Infant Obesity Prevention Programs for Underrepresented Mothers in a Home Visiting Program: A Qualitative and Community-Engaged Needs Assessment.

A qualitative, community-engaged assessment was conducted to identify needs and priorities for infant obesity prevention programs among mothers participating in home visiting programs. Thirty-two stakeholders (i.e., community partners, mothers, home visitors) affiliated with a home visiting program serving low-income families during the prenatal to age three period participated in group level assessment sessions or individual qualitative interviews. Results indicated families face many challenges to obesity prevention particularly in terms of healthy eating. An obesity prevention program can address these challenges by offering realistic feeding options and non-judgmental peer support, improving access to resources, and tailoring program content to individual family needs and preferences. Informational needs, family factors in healthy eating outcomes, and the importance of access and awareness of programs were also noted. To ensure the cultural- and contextual-relevance of infant obesity prevention programs for underserved populations, needs and preferences among community stakeholders and the focal population should be used as a roadmap for intervention development.

Association among friendship skills, involvement in after-school activities, and flourishing for adolescents with asthma and comorbid emotional and behavioral problems.

OBJECTIVES: Primary objectives were to examine the relations among abilities for making and keeping friends, involvement in after-school activities, and flourishing for adolescents with current asthma, as well as comorbid behavior problems, anxiety, or depression. METHODS: Data from the 2021 National Survey of Child Health was analyzed. Parents provided data on one child. Multinomial logistic regression analyses, both unadjusted and adjusted for the sampling weight, were conducted for adolescents with current asthma and comorbid behavior problems, anxiety, or depression. Predictors of flourishing included difficulty in making and keeping friends and involvement in after-school activities. Sex, age, race/ethnic group, and having been bullied were covariates. To examine differences for children with varied comorbid emotional and behavioral problems, relations were tested separately for children with asthma and behavior problems, children with asthma and anxiety, and children with asthma and depression. RESULTS: Skills for making and keeping friends were positively related to flourishing of adolescents with current asthma for all three types of mental health concerns. The relationship between involvements in after-school activities was less clear-cut, as this predictor was not always positively related to flourishing. CONCLUSIONS: Abilities to make and keep friends were related to flourishing, indicating that peer support is a resilience factor. Conversely, it was not clear that involvement in after-school activities was a resilience factor and more research about factors constituting successful after-school involvement for adolescents with asthma is needed. Future research, illuminating how social support from peers and involvement in activities promote flourishing will extend knowledge.

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity.

INTRODUCTION: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. METHODS AND ANALYSIS: Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. ETHICS AND DISSEMINATION: Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO REGISTRATION NUMBER: CRD42020177408.

Brief Report: A Novel Digital Therapeutic that Combines Applied Behavior Analysis with Gaze-Contingent Eye Tracking to Improve Emotion Recognition in Children with Autism Spectrum Disorder.

This study examined the feasibility, acceptability, and efficacy of a video game-based digital therapeutic combining applied behavior analysis techniques and gaze-contingent eye tracking to target emotion recognition in youth with autism spectrum disorder (ASD). Children aged 4-14 years with ASD were randomized to complete Lookware™ (n = 25) or a control video game (n = 29). Results from a 2 × 2 mixed ANOVA revealed that children in the intervention condition demonstrated significant improvements in emotion recognition from pre- to post-intervention compared to children in the control condition, F(1,52) = 17.48, p < 0.001. Children and staff perceived high feasibility and acceptability of Lookware™. Study results demonstrated the feasibility, acceptability, and preliminary efficacy of Lookware™.

Maintenance Following a Randomized Trial of a Clinic and Home-based Behavioral Intervention of Obesity in Preschoolers.

OBJECTIVE: To assess maintenance of improved weight outcomes in preschoolers with obesity 6 and 12 months following a randomized clinical trial comparing a home- and clinic-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health [LAUNCH]) to motivational interviewing and standard care. STUDY DESIGN: Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012, and June 8, 2015, were followed 6 and 12 months post-treatment. Child and caregiver weight, height, and caloric intake, child physical activity, and home environment were assessed. The primary outcome was maintenance of greater reduction of percent over the 50th percentile body mass index (BMI%50th) by LAUNCH compared with motivational interviewing and standard care at the 6- and 12-month follow-up. RESULTS: Significantly lower child BMI%50th was maintained for LAUNCH compared with motivational interviewing at 12-month follow-up and to standard care at the 6-month follow-up; however, the effect sizes were maintained for comparison with standard care at 12-month follow-up. LAUNCH had significantly lower daily caloric intake compared with motivational interviewing and standard care at both follow-ups and maintained significantly fewer high-calorie foods in the home compared with standard care at 6 and 12 months and compared with motivational interviewing at 12 months. However, caloric intake increased by 12% from post-treatment. LAUNCH caregivers did not maintain improved BMI at follow-up. CONCLUSIONS: LAUNCH showed success in reducing weight in preschoolers. However, maintaining treatment gains post-treatment is more difficult. Treatment may need to last longer than 6 months to achieve optimal results. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01546727.

Changes in diet quality and home food environment in preschool children following weight management.

BACKGROUND: Family-based obesity treatment interventions can successfully reduce energy intake in preschoolers. An implicit goal of obesity treatment interventions is to improve diet quality, but diet quality has been less examined as a treatment outcome in studies of preschoolers. The purpose of this study was to conduct a secondary analysis comparing the change in diet quality and home food environment in preschoolers assigned to a behavioral family-based obesity intervention (LAUNCH), motivational interviewing (MI) condition, or standard care (STC) condition. METHODS: Three 24-h dietary recalls were completed at baseline and 6-months and were analyzed using NDS-R software; diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Availability of foods and beverages in the home was assessed through direct observation using the Home Health Environment tool that classifies foods and beverages as 'red' or 'green' based upon fat and sugar content. Repeated measures linear mixed effects models were used to examine changes in diet quality and home food environment between conditions (LAUNCH, MI, STC). RESULTS: At 6-months, preschoolers in the LAUNCH condition had a higher HEI-2010 total score (62.8 ± 13.7) compared to preschoolers in the MI (54.7 ± 13.4, P = 0.022) and STC (55.8 ± 11.6, P = 0.046) conditions. Regarding the home food environment, families in LAUNCH had significantly less 'red' foods in their home at 6-months (12.5 ± 3.4 'red' foods) compared to families in MI (14.0 ± 3.7 'red' foods, P = 0.030), and STC (14.3 ± 3.4 'red' foods, P = 0.006). There were no statistically significant differences across home food environments for number of 'green' foods. CONCLUSION: Family-based obesity treatment interventions for preschoolers can improve overall diet quality and alter the home food environment through reductions in 'red' foods. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01546727 . Registered March 7, 2012.

A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals.

OBJECTIVE: To examine referral by primary care providers (PCPs) of preschool children with obesity (≥95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT), and identify reasons for not referring children. STUDY DESIGN: In phase I, 3 experts in obesity, psychology, and nutrition completed an open card sort and classified PCPs' reasons for declining referral into groups based on similarity of reasons. Categories were then defined and labeled. In phase II, 2 independent sorters placed each decline into 1 of the categories defined in phase I. RESULTS: PCPs referred 78% of eligible children to the RCT. Compared with children declined for referral, referred children had a significantly higher weight (48.4 lb vs 46.1 lb; P < .001) and BMI percentile (97.6 vs 97.0; P < .001). Eleven categories for decline were identified in phase I. In phase II, excellent reliability was obtained between each independent sorter and the phase I categories, and also between the 2 independent sorters (κ values, 0.72-1.0). The most common reason for declining was "family not a good fit" (23.6%), followed by "doesn't believe weight is a problem" (13.9%), "family would not be interested" (12%), and "doesn't believe measurement is accurate" (11.5%). Appropriately, exclusionary criteria of the RCT was a reason as well (11.8%). CONCLUSION: The availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in previous studies. However, concerns about the family's response or interest in a weight management program remained barriers, as did PCPs' perceptions about obesity in young children. TRIAL REGISTRATION: ClinicalTrials.gov:NCT01546727.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps.

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

The impact of a pilot cooking intervention for parent-child dyads on the consumption of foods prepared away from home.

This pilot study investigated the impact of a parent-child dyad cooking intervention on reducing eating dinner away from home. Eating away from home often results in consumption of energy-dense, nutrient-poor foods that can contribute to excess energy consumption in children. A pre-post design to evaluate a 10-week cooking intervention on reducing eating dinner away from home, energy intake, and improving diet quality was implemented. The intervention was delivered at an instructional kitchen on a university campus and assessments were completed at a children's academic medical center. Subjects included six parent-child dyads whom reported eating dinner away from home ≥3 times/week and in which the parent was overweight based on their body mass index (BMI) of ≥25 kg/m(2). Parents were a mean age of 34.7 (SD = 3.9) years, and children were a mean age of 8.7 (SD = 2.0) years. Two-thirds of parents self-identified themselves and their children as White. Results showed the proportion of dinners consumed by parent-child dyads away from home significantly decreased (F (1,161) = 16.1, p < 0.05) from 56% at baseline to 25% at post-treatment. Dyad cholesterol intake at dinner also significantly decreased over time; however, changes in energy intake, total fat, saturated fat, and sodium at dinner were not significant. A large effect size was found for changes in parent ratings of enjoyment of cooking between baseline and post-treatment. A cooking intervention that involves parent-child dyads and incorporates behavior management strategies and nutrition education may be an innovative obesity prevention intervention.

Vignette methodologies for studying clinicians' decision-making: Validity, utility, and application in ICD-11 field studies.

Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that vignettes do not accurately reflect "real world" phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a "hybrid" of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to "real life" behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians' diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations.

Las metodologías basadas en viñetas se utilizan frecuentemente para examinar los procesos de toma de decisiones, incluyendo los de profesionales sanitarios. No obstante, existen dudas sobre si las viñetas reflejan adecuadamente los fenómenos del "mundo real" permitiendo resultados y conclusiones válidas. Ofrecemos una visión de las características, variaciones de diseño, fortalezas y debilidades de estos estudios para examinar cómo los profesionales forman juicios clínicos (como el diagnóstico y tratamiento). Siendo "híbridos" de las encuestas tradicionales y los métodos experimentales, estos estudios pueden ofrecer la alta validez interna de los experimentos y la alta validez externa de las encuestas, para aislar múltiples factores predictivos del comportamiento de los clínicos. Un diseño adecuado para poner a prueba preguntas específicas acerca de los juicios y la toma de decisiones permite resultados altamente generalizables a la "vida real", sin las limitaciones éticas, prácticas y científicas de los métodos alternativos (observación, auto-informe, pacientes estandarizados, análisis de archivos clínicos). Concluimos con recomendaciones metodológicas que se ilustran tras una descripción del uso de las metodologías de viñetas para investigar las decisiones diagnósticas de los clínicos en los estudios de campo de casos y controles para la clasificación de los trastornos mentales y del comportamiento en la CIE-11.

Risk for household safety hazards: Socioeconomic and sociodemographic factors.

INTRODUCTION: Many unintentional injuries to young children occur in the home. The current study examines the relation between family socioeconomic and sociodemographic factors and risk factors for home injury. METHODS: Presence of household hazards was examined in 80 families with toddler-aged children. Parental ability to identify household hazards in pictures was also assessed. ANOVAs and Pearson product-moment correlations examined the relationship between presence of household hazards, knowledge to identify hazards, and factors of yearly family income, parental age, parental education, parental marital status, child ethnicity, and the number of children living in the home. RESULTS: A greater number of hazards were found in the homes of both the lowest and highest income families, but poorer knowledge to identify household hazards was found only among parents of the lowest income families and younger parents. Across family socioeconomic status, parent knowledge of hazards was related to observed household hazards. CONCLUSIONS: The relationship between family income and risk for injury is complex, and children of both lower and higher SES families may be at risk for injury. PRACTICAL APPLICATIONS: While historically particular focus has been placed on risk for injury among children in low income families, injury prevention efforts should target reducing presence of household hazards in both high and low SES families.

Outcomes of a weight management clinic for children with special needs.

OBJECTIVE: Rates of obesity are elevated among children with special needs (e.g., autism spectrum disorder, Down syndrome, or developmental disabilities). The objective of this study was to evaluate the effectiveness of a multidisciplinary tailored intervention to treat obesity among youth with special needs. METHOD: Seventy-six children aged 2 to 19 years participated in a multidisciplinary weight management clinic adapted for children with special needs. A description of the patients presenting for specialized clinical services is provided, and the impact of the intervention on child body mass index (BMI) and food variety was examined for a subset (n = 30) of children. Descriptive statistics of the patient population at baseline were calculated and a series of t tests, correlations, and analysis of variance models examined change in BMI z-scores (BMIz) and diet variety. Factors related to treatment outcomes were also explored. RESULTS: BMIz decreased significantly by the 6-month follow-up (M = 2.43 to M = 2.36, p < .01). There were significant increases in the variety of fruits, vegetables, and grains that children ate (t(16) = 3.18, p < .01; t(16) = 2.63, p = .02; t(16) = 2.37, p = .03, respectively). CONCLUSION: A multidisciplinary clinic-based intervention was effective in reducing BMIz over a 6-month period and increasing the variety of foods that children were eating. These results have implications for providing tailored weight management interventions for youth with obesity and special needs.

Measurement of mealtime behaviors in rural overweight children: an exploratory factor analysis of the Behavioral Pediatrics Feeding Assessment Scale.

OBJECTIVE: The current study presents results of an exploratory factor analysis (EFA) of the Behavioral Pediatric Feeding Assessment Scale (BPFAS) in a sample of rural children with overweight and obesity. Relationships between mealtime behavior and health outcomes are also explored. METHODS: EFA was used to assess the fit of the BPFAS in a group of 160 treatment-seeking children (Mage = 9.11, SD = 1.77) living in rural Midwest communities. Correlations were also computed between factor scores and select health variables (child body mass index z-score and diet variables). RESULTS: The EFA identified a 5-factor solution as the best fitting model (Tucker-Lewis Index = .96, root mean square error of approximation = .05), although several items (i.e., 7 of 25) did not load on any factor. 2 factors were correlated with health variables of interest. CONCLUSION: Study results suggest that certain items on the BPFAS may not be appropriate for use with rural children with pediatric overweight or obesity. Implications for future research and practice are discussed.