Study protocol: intervention in maternal perception of preschoolers' weight among Mexican and Mexican-American mothers.

BACKGROUND: Childhood obesity is a public health issue negatively affecting children's physical and psychosocial health. Mothers are children's primary caregivers, thus key players in childhood obesity prevention. Studies have indicated that mothers underestimate their children's weight. If mothers are unaware of their children's weight problem, they are less likely to participate in activities preventing and treating excess weight. The "Healthy Change" intervention is designed to change maternal perception of child's weight (MPCW) through peer-led group health education in childcare settings. METHODS/DESIGN: The "Healthy Change" is a multicenter two-arm randomized trial in four centers. Three centers are in Mexican States (Nuevo Leon, Tamaulipas, and Zacatecas). The fourth center is in San Antonio, Texas, USA. A total of 360 mother-child pairs (90 pairs per center) are to be randomly and evenly allocated to either the intervention or the control group. Intervention group will receive four-session group obesity prevention education. Control group will receive a four-session personal and food hygiene education. The education is delivered by trained peer-mother promotoras. Data will be collected using questionnaires and focus groups. The primary outcome is a change in proportion of mothers with accurate MPCW. Secondary outcomes include change in maternal feeding styles and practices, maternal self-efficacy and actions for managing child excessive weight gain. McNemar's Test will be used to test the primary outcome. The GLM Univariate procedure will be used to determine intervention effects on secondary outcomes. The models will include the secondary outcome measures as the dependent variables, treatment condition (intervention/control) as the fixed factor, and confounding factors (e.g., mother's education, children's gender and age) as covariates. Sub-analyses will be performed to compare intervention effects on primary and secondary outcomes between the samples from Mexico and Texas, USA. Qualitative data will be analyzed through analysis of inductive content. A combined coding model will be developed and used to code transcripts using the NVivo software. DISCUSSION: Healthy Change intervention could help change MPCW, an initial step for obesity prevention among preschoolers. This study presents a first of its kind intervention available in Spanish and English targeting Mexican and Mexican-American mothers in Mexico and USA. TRIAL REGISTRATION: ISRCTN12281648.

¡Miranos! (Look at Us! We Are Healthy!): Home-Based and Parent Peer-Led Childhood Obesity Prevention.

Parent interventions for childhood obesity prevention have traditionally experienced low participation rates or used passive methods such as newsletters. In contrast, the ¡Miranos! intervention home-based activities included parent-led face-to-face meetings delivered after school, take-home bags with educational materials, and scavenger hunt games to deliver health information to Head Start families regarding nutrition, physical activity, and healthy growth promotion for their preschooler. This study employed a quasi-experimental design with three intervention centers (two that received only center-based activities and one that received center- and home-based activities) and one comparison center. Data were collected on participating Head Start children and their parents/guardians and included parent attendance, parent health message recall through intercept interviews, parent knowledge through pre- and posttests, and family supportive behaviors and child health behaviors through a parent questionnaire. Parents/guardians that received both center- and home-based activities significantly increased knowledge scores (t = 2.50, degrees of freedom = 123, p < .05) and family supportive behaviors from baseline to follow-up (t = 2.12, degrees of freedom = 122, p < .05). This study demonstrates the effects home-based interventions can have when coupled with center-based activities and implemented in the center at the end of the school day.

Associations between a voluntary restaurant menu designation initiative and patron purchasing behavior.

BACKGROUND: Restaurant initiatives provide an efficient opportunity to impact large numbers of patrons. The purpose of this study is to measure patron purchasing behaviors during the ¡Por Vida! menu designation initiative. METHOD: This study used a cross-sectional design and survey data to assess 23 restaurants throughout Bexar County and 152 restaurant patrons. The Patron Awareness Questionnaire assessed if patrons noticed the logo; believed nutrition, cost, and taste were important in making purchasing decisions; and purchased a ¡Por Vida! item. Descriptive statistics, Spearman correlations, and logistic regression were used to analyze the data. RESULTS: Most (93.4%) patrons considered taste very important when deciding what to eat. Cost was very important to 63.8% and nutrition was very important to 55.9% of the sample. The strongest predictors of purchasing a ¡Por Vida! item were the patrons' ages being between 18 and 35 years (odds ratio = 1.474; confidence interval = 0.017, 0.812; p < .05) and if patrons saw the logo (odds ratio = 4.327; confidence interval = 1.696-11.036; p < .01). DISCUSSION/CONCLUSION: Menu logo designation initiatives can potentially influence patron purchasing behaviors among a segment of the population when the logo is visible.

Strategic Sodium Reduction Initiative Reduces Sodium in Meals Served at Older Adult Congregate Meal Program Sites.

Excessive sodium consumption is a public health issue and congregate meal programs provide a unique opportunity to reduce sodium served to a large, at-risk population. A Sodium Reduction Initiative (SRI) was implemented in a congregate meal program that serves over 3,000 older adults. Nutrient analyses conducted at baseline and post-intervention were used to calculate average sodium reduction and the number of low sodium foods; targeted foods were categorized by strategy. Customer satisfaction surveys were collected at baseline and 3- and 6-months post-intervention. Kruskal Wallis and analysis of variance were used to compare sodium reduction differences. Chi-square analysis determined associations among strategies. The SRI impacted 55 foods, low sodium foods increased by 22%, and the average sodium per menu cycle was reduced by 21%. Replacement with a lower sodium food was the most frequently used strategy and had the largest sodium reduction. Sauces and main entrees were most frequently impacted, and thirteen ingredients accounted for 75% of all reduced-sodium foods. Over 50% of the 1,424 survey respondents consumed the reduced-sodium foods and food satisfaction remained stable from baseline to post-intervention. Congregate meals programs that target commonly used foods and key ingredients can significantly reduce sodium served to older adults.

Correlates of family health history discussions between college students and physicians: does family cancer history make a difference?

Effective communication between young adults and their healthcare providers can contribute to early detection of risk for developing cancer and establishment of lifelong habits for engagement in healthcare and health promotion behaviors. Our objectives were to examine factors influencing family health history discussions between college students and physicians and factors associated with perceptions about who is responsible for initiating such discussions. Data from an internet-based study of 632 college students were analyzed. Approximately 60% of college student participants reported they had discussed their family health history with a physician. The perception that physicians are responsible for initiating family health history discussions was associated with being non-White and less than completely knowledgeable about cancer. Having a discussion with a physician was associated with being female, having a regular physician, perceiving genetics as a risk for developing cancer, and having a family member diagnosed with cancer. Understanding variation among college students' perceptions about their role in initiating health-history-related discussions and characteristics of those who have or have not discussed family health issues with physicians can inform healthcare practice to foster optimal healthcare interactions in early adulthood.

Calibrating Wrist-Worn Accelerometers for Physical Activity Assessment in Preschoolers: Machine Learning Approaches.

BACKGROUND: Physical activity (PA) level is associated with multiple health benefits during early childhood. However, inconsistency in the methods for quantification of PA levels among preschoolers remains a problem. OBJECTIVE: This study aimed to develop PA intensity cut points for wrist-worn accelerometers by using machine learning (ML) approaches to assess PA in preschoolers. METHODS: Wrist- and hip-derived acceleration data were collected simultaneously from 34 preschoolers on 3 consecutive preschool days. Two supervised ML models, receiver operating characteristic curve (ROC) and ordinal logistic regression (OLR), and one unsupervised ML model, k-means cluster analysis, were applied to establish wrist-worn accelerometer vector magnitude (VM) cut points to classify accelerometer counts into sedentary behavior, light PA (LPA), moderate PA (MPA), and vigorous PA (VPA). Physical activity intensity levels identified by hip-worn accelerometer VM cut points were used as reference to train the supervised ML models. Vector magnitude counts were classified by intensity based on three newly established wrist methods and the hip reference to examine classification accuracy. Daily estimates of PA were compared to the hip-reference criterion. RESULTS: In total, 3600 epochs with matched hip- and wrist-worn accelerometer VM counts were analyzed. All ML approaches performed differently on developing PA intensity cut points for wrist-worn accelerometers. Among the three ML models, k-means cluster analysis derived the following cut points: ≤2556 counts per minute (cpm) for sedentary behavior, 2557-7064 cpm for LPA, 7065-14532 cpm for MPA, and ≥14533 cpm for VPA; in addition, k-means cluster analysis had the highest classification accuracy, with more than 70% of the total epochs being classified into the correct PA categories, as examined by the hip reference. Additionally, k-means cut points exhibited the most accurate estimates on sedentary behavior, LPA, and VPA as the hip reference. None of the three wrist methods were able to accurately assess MPA. CONCLUSIONS: This study demonstrates the potential of ML approaches in establishing cut points for wrist-worn accelerometers to assess PA in preschoolers. However, the findings from this study warrant additional validation studies.

NEEMA: a school-based diabetes risk prevention program designed for African-American children.

OBJECTIVE: To conduct formative assessment and preliminary biological impact of a school-based diabetes risk prevention program for African-American children during a 14-week study. METHODS: NEEMA is a school-based diabetes prevention program tailored for African-American children. The NEEMA is implemented via four social networks-classroom (Health and Physical Education Class), after school (Health Club), home (Family Fun Fair) and school cafeteria (Food Service Program). Formative assessment data were collected through semistructured interviews with physical education (PE) teachers and a pre-to-post design was used to measure biological impact. Fasting capillary glucose, height, weight, body mass index, percent body fat and fitness data were collected from a sample of 58 fourth-grade students. The six elementary schools had > 40% African-American enrollment and were located in low-income neighborhoods. RESULTS: Face-to-face interview data revealed diabetes, obesity and food insufficiency as major health concerns among PE teachers. Teachers also cited large classes and short PE periods as major challenges for implementing the program. From baseline to follow-up, fitness laps increased from 16.40 (SD = 9.98) to 23.72 (SD = 14.79) (p < 0.000), fasting capillary glucose decreased from 89.17 mg/dl (SD = 10.05) to 83.50 mg/dl (SD = 11.26) (p < 0.000), and percent body fat decreased from 27.26 (SD=12.89) to 26.68 (SD = 11.67) (p < 0.537). CONCLUSION: The NEEMA pilot study provided teacher feedback useful for revising the NEEMA health curricula and positive preliminary impact of the NEEMA PE class on children's fitness and blood glucose levels.

Treatment Interventions for Early Childhood Obesity: A Systematic Review.

CONTEXT: With 25% of preschool-age children in the United States being overweight or obese, effective interventions for these children would have significant public health implications. Randomized trials targeting this age group have been performed since the last systematic review. OBJECTIVE: To systematically review the literature on treatment interventions for overweight or obesity in preschool-age children. DATA SOURCES: Medline (1948-July 2014), the Cochrane Central Registry (1991-July 2014), CINAHL (1990-July2014), and PAS abstracts (2000-2014). STUDY SELECTION: Inclusion criteria were children aged 0 to 6 in the study and adiposity as an outcome. Exclusions were having normal-weight children in the trial and not having a comparison group. DATA EXTRACTION: Data were extracted independently by 2 authors using a template. RESULTS: The initial search yielded 1981 results, narrowed to 289 abstracts after initial review. Further analysis and cross-referencing led to the selection of 6 randomized controlled trials representing 1222 children. Two studies used systems changes and motivational interviewing and showed no significant effect on adiposity. Two studies used an intensive, multidisciplinary approach over 6 months and demonstrated significant decreases in adiposity. One study tested parental coaching and showed a significant reduction in adiposity at 6 months. One study used education on a dairy-rich diet and showed a possible effect on adiposity. LIMITATIONS: The study designs were too heterogeneous for meta-analysis; few ethnic minority subjects were included. CONCLUSIONS: Multidisciplinary, intensive interventions have some evidence of efficacy in reducing adiposity in preschool children.

Factors That Influence Park Use and Physical Activity in Predominantly Hispanic and Low-Income Neighborhoods.

BACKGROUND: Park features' association with physical activity among predominantly Hispanic communities is not extensively researched. The purpose of this study was to assess factors associated with park use and physical activity among park users in predominantly Hispanic neighborhoods. METHODS: Data were collected across 6 parks and included park environmental assessments to evaluate park features, physical activity observations to estimate physical activity energy expenditure as kcal/kg/ minute per person, and park user interviews to assess motivators for park use. Quantitative data analysis included independent t tests and ANOVA. Thematic analysis of park user interviews was conducted collectively and by parks. RESULTS: Parks that were renovated had higher physical activity energy expenditure scores (mean = .086 ± .027) than nonrenovated parks (mean = .077 ± .028; t = -3.804; P < .01). Basketball courts had a significantly higher number of vigorously active park users (mean = 1.84 ± .08) than tennis courts (mean = .15 ± .01; F = 21.9, η(2) = 6.1%, P < .01). Thematic analysis of qualitative data revealed 4 emerging themes-motivation to be physically active, using the play spaces in the park, parks as the main place for physical activity, and social support for using parks. CONCLUSION: Renovations to park amenities, such as increasing basketball courts and trail availability, could potentially increase physical activity among low-socioeconomic-status populations.

Motivations, Barriers, and Behaviors Related to Obtaining and Discussing Family Health History: A Sex-Based Comparison Among Young Adults.

BACKGROUND: Genetic predisposition is a risk factor for many chronic diseases, yet little is known about the frequency in which college students seek out their family health history or with whom they communicate relevant information. PURPOSE: This study examines motivations and barriers associated with obtaining one's family health history and discussing it with others. METHODS: Data were analyzed from 625 college students using an internet-delivered questionnaire, which comprised of questions about intentions and motivations to obtain and share family health history as well as barriers encountered when obtaining family health history. Responses were bifurcated by participants' sex. Chi-squared and t statistics were used to identify response differences by sex. RESULTS: Females were significantly more likely than males to be motivated to obtain their family health history, and more likely to have shared their family health history with others; state that they would share their family health history with others; and express a preference for sharing their family health history with a wider range of people. DISCUSSION: Educational interventions and improved student health services could be effective mechanisms to increase college students' knowledge, awareness, and perceived importance of obtaining their family health history.

Mexican American mothers' perceptions of childhood obesity: a theory-guided systematic literature review.

Childhood obesity continues to increase, disproportionately affecting Mexican American children. The aims of this review are to (a) assess the literature regarding Mexican American mothers' knowledge and perceptions of childhood obesity, prevention, and their role in prevention; (b) critically evaluate the methodological quality of the research conducted on mothers' perceptions of childhood obesity; and (c) make recommendations for future research on parental perceptions of childhood obesity. Four databases were searched for relevant articles and 22 studies met inclusion criteria and were included in the review. Social cognitive theory was used to sort findings across studies. Major findings included the following: (a) barriers to childhood obesity prevention included lack of education regarding prevention and role modeling, (b) only 23% of studies explicitly used a theoretical framework to guide their study, and (c) most studies used heterogeneous groups to examine perceptions. Implications for future research and practice are presented.

College students' perceived disease risk versus actual prevalence rates.

OBJECTIVE: To compare college students' perceived disease risk with disease prevalence rates. METHODS: Data were analyzed from 625 college students collected with an Internet-based survey. Paired t-tests were used to separately compare participants' perceived 10-year and lifetime disease risk for 4 diseases: heart disease, cancer, diabetes, and overweight/obesity. RESULTS: Respondents estimated their risk of developing heart disease as lower than cancer, yet rated their risk of developing heart disease as higher than diabetes and being overweight/obese. CONCLUSION: Incongruence between college students' perceived disease risk and disease prevalence rates calls for improved public health education.