Self-efficacy and autonomous motivation are associated with lower sugar-sweetened beverage consumption in low-income overweight and obese mothers of young children.

Sugar-sweetened beverage (SSB) consumption is strongly associated with obesity. Autonomous motivation and self-efficacy, key concepts of self-determination theory, may influence SSB consumption. Low-income mothers of young children experience disproportionate rates of obesity. Whether autonomous motivation and self-efficacy are associated with SSB consumption in low-income mothers of young children is unknown. This exploratory secondary data analysis explored whether autonomous motivation or self-efficacy were associated with SBB consumption using data from a lifestyle intervention for low-income, overweight or obese mothers with young children. Participants (N = 311) completed surveys assessing autonomous motivation, self-efficacy, and SSB consumption at baseline, after the 16-week intervention, and at 3-month follow-up. Using baseline data, we performed linear regression models to explore associations of self-efficacy and autonomous motivation with SSB consumption. We also performed mixed effects models to explore whether autonomous motivation or self-efficacy were associated with SSB consumption over time. At baseline, a one-point increase in autonomous motivation and self-efficacy were associated with 4.36 (p < 0.001) and 6.43 (p = 0.025) fewer ounces of SSB consumption per day, respectively. In longitudinal models, SSB consumption decreased over time. Change in SSB consumption was associated with self-efficacy (B = -4.88; p = 0.015) and autonomous motivation (B = -2.29; p = 0.008). Our findings suggest self-efficacy and autonomous motivation may influence SSB consumption among mothers of young children with overweight and obesity. Further investigation should explore if self-efficacy and autonomous motivation have long-term effects on SSB consumption.

Using the life course health development model to address pediatric mental health disparities.

TOPIC: Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. PURPOSE: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. SOURCES: Peer-reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. CONCLUSIONS: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children.

A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers.

BACKGROUND: Episodic future thinking (EFT) has shown efficacy in laboratory settings. We conducted a pilot goal-oriented EFT (GoEFT) intervention in a real-world setting to help low-income overweight or obese mothers lose weight. This paper presents intervention acceptability and efficacy. METHODS: The study used a single-group, before-after design. During the 3-week intervention, participants (N = 15) completed weekly web-based lessons and online health coaching sessions to manage stress and emotion, eat healthier, and be more physically active. Participants completed online surveys at baseline and immediately after the intervention. They also completed an interview to evaluate intervention acceptability. We applied paired t-tests to evaluate efficacy and used content analysis to discover interview themes. RESULTS: Participants consistently identified the intervention as acceptable, noting the usefulness of pre-written goals, GoEFT strategies, and goal progress evaluations. The intervention effectively promoted weight loss (d = -0.69), fruit and vegetable intake (d = 0.45-0.49), and emotion control (d = 0.71). It also reduced fat (d = -0.51) and added sugar intake (d = -0.48) and alleviated stress (d = -0.52). Moreover, the intervention increased autonomous motivation (d = 0.75-0.88) and self-efficacy (d = 0.46-0.61). CONCLUSION: The GoEFT intervention was acceptable to participants, showing strong preliminary efficacy.

Mothers In Motion Program: Implementation Process and Acceptability by Community.

BACKGROUND: Implementing lifestyle behavior programs in real-world settings challenges researchers. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has implemented and sustained Mothers In Motion (MIM)'s client videos for clients to promote healthy lifestyle behaviors, and train-the-trainer videos, for personnel to enhance motivational interviewing techniques since 2015 and 2016, respectively. This paper describes the implementation processes and the results of client video implementation acceptability by WIC personnel. METHODS: To document the implementation process, we applied the Framework for Adaptation and Modifications to Evidence-Based Implementation Strategies (FRAME-IS). To evaluate implementation acceptability, we conducted semi-structured interviews with 15 WIC personnel. A qualitative analysis was conducted to identify the common themes. RESULTS: The facilitators for client video implementation were the inclusion of the target audience and family members addressing daily challenges, easy implementation, and compatibility with daily practice. While videos online facilitated implementation, videos in DVD format could challenge implementation. CONCLUSIONS: Future lifestyle intervention programs aimed for future implementation in community settings may consider the inclusion of the target audience and their family members and take into consideration easy implementation and compatibility.

Psychosocial Factors Associated With Physical Activity Among Low-Income Overweight or Obese Mothers with Young Children.

PURPOSE: Investigate the associations between psychosocial factors and physical activity. DESIGN: Secondary data analysis utilizing baseline data of a large-scale community-based randomized controlled lifestyle behavior intervention. SETTING: The Special Supplemental Program for Women, Infants, and Children in Michigan, USA. SUBJECTS: Low-income overweight or obese mothers with young children (N = 740, 65% response rate). MEASURES: Survey data were collected via phone interview. Predictors included self-efficacy, autonomous motivation, emotional coping, and social support. Self-reported leisure physical activity was the outcome variable. Covariates were age, race, smoking, employment, education, body mass index, and postpartum status. ANALYSIS: A multiple linear regression model was applied. RESULTS: Self-efficacy (ß = .32, 95% CI = .11, .52, P = .003) and autonomous motivation (ß = .10, 95% CI = .03, .17, P = .005) were positively associated with physical activity. However, emotional coping and social support were not associated with physical activity. CONCLUSION: Future research should examine the longitudinal association of key psychosocial factors with physical activity.

Organized Physical Activity Program Participation, Physical Activity, and Related Psychosocial Factors Among Urban Adolescents.

The study purpose was to examine whether adolescents who participated in organized physical activity (PA) programs differed from nonparticipants in motivation, social support, and self-efficacy related to PA; PA (min/hr); and sedentary screen time behavior. Thirty-nine 5th-7th grade adolescents participated in organized PA programs; 41 did not. Approximately 56.3% were Black, and 52.5% had annual family incomes <$20,000. Compared to nonparticipants, those who participated reported significantly higher social support (M = 2.32 vs. 3.13, p < .001) and fewer hours watching television or movies on a usual weekend day (M = 2.49 vs. 1.59, p = .016); and had higher accelerometer-measured vigorous PA (M = 0.58 vs. 1.04, p = .009) and moderate-to-vigorous PA (M = 2.48 vs. 3.45, p = .035). Involving adolescents in organized PA programs may be important for improving their moderate-to-vigorous PA, vigorous PA, and related psychosocial factors, as well as reducing sedentary screen time behavior.

Pilot Lifestyle Intervention Effect on Lifestyle Behaviors, Psychosocial Factors, and Affect.

Background: This paper presents results of a pilot intervention effect on lifestyle behaviors, psychosocial factors, and affect among overweight or obese pregnant women. Methods: 70 participants were randomized to the intervention or usual care group. During the 20-week intervention, participants completed a weekly online intervention module and joined individual online health coaching. Data were collected at baseline (<17 weeks gestation), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Lifestyle behaviors included dietary intake (caloric, fat, added sugar, fruit, and vegetable) and physical activity (PA). Psychosocial factors were autonomous motivation, self-efficacy, executive functions, and consideration of future consequences (CFC). Affect comprised stress and emotional control. Two-sample t-tests and Cohen's d effect sizes were used to compare between group mean differences in the change from baseline to T2 and T3. Results: At T2, intervention positively influenced fruit intake (d = 0.47), autonomous motivation for healthy eating (d = 0.36), self-efficacy for healthy eating (d = 0.25) and PA (d = 0.24), executive functions (behavior regulation, d = -0.21; metacognition, d = -0.69), and emotional control (d = 0.79). At T3, the intervention improved PA (d = 0.19), autonomous motivation for healthy eating (d = 0.33), self-efficacy for healthy eating (d = 0.50) and stress management (d = 0.62), executive functions (metacognition, d = -0.46), CFC (d = 0.25), stress (d = -0.45), and emotional control (d = 0.72). Conclusion: The pilot intervention has positive effects on most psychosocial variables and affect in both the short and long terms.

A Pilot Lifestyle Behavior Intervention for Overweight or Obese Pregnant Women: Results and Process Evaluation.

Introduction: This paper presents a pilot lifestyle behavior intervention effect on gestational weight gain and maternal and neonatal outcomes and intervention acceptability. Materials and Methods: Overweight or obese pregnant participants (N = 70) were randomized to the intervention or usual care group. The 20-week intervention integrated Hope theory and goal-oriented episodic future thinking (GoEFT) to prevent excessive gestational weight gain through stress and emotion management, healthy eating, and physical activity. Intervention participants completed a weekly web intervention module with 2 parts (I and II) and joined individual health coaching sessions (10 sessions). The primary outcome was gestational weight gain (GWG). Secondary outcomes included maternal and neonatal outcomes. Data were collected at 3 time points: baseline (< 17 weeks gestation, T1), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Intervention participants completed a semi-structured interview to evaluate the intervention. We compared GWG at T2 and T3 with T1 for intervention and usual care groups using t-tests and conducted content analysis to identify common themes for intervention acceptability. Results: There were no significant group differences in GWG at T2 and T3. Maternal and neonatal outcomes were similar between groups. Common themes for intervention acceptability were disked web Part I intervention presented in text, the need for choosing a weekly intervention topic, raising awareness through GoEFT and self-evaluation, increased motivation through GoEFT, and usefulness of pre-written goals and goal progress evaluation. Conclusions: Results of process evaluation are helpful for researchers to design a lifestyle intervention to prevent excessive gestational weight gain.

Dietary Intake of Micronutrients and Essential Fatty Acids among Overweight or Obese Pregnant Women during Early Pregnancy.

Background: Dietary intake of micronutrients and essential fatty acids in overweight or obese pregnant women during early pregnancy is unknown. We investigated the proportion of pregnant women meeting recommendations for dietary intake of micronutrients and essential fatty acids and compared stress and depressive symptoms between those meeting and below recommendations. Methods: Participants (N = 70) were overweight or obese pregnant women ≤16 weeks gestation. They completed two 24-hour dietary recalls and online surveys measuring stress and depressive symptoms. Micronutrients of interest included B vitamins, choline, and trace minerals (calcium, magnesium, selenium, and zinc). Essential fatty acids were docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Results: Low proportions of participants met recommendations for choline (21.4%) and folate (24.3%). Yet, the proportion of women meeting recommendations for other B vitamins and trace minerals were much better. Less than 9.0% of participants met recommendations for essential fatty acids. Compared with those below recommendations for B3 and selenium, participants meeting recommendations had significantly fewer depressive symptoms. Conclusions: Low proportions of overweight or obese pregnant participants met dietary intake recommendations for micronutrients and essential fatty acids.

Factors Associated with Beverage Intake in Low-Income, Overweight, or Obese Pregnant Women.

This study examined consumption proportions and factors associated with sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and 100% fruit juice (FJ) consumption. We recruited Non-Hispanic Black (n = 136) and White (n = 192) low-income overweight or obese pregnant women aged 18 to 46 years (mean = 25.7 years) from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in Michigan, USA. Independent variables included weight status, trimester, smoking, stress, education, employment, race, and age. Dependent variables were high (consuming ≥ 1 serving/day) versus low consumptions of SSB, ASB, and 100% FJ. Multivariate logistic regression modeling was performed to examine factors associated with beverage consumption. Out of the sample, 48.2%, 6.7%, and 31.3% reported high SSB, ASB, and 100% FJ consumption, respectively. SSB consumption was associated with smoking (OR: 3.77, p < 0.001), education (OR: 0.57, p = 0.03), and race (OR: 1.69, p = 0.03). Artificially sweetened beverage consumption was not associated with any factors examined. One hundred percent FJ consumption was associated with stress (OR: 0.90, p = 0.03) and race (OR: 4.48, p < 0.001). Clinicians may advocate for reductions in SSB and 100% FJ consumption tailored to client consumption characteristics.

Factors Associated with Home Food Environment in Low-Income Overweight or Obese Pregnant Women.

Limited research has examined factors associated with home food availability. This study investigated the associations among demographics, body mass index category, stress, and home food availability among low-income overweight or obese pregnant women. This cross-sectional study enrolled 332 participants who were non-Hispanic black or white. We performed logistic regression modeling for unprocessed food, processed food, overall ultra-processed food, and three subcategories of ultra-processed food (salty snacks, sweet snacks and candies, and soda). Black women were less likely than white women to have large amounts of processed foods (OR = 0.56), salty snacks (OR = 0.61), and soda (OR = 0.49) available at home. Women with at least some college education or at least a college education were more likely to have large amounts of unprocessed food (OR = 2.58, OR = 4.38 respectively) but less likely to have large amounts of soda (OR = 0.44; OR = 0.22 respectively) available at home than their counterparts. Women with higher stress were less likely to have large amounts of unprocessed food available at home (OR = 0.58) than those with lower stress. Home food availability varied by race, education, and levels of stress in low-income overweight or obese pregnant women.

Psychosocial Factors Affecting the Association between a Healthy Lifestyle Behavior Intervention and Depressive Symptoms in Low-Income Overweight or Obese Mothers with Young Children: A Mediational Analysis.

BACKGROUND: Depressive symptoms are particularly prevalent among low-income overweight or obese mothers with young children, indicating the importance of understanding and addressing this serious health condition. Although lifestyle behavior interventions are promising for alleviating depressive symptoms in low-income overweight or obese mothers with young children, mechanisms underlying the association between these interventions and depressive symptoms in this priority population remain unknown. OBJECTIVE: A secondary analysis of data from a randomized controlled trial that tested a 16-week community-based lifestyle behavior intervention for low-income overweight or obese mothers with young children was conducted to examine whether autonomous motivation, coping self-efficacy, and emotional coping mediated the association between the intervention and depressive symptoms. METHODS: The analysis included 338 participants who completed data collection at baseline and immediately after the intervention. Participants responded to validated surveys measuring autonomous motivation, coping self-efficacy, emotional coping, and depressive symptoms. To test mediation effects, composite indicator structural equation modeling was performed adjusting for baseline measures. The proportion of maximum possible (POMP) scores in the outcome variable per unit change in the predictor variables was used to calculate effect size. RESULTS: The intervention alleviated depressive symptoms (B = -2.42, p = 0.015, POMP = -4.31%), and coping self-efficacy negatively and fully mediated the association between the intervention and depressive symptoms (B = -1.42, p = 0.002, POMP = -2.53%). Autonomous motivation and emotional coping were not significant mediators. CONCLUSIONS: Interventions aimed to alleviate depressive symptoms in low-income overweight or obese mothers with young children should include strategies to improve coping self-efficacy. However, continued research is needed to identify other mechanisms that may be contributing to the effect of lifestyle behavior interventions on depressive symptoms in this at-risk group. This information can then be used to simplify and strengthen the interventions and potentially lead to effective dissemination and implementation.

Mediation by Executive Functions in the Associations Between Perceived Stress, Prenatal Distress, Emotional Control, and Dietary Intake in Overweight or Obese Pregnant Women.

Background: The study explored potential mediation by executive functions (behavioral regulation index [BRI] and metacognition index [MI]) in association between perceived stress, prenatal distress, emotional control, and dietary intake (total calorie, total fat, added sugar, fruits, and vegetables). Methods: 70 overweight or obese pregnant women completed validated online surveys and two 24-hour dietary recalls. Path analyses were performed. Results: Increased perceived stress was associated with increased BRI both directly (p < 0.001) and indirectly through increased MI (perceived stress to MI: p < 0.001, MI to BRI: p < 0.001). Subsequently, increased BRI was associated with increased total fat intake (p = 0.01). Two-stage mediation was found in the association of prenatal distress with total fat intake. Increased prenatal distress was associated with increased MI (p < 0.001). Higher MI was associated with higher BRI (p < 0.001), and higher BRI was associated with increased total fat intake (p = 0.01). Conclusions: Future intervention studies for overweight or obese pregnant women might focus on stress management to alleviate perceived stress and prenatal distress or on strategies to boost executive functions, each of which might ultimately help to reduce total fat intake.

Perceptions of African American Adults With Type 2 Diabetes on Family Support: Type, Quality, and Recommendations.

PURPOSE: The overall purpose of the study was to explore perceptions of family support in diabetes self-management among African American adults with type 2 diabetes. METHODS: A qualitative study using focus group methodology and individual interviews was conducted. Thirty-seven African American adults with type 2 diabetes were recruited in the Midwest, United States. Data were analyzed using qualitative content analysis. RESULTS: Themes emerged from the perspectives of the social interdependence theory. Positive family support included emotional support, instrumental support, and specific information or advice on diabetes management strategies. Positivity, family communication, and healthy eating/meal planning were perceived as helpful family behaviors. Negative support was perceived as intentional or unintentional behaviors. Family members' help in decision-making included goal setting with family member(s) and help in making decisions on diet and exercise. Recommendations included exercise and nutritional programs, support groups, family involvement, and materials and resources. Motivations for attending diabetes programs included involving family members, sharing success stories, seeing positive results, encouraging and caring, and providing incentives. CONCLUSIONS: Intervention programs for African Americans should specifically target challenges in family support, healthy eating, and physical activity at an interpersonal level. Health care providers should assess family roles and family support to facilitate diabetes self-management for African Americans.

Perceived stress linking psychosocial factors and depressive symptoms in low-income mothers.

BACKGROUND: Little is known about associations between perceived stress, psychosocial factors (social support, emotional coping, coping self-efficacy, and autonomous motivation), and depressive symptoms in low-income overweight or obese mothers of young children. Using baseline data of a lifestyle intervention study, this secondary analysis investigates whether perceived stress might mediate the associations between the psychosocial factors and depressive symptoms. METHODS: Convenience sampling was applied. Low-income overweight or obese mothers of young children were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, US. Survey data were collected through phone interviews. Participants (N = 740) responded to valid surveys measuring perceived stress, social support, emotional coping, coping self-efficacy, autonomous motivation, and depressive symptoms. Composite indicator structural equation modeling was performed to test for potential mediation. RESULTS: When investigating the potential role of perceived stress as a mediator, the indirect effects of social support (b = - 2.10, p < 0.01), emotion coping (b = - 3.81, p < 0.05), and coping self-efficacy (b = - 7.53, p < 0.01) on depressive symptoms through perceived stress were significant, but the indirect effect of autonomous motivation was not. CONCLUSION: Future intervention studies aiming to alleviate depressive symptoms in low-income overweight or obese mothers of young children might consider including practical strategies to promote social support, emotional coping, and coping self-efficacy to reduce perceived stress, which might potentially decrease depressive symptoms. TRIAL REGISTRATION: Clinical Trials NCT01839708 ; registered February 28, 2013.

Mediators affecting the association between a lifestyle behavior intervention and stress in low-income overweight or obese mothers of young children.

Using data from a community-based lifestyle behavioral intervention study, this secondary data analysis investigated whether emotional coping, coping self-efficacy, and autonomous motivation mediated the association between the intervention and perceived stress in low-income overweight or obese mothers of young children. Results showed that coping self-efficacy significantly mediated the association between the intervention and perceived stress. However, emotional coping and autonomous motivation did not significantly mediate the association between intervention and perceived stress. Interventions may be more effective in helping the target audience reduce stress if they incorporate practical skills that can increase a sense of coping self-efficacy.

Perceived Stress Can Mediate the Associations between a Lifestyle Intervention and Fat and Fast Food Intakes.

This secondary analysis study addressed a gap of knowledge: whether perceived stress reduction created by a lifestyle intervention might serve as a mediator for reducing fat and fast food intakes in low-income overweight or obese mothers of young children. This analysis included 338 low-income overweight or obese mothers of young children who completed a phone interview immediately after the 16-week lifestyle intervention. Valid surveys were used to assess perceived stress and fat and fast food intakes. Composite indicator structural equation modeling was performed to test the mediation effects. The overall effect of the intervention was not significant for fat intake but was significant for fast food intake (B = -0.53, p < 0.05). When assessing the potential role of perceived stress as a mediator, the indirect effects of the intervention on fat (B = -0.39, p < 0.01) and fast food (B = -0.27, p < 0.01) intakes were both significant. Future dietary intervention studies aimed to reduce fat and fast food intakes in low-income overweight or obese mothers of young children might consider including practical strategies aimed at reducing perceived stress.

Mediators of intervention effects on dietary fat intake in low-income overweight or obese women with young children.

PURPOSE: We investigated whether autonomous motivation and self-efficacy might mediate the association between a lifestyle behavior intervention and dietary fat intake in low-income overweight or obese women with young children. METHODS: Participants were randomized to an intervention or comparison group. Intervention participants received a 16-week intervention aimed to prevent weight gain through promotion of stress management, healthy eating and physical activity. During the intervention phase, participants viewed a designated video lesson at home and dialed in a peer support group teleconference every week (weeks 1-4) then every other week (weeks 5-16). Potential mediation effects were analyzed using sequential mixed-effects linear models and path analysis. RESULTS: The intervention led to increased autonomous motivation (ß = 0.34, standard error [SE] = 0.15, P = 0.005), which subsequently increased self-efficacy (ß = 0.18, SE = 0.35, P < 0.001), and higher levels of self-efficacy were associated with decreased dietary fat intake (ß = -0.22, SE = 0.28, P < 0.001). In other words, autonomous motivation and self-efficacy mediated the association between the lifestyle behavior intervention and dietary fat intake. CONCLUSION: To decrease dietary fat intake for low-income overweight or obese women with young children, strategies, such as those promoting peer encouragement, may be warranted in interventions to enhance autonomous motivation and/or practical skills for increasing self-efficacy.

Chaos and psychosocial health in low-income overweight or obese women.

OBJECTIVE: Using baseline data from a community-based weight-gain prevention intervention study, the authors examined whether coping self-efficacy moderated the associations between chaotic home environment and psychosocial health (perceived psychosocial stress, depressive symptoms, and positive and negative affect) in low-income women who are overweight or obese. METHOD: Participants (N = 740; Mage = 28.06 ± 5.12) completed validated self-report measures of coping self-efficacy, chaotic home environment, perceived psychosocial stress, depressive symptoms, and positive and negative affect. Composite indicator structural equation modeling was used to test the moderation effects. Effect size was calculated using proportion of maximum possible (POMP) scores in the endogenous variables per unit change in the exogenous variable. RESULTS: Coping self-efficacy significantly moderated the associations between chaotic home environment and depressive symptoms (p < .001, POMP = -0.62%) and between chaotic home environment and negative affect (p < .01, POMP = -0.36%). However, coping self-efficacy did not moderate the association between chaotic home environment and perceived psychosocial stress or positive affect. CONCLUSIONS: This study suggests that coping self-efficacy could explain some individual differences in responses to home chaos or to interventions aimed at alleviating depressive symptoms and negative affect in low-income women who are overweight or obese and who experience chaos at home. (PsycINFO Database Record (c) 2019 APA, all rights reserved).