Familial Factors in the Development of Social Anxiety Disorder.

The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].

The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial.

BACKGROUND: Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG. METHODS: This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided). RESULTS: In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses. CONCLUSION: The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations. TRIAL REGISTRATION: NCT01331564 , ClinicalTrials.gov.

Behavioral Nutrition Interventions Using e- and m-Health Communication Technologies: A Narrative Review.

e- and m-Health communication technologies are now common approaches to improving population health. The efficacy of behavioral nutrition interventions using e-health technologies to decrease fat intake and increase fruit and vegetable intake was demonstrated in studies conducted from 2005 to 2009, with approximately 75% of trials showing positive effects. By 2010, an increasing number of behavioral nutrition interventions were focusing on body weight. The early emphasis on interventions that were highly computer tailored shifted to personalized electronic interventions that included weight and behavioral self-monitoring as key features. More diverse target audiences began to participate, and mobile components were added to interventions. Little progress has been made on using objective measures rather than self-reported measures of dietary behavior. A challenge for nutritionists is to link with the private sector in the design, use, and evaluation of the many electronic devices that are now available in the marketplace for nutrition monitoring and behavioral change.

Weight-related self-efficacy in relation to maternal body weight from early pregnancy to 2 years post-partum.

Excessive gestational weight gain may lead to long-term increases in maternal body weight and associated health risks. The purpose of this study was to examine the relationship between maternal body weight and weight-related self-efficacy from early pregnancy to 2 years post-partum. Women with live, singleton term infants from a population-based cohort study were included (n = 595). Healthy eating self-efficacy and weight control self-efficacy were assessed prenatally and at 1 year and 2 years post-partum. Body weight was measured at early pregnancy, before delivery, and 6 weeks, 1 year and 2 years post-partum. Behavioural (smoking, breastfeeding) and sociodemographic (age, education, marital status, income) covariates were assessed by medical record review and baseline questionnaires. Multi-level linear regression models were used to examine the longitudinal associations of self-efficacy measures with body weight. Approximately half of the sample (57%) returned to early pregnancy weight at some point by 2 years post-partum, and 9% became overweight or obese at 2 years post-partum. Body weight over time was inversely related to healthy eating (ß = -0.57, P = 0.02) and weight control (ß = -0.99, P < 0.001) self-efficacy in the model controlling for both self-efficacy measures as well as time and behavioural and sociodemographic covariates. Weight-related self-efficacy may be an important target for interventions to reduce excessive gestational weight gain and post-partum weight gain.

Changes in family income status and the development of overweight and obesity from 2 to 15 years: a longitudinal study.

BACKGROUND: An emerging body of research suggests the trajectory of a family's income affects children's health and development more profoundly than the often-measured income at a single time point. The purpose of this study was to examine the associations between changes in family income status, early-life risk factors, and body mass index (BMI) z-score trajectory from age 2 to 15 years. METHODS: This longitudinal study employed a birth cohort (n = 595) located in a rural region of New York State. Data were collected through an audit of medical records and mailed questionnaires. Family low-income and BMI z-score trajectories were identified using latent-class modeling techniques that group children based on similar trends across time. We examined five early-life risk factors in relation to income and BMI z-score trajectories: maternal overweight/obesity, maternal gestational weight gain, maternal smoking during pregnancy, breastfeeding duration, and early-life weight gain trajectory. We used multinomial logistic regression models to estimate the odds of being in a BMI z-score trajectory group based on income trajectory and early-life risk factors. RESULTS: Children who remain low-income throughout childhood were more likely to maintain overweight (AOR = 2.55, 95% CI = 1.03, 5.42) and children who moved into low-income during childhood were more likely to be obese (AOR = 2.36, 95% CI = 1.12, 5.93) compared to children who were never low-income. Maternal overweight/obesity was significantly associated with a child become obese (AOR = 8.31, 95% CI = 3.80, 18.20), become overweight (AOR = 2.37, 95% CI = 1.34, 4.22), and stay overweight (AOR = 1.79, 95% CI = 1.02, 3.14). Excessive gestational weight gain was associated with increased likelihood of a child becoming overweight trajectory (AOR = 2.01, 95% CI = 1.01, 4.00). CONCLUSIONS: Our findings further supports the growing evidence that there are several preventable early-life risk factors that could be targeted for intervention. This study provides new evidence that remaining in low-income and moving into low-income increases risk for adolescent overweight and obesity.

The healthy start partnership: an approach to obesity prevention in young families.

This article investigates the impact of community-based interventions developed by the Healthy Start Partnership (HSP) to promote healthy body weights in families. Intercept surveys were conducted to monitor community exposure. A nonconcurrent, no treatment control design was used to assess population-level weight outcomes. Control (n = 219) and intervention (n = 276) cohorts of pregnant women were recruited and followed until 6 months postpartum. Data were collected through 2 self-administered questionnaires and medical record audits. Results indicate community residents were exposed to interventions. However, little evidence of positive effects of interventions on weight outcomes was found for mothers or infants.

The theory, development, and implementation of an e-intervention to prevent excessive gestational weight gain: e-Moms Roc.

BACKGROUND: Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (e-Moms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women. MATERIALS AND METHODS: Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant's use of e-intervention features. RESULTS: An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools. CONCLUSIONS: To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.

School meals participation and weekday dietary quality were associated after controlling for weekend eating among U.S. school children aged 6 to 17 years.

Prior research has shown positive associations between participation in school meals and some dietary measures, but the evidence is equivocal. Few prior studies have used methodological approaches that address underlying differences in food preferences and health beliefs between school meals participants and nonparticipants, resulting in the potential for selection bias to influence results. This study estimated relationships among school meals participation and weekday energy intake and dietary quality, controlling for weekend dietary intake as a proxy for food preferences and health beliefs. Further, this paper explored how family income moderated these relationships. NHANES data (2003-2008) were analyzed for children aged 6-17 y with reliable dietary recalls for one weekday and one weekend day (n = 2376). Using multivariate linear regression models, we examined weekday-weekend differences in energy intake as a percentage of the estimated energy requirement (%EER) and differences in Healthy Eating Index-2005 (HEI) scores for breakfast and lunch and for the entire day. Overall, school meals participants and nonparticipants had equivalent %EERs and total HEI scores, but participants scored higher for milk and lower for saturated fat and sodium after adjustment for weekend eating. Family income moderated the relationship between school meals participation and HEI. Low-income children who ate school breakfast and lunch had significantly higher total HEI, and total grain, and meat and beans component scores. Conversely, higher income participants had significantly lower scores for total grains, whole grains, and saturated fat. Changes to the content of school meals may differentially affect weekday dietary intake of low-income and higher income participants.

Moving beyond quantity of participation in process evaluation of an intervention to prevent excessive pregnancy weight gain.

BACKGROUND: Few lifestyle interventions have successfully prevented excessive gestational weight gain. Understanding the program processes through which successful interventions achieve outcomes is important for the design of effective programs. The objective of this study was to evaluate the effect of the quantity and quality of participation in a healthy lifestyle intervention on risk of excessive gestational weight gain. FINDINGS: Pregnant women (N = 179) received five newsletters about weight, nutrition, and exercise plus postcards on which they were asked to set related goals and return to investigators. The quantity of participation (dose) was defined as low for returning few or some vs. high for many postcards (N = 89, 49.7%). Quality of participation was low for setting few vs. high for some or many appropriate goals (N = 92, 51.4%). Fisher's exact tests and multivariate logistic regression were used to analyze the effect of participation variables on the proportion with excessive weight gain. Quantity and quality of participation alone were each not significantly associated with excessive gestational weight gain, while quality of participation among those with high-levels of participation approached significance (p = 0.07). The odds of gaining excessively was decreased when women had both a high quantity and quality of participation (OR = 0.04, 95% CI = 0.005, 0.30). CONCLUSIONS: Both quantity and quality of participation are important program process measures in evaluations of lifestyle interventions to promote healthy weight gain during pregnancy.

The web of risk factors for excessive gestational weight gain in low income women.

The objective of this study is to gain an in-depth understanding of issues related to gestational weight gain (GWG) including general health, diet, and physical activity among high and low income women and to elucidate socio-ecological and psychosocial risk factors that increase risk for excessive GWG. We conducted 9 focus groups with high (n = 4 groups) and low (n = 5 groups) income pregnant women aged 18-35 years to discuss health, GWG, diet and physical activity following a discussion guide. The constant comparative method was used to code focus group notes and to identify emergent themes. Themes were categorized within the integrative model of behavioral prediction. Low income women, in contrast to high income women, had higher BMIs, had more children, and were African American. Diet and physical activity behaviors reported by low income women were more likely to promote positive energy balance than were those of high income women. The underlying behavioral, efficacy, and normative beliefs described by both groups of women explained most of these behaviors. Experiencing multiple risk factors may lead to (1) engaging in several behavior changes during pregnancy unrelated to weight and (2) holding more weight gain-promoting beliefs than weight maintaining beliefs. These factors could inhibit diet and physical activity behaviors and/or behavior changes that promote energy balance and in combination, result in excessive GWG. Low income women experience multiple risk factors for excessive GWG and successful interventions to prevent excessive GWG and pregnancy related weight gain will need to recognize the complex web of influences.

Linguistic Modification When Developing Case Studies: An Integrative Review.

BACKGROUND: Students from culturally and linguistically diverse backgrounds experience language barriers that influence their progression through nursing programs. Linguistic modification is a strategy that eliminates unnecessary wording and cultural bias to improve learning outcomes for students from diverse backgrounds. This integrative review adds to the knowledge of best practices in linguistic modification that can be applied to designing case studies for nursing students with diverse backgrounds. METHOD: A comprehensive review of the literature was conducted in scholarly scientific databases from 2002 to the present. RESULTS: Twenty-three articles discussed linguistic modification or summarized previous literature. Only four research studies were found pertaining to linguistic modification for culturally and linguistically diverse nursing students. Faculty and student practices that ameliorated language barriers were identified. CONCLUSION: The use of linguistic modification throughout a nursing curriculum creates an inclusive learning environment. Further research is needed on linguistic modification in nursing education. [J Nurs Educ. 2023;62(9):495-501.].

Nurse practitioner programs: Selection factors and the student experience.

Nurse practitioner (NP) education has faced numerous challenges related to the changing healthcare landscape, shortages of faculty, and limited resources to meet the needs of NP students. The changes within NP education have impacted students, both positively and negatively. This purpose of this review of the literature is to gain an understanding of the primary care NP student perspective related to selecting a NP program, faculty and peer relationships, program success versus attrition, clinical experiences, and transition to practice. Gaps in the literature encompassing NP education will be reviewed. Finally, recommendations will be given for prospective NP students as well as NP educators.

Racial, ethnic, and socioeconomic differences in the incidence of obesity related to childbirth.

OBJECTIVES: We investigated the relationship between childbirth and 5-year incidence of obesity. METHODS: We performed a prospective analysis of data on 2923 nonobese, nonpregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compared with women who did not have children. RESULTS: The 5-year incidence of obesity was 11.3 per 100 parous women, compared with 4.5 per 100 nulliparous women (relative risk [RR] = 3.5; 95% confidence interval [CI] = 2.4, 4.9; P < .001). The 5-year incidence of obesity was 8.6 for primiparous women (RR = 2.8; 95% CI = 1.5, 5.0) and 12.2 for multiparous women (RR = 3.8; 95% CI = 2.6, 5.6). Among parous women, White women had the lowest obesity incidence (9.1 per 100 vs 15.1 per 100 for African Americans and 12.5 per 100 for Hispanics). CONCLUSIONS: Parous women have a higher incidence of obesity than do nulliparous women, and minority women have a higher incidence of parity-related obesity than do White women. Thus, efforts to reduce obesity should target postpartum women and minority women who give birth.

Maternal weight gain during pregnancy and child weight at age 3 years.

OBJECTIVES: To determine the importance of pregnancy weight gain as a predictor of overweight (Body Mass Index [BMI] >85th percentile) in offspring at age 3 years and if its influence varies by maternal BMI. METHODS: Chi-square and logistic regression analyses were conducted on a sample of 208 mother-child pairs from an earlier observational cohort study on postpartum weight retention. RESULTS: In the final reduced regression model, maternal early pregnancy BMI was positively and significantly associated with overweight in offspring, as were birth weight above the sample median of 3,600 g and maternal smoking during pregnancy (P < or = 0.01). In addition, a significant interaction was found between maternal BMI and gestational weight gain (P = 0.03). The risk of offspring overweight that is associated with 5 excess pounds of net pregnancy weight gain increases with maternal BMI. CONCLUSIONS: Excess pregnancy weight gain is associated with increased risk of child overweight at age 3 years and its impact is greater among high and obese BMI women than it is in normal BMI women. Reducing maternal BMI in the preconception period in overweight women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.

Maternal mental health and the persistence of food insecurity in poor rural families.

BACKGROUND: Little is known about the causal relationship between and the mechanisms linking depression and food insecurity. Our purpose was to examine these knowledge gaps. METHODS: Chi-squared analysis of longitudinal data from 29 rural upstate New York families followed for three years and qualitative analysis of interviews were used to identify associations and mechanisms. RESULTS: Depressive symptoms (p=.009) and poor mental health (p=.01) in mothers limited the likelihood families would leave food insecurity. This relationship was mediated through limiting the employment of adult family members and operated in three ways: preventing the depressed household member from working, preventing a different household member from working, and limiting access to childcare for depressed children so adults could work. CONCLUSIONS: Poor mental health is associated with keeping families food-insecure by limiting their employment. High-quality, accessible mental health care is needed for poverty-associated food insecurity to be alleviated.

Use of an Online Diet Goal-Setting Tool: Relationships With Gestational Weight Gain.

OBJECTIVES: To describe (1) the use of a diet goal-setting tool in a self-directed online intervention aimed at promoting a healthy lifestyle, and (2) the association of tool use with gestational weight gain (GWG). DESIGN: Cross-sectional analysis of data from the intervention group in a randomized effectiveness trial. SETTING: An urban county in the northeastern US. PARTICIPANTS: A total of 898 healthy pregnant women aged 18-35 years with body mass indexes of (BMI) ≥18.5 and <35; 39.1% were low-income. MAIN OUTCOME MEASURES: Physical, sociodemographic, and psychosocial characteristics; use of tool features; and GWG. ANALYSIS: Frequencies, chi-square tests of independence, and regression analysis. RESULTS: Use of the online dietary tool was 45.1% completed the assessment, 35.3% set a goal, and 22.6% engaged in self-monitoring. Among women with normal BMI, setting ≥2 goals and engaging in self-monitoring were significantly (P < .05) associated with less GWG. Among women with higher BMI, setting ≥2 goals was significantly associated with greater GWG. CONCLUSIONS AND IMPLICATIONS: Although online diet goal setting is a potentially effective weight management tool for pregnant women with normal BMI, findings suggest that it may not be for higher-BMI women. Additional research is needed to explain this finding.

Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials.

OBJECTIVE: The goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials. METHODS: Intervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention. RESULTS: The intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains. CONCLUSIONS: Weight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients.

The relationship between food insecurity and obesity in rural childbearing women.

CONTEXT: While food insecurity and obesity have been shown to be positively associated in women, little is known about the direction of the causal relationship between these 2 constructs. PURPOSE: To clarify the direction of the causal relationship between food insecurity and obesity. METHODS: Chi-square and logistic regression analysis of data from a cohort of 622 healthy childbearing women living in a 10-county rural area of upstate New York and followed from early pregnancy until 2 years postpartum. FINDINGS: Obesity in early pregnancy was associated with increased risk of food insecurity at 2 years postpartum. Initial food insecurity was not associated with increased risk of obesity at 2 years postpartum. Women who were both obese and food insecure in early pregnancy were at greatest risk of major weight gain over the pregnancy and postpartum period. CONCLUSIONS: Obesity appears to lead to food insecurity rather than the converse. Obesity combined with food insecurity present the greatest risk for major weight gain in this sample of childbearing women.

Association between consistent weight gain tracking and gestational weight gain: Secondary analysis of a randomized trial.

OBJECTIVE: The effective components of interventions for reducing excessive gestational weight gain (GWG) remain to be identified. This study investigated the sociodemographic, physical, psychosocial, and environmental correlates of online GWG tracking and its independent association with GWG outcomes. METHODS: Eight hundred ninety-eight women in the intervention arms of a randomized trial assessing the effectiveness of an integrated online and mobile phone behavioral intervention to decrease the prevalence of excessive GWG were included in this secondary analysis. Data were analyzed using χ2 analysis and modified Poisson and linear regression approaches. RESULTS: Only 16.5% of low-income (Medicaid-eligible) women consistently tracked GWG, as did 34.2% of not-low-income women. More highly educated, older, and white women were more likely to be consistent GWG trackers. Among not-low-income women, consistent GWG tracking was associated with 2.35 kg less GWG (95% CI: -3.23 to -1.46 kg; P < 0.0001) and a reduced risk of excessive GWG (RR 0.73; 95% CI: 0.59 to 0.89; P = 0.002). CONCLUSIONS: Electronic tracking of GWG is an effective component of electronic and mobile health interventions aiming to decrease the prevalence of excessive GWG in not-low-income women. Income group-specific motivators are needed to increase the prevalence of GWG tracking.

Tracking of food choices across the transition to motherhood.

OBJECTIVE: This research addresses 2 questions: What are the patterns in selected food choice behaviors across the transition to motherhood? and Do the patterns vary by mothers' social location, particularly parity, family income, and breast-feeding behavior? DESIGN: A prospective cohort study with healthy, adult women followed from midpregnancy until 2 years postpartum. Data were collected through mailed questionnaires for prepregnancy and pregnancy, at 6 months, at 1 and 2 years postpartum, and through an audit of the women's medical records. SETTING: A hospital and primary care clinic system serving a 10-county area of rural upstate New York. PARTICIPANTS: 360 women of the 622 in the cohort provided data for all time points. VARIABLES MEASURED: Three food choice behaviors served as categorical dependent variables at each of the 5 time points: drinking > or = 2 cups of milk per day, consuming > or = 3 servings of fruits and vegetables per day, and eating breakfast every day. Three social location variables were used as independent variables for the second research question: parity (nulliparous vs primi- and multiparous), family income (low [< or = 185% of federal poverty level] vs higher), and breast-feeding (> or = 1 year vs less). ANALYSIS: McNemar's test was used to compare proportions of women at or above the cutoff value for each food choice behavior across time, and the Fisher exact test was used to compare proportions between groups for each social location variable at each time point. P < or = .05 was considered significant. RESULTS: The proportion of women drinking 2 or more cups of milk per day at 2 years postpartum was not different from prepregnancy, but the proportions consuming 3 or more fruits and vegetables and eating breakfast every day were significantly higher at 2 years postpartum than prior to pregnancy. The pattern of change varied by categories within the social location variables and differed by food choice behavior. CONCLUSIONS AND IMPLICATIONS: The transition to motherhood was associated with a positive change in some food choice behaviors. Women making this transition for the first time showed the most consistent positive changes and should be a target audience for nutrition education.