SLeep Education for Everyone Program (SLEEP) Results in Sustained Improvements in Sleep Outcomes at Six Months.

OBJECTIVE: Community-delivered sleep education interventions have been demonstrated to be effective in improving sleep outcomes, but whether these benefits persist once the program ends is not well characterized. This study sought to determine whether the previously reported positive effects attributed to the SLeep Education for Elders Program (SLEEP) were maintained six months after program completion. METHOD: Nineteen participants were surveyed three times: at baseline, program completion (six weeks), and the six-month post-program timepoint. Sleep outcomes for quality, duration, insomnia symptoms, sleep hygiene behaviors, and excessive daytime sleepiness were assessed using validated surveys, including the Pittsburgh Sleep Quality Index (from which duration was also extracted), the Insomnia Severity Index, the Sleep Hygiene Index, and the Epworth Sleepiness Scale. RESULTS: Longitudinal models adjusted for baseline sleep problems revealed the benefits achieved immediately after the program were retained at six months for sleep quality (estimate: -2.0 (95%CI: -2.7, -1.3)), sleep duration (estimate: 0.9 (95%CI: 0.6, 1.2)), insomnia symptoms (estimate: -3.5 95%CI: (-4.6, -2.3)), and sleep hygiene behaviors (estimate: -2.6 (-4.3, -0.9)). CONCLUSIONS: These results suggest that a community-delivered sleep education intervention can produce sustained benefits for participants and should be considered as a tool to address uncomplicated sleep issues.

Characteristics of eating behavior profiles among preschoolers with low-income backgrounds: a person-centered analysis.

BACKGROUND: Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight. METHODS: A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status. RESULTS: LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles. CONCLUSIONS: Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.

Supporting family meal frequency: Screening Phase results from the Simply Dinner Study.

We aimed to test main, additive, interactive effects, and feasibility of all possible combinations of six intervention components implemented for 8 weeks (Cooking/Serving Resources; Meal Delivery; Ingredient Delivery; Community Kitchen; Nutrition Education; Cooking Demonstrations). Primary outcomes were family meal frequency and preschoolers' dietary quality; secondary outcomes included family meal preparation type, meal preparation barriers, family functioning, and kitchen inventory adequacy. All possible intervention combinations were tested using a randomized factorial trial design in the first phase of a Multiphase Optimization Strategy (MOST). Feasibility was assessed via attendance, delivery logs, and satisfaction. Parent-reported data collection included: socio-demographics, frequency and type of family meals; preschooler dietary intake; perceived barriers to meal planning and preparation; assessment of family functioning; and a kitchen inventory of materials generally needed for meal preparation. Participants (n = 499) were recruited at two Head Start agencies in mid-Michigan with data collection and delivery of some intervention components in participants' homes. Promising intervention bundles were identified by evaluating pre-to post-intervention effect sizes. The combination of Cooking/Serving Resources and Meal Delivery increased family meal frequency (Cohen's d = 0.17), cooking dinner from scratch (d = 0.21), prioritization of family meals (d = 0.23), and kitchen inventory (d = 0.46) and decreased use/consumption of ready-made (d = -0.18) and fast foods (d = -0.23). Effects on diet quality were in the expected direction but effect sizes were negligible. Community Kitchen, Nutrition Education, and Cooking Demonstration showed poor feasibility due to low attendance while Ingredient Delivery was infeasible due to staffing challenges related to its labor intensity. Additionally, although not one of our pre-specified outcomes, Cooking/Serving Resources (RR = 0.74) and Meal Delivery (RR = 0.73) each decreased food insecurity. Cooking/Serving Resources combined with Meal Delivery showed promise as a strategy for increasing family meal frequency.

Rural-urban differences in body mass index and obesity-related behaviors among low-income preschoolers.

BACKGROUND: With one in eight preschoolers classified as obese in the USA, childhood obesity remains a significant public health issue. This study examined rural-urban differences in low-income preschoolers' body mass index z-scores (BMIz), eating behaviors, dietary quality, physical activity (PA) and screen time. METHODS: Pre-intervention data from 572 preschooler-parent dyads participating in a randomized, controlled obesity prevention trial in the Midwest USA were analyzed. We examined the associations among living in rural versus urban areas, child BMIz and child obesity-related behaviors, including eating behaviors, dietary quality, PA and screen time. RESULTS: Rural children had higher BMIz, more emotional overeating behaviors and more time spent playing outdoors compared with urban children. We found no associations between children living in rural versus urban areas and dietary quality and screen time. CONCLUSIONS: The study found that rural-urban differences in BMIz may start as early as 3-4 years of age, if not earlier. To reverse the weight-related health disparities between rural and urban low-income preschoolers, structural changes in rural locations and family supports around coping skills may be needed.

Connecting Primary Care to Community-Based Education: Michigan Physicians' Familiarity With Extension Programs.

Clinical-community linkages enhance health care delivery and enable physician-patient partnerships to achieve better health. The Michigan State University (MSU) Model of Health Extension includes a strategy for forming these linkages by focusing on increasing primary care patient referrals and enrollment in health programs. This article shares the results of a survey of Michigan internal medicine and family medicine physicians (n = 323) to better understand attitudes toward and familiarity with community-based education (CBE) programs and to assess the logistical requirements to make CBE referrals efficient and sustainable. Survey results showed that at most, 55% of respondents were aware of at least one CBE program implemented by Cooperative Extension. Of those who were aware, over 85% agreed that the programs have positive benefits for patients. Thirty-five percent reported at least one referral barrier, and familiarity with the CBE programs was a significant predictor for reporting all referral barriers. The results suggest that increasing physicians' familiarity of CBE health programs is a key first step in identifying ideal strategies to overcome referral barriers. Data from this study may help determine scalable state level models for increasing awareness of chronic disease prevention and other CBE programs in efforts to improve the health of the nation.

Ripple Effects of the Communities Preventing Childhood Obesity Project.

This research examines the practice of community coaching within coalitions in the Communities Preventing Childhood Obesity project. A quasi-experimental design was used in seven Midwestern states. Each state selected two rural, low-income communities with functioning health coalitions. Coalitions were randomly assigned to be intervention or comparison communities. After 4 years of the coaching intervention, ripple effect mapping served as one method for examining the coalitions' work that may affect children's weight status. A research team from each state conducted ripple effect mapping with their two coalitions, resulting in 14 ripple maps. Community capitals framework and the social-ecological model were used for coding the items identified within the ripple maps. A quantitative scoring analysis determined if differences existed between the intervention and comparison coalitions in terms of the activities, programs, funding, and partnerships for social-ecological model score (e.g., individual, community, policy levels), community capitals score, and ripples score (e.g., number of branches formed within the maps). All scores were higher in intervention communities; however, the differences were not statistically significant (p > .05). Assessing community assets, such as availability of a community coach, is necessary in order to decide whether to deploy certain resources when designing health promotion strategies.

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.

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.

Effectiveness of differing levels of support for family meals on obesity prevention among head start preschoolers: the simply dinner study.

BACKGROUND: Despite slight decreases in obesity prevalence in children, nearly 25% of preschool-aged children are overweight or obese. Most interventions focused on promoting family meals as an obesity-prevention strategy target meal planning skills, knowledge and modeling of healthy eating without addressing the practical resources that enable implementation of family meals. There is a striking lack of evidence about what level of resources low-income parents need to implement family meals. This study will identify resources most effective in promoting family meals and, subsequently, test associations among the frequency of family meals, dietary quality and children's adiposity indices among children enrolled in Head Start. METHODS: The Multiphase Optimization Strategy, employed in this study, is a cutting-edge approach to maximizing resources in behavioral interventions by identifying the most effective intervention components. We are currently testing the main, additive and interactive effects of 6 intervention components, thought to support family meals, on family meal frequency and dietary quality (Primary Outcomes) as compared to Usual Head Start Exposure in a Screening Phase (N = 512 low-income families). Components yielding the most robust effects will be bundled and evaluated in a two-group randomized controlled trial (intervention and Usual Head Start Exposure) in the Confirming Phase (N = 250), testing the effects of the bundled intervention on children's adiposity indices (Primary Outcomes; body mass index and skinfolds). The current intervention components include: (1) home delivery of pre-made healthy family meals; (2) home delivery of healthy meal ingredients; (3) community kitchens in which parents make healthy meals to cook at home; (4) healthy eating classes; (5) cooking demonstrations; and (6) cookware/flatware delivery. Secondary outcomes include cooking self-efficacy and family mealtime barriers. Moderators of the intervention include family functioning and food security. Process evaluation data includes fidelity, attendance/use of supports, and satisfaction. DISCUSSION: Results will advance fundamental science and translational research by generating new knowledge of effective intervention components more rapidly and efficiently than the standard randomized controlled trial approach evaluating a bundled intervention alone. Study results will have implications for funding decisions within public programs to implement and disseminate effective interventions to prevent obesity in children. TRIAL REGISTRATION: Clincaltrials.gov Identifier NCT02487251 ; Registered June 26, 2015.

A quasi-experimental study to mobilize rural low-income communities to assess and improve the ecological environment to prevent childhood obesity.

BACKGROUND: The Ecological Model of Childhood Overweight focuses on characteristics that could affect a child's weight status in relation to the multiple environments surrounding that child. A community coaching approach allows community groups to identify their own strengths, priorities and identity. Little to no research currently exists related to community-based efforts inclusive of community coaching in creating environmental change to prevent childhood obesity particularly in rural communities. METHODS: A quasi-experimental study will be conducted with low-income, rural communities (n = 14) in the North Central region of the United States to mobilize capacity in communities to create and sustain an environment of healthy eating and physical activity to prevent childhood obesity. Two rural communities within seven Midwestern states (IN, KS, MI, OH, ND, SD, WI) will be randomly assigned to serve as an intervention or comparison community. Coalitions will complete assessments of their communities, choose from evidence-based approaches, and implement nutrition and physical activity interventions each year to prevent childhood obesity with emphasis on policy, system or environmental changes over four years. Only intervention coalitions will receive community coaching from a trained coach. Outcomes will be assessed at baseline, annually and project end using previously validated instruments and include coalition self-assessments, parental perceptions regarding the built environment, community, neighborhood, and early childhood environments, self-reflections from coaches and project staff, ripple effect mapping with coalitions and, final interviews of key stakeholders and coaches. A mixed-methods analysis approach will be used to evaluate if Community Coaching enhances community capacity to create and sustain an environment to support healthy eating and physical activity for young children. ANOVA or corresponding non-parametric tests will be used to analyze quantitative data relating to environmental change with significance set at P < .05. Dominant emergent themes from the qualitative data will be weaved together with quantitative data to develop a theoretical model representing how communities were impacted by the project. DISCUSSION: This project will yield data and best practices that could become a model for community development based approaches to preventing childhood obesity in rural communities.

Equivalent Improvements in Sleep Duration and Sleep Quality Regardless of Program Delivery Modality: The SLeep Education for Everyone Program (SLEEP).

Sleep issues are pervasive, and treatment can be difficult to access, if available at all. The purpose of this study was to test whether the delivery modality (online vs. in person) of the SLeep Education for Everyone Program (SLEEP) influenced programmatic outcomes. A total of 60 participants completed the study, 28 in the online group and 32 in the in-person group. Across all participants, SLEEP improved sleep duration, sleep quality, and sleep hygiene behaviors (p < 0.001 for all). When comparing delivery modality, sleep duration and quality improved similarly between groups; however, sleep hygiene behaviors improved more in the in-person group (p = 0.033). Sleep hygiene scores did not correlate with sleep duration or quality after the program. Based on these findings, SLEEP appears to be equally effective in improving sleep duration and quality when delivered online or in person. These findings suggest that SLEEP can be delivered based on the organization's and participant's resources, needs, and preferred style of interaction.

Simply Dinner: A Randomized Controlled Trial of Home Meal Delivery.

OBJECTIVE: To determine the effect of a bundled intervention (home meal delivery and provision of cooking/serving resources) on preschoolers' body mass index z-score (BMIz), dietary quality, and family meal frequency. METHODS: Participants (299 families; mean child age 4.4 years, 47% male, 55% White, 18% Black, 27% Hispanic or other race and ethnicity, and 25% were overweight or obese) were randomized to a control group or to provision of cooking/serving resources plus home meal delivery for 12 weeks (meals provided by Meals on Wheels [MOW cohort, n = 83] or a commercial service [COM cohort, n = 216]). Outcomes were child dietary quality, family meal frequency, and child BMIz. RESULTS: The intervention increased dinnertime intake of red and orange vegetables in the full sample (MOW cohort+COM cohort) (0.10 pre- to 0.15 cup equivalents (CE) post-in the intervention group vs 0.10 pre- to 0.09 post- in the control group; P = .01) and the COM cohort (0.11 pre- to 0.17 CE post- vs 0.11 pre- to 0.09 post-; P = .002), and typical daily dietary intake of fruit and fruit juice in the MOW cohort (1.50 CE pre- to 1.66 post- vs 1.48 pre- to 1.19 post-; P = .05). The intervention did not change meal frequency or BMIz. CONCLUSIONS: Short-term home meal delivery with provision of cooking/serving resources improved dietary quality among preschool-aged children but did not change meal frequency or BMIz. Expansion of Meals on Wheels programs to preschool-aged children may be a promising intervention to improve dietary quality. Family meals, when already frequent, are not further increased by reducing the burden of meal preparation.

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.

Three Cooperative Extension initiatives funded to address Michigan's opioid crisis.

People living with opioid use disorder and those experiencing other types of substance misuse are part of a public health crisis in the United States. Rates of opioid misuse, overdose, and opioid-related deaths within different subpopulations show where prevention efforts must focus. Through concerted efforts, aligned with common goals, a statewide community-based educational organization (Michigan State University Extension) has demonstrated ability to acquire multi-year funding from varied sources of state and federal funds that has produced robust support for statewide projects and collaborations. Researchers, educators, public health program managers, and other practitioners can benefit from learning how three funded initiatives in one state resulted in improved awareness and access for individuals and healthcare organizations. By sharing our implementation of health educational programs and presentations, other states' can adopt these evidence-based strategies for similar outreach. Cooperative Extension in Michigan delivers program series and one-time education to the public on the self-management of chronic conditions and pain, mindfulness for stress reduction, anger management, and opioid misuse prevention, treatment, and recovery. These evidence- and research-based health programs implemented by Extension staff teach participants common aspects of prevention such as self-management care, communication skills, self-efficacy, and goal setting or personal health action plans. Education aims to reduce dependency on opioids, prevent opioid misuse and share non-pharmacological solutions to pain management for those living with chronic conditions or at risk for developing dependence. The funded initiatives targeted rural residents, older adults, health care providers, and people living with chronic pain who may have access to prescription opioids. In addition to direct education, projects supported local communities with the development of coalitions, including the training of community partners to become program facilitators thereby increasing community capacity for prevention programs, and through the creation of patient referrals from healthcare settings to community-based education. In rural areas, Cooperative Extension plays a crucial role in connecting community resources to address healthy aging, and chronic disease or chronic pain self-management education. Community partners engaged in public health education and promotion, and healthcare providers alike may not be aware that Cooperative Extension plays a vital role in providing community-based health education.

Sleep Education for Elders Program (SLEEP): Promising Pilot Results of a Virtual, Health Educator-Led, Community-Delivered Sleep Behavior Change Intervention.

PURPOSE: Sleep problems pose serious public health concerns, and evidence suggests that the problem is worsening. Both sufficient sleep quantity and quality are needed for optimal health, particularly among older adults, but access to sleep care can be difficult. This study examined the efficacy of a six-week sleep behavior change program designed for older adults that was delivered virtually by health educators. PARTICIPANTS AND METHODS: This quasi-experimental pilot study (intervention n = 22; control n = 31) explored the effects of the Sleep Education for Elders Program (SLEEP) on sleep outcomes, which included: 1) sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI); 2) sleep duration, extracted from the PSQI; 3) insomnia symptoms, measured by the Insomnia Severity Index; 4) sleep hygiene behaviors, obtained from the Sleep Hygiene Index; and 5) excessive daytime sleepiness, measured by the Epworth Sleepiness Scale. RESULTS: After SLEEP, the intervention group experienced significantly improved sleep quality (p < 0.001), a reduction in maladaptive sleep hygiene behaviors (p = 0.007), and reduced daytime sleepiness (p < 0.027) compared to the control group. Effect sizes for all five sleep measures were medium or large. In the intervention group, all changes were judged to be clinically meaningful (≥ 0.5 SD) except for improvements in daytime sleepiness. CONCLUSION: These data support the efficacy of a group-based, virtual behavior change intervention in improving sleep outcomes among older adults.

Temperament, socioeconomic adversity, and perinatal risk as related to preschoolers' BMI.

OBJECTIVE: Disparities in childhood obesity necessitate identification of risk-protective and risk- augmenting factors for young children experiencing socioeconomic adversity born with perinatal risk. Temperamental reactivity is a biological marker of susceptibility to environmental characteristics. This study tested whether temperamental reactivity moderated the relation between socioeconomic risk and children's body mass index (BMI). METHOD: This study examined 100 Head Start preschoolers (Mage = 4.07 years, SD = 0.56) with perinatal risk, defined as preterm birth (PT, <37 weeks gestation) or low birth weight (LBW, <2500g). Anthropometric measurements were collected from children and parents. Parents completed questionnaires on family level demographics and household food insecurity to create a cumulative socioeconomic risk variable. Parents also completed the Children's Behavior Questionnaire to assess preschoolers' temperamental reactivity. RESULTS: Results supported a differential susceptibility hypothesis such that preschoolers' temperamental reactivity significantly moderated the relation between socioeconomic risk and child BMI z-score (BMIz). Higher BMIz was observed in highly reactive children exposed to higher socioeconomic risk. Alternatively, lower exposure to socioeconomic risk was related to lower BMIz for highly reactive children. CONCLUSIONS: Findings suggest that highly reactive PT/LBW preschoolers are differentially susceptible to early socioeconomic adversity in a for better or for worse manner regarding BMIz. Thus, consideration of temperament as a marker of biological sensitivity to context may be necessary to inform obesity prevention for PT/LBW preschoolers from low-income families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score.

BACKGROUND: Parental mindfulness may be a novel intervention target for child obesity prevention. OBJECTIVE: To examine associations between maternal mindfulness and child body mass index z-score (BMIz). METHODS: In a secondary data analysis of preintervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n = 105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. RESULTS: Children were M = 53.7 (standard deviation [SD] 7.5) months old, and mothers were M = 31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (ß = -.02 (SE 0.01), P = .027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (P = .016) and BMI at the trend level (P = .0595) at the trend level. CONCLUSIONS: Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.

Cross-lagged associations between behaviour problems and obesity in head start preschoolers.

BACKGROUND: Behaviour problems and obesity are related but research findings have been inconclusive regarding the direction of effects. OBJECTIVES: This study examined the cross-lagged associations between behaviour problems, body mass index (BMI) and obesity in preschoolers, and whether sex modified these associations. METHODS: Repeated measures of teacher-reported externalizing (EXT) and internalizing behaviour problems (clinically significant T scores were >90th percentile), BMI z-scores (BMI-Z) and obesity status (BMI ≥95th for age and sex) were assessed in the fall (T1) and spring (T2) of the school year in Head Start preschoolers (N = 423). Associations were examined with cross-lagged modelling. RESULTS: Prospective paths from T1 clinically significant EXT to both T2 BMI-Z (ß = .05) and obesity (ß = .18) were significant. There was no evidence that T1 BMI-Z or obesity preceded T2 behaviour problems. However, sex-specific models indicated that T1 BMI-Z was prospectively associated with higher T2 EXT for boys (ß = .13), but not girls. T1 EXT was predictive of subsequent BMI-Z (ß = .09) and obesity (ß = .33) at T2 for girls only. CONCLUSION: Findings suggest that behaviour problems, particularly externalizing behaviours, are prospectively related to childhood obesity, and early prevention methods should reflect sex-specific modifications.

Communities Partnering With Researchers: An Evaluation of Coalition Function in a Community-Engaged Research Approach.

BACKGROUND: Community coalitions are frequently used as partners for community-engaged research. However, limited research shows how these partnerships affect the coalitions. OBJECTIVE: To evaluate the effects of researcher-coalition collaboration on coalition function in the pilot year of a 4-year intervention program targeting childhood obesity in rural, low-income communities. METHODS: A quasi-experimental study using a quantitative survey (Coalition Self-Assessment Survey [CSAS]) evaluated factors related to coalition function and efficacy. Twelve community coalitions from seven states completed survey evaluations at baseline (n = 133), and at the 1-year follow-up (n = 113). Pearson's χ2 and Mann-Whitney U tests were computed; significance was set at p < .05. RESULTS: Survey results revealed significant changes for coalitions engaged in research partnership. Institutional engagement with community health coalitions in the first year of partnership was related to enhanced coalition function. CONCLUSIONS: Coalitions with a greater degree of researcher collaboration may be more successful in addressing community health problems.