A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework.

BACKGROUND: Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM: The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS: A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS: Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION: Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.

Body Mass Index and Gut Microbiome: A Cluster-Randomized, Controlled, Pilot Feasibility Study.

Background: Prebiotic fiber has been examined as a way to foster gut bacteria less associated with obesity. Tests of prebiotic fiber in reducing obesity have been conducted mainly in animals, adults, and Caucasians when the highest obesity rates are in African American and Latinx youth. Response to prebiotic fiber is determined by the pre-existing intestinal microbiota. The type of microbiota varies based on diet and physical activity (PA), so it is important to examine acceptability and response to prebiotic fiber in those most at risk for obesity. Methods: This cluster-randomized, controlled feasibility trial included an online program designed to improve diet and PA along with administration of a prebiotic fiber for 12 weeks in 123 students of 4th and 5th grade where 98% were eligible for free or reduced-fee lunch. Of these 56% were male; 71% Latinx; 15% African American; and 14% other. Results: Decrease in body fat (BF) was associated with higher pretest BF. Lower body mass index (BMI) was associated with decrease in fecal Tenericutes and increase in Actinobacteria. Conclusions: Prebiotic fiber can be helpful in supporting healthy weight, so inclusion in culturally congruent foods usually eaten by children from groups at high risk for obesity should be considered following additional studies. Determining those most responsive to prebiotic fibers can also permit individual recommendations for greater inclusion in usual diet choices. Clinical Trial Registration Number NCT05671731.

Childhood obesity within the lens of racism.

Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.

Comparing Interprofessional Socialization in Mixed-Discipline and Nursing Student-Only Cohorts.

BACKGROUND: A challenge to substantiating the value of interprofessional education (IPE) has been the limited number of studies that assess the effectiveness of IPE interventions compared with education interventions in which professions were learning separately from one another. PURPOSE: The purpose was to compare interprofessional socialization (IS) in mixed-discipline and single-discipline-only student cohorts to determine if mixed-discipline cohorts demonstrate greater improvement in IS compared with single-discipline cohorts. METHODS: Interprofessional socialization was measured using the Interprofessional Socialization and Valuing Scale in 166 university students who completed a semester-long online palliative care course. RESULTS: Statistically significant increases in IS were seen with all participants, both those in discipline-specific as well as mixed-discipline cohorts and in all IS subscales. No difference was observed between a cohort of nursing student-only learners versus a cohort of mixed-discipline students. CONCLUSION: The study demonstrates that IS can be significantly increased whether students participate with single discipline peers or in mixed-discipline settings.

Child Body Fat and Body Mass Index: Which Determinants are Most Important?

The purpose of this study was to examine child and parent determinants of children's body fat percentage (BF%) along with their body mass index percentile (BMIp). Children's BF% and BMIp auger lifelong health risks when elevated, and one in five children are affected. Participants (N = 135) included 62% female children; 50.7% Caucasian, 31.7% Hispanic, and 8.5% African American. Children were aged 9-15 years (2% underweight, 47.9% normal weight, 19.7% overweight, and 24.6% obese). Parent BMI average was 30.67 (1.4% underweight, 20.4% normal weight, 23.9% overweight, 40% obese, and 7% extreme obesity); 77.5% of the participating parents were mothers. Following multiple imputations, path analyses were conducted of child and parent determinants of children's BF% and BMIp. Children's BF% and BMIp were related to parents' concern about overweight and children's perception of that concern. For children of overweight or obese parents, who are at highest risk for obesity, assessing the parents' concern is the highest priority.

Predeath Grief, Resourcefulness, and Perceived Stress Among Caregivers of Partners With Young-Onset Dementia.

More than 200,000 Americans are currently diagnosed with young-onset dementia (YOD). YOD is dementia diagnosed prior to the age of 65. Most persons of YOD are cared for by their partners. Using the theoretical framework of Resilience Theory, this cross-sectional, correlational study examined the moderating effects of personal and social resourcefulness on the relationship between predeath grief and perceived stress among 104 YOD caregiving partners (life partners/spouses) using an online survey platform. Results indicated a large positive correlation between predeath grief and caregiver perceived stress (r = .65; p < .001). Together predeath grief, personal resourcefulness and social resourcefulness explained 51.5% of the variance in perceived stress. Personal resourcefulness did not moderate the relationship. Social resourcefulness did positively moderate this relationship between predeath grief and perceived stress. These findings allow for a better understanding of the caregiving experience for a partner with YOD and creates opportunities for future research studies.

Physical activity parenting measurement and research: challenges, explanations, and solutions.

Physical activity (PA) parenting research has proliferated over the past decade, with findings verifying the influential role that parents play in children's emerging PA behaviors. This knowledge, however, has not translated into effective family-based PA interventions. During a preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity annual meeting, a PA parenting workgroup met to: (1) Discuss challenges in PA parenting research that may limit its translation, (2) identify explanations or reasons for such challenges, and (3) recommend strategies for future research. Challenges discussed by the workgroup included a proliferation of disconnected and inconsistently measured constructs, a limited understanding of the dimensions of PA parenting, and a narrow conceptualization of hypothesized moderators of the relationship between PA parenting and child PA. Potential reasons for such challenges emphasized by the group included a disinclination to employ theory when developing measures and examining predictors and outcomes of PA parenting as well as a lack of agreed-upon measurement standards. Suggested solutions focused on the need to link PA parenting research with general parenting research, define and adopt rigorous standards of measurement, and identify new methods to assess PA parenting. As an initial step toward implementing these recommendations, the workgroup developed a conceptual model that: (1) Integrates parenting dimensions from the general parenting literature into the conceptualization of PA parenting, (2) draws on behavioral and developmental theory, and (3) emphasizes areas which have been neglected to date including precursors to PA parenting and effect modifiers.

Authoritative feeding behaviors to reduce child BMI through online interventions.

PURPOSE.: The purpose of the study was to examine the feasibility and initial efficacies of parent- and/or child-focused online interventions and variables correlated with child body mass index percentile change. DESIGN AND METHODS.: A feasibility and cluster randomized controlled pilot study was used. RESULTS.: Recruitment was more effective at parent-teacher conferences compared with when materials were sent home with fifth- to eighth-grade culturally diverse students. Retention was 90% for students and 62-74% for parents. Authoritative parent feeding behaviors were associated with lower child body mass index. A larger study is warranted. PRACTICE IMPLICATIONS.: Online approaches may provide a feasible option for childhood obesity prevention and amelioration.

Parenting behaviors of African American and Caucasian families: parent and child perceptions, associations with child weight, and ability to identify abnormal weight status.

This study examined the agreement between parent and child perceptions of parenting behaviors, the relationship of the behaviors with the child's weight status, and the ability of the parent to correctly identify weight status in 176 parent-child dyads (89 Caucasian and 87 African American). Correlational and regression analyses were used. Findings included moderate to weak correlations in child and parent assessments of parenting behaviors. Caucasian dyads had higher correlations than African American dyads. Most parents correctly identified their own and their child's weight status. Parents of overweight children used increased controlling behaviors, but the number of controlling behaviors decreased when the parent expressed concern with their child's weight.

Parenting and feeding behaviors associated with school-aged African American and White children.

Pediatric obesity is multifactorial and difficult to treat. Parenting and feeding behaviors have been shown to influence a child's weight status. Most prior studies have focused on preschool-aged White children. Additional complicating factors include parents' inability to accurately identify their child's abnormal weight status. Parenting and feeding behaviors used by 176 African American and White parents of school-age children were examined. Assessment included (a) identifying what behaviors were reported when parent expressed concern with child's weight and (b) the relationship of these behaviors on child's body mass index percentile (BMI%), considering ethnicity, socioeconomic status (SES), and parent's body mass index (BMI). Findings included African American parents and parents concerned about their child's weight exhibited increased controlling/authoritarian parenting and feeding behaviors. Parents were able to accurately identify their child's weight status. Parenting and feeding behaviors played a significant role in the children's BMI% even when controlling for ethnicity, SES, and parent's BMI.

Challenge with care: reflections on teaching excellence.

A number of faculty have had no formal preparation to teach. Because little nursing research has focused on teaching excellence in recent years, when both nursing practice and approaches to teaching and learning have changed remarkably, this analysis integrates present perspectives and the research foundation for teaching nursing. A constant comparative method incorporating 27 doctoral student reflections and analysis of literature from 1960 to present resulted in four major categories: know and honor students, enthused, knowledgeable, and student centered. Linking the major categories, an Excellent Teacher Circle of Distinction emerged, described as "with enthusiasm and compassion the teacher engages the students and invites learning in a non-judgmental manner, yet, expectations of reciprocal respect and perseverance are present." Better understanding of this foundation can provide direction for those new to teaching, as well as experienced faculty, so as to better prepare the nurses of tomorrow.

What can parents do to reduce youth obesity? An initial study with a diverse sample.

The body mass index (BMI) of diverse, low-income fifth grade students (n = 36) was regressed on physical activity (Child Adolescent Activity Log), percentage dietary fat (Food Habits Questionnaire), and the Food/Activity Parenting Practices Questionnaire. The model explained 50% of the variance in student BMI, adjusted R(2) = .50, F (4, 19) = 6.84, p = .001. Students accurately perceived their weight status. Students' perception of parenting strategies, along with dietary fat, was significantly associated with their BMI. Parent's (n = 14) BMI, not the child's, was associated with the strategies they used. Three parents tested an online authoritative parenting program. Further research is needed.

Autism spectrum disorder: parenting stress, family functioning and health-related quality of life.

The prevalence of Autism Spectrum Disorder (ASD) is 1 in 110 persons in the U.S. Both parents of children with ASD are under stress that may impact their health-related quality of life (HRQL) (physical and mental health). The purpose of the current study was to explore the relationship of parenting stress, support from family functioning and the HRQL (physical and mental health) of both parents. Female (n = 64) and male (n = 64) parents of children with ASD completed Web-based surveys examining parenting stress, family functioning, and physical and mental health. Results of a Wilcoxon signed-ranks test showed that female parent discrepant (D) scores between "what is" and "should be" family functioning were significantly larger than male parents, p = .002. Results of stepwise linear regression for the male-female partners showed that (1) higher female caregiving stress was related to lower female physical health (p < .001), (2) a higher discrepancy score in family functioning predicted lower mental health (p < .001), accounting for 31% of the variance for females and (3) male parent personal and family life stress (p < .001) and family functioning discrepant (D) score (p < .001) predicted poor mental health, with the discrepancy score accounting for 35% of the variance. These findings suggest that there may be differences in mothers' and fathers' perceptions and expectations about family functioning and this difference needs to be explored and applied when working with families of children with ASD.

Advancing nursing education science: an analysis of the NLN's Grants Program 2008-2010.

The National League for Nursing has responded to the increasing need for nursing education research through its grant program. Significant growth in proposals has intensified competition for funds and challenged the Nursing Education Research Advisory Council's review process. The purpose of this article is to explore the NLN's nursing education research proposals from 2008 to 2010 in order to improve performance and provide guidance to future nursing education researchers. Beginning with the 2008 grant cycle, a database was developed to assist in performance improvement. A total of 113 proposals were submitted; of those, 24 were funded for a success rate of greater than 21 percent. Various designs and samples were employed and all geographic regions of the United States were represented. Inter-rater reliability among reviewers remained high and the scientific rigor of proposals steadily increased. Increased funding from other sources is urgently needed to build the science of nursing education.

Teaching excellence: what great teachers teach us.

Given the shortage of nurse educators, we sought to better understand teaching excellence because it is crucial for developing the next generation of nurses. A grounded theory approach was used. The sample included 17 respondents, thought to be excellent teachers, from universities across the United States. Consenting respondents were asked, "What do you do to bring nursing to life with your students?" Using line-by-line coding and the constant comparative method, five major themes emerged: (a) engagement, (b) relevance, (c) student centeredness, (d) facilitation of learning, and (e) dynamic process of becoming an excellent nursing educator. We found that the core category, engagement, included the faculty being (a) current and knowledgeable, (b) being clear in communication of objectives/outcomes, (c) being student centered, (d) being able to draw all students into active questioning and learning so that the process of discovery is enjoyable, and (e) using multiple strategies in teaching the content. The process of becoming an excellent teacher involved "change from 'instiller' to 'facilitator' and laid the foundation for continued development of my teaching self." Those beginning to teach or seeking to improve their teaching may find the results enlightening.

Engaging students through collaboration: how Project FUN works.

Students from three disciplines designed, developed, and implemented exercise and nutrition interventions, online modules and videos, to benefit low-income middle school students. The process used to incorporate the scholarship of teaching ito a collaborative college-level application of learning is described.

Determinants of physical activity and low-fat diet among low income African American and Hispanic middle school students.

African Americans, Hispanics, and those with low income experience disproportionate health problems that can be prevented by physical activity and a lower fat diet. In this descriptive cross-sectional study, antecedents of diet and exercise within the Health Promotion/Transtheoretical Model were examined among low-income African American and Hispanic seventh-grade students (n = 127). Total support was associated with higher physical activity for girls. African Americans perceived greater social support for activity than Hispanics. Family models and support for physical activity and low-fat diet were greater as family income increased. However, higher family role models and lower dietary fat were found among the lowest income Hispanic students' residing ZIP code with a higher concentration of Hispanics and greater availability of Hispanic foods and culture. A school-based approach may be useful to build peer support for physical activity and lower dietary fat. Parish nurse or clinic settings may be most appropriate for building family role models and support. Living in a neighborhood with traditional Hispanic culture and foods appears to have ameliorated the harmful effects of lower income, although further study with larger samples followed over time is needed.

Changing the tide: an Internet/video exercise and low-fat diet intervention with middle-school students.

The rising tide of obesity erodes the health of youths and many times results in adult obesity. The purpose of this investigation was to examine the effectiveness of an eight-session health promotion/transtheoretical model Internet/video-delivered intervention to increase physical activity and reduce dietary fat among low-income, culturally diverse, seventh-grade students. Those who completed more than half the sessions increased exercise, t (103) = -1.99, p = .05, and decreased the percentage of dietary fat, t (87) = 2.73, p = .008. Responses to the intervention by stage of change, race, and income are examined.