The effects of housing insecurity on children's health: a scoping review.

There is a well-established connection between housing conditions and children's health. However, little is known on how housing insecurity indicators including, multiple moves, being behind on rent/mortgage, doubling up and crowding, affect child health. The purpose of this paper is to identify how pathways of association between housing insecurity and health may become established during childhood, using evidence from the literature. Using the Joanna Briggs Institute framework for scoping reviews, a search was conducted using key terms associated with housing insecurity and health among children. Twenty-seven articles were included in the review. Forty-six outcomes related to child health were identified throughout the articles. Physical health was the most commonly examined outcome in these articles. Multiple moves was the most common housing insecurity indicator associated with health. This review identified multiple studies showing negative associations between housing insecurity and poorer health-related indicators among children. Results from this review provide important information on the implication of certain housing insecurity indicators for children's health. Although housing is increasingly recognized as a social determinant of health, it may be particularly important to go beyond physical housing conditions to consider and measure housing insecurity in future work, as a key social determinant shaping health in pediatric populations.

In this scoping review, we examine the evidence for pathways linking housing insecurity including, multiple moves, being behind on rent/mortgage, doubling up and crowding, and multiple health outcomes (i.e. physical and mental health, behavior, cognitive development) in early and middle-aged children. It is important to acknowledge housing insecurity as a barrier to achieving optimal health in children.

When Families Do Not Request Help: Assessing a Social Determinants of Health Screening Tool in Practice.

INTRODUCTION: Using pediatric social determinants of health screening data from a large medical system, we explored social needs dislosures and identified which needs were associated with resource connection requests. METHOD: Data came from records of outpatient pediatric patients (0-18 years) seen between October 2018 and March 2020 (39,251 encounters). We assessed percent of encounters where families (1) indicated a social need, and (2) requested a resource connection. We conducted multivariable logistic regression to identify which needs were associated with resource connection requests. RESULTS: Among all encounters, 8% indicated a need and 2% requested a resource connection. Among families indicating a need, needs associated with resource requests included: housing (odds ratio [OR], 3.49 [2.42-5.03]), employment (OR, 3.15 [2.21-4.50]), food (OR, 1.89 [1.41-2.52]), and transportation (OR, 1.82 [1.30-2.56]). DISCUSSION: Families seldom requested resource connections to address social needs. Better understanding families' interests in receiving assistance is an important next step in pediatric social determinants of health screening system development.

Pathways from racial discrimination to cortisol/DHEA imbalance: protective role of religious involvement.

Objective: Racial discrimination (RD) is hypothesized to dysregulate the production of stress reactive hormones among African Americans. Psychological processes that may mediate the association between RD and such dysregulation (e.g. cortisol/DHEA ratio) are not well articulated. Organizational religious involvement (ORI) has been discussed as a psychological protective factor within the context of RD, but our understanding of ORI as a physiological protective factor remains limited. We evaluated whether RD was directly and indirectly (through depressive symptoms) associated with an imbalance of cortisol and DHEA hormones, and whether ORI buffered these direct and/or indirect pathways.Design: Data were drawn from the Flint Adolescent Study, an ongoing interview study of youth that began in 1994. Participants were 188 African American emerging adults (47.3% Female, ages 20-22). We used mediation and moderated-mediation analyses, as outlined by Hayes [2012. PROCESS SPSS Macro. [Computer Software and Manual]. http://www.afhayes.com/public/process.pdf], to evaluate the study aims.Results: We found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio. We also found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio for individuals reporting low and moderate levels of ORI, but not at high levels.Conclusions: Our findings support the socio-psychobiological model of racism and health [Chae et al. 2011. "Conceptualizing Racial Disparities in Health: Advancement of a Socio-Psychobiological Approach." Du Bois Review: Social Science Research on Race 8 (1): 63-77. doi:10.1017/S1742058X11000166] and suggest that the psychological toll of RD can confer physiological consequences. Moreover, ORI may disrupt pathways from RD to cortisol/DHEA ratio by buffering the psychological toll of RD.

Economic hardship and child intake of foods high in saturated fats and added sugars: the mediating role of parenting stress among high-risk families.

OBJECTIVE: Economic hardship (EH) may link to poorer child diet, however whether this association is due to resource limitations or effects on family functioning is unknown. This study examines whether parenting stress mediates the association between EH and child consumption of foods high in saturated fats and added sugars (SFAS). DESIGN: Data were collected from the Fragile Families and Child Wellbeing study. EH was assessed using eight items collected when children were between 1-9 years old. Mothers reported parenting stress and frequency of child consumption of high SFAS foods when children were 9 years old. Latent growth curve modelling (LGCM) and structural equation modelling tested direct associations between the starting level/rate of change in EH and high SFAS food consumption, and parenting stress as a mediator of the association. SETTING: Twenty US cities. PARTICIPANTS: Mothers/children (n 3846) followed birth through age 9 years, oversampled 'high-risk', unmarried mothers. RESULTS: LGCM indicated a curvilinear trend in EH from ages 1-9, with steeper increases from ages 3-9 years. EH did not directly predict the frequency of high SFAS foods. Average EH at 3 and 5 years and change in EH from ages 1-9 predicted higher parenting stress, which in turn predicted more frequent consumption of high SFAS foods. CONCLUSIONS: Findings suggest it may be important to consider parenting stress in early prevention efforts given potential lasting effects of early life EH on child consumption of high SFAS foods. Future research should explore how supports and resources may buffer effects of EH-related stress on parents and children.

Developmentally informed behaviour change techniques to enhance self-regulation in a health promotion context: a conceptual review.

Self-regulation (SR), or the ability to manage thoughts, emotions, and behaviours in order to achieve a desired goal, is seen as underlying positive health behaviours. In adults, behaviour change techniques (BCTs) are recommended to promote SR across health domains; although establishing healthy habits early in life is important, studies of SR and health in children are rare. This conceptual review provides guidance on developmental considerations for applying BCTs to enhance SR capacity in children and youth with the goal of fostering positive behavioural health trajectories early in the lifespan. Key considerations include the nature of developmental changes in SR and interaction among SR processes; temporal associations between SR and health behaviours; and relevance of health goals for children and youth. Building on a meta-review of BCT's used to promote SR in adults and youth, this conceptual review highlights key SR milestones to consider in behaviour change-focused interventions from early childhood through adolescence and provides an overview of social-ecologic influences on SR development and associations between SR and health behaviours across these age periods. Implications for and examples of using developmentally-informed BCTs in interventions to enhance SR in children and youth are noted and suggestions for future research are discussed.

Poverty and Food Insecurity Predict Mealtime Structure: Mediating Pathways of Parent Disciplinary Practices and Depressive Symptoms.

OBJECTIVE: Structured, well-organized mealtime routines can provide many physical and mental health benefits for children. Poverty and food insecurity (FI) are socioeconomic risk factors for less effective mealtime routines. However, the specific mechanisms by which these social factors may negatively impact mealtime structure are not well-understood. We test whether poverty and FI are associated with parenting factors (mental health and parent disciplinary practices), and whether these parenting factors in turn associate with less mealtime structure. METHODS: Low-income families (N = 270), recruited when children were approximately 6-years-old (wave 1), were followed for 2 years (wave 2). Socioeconomic and parenting factors were assessed at W1 via parent-report. Associations of poverty and FI with two measures of mealtime structure (parent-reported and observed mealtime structure at wave 1 and wave 2), mediated by parent factors (depressive symptoms, lax and overreactive parent disciplinary practices) were assessed in separate path analyses. RESULTS: The association between higher depth of poverty and less mealtime structure in early childhood was mediated by greater parent depressive symptoms. FI was associated with less mealtime structure in early childhood, mediated by overreactive parenting, and with less mealtime structure in early and mid-childhood, mediated by lax parenting. CONCLUSION: Poverty and food insecurity may contribute to suboptimal parent disciplinary practices and poor parent mental health, which may reduce mealtime structure for children. Addressing parent mental health and parent disciplinary practices in the context of socioeconomic adversity may be one way in which interventions can improve mealtime structure for low-income families.

Picky eating, pressuring feeding, and growth in toddlers.

Several common theoretical frameworks have posited causal pathways between picky eating, pressuring feeding, and growth in early childhood. The evidence to support these pathways is limited. This observational cohort study sought to examine the cross-lagged associations between mother-reported pressuring feeding, mother-reported child picky eating, and measured weight-for-length z-score (WLZ) across child ages 21, 27, and 33 months (n = 244). Cross-lagged analysis was used to evaluate longitudinal associations between these three constructs. The sample was 50.5% white, 52.3% male and 37.8% of mothers had a high school education or less. Mean WLZ was 0.52, 0.41, and 0.38 at each age, respectively. Pressuring feeding, picky eating, and WLZ each tracked strongly from 21 to 33 months. There were concurrent associations between pressuring feeding and picky eating. However, there were no prospective associations between pressuring feeding and future WLZ; WLZ and future pressuring feeding; pressuring feeding and future picky eating; picky eating and future pressuring feeding; or picky eating and future WLZ. Our results do not support causal relationships between picky eating, pressuring feeding, and growth in toddlerhood. Future work that examines alternative mechanisms shaping growth in early childhood is needed.

Psychological pathways from racial discrimination to cortisol in African American males and females.

The association between racial discrimination (discrimination) and stress-related alterations in the neuroendocrine response-namely, cortisol secretion-is well documented in African Americans (AAs). Dysregulation in production of cortisol has been implicated as a contributor to racial health disparities. Guided by Clark et al. (Am Psychol 54(10):805-816, 1999. doi: 10.1037/0003-066X.54.10.805 ) biopsychosocial model of racism and health, the present study examined the psychological pathways that link discrimination to total cortisol concentrations in AA males and females. In a sample of 312 AA emerging adults (45.5% males; ages 21-23), symptoms of anxiety, but not depression, mediated the relation between discrimination and total concentrations of cortisol. In addition, the results did not reveal sex differences in the direct and indirect pathways. These findings advance our understanding of racial health disparities by suggesting that the psychological consequences of discrimination can uniquely promote physiologic dysregulation in AAs.

Familial psychosocial risk classes and preschooler body mass index: The moderating effect of caregiver feeding style.

BACKGROUND: Early child weight gain predicts adolescent and adult obesity, underscoring the need to determine early risk factors affecting weight status and how risk factors might be mitigated. Socioeconomic status, food insecurity, caregiver depressive symptomology, single parenthood, and dysfunctional parenting each have been linked to early childhood weight status. However, the associations between these risk factors and children's weight status may be moderated by caregiver feeding styles (CFS). Examining modifiable factors buffering risk could provide key information to guide early obesity intervention efforts. METHODS: This analysis used baseline data from the Growing Healthy project that recruited caregivers/child dyads (N = 626) from Michigan Head Start programs. Caregivers were primarily non-Hispanic white (62%) and African American (30%). After using latent class analysis to identify classes of familial psychosocial risk, CFS was tested as a moderator of the association between familial psychosocial risk class and child body mass index (BMI) z-score. RESULTS: Latent class analysis identified three familial psychosocial risk classes: (1) poor, food insecure and depressed families; (2) poor, single parent families; and (3) low risk families. Interactive effects for uninvolved feeding styles and risk group indicated that children in poor, food insecure, and depressed families had higher BMI z-scores compared to children in the low risk group. Authoritative feeding styles in low risk and poor, food insecure, and depressed families showed lower child BMI z-scores relative to poor, single parent families with authoritative feeding styles. CONCLUSIONS: Uninvolved feeding styles intensified the risk and an authoritative feeding style muted the risk conferred by living in a poor, food-insecure, and depressed family. Interventions that promote responsive feeding practices could help decrease the associations of familial psychosocial risks with early child weight outcomes.

Characteristics Associated With Parent-Teacher Concordance on Child Behavior Problem Ratings in Low-Income Preschoolers.

OBJECTIVE: Assessment of pediatric behavior problems often requires rating scales from multiple reporters in different settings (eg, home and school); however, concordance between reporters may be low. Pediatricians must reconcile differences to inform treatment. We sought to examine characteristics predicting parent-teacher concordance on ratings of preschoolers' behavior problems. METHODS: Data from 562 preschoolers were used from the Growing Healthy study, an obesity prevention trial in Head Start programs (2011-2015). Parents and teachers completed the Eyberg Child Behavior Inventory (ECBI)/Student Behavior Inventory (SBI) and the Social Competence and Behavior-Evaluation (SCBE). Outcome variables were: parent-teacher concordance (teacher minus parent score on each subscale of ECBI/SBI and SCBE); teacher reports problem behavior, parent does not (children rated in the top quintile of challenging behavior by teacher but not parent); and parent reports problem behavior, teacher does not (children rated in the top quintile of challenging behavior by parent but not teacher). Multiple linear and logistic regression models were created for each subscale outcome, including the following covariates: child sex, child race/ethnicity, parent age, parent education, family structure, parent depressive symptoms, and parenting self-efficacy, and time of school year. RESULTS: Lower concordance was associated with child female sex, and child black or Hispanic race/ethnicity; parent older age, lower education, more depressive symptoms, and greater self-efficacy; and beginning of school year. CONCLUSIONS: Low parent-teacher concordance may reflect different perceptions of child behavior. Pediatricians could consider parent depressive symptoms, culture, and implicit bias when interpreting differences in behavior ratings by parents and teachers.

Maternal restrictive feeding and eating in the absence of hunger among toddlers: a cohort study.

BACKGROUND: Restrictive feeding by parents has been associated with greater eating in the absence of hunger (EAH) among children, a risk factor for obesity. However, few studies have examined the association between restrictive feeding and EAH longitudinally, raising questions regarding the direction of associations between restrictive feeding and child EAH. Our objective was to examine the bidirectional prospective associations between restrictive feeding and EAH among toddlers. METHODS: Low-income mother-child dyads (n = 229) participated when children were 21, 27, and 33 months old. Restriction with regard to food amount and food quality were measured with the Infant Feeding Styles Questionnaire. EAH was measured as kilocalories of food children consumed after a satiating meal. A cross-lagged analysis adjusting for child sex and weight-for-length z-score was used to simultaneously test cross-sectional and bidirectional prospective associations between each type of restriction and children's EAH. RESULTS: At 21 months, mothers of children with greater EAH reported higher restriction with regard to food amount (b = 0.17, p < .05). Restriction with regard to food amount at age 21 months was inversely associated with EAH at 27 months (b = -0.20, p < .05). Restriction with regard to food amount at 27 months was not associated with EAH at 33 months and restriction with regard to food quality was not associated with EAH. EAH did not prospectively predict maternal restriction. CONCLUSIONS: Neither restriction with regard to food amount nor food quality increased risk for EAH among toddlers. Current US clinical practice recommendations for parents to avoid restrictive feeding, and the potential utility of restrictive feeding with regard to food amount in early toddlerhood, deserve further consideration.

Does striving to succeed come at a physiological or psychosocial cost for adults who experienced child maltreatment?

While striving to succeed in the face of adversity may provide individuals with outward benefits, it may come at a cost to individuals' physical health. The current study examines whether striving predicts greater physiological or psychosocial costs among those who experienced child maltreatment, a stressor that disrupts the caregiving environment and threatens relationship security. Using data from the National Longitudinal Study of Adolescent to Adult Health, we tested whether greater striving after childhood maltreatment would come at a cost, increasing underlying cardiovascular disease (CVD) risk and depressive symptoms despite showing outward success via income and college degree attainment. The study included 13,341 Black, Hispanic, and White adolescents who self-reported striving and their experiences of childhood neglect, physical abuse, and sexual abuse. As young adults, participants reported depressive symptoms, income, and college degree attainment and completed a health assessment from which a 30-year Framingham-based CVD risk score was calculated. Higher striving was associated with lower CVD risk and depressive symptoms, and higher income and college degree attainment, regardless of maltreatment history. These findings highlight the potential for striving as a target for interventions and support the need to examine multiple biological and behavioral outcomes to understand the multifaceted nature of resilience.

Externalizing behavior is prospectively associated with intake of added sugar and sodium among low socioeconomic status preschoolers in a sex-specific manner.

BACKGROUND: High intake of added sugar and sodium is a public health concern for preschool-aged children living in the US. Externalizing behavior may predict higher consumption of added sugar and/or sodium; however, previous studies have mostly been cross-sectional. The aim was to evaluate whether externalizing behavior is prospectively related to added sugar and intake in a sex-specific manner among preschoolers. METHODS: This was a secondary analysis of 524 preschool children (48% male) from Michigan who participated in an obesity prevention trial that occurred during one school year from 2011 to 2015. Teacher-assessed externalizing behaviors and three 24-h dietary recalls were completed at baseline and follow-up. We used linear mixed effects regression to evaluate the association between externalizing behavior at baseline and added sugar (% of total Calories) and sodium intake (mg/1000 Calories) at follow-up. In adjusted analysis, we included baseline income-to-needs ratio, child race/ethnicity, and baseline overweight status. All models were adjusted for total energy intake and accounted for clustering by classroom. RESULTS: Baseline externalizing behavior was positively associated with added sugar intake at follow-up among boys; after adjustment for confounders, every 5 points lower externalizing T-score (corresponding to higher externalizing behavior) was associated with a 0.6 higher percentage of added sugar per total Calories (95% CI 0.2 to 1.1; P value = 0.004). In contrast, girls with higher levels of externalizing behavior had lower consumption of added sugars; after confounder adjustment, every 5 points lower externalizing T-score was related to 0.6 lower percentage intake (95% CI -1.0 to -0.1; P value = 0.01). Baseline externalizing behavior was inversely associated with sodium intake at follow-up among boys. After potential confounder adjustment, for every 5 points lower externalizing behavior T-score, there was a 22 mg/1000 Cal lower sodium intake (95% CI -45 to 1; P value = 0.06). In contrast, after adjustment for confounders, every 5 points lower externalizing T-score among girls was related to 24 mg/1000 Cal higher sodium intake (95% CI 1 to 46; P value = 0.04). CONCLUSIONS: Externalizing behavior among preschool-aged children was prospectively related to added sugar and sodium intake in a sex-dependent manner. TRIAL REGISTRATION: NCT01398358 Registered 19 July 2011.

Cortisol profiles differ by race/ethnicity among young sexual minority men.

Much of the extant scientific research examining hypothalamic-pituitary-adrenal (HPA)-axis functioning is conducted among White heterosexuals. Very little research examines HPA-axis functioning between different minority groups. Individuals who identify as both sexual and racial minorities may experience increased stigma and discrimination that can affect HPA-axis functioning. In the current study, we examined diurnal cortisol rhythm in young White gay men (WGM) compared to young Black gay men (BGM). The sample consisted of 70 healthy gay men (mean [SD] age=22.9 [3.2]: 68% White and 38% Black) who collected four saliva samples daily for five days. Repeated measures analysis of covariance and post-hoc tests revealed that BGM had higher cortisol levels than WGM in the evening. Secondary analyses revealed no significant group differences for the cortisol awakening response or systemic output throughout the day. However, BGM compared to WGM had a lower drop from peak (morning) to lowest (evening) cortisol concentrations. Taken together, these findings reveal a flatter diurnal cortisol rhythm among BGM compared to WGB. The functional significance of these preliminary findings must be explored further with assessment of psychosocial factors among sexual minorities at the intersection of multiple identities. In summary, we expand health disparities research aimed at delineating sexual minority and race/ethnic variation in stress physiology.

Socioeconomic Disparities in Childhood Obesity Risk: Association With an Oxytocin Receptor Polymorphism.

Importance: Pediatricians are paying increased attention to the effects of socioeconomic status (SES) on children's health. Low SES is a robust predictor of obesity across the life course and may interact with genes affecting metabolism to influence obesity risk. Recent animal literature and burgeoning human research suggest that the hormone oxytocin (OT) may be important for metabolic regulation. To date, this association has not been examined in children. Objectives: To examine whether an OT receptor polymorphism (rs53576) interacts with SES, potentially exacerbating and buffering the effects of stress, to predict anthropometry during childhood, and based on differential neurobiological susceptibility theory, to test whether carriers of the A allele of the OXTR gene, compared with GG genotyped individuals, would be most sensitive to the effects of SES on anthropometry for better or for worse. Design, Setting, and Participants: In this observational study, families were recruited from public school classrooms and enrolled in the Peers and Wellness Study (PAWS), which examined the effects of social status on health. Families were assessed during children's kindergarten year (fall semester of 2003, 2004, and 2005) and again during middle childhood (2009-2011) for a follow-up assessment that included anthropometric measures and DNA collection. The dates of the analysis were January 2015 to June 2016. Exposures: Socioeconomic disparities. Main Outcomes and Measures: Child body mass index z score (BMIz) and triceps skinfold thickness. Family SES was collected through questionnaires mailed to homes. Body measurements and DNA were collected in homes by trained research assistants. Results: From the original community sample of 338 typically developing children, participants were 186 socioeconomically and racially/ethnically diverse children (mean age, 10.3 years; age range, 9.4-11.3 years; 93 females [50%]) who had sufficient data at the follow-up assessment for inclusion in this study. Among 97 A allele carriers, a 1-SD increase in SES was associated with a decrease in BMIz of 0.28 (95% CI, -0.47 to -0.09) and a decrease in skinfold thickness of 0.95 (95% CI, -1.77 to -0.12) mm, such that they exhibited the highest BMIz and skinfold thickness in contexts of low SES but exhibited the lowest BMIz and skinfold thickness in contexts of high SES. Socioeconomic status was unrelated to BMIz (95% CI, -0.21 to 0.26) or skinfold thickness (95% CI, -0.42 to 1.45) for 89 GG genotyped children. Conclusions and Relevance: These findings advance etiologic understanding of childhood obesity, highlighting complex effects of SES on child health and adding to growing evidence that OT relates to human obesity risk. The results also support differential neurobiological susceptibility theory, suggesting that the A allele renders individuals more sensitive to both positive and negative health effects of socioecological context.

Psychological Empowerment Among Urban Youth: Measurement Model and Associations with Youth Outcomes.

Empowerment-based strategies have become widely used method to address health inequities and promote social change. Few researchers, however, have tested theoretical models of empowerment, including multidimensional, higher-order models. We test empirically a multidimensional, higher-order model of psychological empowerment (PE), guided by Zimmerman's conceptual framework including three components of PE: intrapersonal, interactional, and behavioral. We also investigate if PE is associated with positive and negative outcomes among youth. The sample included 367 middle school youth aged 11-16 (M = 12.71; SD = 0.91); 60% female, 32% (n = 117) white youth, 46% (n = 170) African-American youth, and 22% (n = 80) identifying as mixed race, Asian-American, Latino, Native American, or other ethnic/racial group; schools reported 61-75% free/reduced lunch students. Our results indicated that each of the latent factors for the three PE components demonstrate a good fit with the data. Our results also indicated that these components loaded on to a higher-order PE factor (X2  = 32.68; df: 22; p = .07; RMSEA: 0.04; 95% CI: .00, .06; CFI: 0.99). We found that the second-order PE factor was negatively associated with aggressive behavior and positively associated with prosocial engagement. Our results suggest that empowerment-focused programs would benefit from incorporating components addressing how youth think about themselves in relation to their social contexts (intrapersonal), understanding social and material resources needed to achieve specific goals (interactional), and actions taken to influence outcomes (behavioral). Our results also suggest that integrating the three components and promoting PE may help increase likelihood of positive behaviors (e.g., prosocial involvement); we did not find an association between PE and aggressive behavior. Implications and future directions for empowerment research are discussed.

Changes in body mass index associated with head start participation.

OBJECTIVES: The goal of this study was to determine if Head Start participation is associated with healthy changes in BMI. METHODS: The sample included children participating in Head Start between 2005 and 2013 and children from 2 comparison groups drawn from a Michigan primary care health system: 5405 receiving Medicaid and 19,320 not receiving Medicaid. Change in BMI z score from the beginning to the end of each of 2 academic years and the intervening summer was compared between groups by using piecewise linear mixed models adjusted for age, gender, and race/ethnicity. RESULTS: The total sample included 43,748 children providing 83,239 anthropometric measures. The Head Start sample was 64.9% white, 10.8% black, and 14.4% Hispanic; 16.8% of the children were obese and 16.6% were overweight at the initial observation. Children who entered Head Start as obese exhibited a greater decline in the BMI z score during the first academic year versus the comparison groups (ß = -0.70 [SE: 0.05] vs -0.07 [0.08] in the Medicaid group [P < .001] and -0.15 [SE: 0.05] in the Not Medicaid group [P < .001]); patterns were similar for overweight children. Head Start participants were less obese, less overweight, and less underweight at follow-up than children in the comparison groups. CONCLUSIONS: Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid).

Sleep Hygiene Practices and Bedtime Resistance in Low-Income Preschoolers: Does Temperament Matter?

This study examined sleep hygiene practices and bedtime resistance and tested whether associations differed by child temperament. Parents of Head Start preschoolers (n = 374, 56% non-Hispanic white) completed the Going to Bed subscale of the Children's Sleep-Wake Scale (GTB; higher score reflects less bedtime resistance), Children's Sleep Hygiene Scale (CSHS; higher score reflects better sleep hygiene), and Child Behavior Questionnaire (Anger, Activity, Impulsivity subscales indicated difficult temperament). Monte Carlo simulation adjusted for demographic covariates tested associations of CSHS with GTB in children with more- vs. less-difficult temperaments. Children with more- vs. less-difficult temperaments experienced worse sleep hygiene (p < .0001) and had more bedtime resistance (p < .0001). Among children with more difficult temperaments, better sleep hygiene was linearly associated with less bedtime resistance (ß = 1.28, 95% CI 0.77, 1.78). Among children with less difficult temperaments, the association followed a piecewise linear trend: sleep hygiene was not associated with bedtime resistance when CSHS scores were < 4.1 (ß = 0.15, 95% CI -4.87, 3.13), but for CSHS scores ≥ 4.1, an increase in CSHS was associated with lower bedtime resistance (ß = 1.33, 95% CI 1.00, 1.79). Consistent sleep hygiene is associated with less bedtime resistance and may be helpful in reducing bedtime resistance among children with more difficult temperaments.

Sleep timing moderates the concurrent sleep duration-body mass index association in low-income preschool-age children.

OBJECTIVE: To test the independent main and moderating effects of sleep timing on body mass index (BMI) in low-income preschool-age children (M = 4.11 years, SD = 0.54). METHODS: Parents reported demographics and children's sleep concurrently, and a subset of children was followed longitudinally. Child height and weight were measured and BMI z score (BMIz) calculated. Regression analysis evaluated main effects of sleep timing (bedtime, weekday-to-weekend schedule shifting, napping) on concurrent BMIz and future rate of change, and their moderating effects on the sleep duration-BMIz association. RESULTS: Of 366 children (longitudinal subsample = 273), 50% were boys, 57% white, and 37% overweight or obese. Nocturnal sleep duration predicted concurrent BMIz, but not rate of change in BMIz over time. Bedtime was a moderator; the sleep duration-BMIz association was present only among children with bedtimes after 9 pm (ß = -0.44; 95% confidence interval -0.69, -0.18). Schedule shifting was a moderator; the association between greater nocturnal sleep duration and lesser rate of future BMIz increase was present only among children with the most consistent sleep schedules (<45-minute delay in weekend bedtime: ß = -0.12; 95% confidence interval -0.23, -0.01). Daytime napping did not moderate the nocturnal sleep duration-BMIz association. Covariates (sleep-disordered breathing, soda consumption, home chaos) did not explain these associations. CONCLUSIONS: Among low-income preschoolers, sleep timing moderated the nocturnal sleep duration-BMIz association. Understanding how sleep timing and sleep duration relate to childhood obesity is important for prevention efforts.

Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study.

BACKGROUND: Nearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity. METHODS/DESIGN: The Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction. DISCUSSION: The Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov Identifier: NCT01398358.