Feeding Management and Palate Repair Timing in Infants with Cleft Palate with and without Pierre Robin Sequence: A Multisite Study.

OBJECTIVES: Compare the feeding management practices in infants with cleft palate with and without Pierre Robin sequence (PRS) and determine if specific feeding difficulties or interventions predict delayed palate repair. DESIGN: Retrospective cross-sectional study. SETTING: Seventeen cleft palate teams contributed data. PATIENTS: 414 infants were included in this study: 268 infants with cleft palate only and 146 infants with cleft palate and PRS. PROCEDURES: Data were collected via parent interview and electronic health records. MAIN OUTCOME MEASURES: Outcomes for the primary objective included categorical data for: history of poor growth, feeding therapy, milk fortification, use of enteral feeding, and feeding difficulties. The outcome for the secondary objective was age in months at primary palate repair. RESULTS: Infants with PRS had a significantly higher prevalence of feeding difficulties (81% versus 61%) and poor growth (29% versus 15%) compared to infants with cleft palate only. Infants with PRS received all feeding interventions-including feeding therapy, milk fortification, and enteral feeding-at a significantly higher frequency. Infants with PRS underwent primary palate repair at a mean age of 13.55 months (SD = 3.29) which was significantly (P < .00001) later than infants with cleft palate only who underwent palate repair at a mean age of 12.05 months (SD = 2.36). Predictors of delayed palate repair included diagnosis of PRS as well as Hispanic ethnicity and a history of poor growth. CONCLUSIONS: These findings can be used to establish clinical directives focused on providing early, multimodal feeding interventions to promote optimal growth and timely palate repair for infants with PRS.

Factors Associated with Delayed Palatoplasty Before, During, and After the COVID-19 Pandemic.

BACKGROUND: Cleft palatoplasty is typically performed around 10 to 12 months of age in the US, and delays can negatively affect speech development. Early during COVID-19, elective surgeries were canceled. The aims of this study were to (1) identify overall risk factors for greater age at palatoplasty and (2) analyze delays in palatoplasty during COVID-19. METHODS: This study was part of a larger prospective, multicenter comparative study of speech outcomes in palatoplasty. Participants underwent palatoplasty between March 2019 and September 2022 at 18 pediatric hospitals in the United States. Ages were corrected for prematurity. Dates of palatoplasty were divided into 4 periods corresponding to different phases of the pandemic. Factors analyzed included region, language, adoption status, sex, ethnicity, race, rurality, health insurance type, and cleft type. Analyses were performed using ANOVA, Student's test, and multivariable linear regression, with a P value of ≤0.05 being significant. RESULTS: Nine hundred twenty-eight participants were included. Average corrected age at palatoplasty was 374 days. In univariable analysis, palatoplasty was performed later in children who were Hispanic (P=0.003), of a race other than White, Black, or Asian (P<0.001), and without private insurance (P<0.001). On multivariable regression, predictors of delayed palatoplasty were Hispanic ethnicity (P=0.015), from other race (P<0.001), and without private insurance (P<0.001). During COVID-19, disproportionate delays occurred in patients who were female, of other races, from nonrural areas, and on Medicaid. CONCLUSIONS: Palatoplasty was performed later in vulnerable populations. Some of these populations were also disproportionately affected by COVID-19 delays. Providers should be aware of these differences as they pertain to equitable access to craniofacial care. LEVEL OF EVIDENCE: III.

Correspondence between consonant inventories obtained using modified naturalistic listening in real time (NLRT) and parent report.

OBJECTIVE: The current study examined the correspondence between consonant inventories obtained using the modified NLRT approach and parent report. DESIGN: Prospective comparative study. SETTING: Multisite institutional. PARTICIPANTS: Participants included 70 children with repaired CP + L (mean age = 16 months) who were participating in the multicenter study. PROCEDURES: Parents of participants were asked to record approximately two hours of their child's vocalizations/words at home using a Language ENvironmental Analysis (LENATM) recorder. Four ten-minute audio-recorded samples of vocalizations were extracted from the original recording for each participant and analyzed for size of consonant inventory. Parent reported consonant inventory was compared to coder identified consonant inventory. Coders identified an in-inventory consonant using two different criteria: 2+ tokens of each consonant were required in the first analysis and 10+ tokens of each consonant were required in the second analysis. RESULTS: Coder identified consonant inventory was larger (mean = 7.90) than that reported by parents (mean = 6.06) when a minimum of two tokens per consonant was required for inclusion of a consonant in inventory, while the inventory transcribed by coders was smaller (mean = 4.46) than that reported by parents when inclusion criteria required a minimum of ten tokens per consonant. CONCLUSIONS: Although the mean number of consonants in inventory between coders and parents was slightly closer using the 10+ versus 2+ criterion for consonant inclusion, the difference was not significant enough to recommend one protocol over the other.

Standardization of Videorecorded Speech Samples for Children with Cleft Palate: Methods to Facilitate High-Quality Speech Outcomes Data Collection.

BACKGROUND: Collection of high-quality videorecorded speech samples is essential for speech outcomes research. SOLUTION: Cleft palate team SLPs were trained to collect standard videorecorded speech samples in the clinic setting across 20 sites in North America. Standard training and equipment was provided. WHAT WE DID THAT IS NEW: Quality management procedures were developed and utilized to verify video quality and protocol adherence. Over 97% of speech samples collected by trained SLPs met defined quality standards.

Stop Consonant Production in Children with Cleft Palate After Palatoplasty.

The current study examined stop consonant production in children with cleft lip and/or palate (CP ± L) 2-6 months following palatal surgery.Prospective comparative study.Multisite institutional.Participants included 113 children with repaired CP ± L (mean age = 16 months) who were participating in the multicenter CORNET study.Parents of participants were asked to record approximately two hours of their child's vocalizations/words at home using a Language ENvironmental Analysis (LENATM) recorder. Four ten-minute audio-recorded samples of vocalizations were extracted from the original recording for each participant and analyzed for presence of oral stop consonants. A minimum of 100 vocalizations were required for analysis.Preliminary findings indicate that at least one oral stop was evident in the consonant inventory for 95 of the 113 children (84%) at the time of their post-surgery 16-month recording, and 80 of these children (71%) were producing two or more different stops. Approximately 50% of the children (57/113) produced the three voiced stops, and eight of the children (7%) were producing all six stop consonants.The findings of this study suggest that the majority of children with repaired CP ± L from English-speaking homes are producing oral stops within six months following palatal surgery. Similar to same-age children without CL ± P, voiced stops were more frequently evident in the children's inventories than voiceless stops. In contrast to findings of previous reports suggesting place of articulation differences, a somewhat comparable percentage of children in this study produced voiced bilabial, alveolar, and velar stops.

Consonant-Vowel Transition Models Based on Deep Learning for Objective Evaluation of Articulation.

Spectro-temporal dynamics of consonant-vowel (CV) transition regions are considered to provide robust cues related to articulation. In this work, we propose an objective measure of precise articulation, dubbed the objective articulation measure (OAM), by analyzing the CV transitions segmented around vowel onsets. The OAM is derived based on the posteriors of a convolutional neural network pre-trained to classify between different consonants using CV regions as input. We demonstrate that the OAM is correlated with perceptual measures in a variety of contexts including (a) adult dysarthric speech, (b) the speech of children with cleft lip/palate, and (c) a database of accented English speech from native Mandarin and Spanish speakers.

Transcribing toddler vocalizations: comparison of a modified naturalistic listening approach with phonetic transcription.

Previous investigations have demonstrated that naturalistic listening in real time (NLRT) can be used reliability to assess prelinguistic vocalizations and is less time-consuming than phonetic transcription. The current investigation was performed to examine the correspondence of syllable and consonant information obtained using a modified naturalistic listening in real time (NLRT) methodology compared to broad phonetic transcription for 20 toddlers with repaired cleft palate. A forty-minute vocalization sample was obtained for each toddler. Two listeners listened to each recording independently and coded the number of syllables and consonant types produced by each toddler using NLRT. Each recording was phonetically transcribed by each listener 2 to 16 months following the NLRT analysis. High reliability was evident between the modified NSRT method and phonetic transcription for identification of both syllables and consonants. Differences were evident in the actual number of syllables and consonants identified between the two types of assessment across the 20 participants. Possible explanations for those differences are addressed. The results of this investigation indicate that the modified NLRT procedure is a reliable method for determining consonant/inventories of young children. It is less labor intensive than traditional phonetic transcription and may be useful clinically when documentation of early sound development is needed to support early intervention decisions.

Cleft Palate Repair Postoperative Management: Current Practices in the United States.

OBJECTIVE: To describe current postoperative management practices following cleft palate repair. DESIGN: A survey was administered to cleft surgeons to collect information on their demographic characteristics, surgical training, surgical practice, and postoperative management preferences. SETTING: Eighteen tertiary referral hospitals across the United States.Participants: Surgeons (n = 67) performing primary cleft palate repair. RESULTS: Postoperative diet restrictions were imposed by 92% of surgeons; pureed foods were allowed at one week after surgery by 90% of surgeons; a regular diet was allowed at one month by 80% of surgeons. Elbow immobilizers and/or mittens were used by 85% of surgeons, for a median duration of two weeks. There was significant disagreement about postoperative use of bottles (61% allow), sippy cups (68% allow), pacifiers (29% allow), and antibiotics (45% prescribe). Surgeon specialty was not associated with any aspect of postoperative management (p > 0.05 for all comparisons). Surgeon years in practice, a measure of surgeon experience, was associated only with sippy cup use (p < 0.01). The hospital at which the surgeon practiced was associated with diet restrictions (p < 0.01), bottle use (p < 0.01), and use of elbow immobilizers or mittens (p < 0.01); however, many hospitals still had disagreement among their surgeons. CONCLUSIONS: Surgeons broadly agree on diet restrictions and the use of elbow immobilizers or mittens following palate repair. Almost all other aspects of postoperative management, including the type and duration of diet restriction as well as the duration of immobilizer use, are highly individualized.

Does Distraction Lower Risk of VPI Compared to Conventional Maxillary Advancement? A Retrospective Cohort Study of Adolescents with Cleft Palate.

OBJECTIVE: To determine whether method of maxillary advancement in adolescents with cleft palate with or without cleft lip (CP ± L) influences post-operative velopharyngeal function. DESIGN: Retrospective cohort. SETTING: Pediatric Tertiary Care Hospital. PARTICIPANTS: One hundred and ninety-nine patients with CP ± L after LeFort I osteotomy for maxillary advancement at our institution between January 2007 and June 2019. INTERVENTIONS: LeFort I osteotomy via distraction osteogenesis (DO) or conventional osteotomy (CO). MAIN OUTCOME MEASURES: Patients who underwent DO or CO were compared for the presence of new velopharyngeal insufficiency (VPI), as measured by perceptual rating by a craniofacial speech-language pathologist.Of the 199 patients who underwent maxillary advancement, 126 were available for analysis. The DO group was younger, male, and had more severe maxillary hypoplasia. Following surgery, 17/41 (41.5%) of the DO group had new VPI, compared to just 23/85 (27.1%) of the CO group. After adjusting for cleft type and predicted maxillary advancement, however, there was not sufficient evidence to reject the null hypothesis of no difference in risk of post-operative VPI between the two surgical groups (prevalence ratio [PR] 1.40, 95% CI 0.68-2.90). Increased prevalence of VPI after DO versus CO was primarily observed among patients with a pre-operative velopharyngeal need ratio < 0.8 (PR = 2.01, 95% CI 0.79-5.10) and patients with normal velopharyngeal function pre-operatively (PR = 2.86, 95% CI 0.96-8.50).Our results suggest an increased rather than decreased risk of VPI following DO relative to CO. This association is primarily seen among those with a smaller velopharyngeal ratio or perceptually normal velopharyngeal function pre-operatively.

The Contribution of Nutrients of Concern to the Diets of 18-to-30-Year-Old Australians from Food Prepared Outside Home Differs by Food Outlet Types: The MYMeals Cross-Sectional Study.

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.

The association of social and food preparation location context with the quality of meals and snacks consumed by young adults: findings from the MYMeals wearable camera study.

PURPOSE: This study examined the association of social contexts and food preparation location with the quality of meals and snacks (predominately from the five food groups (FFG) versus discretionary foods) in a sample of young Australian adults (18-30 years old) using wearable camera technology. METHODS: A sub-sample from the cross-sectional MYMeals study wore a wearable camera that captured images every 30 s for three consecutive days. Eating episodes from 133 participants (55% female) were classified across 4 domains: food quality (observed proportion of FFG and discretionary items), preparation location, social interaction, and screen use. Socio-economic status (SES) was assigned using residential postcode and gender self-reported. Associations of contexts and demographic factors with food quality stratified by meal type were determined using mixed binary logistic regression models. RESULTS: Of the 1840 eating episodes identified, 1775 were included in analysis (n = 8 preparation location and n = 57 food components that could not be identified were excluded). Food prepared at home was more likely to be from the FFG at lunch (OR = 4.8 95% CI 2.7-8.6), dinner (OR = 14.8 95% CI 7.6-28.6), and snacks (OR = 3.2 95% CI 2.2-4.8). Participants from higher SES areas were more likely to consume breakfasts (OR = 3.2 95% CI 1.4-7.4) and lunches (OR = 1.9 95% CI 1.0-3.7) predominately from the FFG. Females were more likely to consume lunches (OR = 2.0 95% CI 1.1-3.8) that was largely from the FFG. Social interaction and screen use were not associated with meal or snack quality. CONCLUSION: Wearable cameras have verified the importance of addressing meals and snacks prepared outside of home as an important contributor of discretionary food.

Non-Oral Compensatory Misarticulations Revisited.

Non-oral compensatory misarticulation patterns are often associated with the speech of children with cleft palate. Despite their saliency, the etiology, frequency, and treatment of these misarticulations have not been studied extensively. The purpose of this commentary is to review what we know about these atypical patterns of articulation and address clinical assumptions regarding their etiology and treatment.

The Contribution of Foods Prepared Outside the Home to the Diets of 18- to 30-Year-Old Australians: The MYMeals Study.

Young adults are the highest consumers of food prepared outside home (FOH) and gain most weight among Australian adults. One strategy to address the obesogenic food environment is menu labelling legislation whereby outlets with >20 stores in one state and >50 Australia-wide must display energy content in kJ. The aim of this study was to assess the contribution of FOH to the energy and macronutrients, saturated fat, total sugars and sodium intakes of young Australians. One thousand and one 18 to 30-year-olds (57% female) residing in Australia's most populous state recorded all foods and beverages consumed and the location of preparation for three consecutive days using a purpose-designed smartphone application. Group means for the daily consumption of energy, percentage energy (%E) for protein, carbohydrate, total sugars, total and saturated fats, and sodium density (mg/1000 kJ) and proportions of nutrients from FOH from menu labelling and independent outlets were compared. Overall, participants consumed 42.4% of their energy intake from FOH with other nutrients ranging from 39.8% (sugars) to 47.3% (sodium). Independent outlets not required to label menus, contributed a greater percentage of energy (23.6%) than menu labelling outlets (18.7%, p < 0.001). Public health policy responses such as public education campaigns, extended menu labelling, more detailed nutrition information and reformulation targets are suggested to facilitate healthier choices.

A Deep Learning Algorithm for Objective Assessment of Hypernasality in Children With Cleft Palate.

OBJECTIVES: Evaluation of hypernasality requires extensive perceptual training by clinicians and extending this training on a large scale internationally is untenable; this compounds the health disparities that already exist among children with cleft. In this work, we present the objective hypernasality measure (OHM), a speech-based algorithm that automatically measures hypernasality in speech, and validate it relative to a group of trained clinicians. METHODS: We trained a deep neural network (DNN) on approximately 100 hours of a publicly-available healthy speech corpus to detect the presence of nasal acoustic cues generated through the production of nasal consonants and nasalized phonemes in speech. Importantly, this model does not require any clinical data for training. The posterior probabilities of the deep learning model were aggregated at the sentence and speaker-levels to compute the OHM. RESULTS: The results showed that the OHM was significantly correlated with perceptual hypernasality ratings from the Americleft database (r = 0.797, p < 0.001) and the New Mexico Cleft Palate Center (NMCPC) database (r = 0.713, p < 0.001). In addition, we evaluated the relationship between the OHM and articulation errors; the sensitivity of the OHM in detecting the presence of very mild hypernasality; and established the internal reliability of the metric. Further, the performance of the OHM was compared with a DNN regression algorithm directly trained on the hypernasal speech samples. SIGNIFICANCE: The results indicate that the OHM is able to measure the severity of hypernasality on par with Americleft-trained clinicians on thisdataset.

Translating research into practice: outcomes from the Healthy Living after Cancer partnership project.

BACKGROUND: Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. METHODS: In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. RESULTS: Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. CONCLUSIONS: This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Can counter-advertising protect spectators of elite sport against the influence of unhealthy food and beverage sponsorship? A naturalistic trial.

RATIONALE AND OBJECTIVE: Unhealthy, energy-dense nutrient-poor foods and beverages are heavily promoted through sport sponsorship. This naturalistic trial assessed whether exposing young adult spectators to various types of counter-advertising (CA) before watching an unhealthy food sponsored elite sporting event could diminish sponsorship effects and increase support for restrictions on sponsorship. METHOD: Young adults (ages 18-29 years) who planned to watch the Australian Football League (AFL) Grand Final were recruited through an online panel and randomly assigned to one of four conditions: (A) control (neutral advertisement); (B) anti-industry CA (critiquing unhealthy food industry sponsorship of sport); (C) anti-product CA (critiquing the association of sports stars with unhealthy food); or (D) negative health effects CA (highlighting negative health consequences of unhealthy food consumption). Participants (N = 1316) completed a pre-test questionnaire and viewed their assigned CA online 1-3 days before watching the 2017 AFL Grand Final, which featured unhealthy food sponsorship. RESULTS: Participants who reported watching the AFL Grand Final (n = 802) answered post-test measures within five days of the event. Results indicated that participants found the anti-industry CA more believable, attention-grabbing, reassuring and encouraging than the anti-product CA. The anti-industry CA promoted less favourable attitudes to sponsor brands, the anti-product CA promoted reduced intentions to purchase the fast-food sponsor brand, and the negative health effects CA reduced preferences for fast food in general compared to the control condition. CONCLUSIONS: Anti-industry CA may detract from favourable attitudes to unhealthy food sponsor brands and negative health effects CA may detract from intentions to consume fast food in the face of unhealthy food sponsorship exposure. Such interventions may require higher dosage levels than applied in the present study to bolster spectators' resistance to the surfeit of unhealthy food sport sponsorship.

Advertising Placement in Digital Game Design Influences Children's Choices of Advertised Snacks: A Randomized Trial.

BACKGROUND: Children are inhabitants of a media-rich environment rife in extensive, sophisticated, and persistent techniques that are used to market unhealthy food. Exposure is known to influence children's attitudes, choices, and consumption, yet further research is required to explore the influence of contemporary techniques within online games. OBJECTIVE: To explore the influence of modern advertising on children's attitudes, choices, and consumption, techniques (ie, banner advertising, advergame, and rewarded video advertising) were used to promote an unfamiliar confectionery brand within an online game. DESIGN: A between-subjects randomized experimental study. PARTICIPANTS/SETTING: Children (aged 7 to 12 years [n=156]) were recruited in New South Wales, Australia, between September and November 2017. INTERVENTION: Children were required to play a 4-minute online game, complete some questionnaires, and choose one snack to consume afterward. Children were randomly assigned to one of four conditions: a control group with no advertising, and three experimental conditions that promoted an unfamiliar confectionery brand via a banner advertisement, advergame, or rewarded video advertisement. MAIN OUTCOME MEASURES: Questionnaires included the assessment of attitudes to the test brand before and after the game, enjoyment of the game, and children's awareness of advertising. Food choice was recorded and food consumption was measured by weighing the snack in grams, which was translated into kilocalories. STATISTICAL ANALYSES PERFORMED: Statistical tests included analyses of variance, Kruskal-Wallis test, and χ2 test. RESULTS: Attitudes toward the perception of fun (P=0.06) and taste (P=0.21) of the test brand were not influenced by condition. Children who were exposed to the rewarded video advertising chose the test brand significantly more than children in the other three conditions (P<0.002). Condition did not influence overall energy intake measured in grams (P=0.78) or kilocalories (P=0.46). CONCLUSIONS: Children's choice of the test brand was significantly influenced by the rewarded video advertising condition (compared with control, banner advertising, and advergame conditions). This technique is prevalent across online and application games that children play yet the effects of using rewarded video advertising to promote food brands have not been explored from a public health perspective. This study contributes to the understanding of modern strategies used to market unhealthy foods to children.

Remember Me? Exposure to Unfamiliar Food Brands in Television Advertising and Online Advergames Drives Children's Brand Recognition, Attitudes, and Desire to Eat Foods: A Secondary Analysis from a Crossover Experimental-Control Study with Randomization at the Group Level.

BACKGROUND: Limitations in current Australian regulatory provisions may be identified by demonstrating the effect of different marketing methods on children's recognition and attitudes toward unhealthy food brands. OBJECTIVE: To investigate how exposure to different marketing techniques from television (TV) and online food advertising affects children's brand recall, recognition, and attitudinal responses toward brands and brand consumers and children's desire to eat the advertised products. DESIGN: Secondary analysis of data from a crossover experimental-control study. PARTICIPANTS/SETTING: In all, 154 children (7 to 12 years) completed the study, conducted at four 6-day holiday camps from April 2016 to January 2017 in New South Wales, Australia. Children were assigned to a single-media (n=76) or multiple-media (n=78) condition. INTERVENTION: All children viewed 10 TV food advertisements in a cartoon on three occasions. For one of the brands, one set of children additionally played online "advergames" featuring the brand. MAIN OUTCOME MEASURES: Children's recognition and attitudes toward brands and brand consumers and children's desire to eat the product were reported via a brand recognition and attitude survey pre- and postintervention. Marketing techniques were categorized. STATISTICAL ANALYSIS: Pre- and postintervention brand recognition and relationships between brand recognition and attitudes by media condition and desire to eat the product were examined using generalized linear mixed models and linear mixed models. RESULTS: There was a significant increase in the number of brands recognized postexposure by children in both media groups (mean difference=3.8, P<0.0001). The majority of brands appealed to children. Children who reported wanting to eat the advertised products rated brands more positively than children who did not express a desire to eat the products. A larger proportion of children who played the advergames (36%) rated brand consumers as "cool" than children who viewed the TV advertisements only (19%) (P<0.001). Anti-adult themes, fun and humor, and parent pleasing were techniques unique to some of the most recognized and favored advertisements. CONCLUSIONS: The marketing communications increased children's brand recognition and elicited positive attitudinal responses. These findings indicate a need for policy makers to consider additional regulations to protect children from the persuasive influence of unhealthy food advertising.

Speech, Language, and Communication Skills of Adolescents With Craniofacial Microsomia.

Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11-17 years with CFM (n = 107) and demographically similar controls (n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = -1.15 to -0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = -0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = -0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.

Skin Conductance Responses Indicate Children are Physiologically Aroused by Their Favourite Branded Food and Drink Products.

Children's favourite food and beverage brands use various tactics to foster positive associations and loyalty. This brand-consumer dynamic is frequently influenced by the use of implicit techniques and emotional appeals. Few studies have used physiological methods to examine the connections that brands build with children and the influence this has on their automatic responses. These techniques are potentially less prone to bias than behavioural or cognitive methods. This is the first study to explore the implicit response that children have to images of their favourite food and beverage brands using skin conductance responses as a marker of arousal. Australian children aged 8-11 years (n = 48) were recruited. Images of the participants' favourite branded food and beverage products, alongside images of the same products unpackaged, their family and friends, and neutral objects were presented in a randomised order with a standard timed interval between images. Children were significantly more aroused by branded images of their favourite food and beverage products than by their unpackaged counterparts (p < 0.042, d = 0.4). The physiological response to the branded products was similar to the response to the children's family and friends (p = 0.900, d = -0.02). These findings suggest that children may have an implicit connection to their favourite branded products.