Parental and peer factors associated with body image discrepancy among fifth-grade boys and girls.

Many young adolescents are dissatisfied with their body due to a discrepancy between their ideal and actual body size, which can lead to weight cycling, eating disorders, depression, and obesity. The current study examined the associations of parental and peer factors with fifth-graders' body image discrepancy, physical self-worth as a mediator between parental and peer factors and body image discrepancy, and how these associations vary by child's sex. Body image discrepancy was defined as the difference between young adolescents' self-perceived body size and the size they believe a person their age should be. Data for this study came from Healthy Passages, which surveyed 5,147 fifth graders (51 % females; 34 % African American, 35 % Latino, 24 % White, and 6 % other) and their primary caregivers from the United States. Path analyses were conducted separately for boys and girls. The findings for boys suggest father nurturance and getting along with peers are related negatively to body image discrepancy; however, for girls, fear of negative evaluation by peers is related positively to body image discrepancy. For both boys and girls, getting along with peers and fear of negative evaluation by peers are related directly to physical self-worth. In addition, mother nurturance is related positively to physical self-worth for girls, and father nurturance is related positively to physical self-worth for boys. In turn, physical self-worth, for both boys and girls, is related negatively to body image discrepancy. The findings highlight the potential of parental and peer factors to reduce fifth graders' body image discrepancy.

Ventriculoperitoneal shunt failure: an institutional review of 2-year survival rates.

PURPOSE: Prior research has examined predictors of shunt failure in children with hydrocephalus and concluded that the majority of shunts do not survive long-term. However, risk factors such as etiology, birth weight, and gestational age may vary across institutions and populations. We sought to identify the social, clinical, and neonatal factors associated with initial ventriculoperitoneal (VP) shunt failure in the intraventricular hemorrhage (IVH) patient population and the patient population with an etiology other than IVH (non-IVH). METHODS: A retrospective review of patients, born during 2000-2005 diagnosed and treated for hydrocephalus at Children's of Alabama was conducted. Survival analysis identified factors associated with time to shunt failure. RESULTS: Analyses were done separately for the IVH and non-IVH cohorts. Age and weight at initial VP shunt insertion were found to be associated with shunt failure in the non-IVH group (p < .05). Of the 238 patients in the non-IVH cohort, 108 failed within 2 years of their initial insertion. Fifty of those shunt failures occurred within 3 months of initial shunt placement. In the IVH cohort, 56 out of 100 failed within 2 years; 36 of those failed within 3 months post initial shunt insertion. When controlling for type of shunt failure, age at initial shunt placement was associated with time to shunt failure (p = .0004). CONCLUSION: This study confirms previously published studies on the IVH population. A prospective cohort study and standardized clinical decision making are necessary to further assess the impact that shunting has on this patient population.

Fourth graders' reports of fruit and vegetable intake at school lunch: does treatment assignment affect accuracy?

OBJECTIVE: Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition. DESIGN: Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention. SUBJECTS/SETTING: Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day. MAIN OUTCOME MEASURES: Food items were coded as: "match," "omission," or "intrusion." Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake. ANALYSES: Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or chi(2) analyses. RESULTS: Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report. CONCLUSIONS: Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.

The impact of dairy product consumption on nutrient adequacy and weight of Head Start mothers.

OBJECTIVE: To assess the relationship of dairy product consumption on diet quality and weight of low-income women. SETTING: Head Start centres in Texas and Alabama, USA. DESIGN: Cross-sectional study. Women were divided into dairy consumption groups: < or =1, >1 to < or =2 and >2 servings/d. Nutrient intake/diet quality was determined by calculating the percentage meeting the Estimated Average Requirement, guidelines for fat and added sugar, and Mean Adequacy Ratio (MAR). Mean BMI was compared for the dairy consumption groups. SUBJECTS: Mothers with children in Head Start; 609 African-Americans (43 %), Hispanic-Americans (32 %) and European-Americans (24 %). RESULTS: Fifteen per cent of participants consumed >2 servings of dairy products and 57 % consumed < or =1 serving of dairy daily. Intakes of protein, vitamin D, riboflavin, P, Ca, K, Mg and Zn were significantly higher in those consuming >2 servings/d. Total SFA were higher and added sugars were lower in those consuming >2 servings of dairy products daily compared with those consuming < or =2 servings/d. Forty-one per cent of women consuming >2 servings of dairy daily had MAR scores under 85 compared with 94 % consuming < or =1 serving/d. Mean BMI was 30.36 kg/m2; there was no association between BMI and dairy product consumption. CONCLUSIONS: Consumption of dairy products was low and was not associated with BMI in this low-income population. Higher levels of dairy product consumption were associated with higher MAR scores and improved intakes of Ca, K and Mg, which have been identified as shortfall nutrients in the diets of adults.

Diet quality varies by race/ethnicity of Head Start mothers.

BACKGROUND: Despite the key role that women from limited income families play as family food providers and their high risk for diet-related chronic diseases, there is a paucity of data about their diet quality and how it might vary by race/ethnicity. OBJECTIVE: To compare nutrient and food intakes of multiethnic mothers with children in Head Start from Texas and Alabama. DESIGN: Cross-sectional, secondary data analysis. METHODS: The sample was 603 mothers, 33% Hispanic American from Texas; 19% African American from Texas; 24% African American from Alabama; and 24% white from Alabama who were interviewed from fall 2004 to spring 2005. Diet quality was evaluated by averaging 24-hour dietary recalls from 3 nonconsecutive days and calculating the percent meeting the Estimated Average Requirement, the Dietary Guidelines for fat and added sugar, and the mean adequacy ratio for eight nutrients. For multiple comparisons, the least square means statement was used for general linear model procedures, adjusted for age, body mass index, and energy intake. RESULTS: The average mean adequacy ratio scores for diet quality were low overall, but 44% of Hispanic Americans had mean adequacy ratio scores <85, whereas 96% to 97% of other groups did. Most mothers exceeded 35% of energy from fat, with Hispanic Americans having the lowest percentage. Overall, 15% of mothers exceeded 25% of energy from added sugars, with Hispanic Americans having 5% with excess intakes. Energy intakes were highest for Hispanic Americans (2,017 kcal) and lowest for African Americans (1,340 kcal). The Hispanic Americans surveyed averaged 4.6 c fruit and vegetables per day compared to 3.2, 2.3, and 2.9 c/day among African Americans from Texas, African Americans from Alabama, and whites from Alabama, respectively. CONCLUSIONS: Despite limited food resources, Hispanic-American mothers consumed adequate amounts of fruit and vegetables. There was considerable variation in diet quality among race/ethnic groups on a low income budget.

Diet and sex hormones in boys: findings from the dietary intervention study in children.

CONTEXT: Diet reportedly alters serum sex hormone concentrations in adults, but little is known about the influence of diet during puberty on these hormones. OBJECTIVE: We aimed to determine whether an intervention to lower fat intake during adolescence alters serum sex hormone concentrations and progression through puberty. DESIGN: In 1990-1997, we conducted an ancillary study to the Dietary Intervention Study in Children, a multicenter, randomized, controlled clinical trial to test the safety and efficacy of a cholesterol-lowering dietary intervention in children. PARTICIPANTS: Healthy, prepubertal, 8 to 10 yr olds with elevated low-density lipoprotein cholesterol were randomized to usual care or a behavioral intervention. Of 362 randomized Dietary Intervention Study in Children boys, 354 participated in the ancillary study. Eighty-four percent of boys attended last visits when their median time on trial was 7.1 yr. INTERVENTION: The behavioral intervention continued throughout the duration of the trial and promoted a diet with 28% energy from total fat, less than 8% from saturated fat, 9% or less from polyunsaturated fat, and less than 75 mg cholesterol per 1000 kcal. OUTCOME MEASURES: The main outcome measure for boys formulated before study initiation was non-SHBG bound testosterone concentration. Secondary outcomes included serum total testosterone, dihydrotestosterone, androstenedione, estradiol, estrone, SHBG, and Tanner stage. RESULTS: There were no significant treatment group differences in boys' serum hormone levels, SHBG, or Tanner stages at any individual visit or over the course of the trial when evaluated by longitudinal models. CONCLUSION: Modest reductions in total fat, saturated fat, and possibly energy intake do not alter progression through puberty or serum sex hormone concentrations in adolescent boys.

Diet and sex hormones in girls: findings from a randomized controlled clinical trial.

BACKGROUND: Results of several studies have suggested that diet during adolescence may influence the risk of breast cancer in adulthood. We evaluated whether an intervention to lower fat intake among adolescent girls altered their serum concentrations of sex hormones that, in adults, are related to breast cancer development. METHODS: We conducted an ancillary hormone study among 286 of the 301 girls who participated between 1988 and 1997 in the Dietary Intervention Study in Children, in which healthy, prepubertal, 8- to 10-year-olds with elevated low-density lipoprotein cholesterol were randomly assigned to usual care or to a behavioral intervention that promoted a low-fat diet. Median time on the intervention was 7 years. Blood samples collected before randomization and at the year 1, year 3, year 5, and last visits were assayed to determine the girls' serum levels of sex hormones. All P values are two-sided. RESULTS: At the year 5 visit, girls in the intervention group had 29.8% (95% confidence interval [CI] = 5.4% to 47.9%; P =.02) lower estradiol, 30.2% (95% CI = 7.0% to 47.7%; P =.02) lower non-sex hormone binding globulin-bound estradiol, 20.7% (95% CI = 4.7% to 34.0%; P =.02) lower estrone, and 28.7% (95% CI = 5.1% to 46.5%; P =.02) lower estrone sulfate levels during the follicular phase of the menstrual cycle and 27.2% (95% CI = 5.7% to 53.1%; P =.01) higher testosterone levels during the luteal phase of the menstrual cycle than did girls in the usual care group. At the last visit, the luteal phase progesterone level was 52.9% (95% CI = 20.0% to 72.3%) lower for girls in the intervention group than for girls in the usual care group (P =.007). CONCLUSION: Modest reductions in fat intake during puberty are associated with changes in sex hormone concentrations that are consistent with alterations in the function of the hypothalamic-pituitary-ovarian axis. Whether these changes influence breast cancer risk is currently unknown.

Implementation of a family intervention to increase fruit and vegetable intake: the Hi5+ experience.

Family is an important, yet challenging, target for dietary intervention. This article describes the implementation of Hi5+, a family fruit and vegetable (FV) promotion program. Complementing a fourth-grade school curriculum, the seven weekly Family Fun Nites were at-home family meal sharing and game evenings. A sample of families (N = 575; 69% consented) from schools in a southeastern U.S. urban area received tailored intervention materials based on their FV attitudes and family interaction styles. A pyramidal organizational design, using peer leaders, facilitated 71% of families to complete all seven sessions, whereas 84% completed at least one session. Significant independent predictors of program completion were attending an introductory Kick-Off Nite, interactive family style, additional adults in the household, married parents, being African American, earning more than 60,000 dollars, and additional children in the household. Family-specific issues and initial program experience are important considerations for implementing a family intervention.

Hi5+: systematic development of a family intervention to increase fruit and vegetable intake.

This article describes the development of a peer-led home-based intervention to increase fruit and vegetable (FV) intake and family interaction among fourth graders and their families. Hi5+ intervention content and delivery strategies were developed using two complementary processes: cognitive mapping (CM), a consumer-based approach to identifying salient issues, and intervention mapping (IM), a comprehensive planning model. Step 1 involved creating plans to guide the design, implementation, and evaluation of Hi5+. We delineated our performance objectives and then prioritized those determinants we felt were most salient and changeable. Step 2 involved selecting and utilizing cognitive and behavioral theory constructs to develop intervention methods and strategies. Step 3 involved designing and pilot testing the instructional materials and other intervention components. Step 4 entailed developing plans for program adoption and implementation, while the final step (Step 5) involved creating a comprehensive evaluation plan. Implications of this multistep approach to intervention development are discussed.

Testing mediating variables in a school-based nutrition intervention program.

This study identified mediators of a school-based nutrition intervention for 4th graders and their parents. Nine variables were tested for satisfying 4 conclusions necessary to establish mediation of intervention effects on changes in fruit and vegetable consumption (FVC) in 4th graders (N = 1,676). FVC was measured in children by the use of 24-hr dietary recalls. Mediators were assessed by the use of questionnaires completed by children and parents. All 4 conclusions were met for positive outcome expectancies. Knowledge, self-efficacy, and parent consumption satisfied the first 3 conclusions for mediation but the mediating effects were not statistically significant (Conclusion 4). Future mediational analyses and the creation of a national database of mediators are crucial for increasing strength and efficiency of school-based nutrition programs.

Using cognitive mapping to develop a community-based family intervention.

OBJECTIVE: To describe the development of a consumer-oriented intervention for increasing intake of fruits and vegetables (FVs) in families (n=265). METHOD: A cognitive-mapping approach was used to specify intervention performance objectives and a tailoring strategy. RESULTS: MDS and hierarchical cluster analysis indicated that FV perceptions are organized into 6 clusters arrayed along 3 dimensions. In combination with 3 general family-functioning measures, 11 perceptions explained approximately 18% of the variance in parent FVI. K-means cluster analysis revealed 4 types of families. CONCLUSION: Cognitive mapping provides a systematic approach for including qualitative data in the design of tailored interventions.

A summary of results of the Dietary Intervention Study in Children (DISC): lessons learned.

Prevention of cardiovascular disease must begin in childhood, preferably before risk factors develop. Elevated low-density lipoprotein cholesterol levels in children are likely to track over time and become high-risk levels in adults. The Dietary Intervention Study in Children (DISC) was a multicenter, collaborative randomized trial in pre-adolescent children designed to test the efficacy and safety of a dietary intervention to lower saturated fat and cholesterol intake among growing children with elevated low-density lipoprotein cholesterol. Numerous DISC results, which include findings on lipids-lipoproteins, genetics, and nutrient adequacy, as well as descriptions of the behavioral intervention strategies, have been reported. A summary of practical findings and their potential clinical applications have not previously been published. Highlights of key lessons learned from DISC and translational applications of potential interest to nurses and other health care providers are presented.

School programs and characteristics and their influence on student BMI: findings from healthy passages.

BACKGROUND: Little is known about the contribution of school contextual factors to individual student body mass index (BMI). We set out to determine if school characteristics/resources: (1) are associated with student BMI; (2) explain racial/ethnic disparities in student BMI; and (3) explain school-level differences in student BMI. METHODS: Using gender-stratified multi-level modeling strategies we examined the association of school characteristics/resources and individual BMI in 4,387 5(th) graders in the Healthy Passages Longitudinal Study of Adolescent Health. Additionally, we examined the association of race/ethnicity and individual BMI as well as the between-school variance in BMI before and after adding individual and school characteristics to test for attenuation. RESULTS: The school-level median household income, but not physical activity or nutrition resources, was inversely associated with female BMI (ß = -0.12, CI: -0.21,-0.02). Neither school demographics nor physical activity/nutrition resources were predictive of individual BMI in males. In Black females, school characteristics attenuated the association of race/ethnicity and BMI. Individual student characteristics-not school characteristics/resources-reduced the between-school variation in BMI in males by nearly one-third and eliminated it in females. CONCLUSIONS: In this cohort of 5(th) graders, school SES was inversely associated with female BMI while school characteristics and resources largely explained Black/White disparities in female weight status. Between-school differences in average student weight status were largely explained by the composition of the student body not by school characteristics or programming.

Factors associated with intention to vaccinate a daughter against HPV: a statewide survey in Alabama.

PURPOSE: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Adolescent and young adults aged 15-24 were estimated to account for three quarters of new infections in 2000. Two HPV vaccines are currently available. The vaccine is recommended for girls aged 11-12 years. Previous research has indicated that African-American and Asian-American parents are less likely than Caucasians to vaccinate their daughters. This investigation examines the relationship between demographic, medical, and behavioral risk factors for HPV vaccine acceptability among Alabama residents. METHODS: The cross-sectional survey was conducted using random digit dialing. Eligible participants were female caregivers of adolescent girls between the ages of 10 and 14 years. Factors related to intention to vaccinate a daughter within the next six months were examined using chi-square and logistic regression. RESULTS: Caregivers who were informed about HPV vaccination from a health care provider were more likely to intend to vaccinate their daughter within the next six months compared with caregivers who did not report this source of information (OR = 3.59, 95% CI = 1.52, 8.45). Race, education, county of residence, child's age, religious attendance, knowledge and history of HPV, perceived susceptibility, and severity of infection were not significantly related to intention to vaccinate against HPV. CONCLUSION: Caregivers who were informed of the vaccine by their health care provider were more likely to vaccinate their adolescent daughters. Provider attitudes and caregiver education is an essential link to improvement of HPV vaccination uptake in Alabama.

The economic impact of ventriculoperitoneal shunt failure.

OBJECT: Detailed costs to individuals with hydrocephalus and their families as well as to third-party payers have not been previously described. The purpose of this study was to determine the primary caregiver out-of-pocket expenses and the third-party payer reimbursement rate associated with a shunt failure episode. METHODS: A retrospective study of children born between 2000 and 2005 who underwent initial ventriculoperitoneal (VP) shunt placement and who subsequently experienced a shunt failure requiring surgical intervention within 2 years of their initial shunt placement was conducted. Institutional reimbursement and demographic data from Children's Hospital of Alabama (CHA) were augmented with a caregiver survey of any out-of pocket expenses encountered during the shunt failure episode. Institutional reimbursements and caregiver out-of-pocket expenses were then combined to provide the cost for a shunt failure episode at CHA. RESULTS: For shunt failures, the median reimbursement total was $5008 (interquartile range [IQR] $2068-$17,984), the median caregiver out-of-pocket expenses was $419 (IQR $251-$1112), and the median total cost was $5411 (IQR $2428-$18,582). Private insurance reimbursed at a median rate of $5074 (IQR $2170-$14,852) compared with public insurance, which reimbursed at a median rate of $4800 (IQR $1876-$19,395). Caregivers with private insurance reported a median $963 (IQR $322-$1741) for out-of-pocket expenses, whereas caregivers with public insurance reported a median $391 (IQR $241-$554) for out-of-pocket expenses (p = 0.017). CONCLUSIONS: This study confirmed that private insurance reimbursed at a higher rate, and that although patients had a shorter length of stay as compared with those with public insurance, their out-of-pocket expenses associated with a shunt failure episode were greater. However, it could not be determined if the significant difference in out-of-pocket expenses between those with private and those with public insurance was due directly to the cost of shunt failure. This model does not take into consideration community resources and services available to those with public insurance. These resources and services could offset the out-of-pocket burden, and therefore should be considered in future cost models.

Mediators of maternal depression and family structure on child BMI: parenting quality and risk factors for child overweight.

Risk factors for child obesity may be influenced by family environment, including maternal depression, family structure, and parenting quality. We tested a path model in which maternal depression and single parent status are associated with parenting quality, which relates to three risk factors for child obesity: diet, leisure, and sedentary behavior. Participants included 4,601 5th-grade children and their primary caregivers who participated in the Healthy Passages study. Results showed that associations of maternal depression and single parenthood with child BMI are mediated by parenting quality and its relation to children's leisure activity and sedentary behavior. Interventions for child obesity may be more successful if they target family environment, particularly parenting quality and its impact on children's active and sedentary behaviors.

Adjusting adiposity and body weight measurements for height alters the relationship with blood pressure in children.

BACKGROUND: Adiposity measures are associated with increased pediatric blood pressure (BP). However, this correlation can be confounded by the relationship of both variables to height. We evaluated whether adiposity and anthropometric measures were associated with pediatric BP before and after adjusting each value for height. METHODS: Participants included 281 African-American (AA), European-American (EA), and Hispanic-American (HA) children aged 7-12 years. BP percentiles were calculated according to pediatric guidelines using the average of four measurements. Total fat mass was determined using dual-energy X-ray absorptiometry. Socioeconomic status (SES) was calculated with the Hollingshead index. Adiposity measures were indexed for height using log-log regression analysis. Partial correlations identified measures associated with BP. Linear regression was used to test the association of those measures with absolute BP, whereas logistic regression was used to evaluate the odds for hypertension. RESULTS: More AAs (16.3%) presented with potential hypertension than EA (5.1%) or HA (2.7%) children. After adjusting for covariates, fat mass, body mass index, and waist circumference were positively significantly associated with absolute BP and hypertension in AA and EA children (P < 0.05). When these measures were height-indexed, only waist remained significantly positively associated with hypertension risk in these two groups. No measures were significantly associated with BP among HA children. CONCLUSIONS: In this multiethnic pediatric population, waist circumference was the strongest significant adiposity predictor of hypertension risk among AA and EA children. Additional research is needed to determine which environmental and genetic factors contribute to pediatric hypertension, particularly among HA groups.

Impact of dairy and sweetened beverage consumption on diet and weight of a multiethnic population of head start mothers.

Mothers with children in Head Start play a critical role in providing healthful diets and modeling good dietary behaviors to their children, but there is little information available on their diet, especially on beverage consumption. The objective of this study was to assess the association of milk and sweetened beverage consumption with nutrient intake, dietary adequacy, and weight of a multiethnic population of Head Start mothers. Using a cross-sectional, secondary analysis, African-American (43%), Hispanic (33%), and white (24%) women (n=609) were divided into four beverage consumption groups: high milk/low sweetened beverage, high milk/high sweetened beverage, low milk/low sweetened beverage, and low milk/high sweetened beverage. Nutrient intake was determined by averaging 24-hour dietary recalls from 3 nonconsecutive days. Dietary adequacy was determined with the Mean Adequacy Ratio. Mean body mass index for the four beverage consumption groups was compared; there were no differences among the groups (overall mean+/-standard error=30.8+/-0.3). Women in the high milk/low sweetened beverage group had higher mean intakes of vitamins A, D, and B-6; riboflavin; thiamin; folate; phosphorus; calcium; iron; magnesium; and potassium (P<0.0125 for all) when compared with the other beverage consumption groups. Mean Adequacy Ratio was highest in the high milk/low sweetened beverage (71.8+/-0.8) and lowest in the low milk/high sweetened beverage (58.4+/-0.8) consumption groups (P<0.0125). Women in the high milk/low sweetened beverage group consumed more nutrient-dense foods. Overall consumption of milk was low. Consumption of high milk/low sweetened beverage was associated with improved nutrient intake, including the shortfall nutrients, ie, calcium, potassium, magnesium, and vitamin A.

Weight status, quality of life, and self-concept in African American, Hispanic, and white fifth-grade children.

This study examined the association between weight status and quality of life (QOL) in fifth-grade African American, Hispanic, and white children and the potential mediation of this relationship by self-concept. A sample was recruited from fifth-grade public school students in three sites, of whom 599 were African American (40%), Hispanic (34%), or white (26%). During a home interview, physical and psychosocial QOL and global and body-specific self-concept were measured. Measured height and weight were used to calculate BMI. In this sample, 57% were classified by BMI as not overweight, 17%, overweight, and 26%, obese. Although there was no significant interaction between weight classification and race/ethnicity for QOL, obese children reported significantly lower psychosocial but not physical QOL than those classified as not overweight. There was a significant association between BMI (measured continuously) and psychosocial QOL, but only 2% of the variance was accounted for. Both global self-concept and body dissatisfaction independently mediated significant portions of the association between BMI and psychosocial QOL. Being obese in childhood may have negative psychosocial effects.