Missed Work Among Caregivers of Children With a High Body Mass Index: Child, Parent, and Household Characteristics.

An underexamined consequence of childhood obesity is caregivers' missed work attributed to child absence from school due to a health condition. This secondary analysis (N = 123) reported the frequency of missed work among caregivers of children with a body mass index (BMI) at or above the 75th percentile and examined associations with select child, parent, and household characteristics. Caregivers missed work 1.3 (SD = 1.2) times in the past year with 41% reporting 2 or more times. A child visiting a health-care provider 2 or more times in the past year and parent perception of their child's health as good/fair/poor were significantly associated with caregivers' missing work 2 or more times in a year (OR = 5.8 and OR = 3.0, respectively). A significant association between children's physical and psychosocial well-being and caregivers' missed work emphasizes the school nurse role working with children with high BMI and families to address student absenteeism and caregivers' missed work.

The Association between Parents and Children Meeting Physical Activity Guidelines.

PURPOSE: To examine the association between parents and children meeting physical activity (PA) guidelines, by gender, among 8-12 year old children with BMI ≥75th percentile DESIGN AND METHODS: This was a secondary analysis of baseline data from a school-based healthy weight management intervention in Minnesota for 8-12 year old children. Survey data about PA participation were collected from 2014 through 2018. Analyses entailed descriptive statistics and multivariate logistic regression controlling for child age, race/ethnicity, BMIz, child's perception of parent support for activity, and number of sports played. RESULTS: Children's (n = 132) mean age was 9.32 ± 0.89 years, 49% were female, 63% were members of racial/ethnic minority groups, and 33% met PA Guidelines (≥60 minutes daily). Parents' (n = 132) mean age was 39.11 ± 7.05 years, mean BMI of 30.90 ± 8.44, 94% were female, 42% were members of racial/ethnic minority groups, and 57% met PA Guidelines for Americans (≥150 minutes moderate or >75 minutes vigorous PA weekly). There was no association between parents and children meeting PA guidelines for the total sample (OR = 1.43, 95% CI = 0.63-3.24, p = 0.39) or girls (OR = 0.65, 95% CI = 0.18-2.33, p = 0.51). Boys whose parents met PA guidelines had 3.84 times greater odds of meeting PA guidelines (95% CI = 1.28-13.4, p = 0.04). CONCLUSIONS: PA interventions for boys may benefit from focus on parents' PA. Further research should investigate correlates of girls' PA. PRACTICE IMPLICATIONS: Pediatric nurses working with children to increase PA should encourage parents' PA. For parents of boys, this may increase the child's PA. Considered broadly, nurses should be aware of gender influences on children's engagement in PA.

The Identification of Family Social Environment Typologies Using Latent Class Analysis: Implications for Future Family-Focused Research.

The family social environment is the first environment that a child experiences and has implications for children's health. However, the majority of family social environment measures do not account for its complexity. There is a need for novel approaches for assessing the family social environment that transcends the traditional way of measuring family composition and interaction. The purpose of this secondary data analysis research was to identify distinct family social environment typologies that consider both family composition and interaction and to describe the characteristics of the identified family social environment typologies. A series of latent class analysis results indicated three distinct typologies of family social environment with significant differences in family composition, family problem-solving skills, and demographic characteristics. The process used to identify the typologies and significant differences between the typologies showcases how the field could advance family-focused research by considering family composition and interaction.

Association Between Parent Television-Viewing Practices and Setting Rules to Limit the Television-Viewing Time of Their 8- to 12-Year-Old Children, Minnesota, 2011-2015.

INTRODUCTION: Television (TV) viewing is popular among adults and children, and child TV-viewing time is positively associated with parent TV-viewing time. Efforts to limit the TV-viewing time of children typically target parent rule-setting. However, little is known about the association between parent TV-viewing practices and rule-setting. METHODS: We used baseline height and weight data and survey data collected from 2011 through 2015 on parents and their 8- to 12-year-old children (N = 212 parent/child dyads) who were participants in 2 community-based obesity prevention intervention trials conducted in metropolitan Minnesota. Multivariable binary logistic regression analysis was used to assess the association between parent TV-viewing time on weekdays or weekend days (dichotomized as ≤2 hrs/d vs ≥2.5 hrs/d) and parent rules limiting child TV-viewing time. RESULTS: Child mean age was 10 (standard deviation [SD], 1.4) years, mean body mass index (BMI) percentile was 81 (SD, 16.7), approximately half of the sample were boys, and 42% of the sample was nonwhite. Parent mean age was 41 (SD, 7.5) years, and mean BMI was 29 (SD, 7.5); most of the sample was female, and 36% of the sample was nonwhite. Parents who limited their TV-viewing time on weekend days to 2 hours or fewer per day were almost 3 times more likely to report setting rules limiting child TV-viewing time than were parents who watched 2.5 hours or more per day (P = .01). A similar association was not seen for parent weekday TV-viewing time. CONCLUSION: For most adults and children, a meaningful decrease in sedentariness will require reductions in TV-viewing time. Family-based interventions to reduce TV-viewing time that target the TV-viewing practices of both children and parents are needed.

District wellness policies and school-level practices in Minnesota, USA.

OBJECTIVE: To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers. DESIGN: District-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion. SETTING: State-wide sample of 180 districts and 212 public schools in Minnesota, USA. RESULTS: The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices. CONCLUSIONS: Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.

Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial.

BACKGROUND: Family meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth. METHODS: Families (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011-2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score. RESULTS: General linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts. CONCLUSIONS: The study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.

HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children's sedentary behavior, and prevent obesity.

BACKGROUND: Involvement in meal preparation and eating meals with one's family are associated with better dietary quality and healthy body weight for youth. Given the poor dietary quality of many youth, potential benefits of family meals for better nutritional intake and great variation in family meals, development and evaluation of interventions aimed at improving and increasing family meals are needed. This paper presents the design of key intervention components and process evaluation of a community-based program (Healthy Home Offerings via the Mealtime Environment (HOME) Plus) to prevent obesity. METHODS: The HOME Plus intervention was part of a two-arm (intervention versus attention-only control) randomized-controlled trial. Ten monthly, two-hour sessions and five motivational/goal-setting telephone calls to promote healthy eating and increasing family meals were delivered in community-based settings in the Minneapolis/St. Paul, MN metropolitan area. The present study included 81 families (8-12 year old children and their parents) in the intervention condition. Process surveys were administered at the end of each intervention session and at a home visit after the intervention period. Chi-squares and t-tests were used for process survey analysis. RESULTS: The HOME Plus program was successfully implemented and families were highly satisfied. Parents and children reported that the most enjoyable component was cooking with their families, learning how to eat more healthfully, and trying new recipes/foods and cooking tips. Average session attendance across the ten months was high for families (68%) and more than half completed their home activities. CONCLUSIONS: Findings support the value of a community-based, family-focused intervention program to promote family meals, limit screen time, and prevent obesity. TRIAL REGISTRATION: NCT01538615.

Association Between Student Body Mass Index and Access to Sports Drinks in Minnesota Secondary Schools, 2012-2013.

This ecologic study evaluated the association between school policy allowing students to purchase sports drinks from school vending machines and school stores and student body mass index (BMI). Data were from surveillance surveys of Minnesota secondary schools (n = 238) and students (n = 59,617), administered in 2012 and 2013, respectively. We used generalized linear models to assess the association between policies and mean age- and sex-adjusted BMI percentile. In adjusted multivariate analysis, school policy was positively associated with BMI percentile (P = .005). School policy restricting student access to sports drinks at school may contribute to decreasing consumption of sport drinks among school-aged youth and improving student weight outcomes in this population.

Child's Weight Status and Parent's Response to a School-Based Body Mass Index Screening and Parent Notification Program.

This study examined the response of parents of elementary school-aged children to a school-based body mass index (BMI) screening and parent notification program conducted in one Minnesota school district in 2010-2011 and whether parent's response was moderated by child's weight status. Randomly selected parents (N = 122) of second- and fourth-grade students completed a mailed self-administered anonymous survey. Child's weight status was determined using measured height and weight. Most parents read the BMI notification letter and considered it helpful, independent of child's weight status. Parents of overweight children were significantly more likely than parents of normal weight children to report healthy lifestyle changes. This low-intensity intervention has the potential to support children, especially overweight children, and their parents to make healthy lifestyle changes. Future studies should investigate whether parent's response contributes to improved short- and long-term health outcomes for children.

Recommended school policies are associated with student sugary drink and fruit and vegetable intake.

OBJECTIVE: To examine the association between 8 recommended school obesity-related policies and student behaviors and weight in a cohort of Minnesota schools. METHOD: Existing surveillance surveys were used to examine the relationship between school policies to promote healthy eating and physical activity and student weight, diet, and activity behaviors from 2002 to 2006 among students (n=18,881) in a cohort of 37 Minnesota junior-senior high and high schools using fixed effects linear regression models. RESULTS: Each additional recommended policy was associated with a significant decrease in consumption of sugary drinks and an increase in consumption of fruits and vegetables. There were no associations with weekly hours of sedentary activities, days per week of vigorous activity, or body mass index percentile. CONCLUSION: Students attending schools that added recommended policies to promote healthy eating showed improved dietary behaviors, independent of secular trends compared with students in schools that did not add recommended policies.

Evaluating school obesity-related policies using surveillance tools: lessons from the ScOPE study.

The evidence evaluating the association between school obestiy prevention policies and student weight is mixed. The lack of consistent findings may result, in part, from limited evaluation approaches. The goal of this article is to demonstrate the use of surveillance data to address methodological gaps and opportunities in the school policy evaluation literature using lessons from the School Obesity-Related Policy Evaluation (ScOPE) study. The ScOPE study uses a repeated, cross-sectional study design to evaluate the association between school food and activity policies in Minnesota and behavioral and weight status of youth attending those schools. Three surveillance tools are used to accomplish study goals: Minnesota School Health Profiles (2002-2012), Minnesota Student Survey (2001-2013), and National Center for Educational Statistics. The ScOPE study takes two broad steps. First, we assemble policy data across multiple years and monitor changes over time in school characteristics and the survey instrument(s), establish external validity, and describe trends and patterns in the distribution of policies. Second, we link policy data to student data on health behaviors and weight status, assess nonresponse bias, and identify cohorts of schools. To illustrate the potential for program evaluators, the process, challenges encountered, and solutions used in the ScOPE study are presented.

Parent interest in a school-based, school nurse-led weight management program.

Because one in three children is already overweight or obese, school-based interventions targeting secondary obesity prevention merit consideration. This study assessed parent interest in participating in a school-based, school nurse-led weight management program for young school-aged children. A random sample of parents (n = 122) of second and fourth grade students in one large midwestern suburban school district completed a mailed survey. Associations between parent and child characteristics and interest in a school nurse-led after school weight management program for children, parent support group, and school nurse meeting with parent and child for weight management education were assessed using multivariate logistic regression. Non-White parents, parents concerned about their child's weight, and parents of girls were significantly more likely to express interest in program components than their counterparts. Future studies that develop, implement, and evaluate school-based, school nurse-led weight management programs targeting children who are overweight and obese merit attention.

Food Insecurity and Changes in Diet Quality and Body Mass Index z-Scores Among Elementary School Students.

Background: Previous research has identified food insecurity as a risk factor for obesity but those studies employed cross-sectional designs and were largely focused on adults and young children. In addition, there is a paucity of studies examining the association between food insecurity and changes in children's overall diet quality. This study aimed to assess whether food insecurity is associated with subsequent changes in diet quality and BMI z-scores over 2 years among 7- to 12-year-old children. Methods: We used 2011-2019 secondary data (n = 404) from three randomized controlled trials in Minnesota. Food insecurity was identified using the U.S. Household Food Security Survey Module at baseline (Time 0). Diet quality was determined using the Healthy Eating Index (HEI)-2015 from 24-hour recalls, and BMI z-scores were calculated using measured height and weight. These two outcomes were measured at Time 0, Time 1 (10-12 months from Time 0), and Time 2 (15-24 months from Time 0). Results: Compared with children from food-secure households, those from food-insecure households experienced a 0.13 greater increase in BMI z-scores from Time 0 to Time 2 [95% confidence interval (CI): 0.04 to 0.21] and a 4.5 point increase in HEI-2015 from Time 0 to Time 1 (95% CI: 0.99 to 8.01). Conclusion: Household food insecurity may widen weight disparities among elementary school-aged children. Further studies are needed to identify the role of diet quality in weight changes among children with food insecurity. Clinical Trial Registration Number: NCT01538615, NCT02029976, NCT02973815.

A healthy trend: less food used in fundraising and as rewards and incentives in Minnesota middle and high schools.

OBJECTIVE: To assess change in the 4-year prevalence (2006-2009) of the use of food in school fundraising and as rewards and incentives for students, following implementation of federal legislation in the USA in 2006. DESIGN: Serial cross-sectional design using trend analysis to assess school-level data collected over four consecutive years from 2006/2007 to 2009/2010. SETTING: Minneapolis/St. Paul, MN. SUBJECTS: Convenience sample of middle and high schools participating in two longitudinal, aetiological studies that examined youth, their environment and obesity-related factors. RESULTS: A significant and sustained decrease was demonstrated in the use of low-nutrient, energy-dense foods in school fundraising activities and the use of food and food coupons as rewards and incentives by teachers and school staff. CONCLUSIONS: Results support the utility of policy and legislative action as a tool for creating healthy, sustainable environmental change.

Comparison of health-risk behaviors among students attending alternative and traditional high schools in Minnesota.

Previous research, over a decade old, suggests students attending alternative high schools (AHS) engage in high levels of health-risk behaviors. Data from the 2007 Minnesota Student Survey for students attending AHS (n = 2,847) and traditional high schools (THS; n = 87,468) were used for this cross-sectional analysis to compare prevalence estimates, adjusted for age, race/ethnicity, and free and reduced lunch, for 28 health-risk behaviors. Students attending AHS were significantly more likely than students attending THS to report engaging in all behaviors related to unintentional injury and violence, tobacco use, alcohol and other drug use, and sexual activity, and were significantly less likely to report participating in physical activity, including sports teams. Students attending AHS continue to engage in high levels of health-risk behaviors as compared to their peers in THS. Updated national prevalence data were needed, as well as studies examining the role of protective factors in the lives of students attending AHS.

More-To-Less Home Healthful Foods Ratio is Associated With Diet Quality in Preadolescents With Elevated Body Mass Index.

OBJECTIVE: To examine home food availability (HFA) and the association with diet quality in preadolescents with elevated body mass index. METHODS: A cross-sectional analysis examined HFA and diet quality (using the 2015-Health Eating Index [HEI] derived from 1 or 2 24-hour dietary recalls) among preadolescents (n = 111; aged 8-12 years; body mass index ≥ 75th percentile). A novel ratio of more-to-less healthful items was created to represent HFA. Multivariate linear regression models examined the HFA ratio and individual food and beverage groups as correlates of HEI. RESULTS: The HFA ratio was associated with higher HEI (ß = 5.3 [1.3]; P < 0.001). Home food availability of sweets (ß = -2.6 [0.9]; P = 0.003) and sugar-sweetened beverages (ß = -2.3 [1.0]; P = 0.02) were associated with lower HEI. Home food availability of fruits was associated with higher HEI (ß = 1.3 [0.7]; P = 0.05). CONCLUSIONS AND IMPLICATIONS: Structuring the HFA so that more healthful choices are available relative to less healthful foods could be an effective approach for improving diet quality in preadolescents at risk for obesity.

Substance use and dietary practices among students attending alternative high schools: results from a pilot study.

BACKGROUND: Substance use and poor dietary practices are prevalent among adolescents. The purpose of this study was to examine frequency of substance use and associations between cigarette, alcohol and marijuana use and selected dietary practices, such as sugar-sweetened beverages, high-fat foods, fruits and vegetables, and frequency of fast food restaurant use among alternative high school students. Associations between multi-substance use and the same dietary practices were also examined. METHODS: A convenience sample of adolescents (n = 145; 61% minority, 52% male) attending six alternative high schools in the St Paul/Minneapolis metropolitan area completed baseline surveys. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention pilot trial. Mixed model multivariate analyses procedures were used to assess associations of interest. RESULTS: Daily cigarette smoking was reported by 36% of students. Cigarette smoking was positively associated with consumption of regular soda (p = 0.019), high-fat foods (p = 0.037), and fast food restaurant use (p = 0.002). Alcohol (p = 0.005) and marijuana use (p = 0.035) were positively associated with high-fat food intake. With increasing numbers of substances, a positive trend was observed in high-fat food intake (p = 0.0003). There were no significant associations between substance use and fruit and vegetable intake. CONCLUSIONS: Alternative high school students who use individual substances as well as multiple substances may be at high risk of unhealthful dietary practices. Comprehensive health interventions in alternative high schools have the potential of reducing health-compromising behaviors that are prevalent among this group of students. This study adds to the limited research examining substance use and diet among at-risk youth. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT01315743.

Association between food opportunities during the school day and selected dietary behaviors of alternative high school students, Minneapolis/Saint Paul, Minnesota, 2006.

INTRODUCTION: Availability of competitive foods in schools has been linked to unhealthful dietary behaviors of students. Little is known about the food environment of alternative high schools, schools that enroll students at risk of academic failure. We examined correlations between food opportunities during the school day and selected dietary behaviors of students attending alternative high schools. METHODS: Baseline data were collected in fall 2006 as part of the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. Students (n = 145) attending 6 alternative high schools in Minneapolis/Saint Paul, Minnesota, completed a survey on food opportunities during the school day and selected dietary behaviors. We used mixed-model multivariate cross-sectional analysis and adjusted for demographic characteristics to examine associations of interest. RESULTS: Food opportunities during the school day were positively associated with overall consumption of sugar-sweetened beverages, high-fat foods, and fast-food restaurant use. CONCLUSION: Having many food opportunities during the school day at alternative high schools was linked to the consumption of foods and beverages high in sugar and fat and low in nutrients. School-based interventions should focus on changing the food environment in alternative high schools to decrease less healthful eating opportunities and to increase the availability of healthful foods and beverages.

Obesity prevention practices of elementary school nurses in Minnesota: findings from interviews with licensed school nurses.

Elementary schools are an optimal setting to provide obesity prevention interventions, yet little is known about the obesity prevention practices of elementary school nurses. The purpose of this study was to gain insight into current obesity-related school nursing practice in elementary schools in Minnesota, opinions regarding school nurse-led obesity prevention programs, and school nurses' interest in implementing obesity prevention programs. Semistructured interviews were conducted with key informants from 21 Minnesota school districts (urban = 7; suburban = 8; and rural = 6), who were licensed school nurses (LSNs). Findings indicated that LSNs provided some primary and secondary obesity prevention services. Key informants felt school nurses, administrators, and parents would be supportive of school-based, LSN-led obesity prevention efforts. Interest in increasing efforts was limited by time constraints, staffing, and resources. School nurses are well positioned to provide prevention services that will contribute to reducing childhood obesity.