing relief and reassurance in response to members' experiences.

Relationship between teacher fidelity to an early childhood obesity prevention program and the Child care center nutrition and physical activity environment.

Background: Child care centers (CCC) can be strategic settings to establish healthy lifestyle behaviors through obesity prevention programs. Fidelity to the implementation of such programs is a vital evaluation component, but is often not measured. This study assessed CCC teacher fidelity to the implementation of "Healthy Caregivers, Healthy Children (HC2)", a CCC-based obesity prevention intervention. Methods: CCCs serving low-resource, ethnically diverse families with ≥ 50 children ages 2-to-5 years old that were randomized to the HC2 intervention and that had teacher fidelity data collected (n = 9 CCC) were included in this analysis. The Environment and Policy Assessment and Observation (EPAO) tool assessed the CCC nutrition and physical activity (PA) environment at the beginning/end of the school year. Fidelity assessments were conducted in CCCs randomized to HC2 in Spring 2016 (n = 33 teachers) and 2017 (n = 39 teachers) by a trained observer. The relationship between teacher fidelity and EPAO was assessed via mixed models. Results: For every-one unit rise in teacher fidelity, EPAO nutrition increased 0.055 points (p =.006). No significant relationship was shown between teacher fidelity and EPAO PA score (p =.14). Conclusion: Teacher fidelity to obesity prevention program implementation may support a healthy CCC obesity prevention and nutrition environment but might require continued support for all components.

Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum.

OBJECTIVE: To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women. DESIGN: Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders. SETTING: Participants were recruited from prenatal clinics. PARTICIPANTS: 343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other). RESULTS: Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0·032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0·019), allow their infant to eat whenever he/she wanted (P = 0·023) and only allow their infant to eat at set times (P < 0·001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors. CONCLUSIONS: Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum.

Cluster-randomised trial of the impact of an obesity prevention intervention on childcare centre nutrition and physical activity environment over 2 years.

OBJECTIVE: The prevalence of obesity among pre-school-aged children in the USA remains unacceptably high. Here, we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a childcare centre (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over 2 school years. DESIGN: This was a cluster-randomised trial with twelve CCC receiving the HC2 intervention arm and twelve in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over 2 school years (Fall 2015, Spring 2016 and Spring 2017). Changes in EPAO physical activity and nutrition score were analysed via a: (1) random effects mixed models and (2) mixed models to determine the effect of HC2 v. control. SETTING: The study was conducted in twenty-four CCC serving low-income, ethnically diverse families in Miami-Dade County. PARTICIPANTS: Intervention CCC received (1) teachers/parents/children curriculum, (2) snack, beverage, physical activity, and screen time policies, and (3) menu modifications. RESULTS: Two-year EPAO nutrition score changes in intervention CCC were almost twice that of control CCC. The EPAO physical activity environment scores only slightly improved in intervention CCC v. control CCC. Intervention CCC showed higher combined EPAO physical activity and nutrition scores compared to control CCC over the 2-year study period (ß = 0·09, P = 0·05). CONCLUSIONS: Obesity prevention programmes can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCC may need consistent support to improve the physical activity environment to ensure the policies remain intact.

Intergenerational cardiovascular disease risks among Hispanics living in the United States.

BACKGROUND: Few studies have assessed intergenerational associations of obesity and cardiovascular disease risks from parents to their children among Hispanic Americans. OBJECTIVES: To assess intergenerational cardiovascular associations among Hispanic families. METHODS: Using baseline data from an obesity-focused efficacy trial targeting Hispanic adolescents (n = 280) and their parents, we conducted a series of logistic regression analyses to investigate the effects of parental BMI and blood pressure on adolescents' BMI and blood pressure, respectively. RESULTS: After adjusting for significant socio-demographic variables and adolescents' lifestyle behaviours, adolescents were more than twice as likely to be in the severely obese versus overweight range when their parents had obesity (vs. non-obese; OR = 2.55, 95% CI = 1.20, 5.39) and more than twice as likely to be in the severely obese versus obese weight range (OR = 2.44, 95% CI = 1.22, 4.87) when their parents had obesity. When compared to those with normal blood pressure, adolescents who had parents with elevated blood pressure/hypertension were more than twice as likely to have elevated blood pressure (OR = 2.05, 95% CI = 1.04, 4.00) or be classified as hypertensive stage 1/2 (OR = 2.81, 95% CI = 1.31, 6.01). CONCLUSIONS: Both severe obesity and elevated blood pressure are highly associated among Hispanic parent-child dyads. Findings underscore the potential benefits of intervening with the family system.

A qualitative study of cognitive, behavioral, and environmental influences on Hispanic mothers' early childhood feeding practices.

Young children's lifestyle behaviors are largely shaped by their parents. There are socioeconomic risk factors particular to Hispanic populations that influence the way parents feed their children. As obesity continues to be a public health issue with substantial inequities across race and ethnicity, it is critical to understand Hispanic parents' food choices and feeding practices. The objective of this qualitative study is to identify the behavioral, environmental, and cognitive factors that influence the parental food choices and feeding behaviors of Hispanic mothers of children ages 0-5 years. Snowball sampling was used to recruit participants from the community (n = 30) who were 1) female; 2) Hispanic; 3) over the age of 18; and 4) a mother to child(ren) between the ages zero and five. Each interview consisted of a brief demographic survey and a set of open-ended questions based on Social Cognitive Theory constructs. A thematic analysis using a combined deductive and inductive approach was used to analyze transcriptions. Results indicated that mothers' attitudes around breastfeeding were connected with their challenges, while their attitudes around solid foods were expressed in their feeding strategies. Mothers used strategies of modeling, repeated exposure, and practices of "sneaking" in healthy foods and bribing to promote healthy eating. Mothers were most likely to seek out information from (1) pediatricians, (2) female family members, and (3) the internet. Hispanic mothers actively seek out information from many different sources that impact how they feed their young children. Understanding their trusted sources and how it influences the SCT constructs is an important step in preventing early childhood obesity.

A Feasibility Trial of an Online-Only, Family-Centered Preventive Intervention for Hispanics: e-Familias Unidas.

We piloted the preventive intervention e-Familias Unidas, delivered exclusively through the Internet to maximize reach and sustainability. This program is an adaptation of an evidence-based, family-centered intervention that aims to prevent Hispanic adolescent drug use and risky sexual behavior through improving family functioning. The purpose of this feasibility trial was to: (1) explore the use of Facebook and a trusted community champion in the online recruitment of Hispanic parents of adolescents, (2) test an online-only assessment and randomization protocol, (3) pilot intervention delivery via e-familiasunidas.com, and (4) assess pre-post changes in family functioning. We tracked participant recruitment and enrollment via Facebook analytics and REDCap. Intervention completion was tracked via our website. We conducted an ANCOVA to test for between group (e-Familias Unidas vs. control) differences post-intervention. Recruitment lasted for a total of 10 weeks and was divided into three phases, with each phase systematically assessing which strategies maximized recruitment and enrollment. Overall, 93 Hispanic parents enrolled in the study. Of those randomized to the intervention group (n = 46), 70% were engaged and watched an average of 5.4 out of the 12 online videos. We found that participants recruited through a community champion, versus Facebook advertisements, had higher rates of enrollment and intervention completion. There was a significant improvement in parent-adolescent communication for parents who received e-Familias Unidas compared to those in the control group (n = 47). This pilot trial demonstrated it is feasible to recruit, assess, and deliver e-Familias Unidas to Hispanic parents through an online-only platform. Our findings highlight the promise of an online platform to optimize the reach of preventive interventions for underserved populations, to more effectively target participants, and to disseminate sustainable evidence-based interventions. We discuss lessons learned and recommendations for future research.

Relationship between parent perception of child anthropometric phenotype and body mass index change among children with developmental disabilities.

BACKGROUND: Preschool-age children with developmental disabilities (DD) have higher prevalence of obesity than children without DD. This study aimed to explore the relationship between parent perception of their children's anthropometric phenotype and child body mass index (BMI) z score change over one school year among preschoolers with DD. METHODS: The analysis consisted of a subsample (N  =  64) of children with DD from a larger randomized controlled trial to test an obesity prevention program in the childcare center setting. Parents ranks their child's anthropometric phenotype on a visual silhouette chart on a scale from 1 (underweight) to 7 (obese) and that rank score is compared to their BMI z score change over one school year. RESULTS: The majority (75%) of parents with an obese child underestimated their child's anthropometric phenotype while 7% parents with a non-obese child overestimated. Parent overestimation of child anthropometric phenotype status is associated with increased BMI z score change over 1 school year among preschool-age children with disabilities. CONCLUSION: Parental overestimation of child anthropometric phenotype status was associated with weight gain in preschool children with DD after one school year.

An Implementation Approach Comparison of a Child Care Center-Based Obesity Prevention Program.

OBJECTIVE: To compare the effectiveness of the Healthy Caregivers-Healthy Children (HC2) phase 1 (2011-2014) and 2 (2015-2018) child care center (CCC)-based obesity prevention intervention(s) on child dietary practices and body mass index percentile (PBMI) outcomes over 2 years. Phase 1 was implemented via a university-based research team, and phase 2 was delivered via a train-the-trainers approach (university-based research team trains preschool-based coaches, who in turn train CCC teachers to implement and disseminate HC2). METHODS: Phase 1 and 2 were both cluster randomized controlled trials of the HC2 obesity prevention intervention. Phase 1 was composed of 1224 children in 28 CCCs (12 intervention and 16 control). Phase 2 was composed of 825 children in 24 CCCs (12 intervention and 12 control). Both phases included CCCs serving low-resource, predominantly ethnic minority families. RESULTS: The mean rate of weekly fruit consumption significantly increased (ß = 0.16, p = 0.001) in phase 1, whereas vegetable intake significantly increased (ß = 0.16, p = 0.002) in phase 2 intervention CCCs. Fried (ß = -0.36, p < 0.001), fast (ß = -0.16, p = 0.001), and other unhealthy food (ß = -0.57, p < 0.001) consumption significantly decreased in phase 1 only. The mean rate of snack food consumption significantly decreased in phase 2 (ß = -0.97, p < 0.001). Mean child PBMI remained in the healthy range over 2 years for all groups in both study phases. CONCLUSION: A university-based research team implementation and dissemination approach seemed to be more effective than a train-the-trainers implementation method in improving dietary intake patterns. This finding suggests that CCCs may need robust educational support beyond their existing internal resources for long-term positive dietary intake pattern changes.

Results of a Family-Based Intervention Promoting Healthy Weight Strategies in Overweight Hispanic Adolescents and Parents: An RCT.

INTRODUCTION: Hispanic adolescents in the U.S. are disproportionately affected by overweight and obesity compared with their White, non-Hispanic counterparts. This study examines the efficacy of an evidence-based family intervention adapted to target obesity-related outcomes among Hispanic adolescents who were overweight/obese compared with prevention as usual. STUDY DESIGN: This study was an RCT. SETTING/PARTICIPANTS: Participants were Hispanic adolescents who were overweight/obese (n=280, mean age=13.01 [SD=0.82] years) in the 7th/8th grade and their primary caregivers. Primary caregivers were majority female legal guardians (88% female, mean age=41.88 [SD=6.50] years). INTERVENTION: Participants were randomized into the family-level obesity-targeted intervention or referral to community services offered for overweight/obese adolescents and families (condition). Data collection began in 2015. MAIN OUTCOME MEASURES: Primary outcomes included dietary intake (e.g., reduction of sweetened beverages) and past-month moderate-to-vigorous physical activity. Secondary outcomes were BMI and family functioning assessed among adolescents and primary caregivers. RESULTS: Study analyses (2019) indicated no significant intervention effects for adolescents' primary outcomes. Intervention effects were found for parents' intake of fresh fruits and vegetables (ß=0.12, 95% CI=0.02, 0.23), added sugar (ß= -0.11, 95% CI= -0.22, -0.004), and sweetened beverages (ß= -0.12, 95% CI=-0.23, -0.02), and parents showed decreased BMI (ß= -0.05, 95% CI= -0.11, -0.01) at 6 months after baseline compared with usual prevention. Intervention effects were found for adolescent family communication (ß=0.13, 95% CI=0.02, 0.24), peer monitoring (ß=0.12, 95% CI=0.01, 0.23), and parental involvement (ß=0.16, 95% CI=0.06, 0.26) at 6 months after baseline compared with prevention as usual. CONCLUSIONS: This intervention was not effective in improving overweight/obesity-related outcomes in adolescents. The intervention was effective in improving parents' dietary intake and BMI; however, the effects were not sustained in the long term. Other intervention strategies (e.g., booster sessions, increased nutritional information) may be necessary to sustain beneficial effects and extend effects to adolescent participants. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03943628.

Comparison of Early Life Obesity-Related Risk and Protective Factors in Non-Hispanic Black Subgroups.

OBJECTIVES: Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children. METHODS: Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced. RESULTS: Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6 lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced. CONCLUSIONS: Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child's development.

Determinants of accurate visual perception of child anthropometric phenotype among ethnically diverse preschool parents in the United States.

The literature reports that regardless of the high obesity prevalence estimates in young children, parents often do not accurately perceive their child's weight status. The purpose of this analysis was to examine the association between parent/child demographic characteristics including ethnicity, country of birth and years living in the United States and the perception of child's anthropometric phenotype status based on a visual silhouette instrument. Caregiver (n = 456) and child sociodemographic, perception of child anthropometric phenotype status and height/weight measurements were collected in 2015, from 24 childcare centres in Miami, Florida, among children ages 2-to-5 years old. Chi-square analysis determined parent perception accuracy by actual child healthy (

Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity.

OBJECTIVE: To investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents. DESIGN: Cross-sectional analysis of a randomized control trial SETTING: Eighteen middle schools in Miami-Dade County, Florida. PARTICIPANTS: Two-hundred and eighty Hispanic seventh- and eighth-grade students MAIN OUTCOME MEASURES: Physical activity, fruit and vegetable intake, and added sugar intake. ANALYSIS: Structural equation modeling. RESULTS: The findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (ß = .30; P = .001; 95% confidence interval [CI], 0.52-2.68) and physical activity in girls (ß = .26; P = .010; 95% CI, 0.16-1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [ß= .18; P = .039; 95% CI, 0.02-2.60] but had a moderating effect on fruit and vegetable consumption in girls (ß = .21; P = .015; 95% CI, 0.14-2.19). CONCLUSIONS AND IMPLICATIONS: Family mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

Barriers and facilitators to obesity prevention dissemination and implementation efforts in the childcare centre setting from the provider perspective.

BACKGROUND: It has been established that the childcare centre (CCC) is a setting suitable for healthy weight promotion efforts. As the field advances, it is important to understand the barriers and facilitators to early childhood obesity prevention implementation and dissemination efforts from the CCC providers' perspective. This is especially true among those who serve low-income and diverse populations to maximize scalability success. METHODS: Focus groups were held in English or Spanish with CCC providers across six CCCs who implemented healthy caregivers-healthy children (HC2), an early childhood healthy weight promotion programme targeting 2- to 5-year-olds from low-resource backgrounds. Centres represented both rural and urban environments. Focus groups were audio recorded, transcribed, and coded. A thematic analysis that combined a deductive and inductive approach was conducted. Codes were analysed using Dedoose to identify general themes and subthemes. RESULTS: CCC providers stated that (a) children understood the nutritional benefits of healthy foods; (b) improved cognitive development as a result of HC2; (c) parents were barriers to HC2 implementation efforts, particularly in terms of cooperative healthy lifestyle efforts; and (d) modelling healthy eating and making healthy CCC environmental changes facilitated HC2 implementation. Overall, HC2 was well received by CCC teachers, and they shared creative classroom HC2 adaptions and improvements. CONCLUSIONS: CCC providers can provide valuable insight to guide early childhood healthy weight promotion programme dissemination and implementation efforts. Although they value the implementation of HC2 programme in their classroom settings, they perceive parents as somewhat obstructive. This information is critical to informing future healthy weight promotion efforts in this setting, especially among low-resource families. It is important to continue to include the CCC provider viewpoint in future obesity prevention efforts to maximize scalability and sustainability efforts.

"Am I doing this wrong?" Breastfeeding mothers' use of an online forum.

As mothers seek out information around breastfeeding, many are turning to online message boards, listservs, or social media for advice. Babycenter.com, a parenting website with widespread use, hosts a Breastfeeding Support and Help community forum with over 140,000 users and more than one million conversation threads. The purpose of this study is to examine this online support forum to understand the information seeking and sharing practices of its users. We extracted a total of 258 original posts and 1,445 corresponding comments from Babycenter.com's breastfeeding forum posted over a 10-day period. Using content analysis, we coded the posts into 15 categories reflective of the types of information users were seeking. We then randomly selected 45 conversation threads across the most popular categories to further understand how users were sharing information. The most popular breastfeeding topics for which users sought out information included feeding challenges, supply issues, feeding schedule and duration, pumping, physical health, excretion issues, storing milk, nipple issues, and general breastfeeding questions. Participants elicited information from others using interviewing questions and built consensus around issues by agreeing with previous posts. They shared their knowledge and personal breastfeeding experiences and also provided encouragement to continue breastfeeding and overcome challenges. Online support forums are actively being used by breastfeeding mothers seeking information from others with similar experiences. This presents an important resource for breastfeeding mothers and may, therefore, be an important component of future breastfeeding interventions.

Psychometric properties of an abbreviated Childhood Family Mealtime Questionnaire among overweight and obese Hispanic adolescents.

The current family mealtime literature shows that assessments of the mealtime environment are typically self-report, yet few studies discuss validation techniques or report using validated scales. As such, the current analysis was conducted to validate one of the only published measures to assess the mealtime environment from the adolescent perspective. Specifically, the Childhood Family Mealtime Questionnaire (CFMQ) was evaluated in a sample of 280 overweight and obese Hispanic adolescents to address the need for a validated measure of the family mealtime environment in a demographic that is disproportionately affected by the current obesity epidemic. Results of exploratory and confirmatory factor analyses to evaluate the optimal factor structure, reliability, and validity for a revised, abbreviated CFMQ are presented here. The concurrent validity of the CFMQ was evaluated using correlations between the factor structures and the previously used, culturally appropriate comparable measure of family functioning. Correlations were also computed between factor scores and obesogenic outcomes (fruit and vegetable intake, added sugar intake, and physical activity). Analyses produced a revised, abbreviated version that includes 22 items (reduced from a total of 69 items) and consists of the following 4 factors: family mealtime communication (5 items), family mealtime stress (7 items), appearance weight control (5 items), and mealtime structure (6 items). Cronbach's alphas are reported for reliability. When examining CFMQ concurrent validity with the family functioning latent variable, results showed the family mealtime communication subscale ranked highest. Additionally, the family mealtime communication subscale was associated with all three obesogenic outcomes. This abbreviated CFMQ may be a useful tool for those studying family mealtime environments and their influence on obesity and its associated lifestyle behaviors.