Patterns of caregivers' feeding practices and associated characteristics among preschool-age children in the United States.

During early childhood, caregiver feeding practices (FP) influence children's diet and eating habits. Inconsistent methods of operationalizing FP have resulted in limited evidence regarding simultaneous FP patterns. This study examined the heterogeneity in FP among caregivers of preschoolers, along with the child, caregiver, and family characteristics associated with FP patterns. Caregivers of preschoolers (n = 437, 90% women) enrolled in 50 childcare centers across Maryland completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and provided demographic information and perceptions of their child's size and temperament. Exploratory Factor Analysis of CFPQ identified 13 factors, and latent profile analysis (LPA) empirically identified three FP classes. Using multinomial structural equation models, we regressed FP classes on child sex, race, age, poverty level, food insecurity education, caregiver perception of child size and temperament. The most common FP pattern (69%) reflected high coercive and control with low autonomy and structural practices (Controlling Class). A second pattern (16%) had high coercive control with moderate structural and autonomy practices (Regulating Class). The third pattern (15%) reflected moderate levels of all practices (Balancing Class). Caregivers who desired their child to be heavier (aOR = 0.40, 95% CI = 0.22-0.72), were more financially secure (aOR = 0.80, 95%CI = 0.65-0.98), and were single (aOR = 0.38, 95% CI = 0.18-0.80) were less likely to be in the Balancing versus Controlling class. For each unit increase in child temperament t-score [higher = difficult], caregivers were more likely to be in the Balancing (aOR = 1.04, 95% CI = 1.01-1.07) or Regulating class (aOR = 1.04, 95% CI = 1.01-1.08) compared to the Controlling class. In this statewide sample, many caregivers endorsed controlling behaviors without endorsing empowering behaviors to help children become healthy eaters. Future studies should examine how caregiver feeding practices evolve and relate to children's eating habits, growth, and development over time.

Environmental health nursing education: One school's journey.

Nurse educators have long recognized the need for an increased focus on environmental health education in nursing. For decades, schools of nursing have answered the call to action put forth by the Institute of Medicine and the American Nurses Association to incorporate environmental health content into nursing curricula. This article details the experiences of faculty and staff at the University of Maryland School of Nursing as they launched a national environmental health nursing organization, developed individual undergraduate elective courses on environmental health and climate change, and created a post-baccalaureate certificate program. We also report student registration and evaluation data from five environmental health courses over 10 years. Five hundred five undergraduate and 291 graduate nursing students from a variety of programs received formal environmental health education. Relevance of content was consistently highly rated, ranging from 4.17 to 4.61 out of 5, and students completed projects on a wide range of environmental health topics. Graduates of the certificate program have greatly impacted their communities in the areas of nursing practice, education, and policy.

Pesticide monitoring on soccer fields via shoe wipes and urine samples.

OBJECTIVE: We sought to determine the feasibility of measuring pesticide exposure of children using athletic fields to which pesticides were recently applied. DESIGN AND SAMPLE: This project was a pilot feasibility study designed to measure pre and posttest environmental exposure to Horsepower; a combination herbicide containing (4-Chloro-2-methylphenoxy) acetic acid (MCPA), dicamba and triclopyr. A spot application of Horsepower to a soccer field occurred at 8AM. Six players, ages 5-11 years, provided shoe wipes and urine samples before and after evening soccer practice on the field later the same day. MEASUREMENTS AND RESULTS: We sent samples to commercial labs where shoe wipes were analyzed for a panel of herbicides and urine samples were analyzed for dicamba, triclopyr, and creatinine. All analytes were below level of detection. CONCLUSIONS: We established the feasibility of both the recruitment and sampling procedures. Spot application, in the one instance examined, did not result in measurable exposure to pesticides. A larger study involving both spot and broadcast application and including direct observation of pesticide application is needed to ascertain whether pesticide application on athletic fields results in measurable and potentially hazardous exposure of children.

Evaluation of the Children's Environmental Health Network's environmental stewardship checklist responses.

Children are subject to multiple hazards on a daily basis, including in child care facilities. Research has shown that children in the child care setting may be exposed to lead, radon, pesticides, and multiple chemicals that are associated with known or suspected adverse health effects. The authors' study used an existing environmental health endorsement program to describe current practices of child care facilities as related to environmental health and safety. The facilities varied greatly in size and were located mainly in the U.S. with a few from Canada and Australia. A few checklist items had nearly a 100% positive response rate; however, some of the items had more than 10% of the facilities answer "false" or "don't know." Although many areas exist in which these sampled child care facilities are being environmentally responsible, further education is needed, particularly as related to the use of wall-to-wall carpeting, radon testing, aerosols, and air fresheners.

Systematic Review: Association of Pesticide Exposure and Child Wheeze and Asthma.

BACKGROUND: The prevalence of wheeze and asthma has risen over recent decades for all age groups, especially children. These disorders can lead to decreased quality of life, missed school, urgent care and emergency department visits, hospitalizations, and increased health care costs. Environmental exposures, including pesticide exposure, are likely a contributing factor to this increased prevalence. OBJECTIVE: To evaluate the association of pesticide exposure with childhood wheeze and asthma. METHODS: We conducted a systematic review evaluating studies of pesticide exposure (measured objectively) and child respiratory outcomes. We searched PubMed, Embase (Elsevier), CINAHL (EBSCO), Scopus (Elsevier), Cochrane Database of Systematic Reviews (Wiley), and ClinicalTrials. gov from 1988 - 2021. Main search keywords included "pesticides", "insecticides", "herbicides", "respiratory", "asthma" and "wheeze". RESULTS: Out of 5767 studies, 25 met the inclusion criteria; eight evaluated prenatal pesticide exposure (n=8407), twelve evaluated postnatal exposures (n= 50,488), and five evaluated pre-and postnatal exposures (n=20,919). Main pesticides investigated were dichlorodiphenyldichloroethylene (DDE) (14 studies) followed by organophosphates (7 studies). Primary methods of outcome assessment were questionnaire-based (84%), followed by spirometry (16%), registry data, and blood measures. Studies varied in the strength of evidence relating to study design and measures. Most studies (84%) reported a positive association of exposure with adverse child respiratory health. CONCLUSION: The studies suggest an association of pesticide exposure and childhood wheeze and asthma. The varying results and methods reinforce the need for more research and standardized approaches to these studies to confirm the suggested association of pesticide exposure and childhood wheeze and asthma.

Potential health effects related to pesticide use on athletic fields.

OBJECTIVES: Children come in contact with athletic fields on a daily basis. How these fields are maintained may have an impact on children's potential exposure to pesticides and associated health effects. DESIGN AND SAMPLE: This is a cross-sectional, descriptive study that utilized a survey to assess playing field maintenance practices regarding the use of pesticides. Athletic fields (N = 101) in Maryland were stratified by population density and randomly selected. MEASURES: A survey was administered to field managers (n = 33) to assess maintenance practices, including the use of pesticides. Analysis included descriptive statistics and generalized estimating equations. RESULTS: Managers of 66 fields (65.3%) reported applying pesticides, mainly herbicides (57.4%). Managers of urban and suburban fields were less likely to apply pesticides than managers of rural fields. Combined cultivation practice was also a significant predictor of increased pesticide use. CONCLUSIONS: The use of pesticides on athletic fields presents many possible health hazards. Results indicate that there is a significant risk of exposure to pesticide for children engaged in sports activities. Given that children are also often concurrently exposed to pesticides as food residues and from home pest management, we need to examine opportunities to reduce their exposures. Both policy and practice questions are raised.

Pesticides use in hospitals: health protection, health hazards, and viable alternatives.

The literature is replete with evidence of human health risks associated with cleaning products, sterilants, disinfectants, antimicrobials, and a wide range of pesticides such as insecticides, fungicides, and rodenticides. This article focuses on the health risks associated with pesticide and antimicrobial use in the health care setting and the roles that nurses can play in assessing and addressing the human health risks associated with exposure to these chemicals. Specifically, common biocides, sterilants, insecticides, herbicides, and fungicides are reviewed, including products in which they may be found in and the health effects associated with their use. Then follows a discussion of actions nurses and nurse administrators can implement to reduce exposure to these chemicals. These interventions include improving assessment of patient exposure, education of staff and patients on health effects of hazardous chemicals and safer alternatives, and implementation of integrated pest management policies and programs within facilities and in the community.

Gestational Pesticide Exposure and Child Respiratory Health.

BACKGROUND: Childhood wheeze may be related to pesticide exposure, and diet and genetics (Paroxonase; PON1) may modify the effects of exposure. METHODS: We analyzed data from the HOME Study, a prospective pregnancy and birth cohort, to examine the association of gestational urinary organophosphate (OP) and pyrethroid (3PBA) metabolite concentrations with child wheeze, forced expiratory volume in one second (FEV1) at ages 4 and 5 years, and wheeze trajectory patterns through age 8 years. RESULTS: Among 367 singletons, the frequency of wheeze ranged from 10.6% to 24.1% at each measurement age. OP and 3PBA metabolite concentrations were not associated with wheeze at 8 years or from birth to 8 years, but there were three significant interactions: (1) maternal daily fruit and vegetable consumption (less than daily consumption and increasing 3PBA was associated with wheeze at age 8 years, OR = 1.40), (2) maternal PON1-108 allele (CT/TT genotypes and high DE was associated with wheeze at age 8 years, OR = 2.13, 2.74) and (3) PON1192 alleles (QR/RR genotypes with higher diethylphosphate (DE) and dialkyl phosphate (DAP) were associated with wheeze at age 8 years, OR = 3.84). Pesticide metabolites were not consistently related to FEV1 or wheeze trajectory. CONCLUSIONS: Gestational OP and 3PBA metabolites were associated with child respiratory outcomes in participants with maternal dietary and genetic susceptibility.

Pesticides and health risks.

Pesticides are a category of chemicals formulated to kill or repel a pest or halt its reproduction. In this article we review the toxicological and epidemiological literature; describe common potential pesticide exposures; and focus on the associated health risks to fetal development. Clinical implications are reviewed, and recommendations are made regarding the integration of this environmental health concern into nursing education, practice, research, and policy/advocacy work. Recommendations for pesticide elimination and reduction in health care settings are included.