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BACKGROUND: Antidepressants are among the most commonly prescribed medications, but evidence on comparative weight change for specific first-line treatments is limited. OBJECTIVE: To compare weight change across common first-line antidepressant treatments by emulating a target trial. DESIGN: Observational cohort study over 24 months. SETTING: Electronic health record (EHR) data from 2010 to 2019 across 8 U.S. health systems. PARTICIPANTS: 183 118 patients. MEASUREMENTS: Prescription data determined initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine. The investigators estimated the population-level effects of initiating each treatment, relative to sertraline, on mean weight change (primary) and the probability of gaining at least 5% of baseline weight (secondary) 6 months after initiation. Inverse probability weighting of repeated outcome marginal structural models was used to account for baseline confounding and informative outcome measurement. In secondary analyses, the effects of initiating and adhering to each treatment protocol were estimated. RESULTS: Compared with that for sertraline, estimated 6-month weight gain was higher for escitalopram (difference, 0.41 kg [95% CI, 0.31 to 0.52 kg]), paroxetine (difference, 0.37 kg [CI, 0.20 to 0.54 kg]), duloxetine (difference, 0.34 kg [CI, 0.22 to 0.44 kg]), venlafaxine (difference, 0.17 kg [CI, 0.03 to 0.31 kg]), and citalopram (difference, 0.12 kg [CI, 0.02 to 0.23 kg]); similar for fluoxetine (difference, -0.07 kg [CI, -0.19 to 0.04 kg]); and lower for bupropion (difference, -0.22 kg [CI, -0.33 to -0.12 kg]). Escitalopram, paroxetine, and duloxetine were associated with 10% to 15% higher risk for gaining at least 5% of baseline weight, whereas bupropion was associated with 15% reduced risk. When the effects of initiation and adherence were estimated, associations were stronger but had wider CIs. Six-month adherence ranged from 28% (duloxetine) to 41% (bupropion). LIMITATION: No data on medication dispensing, low medication adherence, incomplete data on adherence, and incomplete data on weight measures across time points. CONCLUSION: Small differences in mean weight change were found between 8 first-line antidepressants, with bupropion consistently showing the least weight gain, although adherence to medications over follow-up was low. Clinicians could consider potential weight gain when initiating antidepressant treatment. PRIMARY FUNDING SOURCE: National Institutes of Health.
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Antidepressivos , Aumento de Peso , Humanos , Antidepressivos/uso terapêutico , Antidepressivos/efeitos adversos , Feminino , Masculino , Aumento de Peso/efeitos dos fármacos , Pessoa de Meia-Idade , Adulto , Bupropiona/uso terapêutico , Bupropiona/efeitos adversos , Citalopram/uso terapêutico , Citalopram/efeitos adversos , Cloridrato de Duloxetina/uso terapêutico , Cloridrato de Duloxetina/efeitos adversos , IdosoRESUMO
BACKGROUND: National child obesity rates continue to climb. While neighborhood factors are known to influence childhood weight, more work is needed to further our understanding of these relationships and inform intervention and policy approaches reflective of complex real-world contexts. METHODS: To evaluate the associations between neighborhood components and childhood overweight/obesity, we analyzed sequential, cross-sectional data from the National Survey of Children's Health collected annually between 2016 and 2021. To characterize the complexity of children's neighborhood environments, several interrelated neighborhood factors were examined: amenities, detractions, support, and safety. We used ordinal logistic regression models to evaluate the associations between these exposures of interest and childhood weight status, adjusting for potential confounders. RESULTS: Our analytic sample contained 96,858 children representing a weighted population of 28,228,799 children ages 10-17 years. Child weight status was healthy in 66.5%, overweight in 16.8%, and obese in 17.2%. All four neighborhood factors were associated with child weight status. The odds of overweight or obesity generally increased with a decreasing number of amenities and increasing number of detractions, with the highest adjusted odds ratio seen with no amenities and all three possible detractions (1.71; 95% confidence interval [1.31, 2.11]). CONCLUSIONS: Multiple factors within a child's neighborhood environment were associated with child weight status in this sample representative of the US population aged 10-17 years. This suggests the need for future research into how policies and programs can support multiple components of a healthy neighborhood environment simultaneously to reduce rates of childhood overweight/obesity.
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Background: Understanding how different populations respond to a childhood obesity intervention could help optimize personalized treatment strategies, especially with the goal to reduce disparities in obesity. Methods: We conducted a secondary analysis of the Greenlight Cluster Randomized Controlled Trial, a health communication focused pediatric obesity prevention trial, to evaluate for heterogeneity of treatment effect (HTE) by child biological sex, caregiver BMI, caregiver reported race and ethnicity, primary language, and health literacy. To examine HTE on BMI z-score from 2 to 24 months of age, we fit linear mixed effects models. Results: We analyzed 802 caregiver-child pairs, of which 52% of children were female, 58% of households reported annual family income of <$20,000, and 83% did not have a college degree. We observed evidence to suggest HTE by primary language (p = 0.047 for Spanish vs. English) and the combination of primary language and health literacy (p = 0.01). There was insufficient evidence to suggest that the Greenlight intervention effect differed by biological sex, caregiver BMI, or by race/ethnicity. Conclusions: This HTE analysis found that the Greenlight obesity prevention intervention had a more beneficial effect on child BMI z-score over 2 years for children of caregivers with limited health literacy and for caregivers for whom Spanish was the primary language.
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BACKGROUND: Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS: Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS: Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Anti-Hipertensivos , Prescrições de Medicamentos , Registros Eletrônicos de Saúde , Fidelidade a Diretrizes , Hipertensão , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Humanos , Anti-Hipertensivos/uso terapêutico , Pessoa de Meia-Idade , Hipertensão/tratamento farmacológico , Feminino , Adulto , Idoso , Masculino , Estados Unidos , Estudos Transversais , Registros Eletrônicos de Saúde/tendências , Padrões de Prática Médica/tendências , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/normas , Idoso de 80 Anos ou mais , Fidelidade a Diretrizes/tendências , Adulto Jovem , Prescrições de Medicamentos/estatística & dados numéricos , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/uso terapêuticoRESUMO
BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life. METHODS: We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors. RESULTS: A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively. CONCLUSIONS: In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.
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Ferimentos e Lesões , Humanos , Masculino , Feminino , Lactente , Ferimentos e Lesões/prevenção & controle , Ferimentos e Lesões/epidemiologia , Pré-Escolar , Análise por Conglomerados , Avaliação de Programas e Projetos de SaúdeRESUMO
OBJECTIVE: This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity. METHODS: Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity. RESULTS: Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)]. CONCLUSION: Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.
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Cuidadores , Idioma , Humanos , Feminino , Masculino , Cuidadores/psicologia , Lactente , Pré-Escolar , Comunicação , Barreiras de Comunicação , Hispânico ou Latino , Adulto , Modelos Logísticos , Estudos Longitudinais , Recém-Nascido , Relações Médico-Paciente , Inquéritos e Questionários , Satisfação Pessoal , Tradução , Continuidade da Assistência ao PacienteRESUMO
PURPOSE OF REVIEW: Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS: Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Obesidade Infantil , Bebidas Adoçadas com Açúcar , Humanos , Criança , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Saúde Pública , Políticas , Estado Nutricional , BebidasRESUMO
INTRODUCTION: Excessive maternal gestational weight gain (GWG) is strongly correlated with childhood obesity, yet how excess maternal weight gain and gestational diabetes mellitus (GDM) interact to affect early childhood obesity is poorly understood. The purpose of this study was to investigate whether overall and trimester-specific maternal GWG and GDM were associated with obesity in offspring by age 6 years. METHODS: A cohort of 10,335 maternal-child dyads was established from electronic health records. Maternal weights at conception and delivery were estimated from weight trajectory fits using functional principal components analysis. Kaplan-Meier curves and Cox regression, together with generalized raking, examined time-to-childhood-obesity. RESULTS: Obesity diagnosed prior to age 6 years was estimated at 19.7% (95% CI: 18.3, 21.1). Maternal weight gain during pregnancy was a strong predictor of early childhood obesity (p < 0.0001). The occurrence of early childhood obesity was lower among mothers with GDM compared with those without diabetes (adjusted hazard ratio = 0.58, p = 0.014). There was no interaction between maternal weight gain and GDM (p = 0.55). Higher weight gain during the first trimester was associated with lower risk of early childhood obesity (p = 0.0002) whereas higher weight gain during the second and third trimesters was associated with higher risk (p < 0.0001). DISCUSSION: Results indicated total and trimester-specific maternal weight gain was a strong predictor of early childhood obesity, though obesity risk by age 6 was lower for children of mothers with GDM. Additional research is needed to elucidate underlying mechanisms directly related to trimester-specific weight gain and GDM that impede or protect against obesity prevalence during early childhood.
Excessive maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) have been linked to childhood obesity. Yet, research on how excessive total and trimester-specific GWG and GDM interact to affect early childhood obesity remains inconclusive. This study found that inadequate weight gain in the first trimester and excessive weight gain in the second and third trimester were associated with higher risks of childhood obesity by age 6. No significant interaction between maternal GWG and GDM was noted suggesting that these two important maternal conditions do not have a combined effect on the risk of early childhood obesity.
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Diabetes Gestacional , Ganho de Peso na Gestação , Obesidade Infantil , Criança , Gravidez , Feminino , Pré-Escolar , Humanos , Diabetes Gestacional/epidemiologia , Obesidade Infantil/epidemiologia , Incidência , Índice de Massa Corporal , Aumento de PesoRESUMO
Background: To characterize the association between multiple social determinants of health (SDOH) and overweight and obesity among US children. Methods: We conducted a cross-sectional analysis using the 2016-2020 National Survey of Children's Health. SDOH domains consisted of Economic Stability, Social and Community Context, Neighborhood and Built Environment, and Health Care Access and Quality. We used ordinal logistic regression to model associations between SDOH and weight status and calculate predicted probabilities of having overweight or obesity for various SDOH profiles. Results: Data from 81,716 children represented a weighted sample of 29,415,016 children ages 10-17 years in the United States. Of these, 17% had overweight and 17% had obesity. Compared with children with the theoretically lowest-risk SDOH profile, children with the highest-risk SDOH profiles in all four domains had an odds ratio of having a higher BMI category of 4.38 (95% confidence interval 1.67-7.09). For the lowest risk profile, the predicted probability of obesity varied from 8% to 11%, depending on race. For the highest risk profile, the predicted probability of obesity varied from 26% to 34%, depending on race. Conclusions: While high-risk values in each SDOH domain were associated with higher predicted probability of overweight and obesity, it was the combination of highest risk values in all the SDOH domains that led to greatest increases. This suggests a complex and multilayered relationship between the SDOH and childhood obesity, necessitating a comprehensive approach to addressing health equity to reduce childhood obesity.
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Obesidade Infantil , Criança , Humanos , Obesidade Infantil/epidemiologia , Sobrepeso/epidemiologia , Determinantes Sociais da Saúde , Estudos Transversais , Acessibilidade aos Serviços de SaúdeRESUMO
BACKGROUND: While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in two-year-old children. METHODS: We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site. RESULTS: 532 toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤$20,000 annual household income). Median daily TV watching time was 42 minutes [IQR: 25, 60]; 25% reported the TV was "usually on" during mealtimes. After adjustment, toddlers who watched more TV daily had higher odds of consuming sugar-sweetened beverages (SSB), fast food, and more junk food; those watching less TV had higher odds of consuming more fruits/vegetables. Those with the TV "usually on" during mealtimes were more likely to consume SSB [aOR 3.72 (95%CI 2.16-6.43)], fast food [aOR 2.83 (95%CI 1.54-5.20)], and more junk food [aOR 4.25 (95%CI 2.71-6.65)]. CONCLUSIONS: Among toddlers from primarily minoritized populations and of lower socioeconomic status, those who watched more TV daily and usually had the TV on during meals had significantly less healthy dietary practices, even after adjusting for known covariates. This study supports the current American Academy of Pediatrics screen time guidelines and underscores the importance of early counseling on general and mealtime TV.
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OBJECTIVE: Infants with high birthweight have increased risk for adverse outcomes at birth and across childhood. Prenatal risks to healthy food access may increase odds of high birthweight. We tested whether having a poor neighborhood food environment and/or food insecurity had associations with high birthweight. METHODS: We analyzed cross-sectional baseline data in Greenlight Plus, an obesity prevention trial across six US cities (n = 787), which included newborns with a gestational age greater than 34 weeks and a birthweight greater than 2500 g. We assessed neighborhood food environment using the Place-Based Survey and food insecurity using the US Household Food Security Module. We performed logistic regression analyses to assess the individual and additive effects of risk factors on high birthweight. We adjusted for potential confounders: infant sex, race, ethnicity, gestational age, birthing parent age, education, income, and study site. RESULTS: Thirty-four percent of birthing parents reported poor neighborhood food environment and/or food insecurity. Compared to those without food insecurity, food insecure families had greater odds of delivering an infant with high birthweight (adjusted odds ratios [aOR] 1.96, 95% confidence intervals [CI]: 1.01, 3.82) after adjusting for poor neighborhood food environment, which was not associated with high birthweight (aOR 1.35, 95% CI: 0.78, 2.34). Each additional risk to healthy food access was associated with a 56% (95% CI: 4%-132%) increase in high birthweight odds. CONCLUSIONS: Prenatal risks to healthy food access may increase high infant birthweight odds. Future studies designed to measure neighborhood factors should examine infant birthweight outcomes in the context of prenatal social determinants of health.
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OBJECTIVE: To evaluate the association between baseline ultra-processed food consumption in early childhood and child BMI Z-score over 36 months. METHODS: We conducted a prospective cohort analysis as a secondary data analysis of the Growing Right Onto Wellness randomised trial. Dietary intake was measured via 24-h diet recalls. The primary outcome was child BMI-Z, measured at baseline and at 3-, 9-, 12-, 24- and 36-month timepoints. Child BMI-Z was modelled using a longitudinal mixed-effects model, adjusting for covariates and stratifying by age. RESULTS: Among 595 children, median (Q1-Q3) baseline age was 4.3 (3.6-5.0) years, 52.3% of the children were female, 65.4% had normal weight, 33.8% were overweight, 0.8% were obese and 91.3% of parents identified as Hispanic. Model-based estimates suggest that, compared with low ultra-processed consumption (300 kcals/day), high ultra-processed intake (1300 kcals/day) was associated with a 1.2 higher BMI-Z at 36 months for 3-year-olds (95% CI = 0.5, 1.9; p < 0.001) and a 0.6 higher BMI-Z for 4-year-olds (95% CI = 0.2, 1.0; p = 0.007). The difference was not statistically significant for 5-year-olds or overall. CONCLUSIONS: In 3- and 4-year-old children, but not in 5-year-old children, high ultra-processed food intake at baseline was significantly associated with higher BMI-Z at 36-month follow-up, adjusting for total daily kcals. This suggests that it might not be only the total number of calories in a child's daily intake that influences child weight status, but also the number of calories from ultra-processed foods.
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Alimento Processado , Obesidade , Humanos , Feminino , Pré-Escolar , Masculino , Índice de Massa Corporal , Estudos Prospectivos , Dieta , Ingestão de Energia , Fast Foods/efeitos adversosRESUMO
OBJECTIVE: The study purpose was to describe feasibility of implementation of the Reaching Out to Kids with Emotional Trauma (ROcKET) intervention. We hypothesised that the ROcKET Intervention would be feasible in a poor resource school. DESIGN: We performed a single-arm, single-centr feasibility study of an intervention pilot, based on the RE-AIM framework. SETTING: The intervention was delivered in a single K-4th elementary charter school in the Nashville, TN area, in a low-resource community. PARTICIPANTS: 57 elementary school children attending our partner school and reporting exposure to at least one adverse childhood experience (ACE) and their parents. INTERVENTIONS: The Reaching Out to Kids with Emotional Trauma (ROcKET) intervention is a school-based multilevel intervention (individual child, family and school) that promotes positive health behaviours in children who have been exposed to ACEs. OUTCOMES: Outcomes were gathered qualitatively via focus groups. The primary outcome was feasibility. The secondary outcomes were implementation outcomes according to the RE-AIM framework, including Reach, Effectiveness, Adoption and Implementation. RESULTS: Of 105 eligible children, 57 children and their parents participated (54%) with 31 (54%) girls, 47 (82%) Black/African American, 5 (9%) Hispanic and 5 (9%) white. The school staff implemented all planned ROcKET sessions with >90% fidelity in each session, and 52 (91%) of children who completed the final intervention session went on to complete 6 month follow-up assessments. The average attendance at the in-school child sessions was 57 students (87%), and 35 (61%) of parents attended at least one family session, with 25 (44%) of parents attending at least half of the family sessions. 13 (23%) parents participated in the focus groups. Qualitative data suggested high parent participant satisfaction, uptake of positive health behaviours targeted by the intervention and increased quality of life. CONCLUSIONS: Our study suggests that the ROcKET intervention was feasible and acceptably delivered in a local elementary school with high reach to low-income and minority populations. These data suggest that schools, especially those serving low-income and minority children, can be an appropriate avenue for interventions designed to address health disparities. Data from this study will be used to advise a pilot study of the intervention.
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Qualidade de Vida , Instituições Acadêmicas , Criança , Feminino , Humanos , Masculino , Estudos de Viabilidade , Projetos Piloto , PaisRESUMO
BACKGROUND: The Nova classification system categorizes foods into 4 processing levels, including ultraprocessed foods (UPFs). Consumption of UPFs is extensive in the United States, and high UPF consumption is associated with chronic disease risk. A reliable and valid method to Nova-categorize foods would advance understanding of UPF consumption and its relationship to health outcomes. OBJECTIVES: Test the reliability and validity of training coders and assigning Nova categories to individual foods collected via 24-h dietary recalls. DESIGN: A secondary analysis of 24-h dietary recalls from 610 children who participated in a randomized controlled trial and were 3-5 y old at baseline was conducted. The Nutrition Data System for Research (NDSR) software was used to collect 2-3 dietary recalls at baseline and yearly for 3 y. Trained and certified coder pairs independently categorized foods into one of 4 Nova categories (minimally processed, processed culinary ingredients, processed, and ultraprocessed). Interrater reliability was assessed by percent concordance between coder pairs and by Cohen's κ coefficient. Construct validity was evaluated by comparing the average daily macronutrient content of foods between Nova categories. RESULTS: In 5546 valid recall days, 3099 unique foods were categorized: minimally processed (18%), processed culinary ingredients (0.4%), processed (15%), and ultraprocessed (67%). Coder concordance = 88.3%, and κ coefficient = 0.75. Descriptive comparisons of macronutrient content across 66,531 diet recall food entries were consistent with expectations. On average, UPFs were 62% (SD 19) of daily calories, and a disproportionally high percentage of daily added sugar (94%; SD 16) and low percentage of daily protein (47%; SD 24). Minimally processed foods were 30% (SD 17) of daily calories, and a disproportionally low percentage of daily added sugar (1%; SD 8) and high percentage of daily protein (43%; SD 24). CONCLUSIONS: This method of Nova classifying NDSR-based 24-h dietary recalls was reliable and valid for identifying individual intake of processed foods, including UPFs.
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Fast Foods , Manipulação de Alimentos , Criança , Humanos , Reprodutibilidade dos Testes , Dieta , Ingestão de Energia , AçúcaresRESUMO
OBJECTIVE: The purpose of this study is to understand how families from diverse sociodemographic backgrounds perceived the impact of the pandemic on the development of their children. METHODS: We used a multimethod approach guided by Bronfenbrenner's Ecological Systems Theory, which identifies 5 developmental systems (micro, meso, exo, macro, and chrono). Semistructured interviews were conducted in English or Spanish with parents living in 5 geographic regions of the United States between July and September 2021. Participants also completed the COVID-19 Exposure and Family Impact Survey. RESULTS: Forty-eight families participated, half of whose preferred language was Spanish, with a total of 99 children ages newborn to 19 years. Most qualitative themes pertained to developmental effects of the microsystem and macrosystem. Although many families described negative effects of the pandemic on development, others described positive or no perceived effects. Some families reported inadequate government support in response to the pandemic as causes of stress and potential negative influences on child development. As context for their infant's development, families reported a variety of economic hardships on the COVID-19 Exposure and Family Impact Survey, such as having to move out of their homes and experiencing decreased income. CONCLUSION: In addition to negative impacts, many parents perceived positive pandemic-attributed effects on their child's development, mainly from increased time for parent-child interaction. Families described economic hardships that were exacerbated by the pandemic and that potentially affect child development and insufficient government responses to these hardships. These findings hold important lessons for leaders who wish to design innovative solutions that address inequities in maternal, family, and child health.
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COVID-19 , Pandemias , Recém-Nascido , Adolescente , Humanos , Lactente , Estados Unidos/epidemiologia , Desenvolvimento do Adolescente , COVID-19/epidemiologia , Pais , Relações Pais-FilhoRESUMO
INTRODUCTION: Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding. METHODS: This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022. RESULTS: Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001). CONCLUSIONS: The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence.
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Aleitamento Materno , Mães , Feminino , Humanos , Estudos Transversais , Etnicidade , Apoio SocialRESUMO
Electronic health record (EHR) data are increasingly used for biomedical research, but these data have recognized data quality challenges. Data validation is necessary to use EHR data with confidence, but limited resources typically make complete data validation impossible. Using EHR data, we illustrate prospective, multiwave, two-phase validation sampling to estimate the association between maternal weight gain during pregnancy and the risks of her child developing obesity or asthma. The optimal validation sampling design depends on the unknown efficient influence functions of regression coefficients of interest. In the first wave of our multiwave validation design, we estimate the influence function using the unvalidated (phase 1) data to determine our validation sample; then in subsequent waves, we re-estimate the influence function using validated (phase 2) data and update our sampling. For efficiency, estimation combines obesity and asthma sampling frames while calibrating sampling weights using generalized raking. We validated 996 of 10,335 mother-child EHR dyads in six sampling waves. Estimated associations between childhood obesity/asthma and maternal weight gain, as well as other covariates, are compared to naïve estimates that only use unvalidated data. In some cases, estimates markedly differ, underscoring the importance of efficient validation sampling to obtain accurate estimates incorporating validated data.
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Asma , Ganho de Peso na Gestação , Obesidade Infantil , Humanos , Criança , Feminino , Gravidez , Registros Eletrônicos de Saúde , Estudos Prospectivos , Asma/epidemiologiaRESUMO
Objective: To demonstrate the utility of growthcleanr, an anthropometric data cleaning method designed for electronic health records (EHR). Materials and Methods: We used all available pediatric and adult height and weight data from an ongoing observational study that includes EHR data from 15 healthcare systems and applied growthcleanr to identify outliers and errors and compared its performance in pediatric data with 2 other pediatric data cleaning methods: (1) conditional percentile (cp) and (2) PaEdiatric ANthropometric measurement Outlier Flagging pipeline (peanof). Results: 687 226 children (<20 years) and 3 267 293 adults contributed 71 246 369 weight and 51 525 487 height measurements. growthcleanr flagged 18% of pediatric and 12% of adult measurements for exclusion, mostly as carried-forward measures for pediatric data and duplicates for adult and pediatric data. After removing the flagged measurements, 0.5% and 0.6% of the pediatric heights and weights and 0.3% and 1.4% of the adult heights and weights, respectively, were biologically implausible according to the CDC and other established cut points. Compared with other pediatric cleaning methods, growthcleanr flagged the most measurements for exclusion; however, it did not flag some more extreme measurements. The prevalence of severe pediatric obesity was 9.0%, 9.2%, and 8.0% after cleaning by growthcleanr, cp, and peanof, respectively. Conclusion: growthcleanr is useful for cleaning pediatric and adult height and weight data. It is the only method with the ability to clean adult data and identify carried-forward and duplicates, which are prevalent in EHR. Findings of this study can be used to improve the growthcleanr algorithm.