Perceptions of Parental Support for Physical Activity and Healthy Eating among School-age Children During COVID-19 pandemic.

Family routines play a key role in promoting child health behaviors. This study 1) describes changes in children's perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explores how sex, age, and pandemic-related economic stressors relate to changes. Children's perceptions of family routines were assessed using four subscales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Linear mixed models assessed changes in perceptions and associated factors (child age and sex; caregiver(s) job loss during pandemic). Children (N=277) were aged 9.3-15.5y at pandemic onset (March 2020), dichotomized by median age (12.1y) as younger and older. Children's perceptions of PA-policies (pre-pandemic mean=15.4) and Diet-policies (pre-pandemic mean=26.3) increased significantly from pre- to early (b=1.2 and 2.3, respectively) and mid-pandemic (b=1.0 and 1.2, respectively). Diet-rules (pre-pandemic mean=10.8) decreased significantly from pre- to early (b=-1.1) and mid-pandemic (b=-2.0), with no PA-Diet-role-model changes. Younger children had a greater increase in perceived PA-policies and Diet-policies across the pandemic. Females (59.9%) had a greater decrease in perceived Diet-rules across the pandemic and less increase in Diet-policies and PA-Diet-role-model from pre- to early pandemic. Children whose caregiver(s) lost employment (51.8%) perceived a greater increase in PA-policies. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules for diet during the pandemic. Future research is needed to understand how changes in family routines relate to PA and healthy eating behaviors.

A Randomized Multiple Micronutrient Powder Point-of-Use Fortification Trial Implemented in Indian Preschools Increases Expressive Language and Reduces Anemia and Iron Deficiency.

BACKGROUND: Anemia is a global public health problem that undermines childhood development. India provides government-sponsored integrated nutrition/child development preschools. OBJECTIVES: This double-masked, cluster-randomized controlled trial examines whether point-of-use multiple micronutrient powder (MNP) compared with placebo fortification of preschool meals impacts child development and whether effects vary by preschool quality (primary outcome) and biomarkers of anemia and micronutrients (secondary outcomes). We also measured growth and morbidity. METHODS: We randomly assigned 22 preschools in rural India to receive MNP/placebo fortification. We administered baseline and endline blood sampling and measures of childhood development (Mullen Scales of Early Learning, inhibitory control, social-emotional), anthropometry, and morbidity to preschoolers (aged 29-49 mo). Preschools added MNP/placebo to meals 6 d/wk for 8 mo. We conducted linear mixed-effects regression models accounting for preschool clustering and repeated measures. We evaluated child development, examining effects in high- compared with low-quality preschools using the Early Childhood Environment Rating Scale-Revised and the Home Observation for the Measurement of the Environment Inventory, modified for preschools. RESULTS: At baseline, mean age ± SD was 36.6 ± 5.7 mo, with 47.8% anemic, 41.9% stunted, and 20.0% wasted. Baseline expressive/receptive language scores were higher in high-quality compared with low-quality preschools (P = 0.02 and P = 0.03, respectively). At endline (91% retention, n = 293/321), we found MNP compared with placebo effects in expressive language (Cohen's standardized effect d = 0.4), inhibitory control (d = 0.2), and social-emotional (d = 0.3) in low-quality, not high-quality, preschools. MNP had significantly greater reduction of anemia and iron deficiency compared with placebo (37% compared with 13.5% and 41% compared with 1.2%, respectively). There were no effects on growth or morbidity. CONCLUSIONS: Providing multiple micronutrient-fortified meals in government-sponsored preschools is feasible; reduced anemia and iron deficiency; and, in low-quality preschools, increased preschoolers' expressive language and inhibitory control and reduced developmental disparities. Improving overall preschool quality by incorporating multiple components of nurturing care (responsive care, learning, and nutrition) may be necessary to enhance preschoolers' development. This trial was registered at clinicaltrials.gov as NCT01660958.

Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families.

BACKGROUND: Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families. PURPOSE: To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight. METHODS: Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score. RESULTS: Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score. CONCLUSIONS: Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities. TRIAL REGISTRATION NUMBER: NCT02615158.

Assessment of risk for food insecurity among African American urban households: utilizing cumulative risk indices and latent class analysis to examine accumulation of risk factors.

African American caregivers in low-income, urban communities have high rates of food insecurity. Unemployment, education, smoking, stress, and depressive symptoms are associated with household food insecurity. A cumulative risk model suggests that accumulation of risk may compound food insecurity risk, and certain risk factors are more likely to co-occur. This study utilizes two approaches to examine food insecurity risk among African American caregivers with an adolescent daughter-a cumulative risk index to examine accumulation of risk and food insecurity risk; latent class analysis (LCA) to determine if certain risk profiles exist and their relation to food insecurity risk. Caregivers completed surveys including demographic, psychosocial, and behavioral questions (to create a cumulative risk index) and a validated 2-item food insecurity screen. LCA was used to identify risk profiles. Logistic regression was used to examine relations between cumulative risk, risk profiles, and food insecurity risk. Each additional cumulative risk index factor was associated with a 54% increase in odds of risk of food insecurity. LCA identified three subgroups: high stress/depression (class #1), low education/low stress and depression (class #2), and low risk overall (class #3). Odds of food insecurity risk were 4.7 times higher for class #1, and 1.5 times higher for class #2 compared with class #3. This study contributes to understanding of how food insecurity risk relates to cumulative risk and risk profiles. Findings can be used to improve food insecurity risk screening in clinical settings, enhancing intervention/referral for food security risk and mental health among African American caregivers and their households.

Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers.

BACKGROUND: Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers. METHODS: A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores. RESULTS: Response rate was 40% (n = 610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B = 0.26, p < 0.001; B = 0.26, p = 0.001, respectively); policies with foods served (B = 0.22, p = 0.002); and policies, provider training, and feeding environment with physical activity (B = 0.19, p = 0.001; B = 0.24, p = 0.010; B = 0.38, p < 0.001). CONCLUSIONS: Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.

Food swamps and food deserts in Baltimore City, MD, USA: associations with dietary behaviours among urban adolescent girls.

OBJECTIVE: To determine whether living in a food swamp (≥4 corner stores within 0·40 km (0·25 miles) of home) or a food desert (generally, no supermarket or access to healthy foods) is associated with consumption of snacks/desserts or fruits/vegetables, and if neighbourhood-level socio-economic status (SES) confounds relationships. DESIGN: Cross-sectional. Assessments included diet (Youth/Adolescent FFQ, skewed dietary variables normalized) and measured height/weight (BMI-for-age percentiles/Z-scores calculated). A geographic information system geocoded home addresses and mapped food deserts/food swamps. Associations examined using multiple linear regression (MLR) models adjusting for age and BMI-for-age Z-score. SETTING: Baltimore City, MD, USA. SUBJECTS: Early adolescent girls (6th/7th grade, n 634; mean age 12·1 years; 90·7 % African American; 52·4 % overweight/obese), recruited from twenty-two urban, low-income schools. RESULTS: Girls' consumption of fruit, vegetables and snacks/desserts: 1·2, 1·7 and 3·4 servings/d, respectively. Girls' food environment: 10·4 % food desert only, 19·1 % food swamp only, 16·1 % both food desert/swamp and 54·4 % neither food desert/swamp. Average median neighbourhood-level household income: $US 35 298. In MLR models, girls living in both food deserts/swamps consumed additional servings of snacks/desserts v. girls living in neither (ß=0·13, P=0·029; 3·8 v. 3·2 servings/d). Specifically, girls living in food swamps consumed more snacks/desserts than girls who did not (ß=0·16, P=0·003; 3·7 v. 3·1 servings/d), with no confounding effect of neighbourhood-level SES. No associations were identified with food deserts or consumption of fruits/vegetables. CONCLUSIONS: Early adolescent girls living in food swamps consumed more snacks/desserts than girls not living in food swamps. Dietary interventions should consider the built environment/food access when addressing adolescent dietary behaviours.

Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes.

Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth outcomes. 9,995 mothers of children <48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child's birth, or consistently housed. Outcomes included birth weight as a continuous variable, as well as categorical outcomes of low birth weight (LBW; <2,500 g) and preterm delivery (<37 weeks). Multiple logistic regression and adjusted linear regression analyses were performed, comparing prenatal and postnatal homelessness with the referent group of consistently housed mothers, controlling for maternal demographic characteristics, smoking, and child age at interview. Prenatal homelessness was associated with higher adjusted odds of LBW (AOR 1.43, 95 % CI 1.14, 1.80, p < 0.01) and preterm delivery (AOR 1.24, 95 % CI 0.98, 1.56, p = 0.08), and a 53 g lower adjusted mean birth weight (p = 0.08). Postnatal homelessness was not associated with these outcomes. Prenatal homelessness is an independent risk factor for LBW, rather than merely a marker of adverse maternal and social characteristics associated with homelessness. Targeted interventions to provide housing and health care to homeless women during pregnancy may result in improved birth outcomes.

Prenatal drug exposure moderates the association between stress reactivity and cognitive function in adolescence.

Prenatal drug exposure (PDE) can undermine subsequent health and development. In a prospective longitudinal study we examine whether PDE moderates the link between stress reactivity and cognitive functioning in adolescence. Participants were 76 prenatally drug-exposed and 61 nonexposed (NE) community comparison African American youth (50% male, mean age 14.17 years) living in an urban setting. All participants completed neuropsychological and academic achievement tests (Children's Memory Scales, the California Verbal Learning Test - Children's version and the Wide Range Achievement Test 4) over the course of 1 day in a laboratory setting. Two mild stressors (Balloon Analog Risk Task - Youth and Behavioral Indicator of Resilience to Distress) were administered, with saliva samples (assayed for cortisol) collected pre- and poststress task. A higher percentage in the NE group, compared to the PDE group (26% vs. 12%, χ(2) = 4.70, d.f. = 1, n = 137, p = 0.03), exhibited task-related increases in salivary cortisol. PDE moderated the association between stress reactivity and 11 of 15 cognitive performance scales. In each case, the NE stress reactive group had better cognitive performance than either the NE lower cortisol reactive group or the PDE group regardless of stress reactivity status. Stress-related reactivity and regulation of the hypothalamic-pituitary-adrenal axis in adolescence may be disrupted by PDE, and the disruption may be linked to lower cognitive performance.

Prenatal drug exposure, behavioral problems, and drug experimentation among African-American urban adolescents.

PURPOSE: To examine how prenatal drug exposure (PDE) to heroin/cocaine and behavioral problems relate to adolescent drug experimentation. METHODS: The sample included African-American adolescents (mean age = 14.2 years, SD = 1.2) with PDE (n = 73) and a nonexposed community comparison (n = 61). PDE status was determined at delivery through toxicology analysis and maternal report. Internalizing/externalizing problems were assessed during adolescence with the Behavior Assessment System for Children, Second Edition. Drug experimentation was assessed by adolescent report and urine analysis. Logistic regression evaluated the likelihood of drug experimentation related to PDE and behavioral problems, adjusting for age, gender, PDE, perceived peer drug use, and caregiver drug use. Interaction terms examined gender modification. RESULTS: Sixty-seven subjects (50%) used drugs: 25 (19%) used tobacco/alcohol only and 42 (31%) used marijuana/illegal drugs. Ninety-four subjects (70%) perceived peer drug use. PDE significantly increased the risk of tobacco/alcohol experimentation (odds ratio = 3.07, 95% confidence interval [CI] 1.09-8.66, p = .034) but not after covariate adjustment (adjusted odds ratio [aOR] = 1.16, 95% CI .31-4.33, p > .05). PDE was not related to the overall or marijuana/illegal drug experimentation. The likelihood of overall drug experimentation was doubled per SD increase in externalizing problems (aOR = 2.28, 95% CI 1.33-3.91, p = .003) and, among girls, 2.82 times greater (aOR = 2.82, 95% CI 1.34-5.94, p = .006) per SD increase in internalizing problems. Age and perceived peer drug use were significant covariates. CONCLUSIONS: Drug experimentation was relatively common (50%), especially in the context of externalizing problems, internalizing problems (girls only), older age, and perceived peer drug use. Findings support the Problem Behavior Theory and suggest that adolescent drug prevention addresses behavioral problems and promotes prosocial peer groups.

The perceived and built environment surrounding urban schools and physical activity among adolescent girls.

BACKGROUND: Neighborhood perceived/built environment and physical activity (PA) associations have been examined for adolescents around homes, but not surrounding schools. PURPOSE: The purpose of this paper is to examine if positive perceptions/built environment in neighborhoods surrounding schools predict PA among low-income, urban adolescent girls. METHODS: Measures include: minutes in moderate-vigorous PA (MVPA, ankle accelerometry), perceptions of the school environment (questionnaire), built environment (neighborhood audit). Analyses include multi-level models. RESULTS: Two hundred twenty-four sixth and seventh grade girls [mean(sd) age = 12.1(0.7) years] from 12 schools serving low-income, primarily African American communities; mean MVPA 35.4 min (mean days assessed = 5.8). Girls in schools with more positive perceptions of the neighborhood environment surrounding the school were less active (ß = 7.2, p = 0.043). Having "places to go within walking distance" (perceptions) and number of food stores near school (built environment) positively relate to MVPA (ß = 5.5, p = 0.042 and ß = 0.59, p = 0.047). CONCLUSIONS: Among neighborhoods surrounding urban schools, positive perceptions do not predict PA; accessibility, via both perceived and built environment, support PA.

¿Cómo alimentar a los niños? La práctica de conductas alimentarias saludables desde la infancia / How to feed children? Healthy eating behaviors starting at childhood

Las intervenciones para prevenir la desnutrición o el exceso de peso en los niños se enfocan en la dieta, y dan poca atención a los comportamientos de las personas responsables de su cuidado. En sus primeros dos años los niños adoptan prácticas establecidas en su entorno y las conductas de sus cuidadores, los cuales constituyen patrones alimentarios que persistirán a lo largo de su vida. Así, los niños y sus cuidadores establecen una relación en que reconocen, interpretan y responden a las señales de comunicación verbal y no verbal. Alimentar al niño adoptando una conducta “responsiva” en la que los cuidadores proveen la dirección y estructura, y responden a los señales de hambre y saciedad de los niños, promueve la autorregulación y la responsabilidad de los niños para una alimentación sana. En este artículo, damos recomendaciones para incorporar la alimentación responsiva y modelar conductas alimentarias saludables en las intervenciones nutricionales.

Interventions to prevent malnutrition or overweight in children focus on the diet, and give little attention to the behaviors of their caretakers. In their first two years of life, children adopt practices that are embedded in their environment and the behaviors of their caretakers, thus turning into nutrition patterns that will persist during their lifetimes. Therefore, children and caretakers establish a relationship in which they recognize, construe and respond to verbal and non verbal communication signs. Feeding a child by adopting a “responsive” behavior in which caretakers provide guidance and structure, and respond to children’s signs of hunger and satiety promotes self-regulation and children’s awareness of healthy nutrition. In this article, we give recommendations to include responsive nutrition and model healthy eating behaviors in nutritional interventions.

Integrated strategies needed to prevent iron deficiency and to promote early child development.

Iron deficiency (ID) and iron deficiency anemia (IDA) are global public health problems that differentially impact pregnant women and infants in low and middle income countries. IDA during the first 1000 days of life (prenatally through 24 months) has been associated with long term deficits in children's socio-emotional, motor, cognitive, and physiological functioning. Mechanisms linking iron deficiency to children's development may include alterations to dopamine metabolism, myelination, and hippocampal structure and function, as well as maternal depression and unresponsive caregiving, potentially associated with maternal ID. Iron supplementation trials have had mixed success in promoting children's development. Evidence suggests that the most effective interventions to prevent iron deficiency and to promote early child development begin early in life and integrate strategies to ensure adequate iron and nutritional status, along with strategies to promote responsive mother-child interactions and early learning opportunities.

Memory ability and hippocampal volume in adolescents with prenatal drug exposure.

The objective of the present study was to examine the influence of prenatal drug exposure (PDE) on memory performance and supporting brain structures (i.e., hippocampus) during adolescence. To achieve this goal, declarative memory ability and hippocampal volume were examined in a well-characterized sample of 138 adolescents (76 with a history of PDE and 62 from a non-exposed comparison group recruited from the same community, mean age=14 years). Analyses were adjusted for: age at time of the assessments, gender, IQ, prenatal exposure to alcohol and tobacco, and indices of early childhood environment (i.e., caregiver depression, potential for child abuse, and number of caregiver changes through 7 years of age). Results revealed that adolescents with a history of PDE performed worse on the California Verbal Learning Test-Child Version (CVLT-C), and story recall from the Children's Memory Scale (CMS), and had larger hippocampal volumes, even after covariate adjustment. Hippocampal volume was negatively correlated with memory performance on the CVLT-C, with lower memory scores associated with larger volumes. These findings provide support for long-term effects of PDE on memory function and point to neural mechanisms that may underlie these outcomes.

Prenatal drug exposure and peer victimization in early adolescence: testing childhood anxiety/depression and aggression as possible mediators.

OBJECTIVE: Children who are prenatally exposed to drugs may be at risk for emotion dysregulation, including childhood anxiety/depression and aggression, potentially increasing their risk for peer victimization. The objectives of this study were to investigate how prenatal drug exposure relates to adolescent peer victimization and the mediating effects of childhood anxiety/depression and aggression. METHODS: Seventy-six prenatally drug exposed (PDE) and 38 nonexposed (NE) adolescent-caregiver dyads followed since birth and middle childhood, respectively, participated in an evaluation during adolescence. In middle childhood, caregivers reported on their child's anxiety/depression and aggression, and children reported on violence exposure. In adolescence, caregivers and adolescents responded to a parallel single-item measure of peer victimization. Analyses were conducted using multivariate linear and logistic regression models, adjusting for covariates, including violence exposure. RESULTS: One-third (33.3%, n = 35) of the sample endorsed peer victimization: 40.8% PDE and 17.6% NE, p = .01. In middle childhood, PDE youth had more aggressive behaviors (11.92 vs 7.45, p < .01) and anxiety/depression symptoms (3.43 vs 1.76, p < .01) than NE youth. Anxious/depressed behavior during childhood mediated the association between prenatal drug exposure and adolescent peer victimization. Aggression was not a significant mediator. CONCLUSIONS: The consequences of prenatal drug exposure extend into adolescence. Prenatal drug exposure may interfere with emotion regulation, resulting in anxious/depressed behavior during childhood and significantly increasing the risk for peer victimization during adolescence, even in the presence of violence exposure. Strategies to reduce anxious/depressed behavior among children with a history of prenatal drug exposure may reduce adolescent peer victimization.

Iron deficiency and iron-deficiency anemia in the first two years of life: strategies to prevent loss of developmental potential.

This article examines the association of iron deficiency (ID) and iron deficiency anemia (IDA) with children's development and behavior, with the goal of providing recommendations to prevent the developmental loss associated with these conditions. Children's risk for ID and IDA is particularly high during the second 6 months of life when prenatal stores are depleted. Longitudinal studies from infancy through adolescence and early adulthood suggest that socioemotional development is uniquely vulnerable to ID and IDA, perhaps being associated with shared neural pathways, and the effects of early iron deficiencies may be irreversible. In addition to direct effects on brain function, ID and IDA may also affect child development indirectly through non-responsive mother-child interactions. Maternal ID is a global problem that may contribute to high rates of maternal depression and non-responsive caregiving. Intervention trials illustrate that children benefit from both nutritional intervention and early learning interventions that promote responsive mother-child interactions. Recommendations to reduce the developmental loss associated with ID and IDA are to reduce the incidence of these conditions by efforts to prevent premature birth, delay cord clamping, ensure adequate maternal iron status, provide iron-rich complementary foods, and ensure access to postnatal interventions that promote responsive mother-infant interaction patterns and early learning opportunities for infants.

B12 in fetal development.

Vitamin B12 (cobalamin) is necessary for development of the fetus and child. Pregnant women who are vegetarian or vegan, have Crohn's or celiac disease, or have undergone gastric bypass surgery are at increased risk of B12 deficiency. Low serum levels of B12 have been linked to negative impacts in cognitive, motor, and growth outcomes. Low cobalamin levels also may be related to depression in adults. Some studies indicate that B12 supplementation may improve outcomes in children, although more research is needed in this area. Overall, the mechanisms of B12 action in development remain unclear. Further studies in this area to elucidate the pathways of cobalamin influence on development, as well as to prevent B12 deficiency in pregnant women and children are indicated.

Case study on iron in mental development--in memory of John Beard (1947-2009).

Iron deficiency (ID) anemia is associated with poor neurocognitive development in infants and children. Depending on the stage of development at the time of deficiency, these adverse effects may be reversible. Recent investigations using sensitive measurements have confirmed that the deposition of iron in the brain varies according to brain region and age, and that dopamine-dependent behaviors are among the core deficits in ID. Dr John Beard (1947-2009) has been one of the leading scientists and pioneers in the area of iron and child development. His legacy to this area of science will grow through the continuation of his work by his co-workers and colleagues.