The Role of SNAP in Home Food Availability and Dietary Intake among WIC Participants Facing Unstable Housing.

OBJECTIVE: Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e., Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing. DESIGN AND SAMPLE: Cross-sectional study among vulnerable families. Low-income, multiethnic families with children participating in WIC (n = 54). MEASURES: Dietary intake was assessed with 24-hr recalls. Home food availability was assessed with an adapted home food inventory for low-income, multiethnic families. Validation results from adapted home food inventory for these families are also reported. RESULTS: SNAP households had more foods than non-SNAP households; few significant associations were observed between food availability and child dietary intake. CONCLUSIONS: With few exceptions, the home food environment was not related to children's dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing.

Diabetes Prevention for Latino Youth: Unraveling the Intervention "Black Box".

The translation of research findings into sustainable health promotion and disease prevention programs in community settings remains a challenge. This report describes the process of substantiating a community-developed diabetes prevention program for Latino youth through research. Included are design considerations, measurement strategies, and the context through which the project is culturally grounded for relevance and fit within a local community. The process included (1) refining the program to include salient, stakeholder-identified behavioral components; (2) refining the collaborative effort to embrace the capacity for facilitating relevant behavior change on targeted health-related outcomes to enhance intervention effectiveness; and (3) including the accurate assessment of intervention efficacy via precise assessment of diabetes-related health outcomes. We explain the process of collaborating with community partners to enhance the cultural relevance and sustainability of intervention effects on both individuals and communities. We discuss the rationale for empirical support for academic-community collaborations that function in both a "top-down" and a "bottom-up" manner to advance the science and practice of sustainable and efficacious community health promotion.

Physical activity and depressive symptoms after stillbirth: informing future interventions.

BACKGROUND: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth. Physical activity may improve depression in these women, however, little is known about acceptable physical activity interventions for women after stillbirth. This is the purpose of this descriptive exploratory study. METHODS: Eligible women were between ages 19 and 45, and experienced stillbirth within one year of the study. An online survey was used to ask questions related to 1) pregnancy and family information (i.e., time since stillbirth, weight gain during pregnancy, number of other children) 2) physical activity participation, 3) depressive symptomatology, and 4) demographics. RESULTS: One hundred seventy-five women participated in the study (M age = 31.26 ± 5.52). Women reported participating in regular physical activity (at least 150 minutes of moderate activity weekly) before (60%) and during (47%) their pregnancy, as well as after their stillbirth (61%). Only 37% were currently meeting physical activity recommendations. Approximately 88% reported depression (i.e., score of >10 on depression scale). When asked how women cope with depression, anxiety, or grief, 38% said physical activity. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), followed by jogging (35%), and yoga (23%). Women who participated in physical activity after stillbirth reported significantly lower depressive symptoms (M = 15.10, SD = 5.32) compared to women who did not participate in physical activity (M = 18.06, SD = 5.57; t = -3.45, p = .001). CONCLUSIONS: Physical activity may serve as a unique opportunity to help women cope with the multiple mental sequelae after stillbirth. This study provides data to inform healthcare providers about the potential role of physical activity in bereavement and recovery for women who have experienced stillbirth. Additional research is necessary in this vulnerable population.

Developmental cascade effects of the New Beginnings Program on adolescent adaptation outcomes.

Using data from a 6-year longitudinal follow-up sample of 240 youth who participated in a randomized experimental trial of a preventive intervention for divorced families with children ages 9-12, the current study tested alternative cascading pathways by which the intervention decreased symptoms of internalizing disorders, symptoms of externalizing disorders, substance use, and risky sexual behavior and increased self-esteem and academic performance in mid- to late adolescence (15-19 years old). It was hypothesized that the impact of the program on adolescent adaptation outcomes would be explained by progressive associations between program-induced changes in parenting and youth adaptation outcomes. The results supported a cascading model of program effects in which the program was related to increased mother-child relationship quality that was related to subsequent decreases in child internalizing problems, which then was related to subsequent increases in self-esteem and decreases in symptoms of internalizing disorders in adolescence. The results were also consistent with a model in which the program increased maternal effective discipline that was related to decreased child externalizing problems, which was related to subsequent decreases in symptoms of externalizing disorders, less substance use, and better academic performance in adolescence. There were no significant differences in the model based on level of baseline risk or adolescent gender. These results provide support for a cascading pathways model of child and adolescent development.

Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit.

PURPOSE: Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. METHODS: Randomised controlled trial, 40 patients aged 55 and older. INTERVENTION: Participants randomly assigned to receive music listening or usual care for 60 minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses. OUTCOMES: Heart rate, respiratory rate, systolic and diastolic blood pressure, confusion assessment method. RESULTS: Repeated measures ANOVA, F(4, 134) = 4.75, p = .001, suggested statistically significant differences in heart rate pre/post music listening, and F(1, 37) = 10.44, p = .003 in systolic blood pressure pre/post music listening. Post-hoc analysis reported changes at three time periods of statistical significance; (p = .010), (p = .005) and (p = .039) and a change in systolic blood pressure pre/post music listening; (p = .001) of statistical significance. All participants screened negative for delirium. CONCLUSION: Music addresses pathophysiologic mechanisms that contribute to delirium; neurotransmitter imbalance, inflammation and acute physiologic stressors. Music to prevent delirium is one of few that provide support in a critical care setting.

Acculturation, Cultural Values, and Breastfeeding in Overweight or Obese, Low-Income, Hispanic Women at 1 Month Postpartum.

BACKGROUND: Most Hispanic infants are fed formula during the first 6 weeks, and although 80% of Hispanic women initiate breastfeeding, rates of exclusive breastfeeding are much lower. Research aim: The purpose was to examine the influence of acculturation and cultural values on the breastfeeding practices of pregnant women of Mexican descent participating in the Special Supplemental Nutrition Program for Women, Infants, and Children who were enrolled in a prospective randomized clinical trial that aimed to reduce child obesity. The data were abstracted from a larger randomized clinical trial focused on prevention of child obesity. METHODS: The sample consisted of 150 women of Mexican origin who were enrolled at the time of these analyses from the randomized clinical trial and had a prepregnancy body mass index of ≥ 25 and spoke English and/or Spanish. All breastfeeding data for this report came from data collection at 1 month postpartum. RESULTS: A higher score on the Anglo orientation scale of the Acculturation Rating Scale for Mexican Americans was associated with less breastfeeding at 1 month postpartum and less exclusive breastfeeding. CONCLUSION: Acculturation plays a role in breastfeeding practice. Exploring acculturation associated with breastfeeding can guide us to design culturally relevant interventions to promote breastfeeding exclusivity among immigrant mothers.

Online Lactation Education for Healthcare Providers: A Theoretical Approach to Understanding Learning Outcomes.

BACKGROUND: Breastfeeding competencies are not standardized in healthcare education for any of the health professions. A few continuing education/professional development programs have been implemented, but research regarding the efficacy of these programs is scarce. Research aim: After a 45-hour lactation course, (a) Does breastfeeding knowledge increase? (b) Do beliefs and attitudes about infant feeding improve? (c) Does perceived behavioral control over performance of evidence-based lactation support practices increase? and (d) Do intentions to carry out evidence-based lactation support practices increase? METHODS: A nonexperimental pretest-posttest self-report survey design was conducted with a nonprobability sample of participants ( N = 71) in a lactation course. Theory of Planned Behavior variables were measured and a before-after course analysis was completed. RESULTS: Significantly higher scores were found on the posttests for knowledge, beliefs about breastfeeding scale, and the perceived behavioral control scale. Participants' self-efficacy increased after the course; their beliefs about social norms and their ability to effect change in their workplaces did not change significantly. Participants' intention to perform actions that are consistent with the evidence-based breastfeeding supportive behaviors increased significantly. Positive beliefs about formula feeding significantly increased; this was unexpected. CONCLUSION: The Theory of Planned Behavior provided a useful approach for examining more meaningful learning outcomes than the traditional knowledge and/or satisfaction outcomes. This study was the first to suggest that more meaningful learning outcomes are needed to evaluate lactation programs. However, it is not enough to educate healthcare providers in evidence-based practice; the places they practice must have the infrastructure to support evidence-based practice.

Perceptions, Uses of, and Interests in Complementary Health Care Approaches in Depressed Pregnant Women: The PAW Survey.

Depression affects up to 23% of pregnant women and is associated with adverse physical/mental health outcomes for both the mother and baby. Depressed pregnant women may be more likely to engage in unhealthy lifestyle behaviors that contribute to an increased risk for chronic disease. Little is known regarding depressed pregnant women's perceptions, uses of, and interests in complementary health approaches. Study participants (mean age 28.7 ± 6.8; n = 1032) included pregnant women ≥8 weeks gestation who responded to a survey assessing physical and mental health and wellness practices. Of those completing the survey, depressed pregnant women (n = 272) had significantly higher levels of anxiety (P < .001) and stress (P < .001) and had poorer sleep quality (P < .001), mindfulness (P < .001), and social support (P < .001) compared to nondepressed pregnant women (n = 760). A majority (84%) of depressed pregnant women would consider using a complementary health approach for weight and/or stress management during pregnancy, and more than 50% were interested in yoga.

Symptoms of Restless Legs Syndrome in Biological Caregivers of Children with Autism Spectrum Disorders.

STUDY OBJECTIVES: In this study, we investigated the prevalence of symptoms of restless legs syndrome (RLS) in biological caregivers of children with a diagnosis of autism spectrum disorder (ASD).The relationship of RLS symptoms to caregiver health-related quality of life (HRQoL) was also examined. Finally, we compared the sleep quality and daytime behaviors of children with ASD in caregivers with and without symptoms of RLS. METHODS: Biological caregivers (n = 50) of children ages 6 to 11 y with a diagnosis of ASD completed a Sleep Habits Questionnaire (SHQ) that included RLS as determined by four questions. HRQoL was assessed using the Medical Outcomes Survey (MOS) 12-Item Short Form (SF-12). Caregivers also completed the Children's Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL6/18). RESULTS: Eleven caregivers (22%) fit the criteria for RLS symptomatology and caregivers with RLS reported poorer mental health. Caregivers with RLS described more night waking and greater internalized behavior problems in their children with ASD than the caregivers without RLS. CONCLUSIONS: Biological caregivers of children with ASD demonstrated a high prevalence of RLS symptoms and poorer mental health. RLS is known as a sleep disorder that has strong heritability, and it is possible that many of the children with ASD also have symptoms of RLS. RLS as a possible disruptor of sleep should be considered in caregivers and in their children with ASD.

A Pilot Intervention Designed to Address Behavioral Factors That Place Overweight/Obese Young Children at Risk for Later-Life Obesity.

The purpose of this pilot randomized controlled trial (RCT) was to intervene with parents of overweight/obese 4- to 8-year-old children to improve child internalizing and externalizing behaviors. Parent-child dyads ( N = 60) were randomly assigned to treatment or comparison conditions. Parents attended four intervention sessions at their child's primary health care office over 3 months. Child behaviors were assessed at 0, 3, 6, and 12 months post intervention. Parental beliefs in their skills/abilities increased in the experimental group parents, but there was no statistical difference between groups at any time. Child externalizing behaviors significantly decreased from baseline to postintervention for both groups ( F = 3.26, p = .020). Post hoc model testing suggests that this change was more pronounced in the intervention group ( F = 0.56, p = .692). Child somatic symptoms significantly decreased over time ( F = 4.55, p = .004), and there were group differences in child depressive behaviors ( F = 6.19, p = .020). These findings suggest that a parent-focused intervention program demonstrated positive preliminary effects on children's behaviors.

Development and design of an intervention to improve physical activity in pregnant women using Text4baby.

Text4baby is a free, mobile health information service for pregnant and post-partum women. This study aims to understand preferences of physical activity text messages (SMS), sequentially develop prototype SMS, and determine preferred dose of SMS to inform a future study utilizing Text4baby. This study had a user-centered design with three phases: (1) literature review and interviews with pregnant women for development of prototype SMS, (2) interviews with health care professionals and pregnant women for prototype SMS feedback, and (3) survey to determine preferred dose of SMS. Data from interviews identified knowledge and support as major themes. Prototypes were developed (N = 14) and informed 168 SMS. Pregnant women (N = 326) thought three SMS/week were about right (50.2 %) and preferred three SMS/week throughout pregnancy (71.9 %). There is a need for opportunities for behavioral scientists to incorporate evidence-based practices within scalable interventions. As such, this research will inform utilization of Text4baby to potentially improve physical activity participation.

Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients.

PURPOSE: Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. DESIGN: A two-group parallel randomized controlled trial. SETTING: Primary care, safety-net clinics. SUBJECTS: Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. INTERVENTION: Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. MEASURES: Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. ANALYSIS: Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. RESULTS: Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n = 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. CONCLUSION: A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both interventions' engagement factor facilitated positive attitudes about CRC screening associated with behavior change.

A biobehavioral model of weight loss associated with meditative movement practice among breast cancer survivors.

Women with breast cancer often experience weight gain during and after treatment, significantly increasing risk for recurrence as well as all-cause mortality. Based on a growing body of evidence, meditative movement practices may be effective for weight management. First, we describe the effects of stress on factors associated with weight gain for breast cancer survivors. Then, a model is proposed that utilizes existing evidence to suggest how meditative movement supports behavioral, psychological, and neurohormonal changes that may explain weight loss. Application of the model suggests how a novel "mindful-body-wisdom" approach may work to help reduce weight for this at-risk group.

The preliminary effects of a primary care-based randomized treatment trial with overweight and obese young children and their parents.

INTRODUCTION: Twenty-three percent of preschoolers are overweight/obese, which puts these children at risk for the development of chronic health comorbidities. The purpose of this randomized control pilot study was to determine the feasibility and preliminary effects of a theoretically based, primary care intervention on the physical outcomes of 60 overweight/obese preschool/early school-aged 4- to 8-year-old children. METHODS: After recruitment and baseline assessment, parent-child dyads were randomly assigned to either the treatment or the control condition. Four intervention sessions were conducted with the parents in their child's primary health care office. The impact of the intervention was evaluated by assessing child anthropometric measures (e.g., waist, waist-by-height ratio, and body mass index [BMI]) immediately, 3 months, and 6 months after the intervention period. RESULTS: Analysis of variance models suggested that children in the experimental group were found to have reduced waist circumference and waist-by-height ratio immediately after the intervention that persisted for 3 and 6 months (f = 0.33, 0.35, respectively). BMI and BMI percentile were not differentially affected. DISCUSSION: These promising findings suggest that a primary care-based, parent-focused overweight/obesity treatment program is feasible and demonstrated positive preliminary effects, improving the children's overall health trajectory.

Reducing anxiety among children born preterm and their young mothers.

PURPOSE: To examine the efficacy of COPE on maternal and child anxiety associated with younger mothers of premature infants. The COPE program provides instruction and practice in parenting behaviors specific to the NICU, in combination with information that reduces ambiguity about their infant's appearance and behaviors. STUDY DESIGN AND METHODS: Secondary data analysis was conducted on data obtained from a larger randomized controlled trial with 253 mothers of low birthweight premature infants to examine the efficacy of the Creating Opportunities for Parent Empowerment (COPE) program, an educational-behavioral parent intervention in the NICU, on maternal and child anxiety based on maternal age. For these analyses, child and maternal anxiety were assessed using the Child Behavior Checklist for Ages 2 to 3 and the State-Trait Anxiety Inventory collected at 24 months and 2 to 4 days postintervention, respectively. To test study hypotheses, we conducted multiple regression models using the structural equation modeling approach to path analysis. RESULTS: Multiple regression results for the full model indicated that there was a significant COPE × mothers' age interaction effect on both mothers' anxiety and child anxiety. Participation in the COPE program significantly predicted lower levels of mothers' anxiety at postintervention as well as lower levels of child anxiety at 24 months for younger mothers (18-21 years old), but not for mothers over 21 years old. CLINICAL IMPLICATIONS: Participating in COPE was associated with more favorable mental health outcomes for younger mothers and their children than mothers over 21 years old. Participation in the COPE program may help close the health disparities gap by improving behaviors in infants of younger mothers to rates similar to those of children of mothers over 21 years old.

Maternal Warmth Moderates the Link between Harsh Discipline and Later Externalizing Behaviors for Mexican American Adolescents.

OBJECTIVE: This study examined maternal warmth as a moderator of the relation between harsh discipline practices and adolescent externalizing problems 1year later in low-income, Mexican American families. DESIGN: Participants were 189 adolescents and their mothers who comprised the control group of a longitudinal intervention program. RESULTS: Maternal warmth protected adolescents from the negative effects of harsh discipline such that, at higher levels of maternal warmth, there was no relation between harsh discipline and externalizing problems after controlling for baseline levels of externalizing problems and other covariates. At lower levels of maternal warmth, there was a positive relation between harsh discipline practices and later externalizing problems. CONCLUSIONS: To understand the role of harsh discipline in the development of Mexican American youth outcomes, researchers must consider contextual variables that may affect youths' perceptions of their parents' behavior such as maternal warmth.

Physical activity of young overweight and obese children: parent reports of child activity level compared with objective measures.

The purpose of this study was to compare objectively measured physical activity (PA) and parent-reported assessments of the children's PA in an overweight/obese child sample. A total of 67 child-parent dyads were recruited for study participation. Child anthropometric measures and parent-reported questionnaires were completed, and then PA was measured by accelerometers for 48 consecutive hours. These children demonstrated moderate-to-vigorous PA for 17.32 min per day on average. The children spent 86.7% of their time in sedentary activities. Parents' reports of hyperactivity were significantly related to the objectively measured PA; however, the parents significantly overestimated the average amount of time children spent in each activity level. These findings suggest that although parents may be able to generally characterize their child's PA, they may not be able to accurately report specific information and thus may struggle to identify clear activity goals for their child and/or be unable to assess intervention effects.

Spanish translation and cross-language validation of a sleep habits questionnaire for use in clinical and research settings.

STUDY OBJECTIVES: To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. METHODS: Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. RESULTS: All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. CONCLUSIONS: The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples.

A parent-directed portion education intervention for young children: Be Beary Healthy.

PURPOSE: This pilot study aimed to determine the effects of an intervention on nutrition knowledge, food parents serve, and children's dietary intake. DESIGN AND METHODS: A single-group pre-/posttest design was used with 45 mothers and their 4- to 6-year-old children. After pretesting, parents received child nutrition information and portion-related activities. RESULTS: Paired samples t-tests revealed that from pre- to posttest the average calories mothers served and the average calories children ate significantly decreased (medium effect size). Medium effects also were recognized from pre- to posttest for the carbohydrates served and carbohydrates consumed. No significant change was found in parents' nutrition knowledge. PRACTICE IMPLICATIONS: Interventions focusing on skill building rather than on increasing knowledge may more effectively lead to changed child intake.

Randomized trial of a broad preventive intervention for Mexican American adolescents.

OBJECTIVE: This randomized trial of a family-focused preventive intervention for Mexican American (MA) adolescents evaluated intervention effects on adolescent substance use, internalizing and externalizing symptoms, and school discipline and grade records in 8th grade, 1 year after completion of the intervention. The study also examined hypothesized mediators and moderators of intervention effects. METHOD: Stratified by language of program delivery (English vs. Spanish), the trial included a sample of 516 MA adolescents (50.8% female; M = 12.3 years, SD = 0.54) and at least one caregiver that were randomized to receive a low-dosage control group workshop or the 9-week group intervention that included parenting, adolescent coping, and conjoint family sessions. RESULTS: Positive program effects were found on all 5 outcomes at 1-year posttest but varied depending on whether adolescents, parents, or teachers reported on the outcome. Intervention effects were mediated by posttest changes in effective parenting, adolescent coping efficacy, adolescent school engagement, and family cohesion. The majority of intervention effects were moderated by language, with a larger number of significant effects for families who participated in Spanish. Intervention effects also were moderated by baseline levels of mediators and outcomes, with the majority showing stronger effects for families with poorer functioning at baseline. CONCLUSION: Findings not only support the efficacy of the intervention to decrease multiple problem outcomes for MA adolescents but also demonstrate differential effects for parents and adolescents receiving the intervention in Spanish vs. English, and depending on their baseline levels of functioning.