Goals, Barriers, and Facilitators of Caregivers Who Participated in an In-Home Intervention to Improve Food Parenting Practices and Child Diet Quality.

OBJECTIVE: To explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments. DESIGN: Secondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention. PARTICIPANTS: Thirty-three Hispanic/Latinx caregivers, predominantly of low income. PHENOMENON OF INTEREST: Patterns in goal content and anticipated barriers and facilitators. ANALYSIS: Thematic analysis of goal sheets with a mixed inductive-deductive approach. RESULTS: Almost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers' perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members' eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation). CONCLUSIONS AND IMPLICATIONS: Understanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators.

Height and Weight Measurement and Communication With Families in Head Start: Developing a Toolkit and Establishing Best Practices.

Background: Head start (HS) programs are required to collect children's height and weight data. Programs also communicate these results to families. However, no standardized protocol exists to guide measurements or communicate results. The purpose of this article was to describe the development of a measurement toolkit and best practices for communication. Methods: HS programs contributed to the development and pilot testing of a toolkit for HS staff to guide child measurement. We used a three-phase iterative approach and qualitative methods to develop and test the toolkit, which included a video and handout. In addition, we convened an advisory group to draft best practices for communication. Results: HS program staff appreciated the toolkit materials for their simplicity and content. The advisory group highlighted the importance of weight stigma and the need to be cautious in the way that information is communicated to families. The group underscored the role of emphasizing health behavior change, instead of focusing solely on BMI. Best practices were organized into (1) Policies and procedures for communicating screening results, (2) training for HS program staff to improve communication related to screening and health behaviors, and (3) other best practices to promote health behaviors and coordinate data systems. Conclusions: Our toolkit can improve anthropometric measurements of HS to ensure that potential surveillance data are accurate. Advisory group best practices highlight opportunities for HS to develop and implement policies, procedures, and trainings across the country to improve communication with HS families. Future research should test the implementation of these best practices within HS.

A Dietary Pattern With More Fruits and Vegetables in Children of Mothers Who Immigrated to the United States From Latin America Is Associated With Healthful Nutrient Intake and Weight Status.

BACKGROUND: Children from families who immigrated to the United States may consume a lower-quality diet compared with their US-born peers. However, specific features of their dietary patterns, which could be a focus for improving diet quality, are not well-studied. OBJECTIVE: The aim of this study was to examine dietary patterns that distinguish interpersonal variability in dietary intake and explore the association of dietary patterns with nutrient intake and weight status. DESIGN: This study was a cross-sectional analysis of baseline data from the Live Well randomized controlled trial collected between 2009 and 2010. PARTICIPANTS/SETTING: Study participants included 313 children (3-12 years) whose mothers immigrated to the United States from Latin America and resided in Somerville, Massachusetts. MAIN OUTCOME MEASURES: Dietary patterns (derived using principal component analysis); nutrient intake (derived from dietary data collected using the Block Food Screener); and weight status (categorized using body mass index z score based on measured height and weight). STATISTICAL ANALYSES PERFORMED: Nutrient intake levels were compared across quartiles for dietary patterns using analysis of covariance. Multivariable logistic or linear regression models were used to determine the associations between dietary pattern scores and odds of overweight or obesity or z scores. RESULTS: Two dietary patterns emerged: "fruits and vegetables" and "meat and sweets." Highest adherence to the fruits and vegetables pattern was associated with more healthful nutrient intake and lower odds of having overweight or obesity (odds ratio 0.37; 95% CI 0.16 to 0.98), but not body mass index z score (ß = -.07; 95% CI -.51 to 0.36) compared with the lowest adherence. Adherence to the meat and sweets pattern was associated with less healthful nutrient intake but not with the odds of experiencing overweight or obesity (odds ratio 0.48; 95% CI 0.16 to 1.46). CONCLUSIONS: A healthful dietary pattern in children of families who immigrated to the United States from Latin America may include a variety of fruits and vegetables. Longitudinal studies should be conducted to further assess the role of dietary intake patterns on the health of these children.

Developing and testing a produce prescription implementation blueprint to improve food security in a clinical setting: a pilot study protocol.

BACKGROUND: Food insecurity is common in the United States, especially in Rhode Island, where it affects up to 33% of residents. Food insecurity is associated with adverse health outcomes and disproportionally affects people from minoritized backgrounds. Produce prescription programs, in which healthcare providers write "prescriptions" for free or reduced cost vegetables, have been used to address food insecurity and diet-related chronic disease. Although there is growing evidence for the effectiveness of produce prescription programs in improving food security and diet quality, there have been few efforts to use implementation science methods to improve the adoption of these programs. METHODS: This two-phase pilot study will examine determinants and preliminary implementation and effectiveness outcomes for an existing produce prescription program. The existing program is funded by an Accountable Care Organization in Rhode Island and delivered in primary care practices. For the first phase, we conducted a formative evaluation, guided by the Consolidated Framework for Implementation Research 2.0, to assess barriers, facilitators, and existing implementation strategies for the produce prescription program. Responses from the formative evaluation were analyzed using a rapid qualitative analytic approach to yield a summary of existing barriers and facilitators. In the second phase, we presented our formative evaluation findings to a community advisory board consisting of primary care staff, Accountable Care Organization staff, and staff who source and deliver the vegetables. The community advisory board used this information to identify and refine a set of implementation strategies to support the adoption of the program via an implementation blueprint. Guided by the implementation blueprint, we will conduct a single-arm pilot study to assess implementation antecedents (i.e., feasibility, acceptability, appropriateness, implementation climate, implementation readiness), implementation outcomes (i.e., adoption), and preliminary program effectiveness (i.e., food and nutrition security). The first phase is complete, and the second phase is ongoing. DISCUSSION: This study will advance the existing literature on produce prescription programs by formally assessing implementation determinants and developing a tailored set of implementation strategies to address identified barriers. Results from this study will inform a future fully powered hybrid type 3 study that will use the tailored implementation strategies and assess implementation and effectiveness outcomes for a produce prescription program. TRIAL REGISTRATION: Clinical trials: NCT05941403 , Registered June 9, 2023.

Effect of a Technology-Integrated Curriculum on Sugary Drink and Snack Intake of Elementary-Aged Youth Experiencing Low Income.

OBJECTIVE: To describe the results of a technology-integrated intervention on sugar-sweetened beverage (SSB) and energy-dense snack intake with third graders experiencing low income. DESIGN: A 2 × 2 quasi-randomized cluster-block, parallel-group experimental research design. SETTING: Low-income schools in Rhode Island. PARTICIPANTS: Two-hundred seventeen intervention and 242 control third-grade students in low-income (89.6% and 88.2% free/reduced meals, respectively), ethnically and racially diverse (63% Hispanic/20% Black and 62% Hispanic/18% Black, respectively) schools. INTERVENTION(S): A 13-week in-school program held once per week for 1 hour. The hands-on, technology-integrated program used a modified version of the Body Quest: Food of the Warrior curriculum. MAIN OUTCOME MEASURE(S): Intake of SSB and energy-dense snacks, both salty and sweet snacks, using baseline (week 1) and postassessment (week 13) previous day self-recall. ANALYSIS: Generalized mixed modeling with nesting. RESULTS: Intervention students significantly reduced their SSB intake by 38% (0.5 times/d; F[1, 540] = 4.26; P = 0.04) and salty snack intake by 58% (0.8 times/d; F[1, 534] = 6.58, P < 0.01) from baseline to postassessment as compared with the control students. CONCLUSIONS AND IMPLICATIONS: Findings suggest a technology-integrated curriculum is effective in decreasing SSB and salty snacks in elementary-aged students of low-income, minoritized populations. Improved dietary habits can potentially influence other facets of students' lives.

Are Caregivers' Feeding Competence and Autonomy Associated with Healthier Restaurant Food Purchases for Their Child at Fast Food or Counter Service Restaurants? A Cross-Sectional Study in a Diverse Sample of U.S. Caregivers.

This study examined the cross-sectional relationship between caregivers' perceived competence and autonomy (as defined by the Self-Determination Theory) and their fast food or counter service restaurant food purchases (side dishes, beverage, and dessert) for their child. A U.S. national convenience sample of caregivers with at least one 3-12-year-old child completed an online survey with questions adapted from the Intrinsic Motivation Inventory that measured perceived competence and autonomy for feeding fruits and vegetables and limiting sugar-sweetened beverages (SSBs) and desserts. The survey included four questions asking about their fast food or counter service restaurant food purchases (side dish, beverage, and dessert). We applied logistic and multinomial logistic regression models to examine the associations between competence or autonomy and restaurant orders. Competence and autonomy were associated with ordering fruits and vegetables as side dishes (OR [95% CI], 1.14 [1.06, 1.24] and 1.09 [1.03, 1.14], respectively). However, higher competence was also associated with ordering desserts at restaurants and higher autonomy was associated with lower odds of ordering water. These findings will inform interventions and programs that aim to support caregivers' psychological needs, like competence and autonomy, to promote supportive environments and healthier restaurant purchases for their children.

Higher morning cortisol is associated with lower intuitive eating in midlife women.

BACKGROUND: Stress is associated with negative health outcomes in adults, including increased adiposity. Eating behaviors to cope with stress can have a negative effect on adiposity. There is limited research on positive eating behaviors, such as intuitive eating (IE), and their relationship to stress and adiposity. Thus, this study aimed to examine the association between stress and adiposity and to assess whether IE is a mediator of that pathway. METHODS: Data were analyzed from a cross-sectional study of 114 women between 40-64 years of age. Participants completed in-person visits and self-reported questionnaires, including the Intuitive Eating Scale and Perceived Stress Scale. Adiposity was assessed using dual energy x-ray absorptiometry. Measurements included total body fat percentage and android/gynoid (AG) ratio as a measure of abdominal adiposity. Participants provided ten salivary cortisol samples over two days, collected upon waking, 30-, 45-, and 60-minutes after waking, and prior to bed. Several methods were used to characterize cortisol secretion and exposure, including the diurnal cortisol slope and the cortisol area under the curve with respect to ground (AUCg). Linear regression was used to assess the associations between perceived stress and IE and between features of diurnal cortisol and IE. Mediation models were tested to examine the indirect effects of IE on the relationship between perceived stress and adiposity and to test the indirect effects of IE on the relationship between cortisol measures and adiposity. RESULTS: Linear regression analyses indicated that higher cortisol AUCg was associated with lower scores on the eating for physical reasons subscale (ß: -0.01, p = 0.008). After adjusting for covariates, neither higher perceived stress nor diurnal cortisol were associated with intuitive eating. There was no evidence of mediation of the association of stress on adiposity through IE. CONCLUSION: Our findings demonstrate a relationship between higher overall morning cortisol and lower scores on the eating for physical reasons subscale of the Intuitive Eating Scale. Future research should seek to understand how intuitive eating may be used as a technique for individuals who engage in emotional eating to cope with stress, and to prevent excess adiposity resulting from stress in midlife women.

The longitudinal association between caregivers' perceived competence and autonomy and children's dietary consumption before and 10 months into the COVID-19 pandemic.

The COVID-19 pandemic has been stressful, potentially affecting caregivers' feeding choices. Caregivers play a role in shaping children's diets, yet few studies have explored how their competence and autonomy, defined by the Self-Determination Theory, impact children's diets. We examined the relationship between caregivers' autonomy and competence and their feeding practices before and during the first year of the pandemic. A national convenience sample of caregivers with 3-12-year-old children completed an online survey during two time-periods. Questions adapted from the Intrinsic Motivation Inventory measured perceived competence and autonomy for feeding fruits and vegetables (F/V) and limiting sugar-sweetened beverages (SSBs) and desserts. National Health and Nutrition Examination Survey Dietary Screener questions measured children's consumption of F/V, SSBs, and desserts. Paired t-tests examined how child consumption and caregiver's perceived competence and autonomy changed, and logistic regressions examined whether caregivers' competence and autonomy predicted the change in child consumption and if changes in competence and autonomy were associated with changes in child consumption. Caregivers (n = 597) were mostly Black/African American (33.0%) or Latina/o/x (42.7%) and older than 30 years (84.1%). Children's consumption did not change overall, but caregivers' competence for feeding F/V increased, and their competence for limiting SSBs and desserts decreased. Caregiver competence and autonomy before COVID-19 did not predict child dietary consumption during the pandemic. However, change in competence was a significant predictor of the change in child consumption of F/V [OR (95%CI): 0.70 (0.57, 0.86)]. The association between caregiver's perceived competence for feeding F/V and child consumption remained positive and significant in both periods [OR (95%CI) pre and during COVID: 2.09 (1.69, 2.57) - 2.40 (1.88, 3.06)]. This study can inform behavioral interventions supporting caregivers' competence and autonomy around feeding choices.

Illuminating Child and Adult Care Food Program Partnerships That Improved Food Access and Waiver Utilization for Feeding Young Children in Early Care and Education Programs During COVID-19: A Qualitative Study.

BACKGROUND: Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. OBJECTIVE: This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DESIGN: Qualitative semi-structured interviews with 24 participants representing 21 states across the United States. PARTICIPANTS/SETTING: Virtual interviews with CACFP directors from December 2020 through May 2021. ANALYSIS: Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. RESULTS: Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). CONCLUSIONS: The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.

Mediation of the association between social environmental characteristics of family childcare home and weight status in children by diet quality.

BACKGROUND: The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. METHODS: Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N = 370) in FCCHs (N = 120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. RESULTS: Children's total HEI scores significantly mediated the relationship between the EPAO subscale Food Provided and children's BMI z-scores (B=-0.01, p < .05, 95% CI = [-0.03, - 0.002]). Further, the EPAO subscale Food Provided was positively associated with the total HEI score (B = 0.75, p < .01, 95% CI = [0.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-0.01, p < .05, 95% CI = [-0.02, - 0.001]). CONCLUSION: Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.

Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads.

BACKGROUND: Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads. METHODS: Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively. RESULTS: At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children. CONCLUSIONS: Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.

Associations between Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Maternal Diet Quality.

BACKGROUND: An objective of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is to improve maternal diet quality, but its effectiveness remains unclear. Better understanding how WIC participation shapes women's diet quality is crucial given that maternal diet plays a critical role in determining mothers' and children's short- and long-term overall health. OBJECTIVES: This study aimed to compare the diet quality of WIC-participating women to WIC-eligible nonparticipating women and higher-income pregnant and postpartum women using a nationally representative sample. METHODS: This was a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles. Women aged 20 to 44 with at least one 24-h recall and complete data on pregnancy and postpartum status and WIC participation were included (n = 626). Diet quality was evaluated using the Healthy Eating Index-2015 (HEI-2015). Multivariable Tukey-adjusted linear models were used to compare HEI-2015 total and component scores between groups. Models were adjusted for age, pregnancy and postpartum status, breastfeeding status, race and ethnicity, and food security. RESULTS: Most women were postpartum and not pregnant (75%), nonbreastfeeding (60%), identified as non-Hispanic White (58%), and food secure (64%). WIC participants, WIC-eligible nonparticipants, and income-ineligible women had mean Total HEI-2015 scores of 52.7 (95% confidence interval [CI]: 50.6, 54.8), 54.2 (95% CI: 51.6, 56.7), and 55.0 (95% CI: 51.8, 58.2), respectively. There were no differences between groups for total and most component scores. Income-ineligible women had better Fatty Acids scores (5.7; 95% CI: 5.0, 6.4) than WIC participants (4.7; 95% CI: 4.1, 5.3; P < 0.05). WIC-eligible nonparticipants had better Refined Grains scores (6.0; 95% CI: 5.3, 6.6) than WIC participants (5.0; 95% CI: 4.4, 5.6; P < 0.05). CONCLUSIONS: Overall diet quality was similar across WIC and income groups. Lower HEI-2015 component scores for WIC participants compared with WIC-eligible nonparticipants warrant further exploration. Research evaluating WIC's impact on maternal diet quality is needed to ensure continued support for low-income women's health.

Mediation of the Association between Social Environmental Characteristics of Family Childcare Home and Weight Status in Children by Diet Quality.

Background: The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. Methods: Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N=370) in FCCHs (N=120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated from. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. Results: Children's total HEI scores significantly mediated the relationship between the EPAO subscale "Food provided" and children's BMI z-scores (B=-.01, p<.05, 95% CI = [-.03, -.002]). Further, the EPAO subscale "Food provided" was positively associated with the total HEI score (B=.75, p<.01, 95% CI = [.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-.01, p<.05, 95% CI = [-.02, -.001]). Conclusion: Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.

Higher intuitive eating is associated with lower adiposity in midlife women.

OBJECTIVE: Intuitive eating (IE) is consistently associated with a lower body mass index, though its relationship with adiposity, specifically abdominal adiposity, is unknown. Given that midlife women often experience increases in adiposity during midlife, our objective was to examine the association between IE and adiposity in midlife women. We also aimed to validate the factor structure of the Intuitive Eating Scale (IES) in a sample of midlife women. METHOD: We analyzed data from a cross-sectional study of 116 women between 40 and 64 years of age. Participants completed in-person visits and self-reported questionnaires, including the 21-item IES. Adiposity was assessed using dual energy x-ray absorptiometry. Measurements included total body fat percentage and android/gynoid (AG) ratio as a measure of abdominal adiposity. RESULTS: Confirmatory factor analysis of the IES demonstrated a poor fit to the data. Thus, we conducted an exploratory factor analysis which resulted in a 15-item scale with five items on each subscale, and demonstrated improved fit. Higher intuitive eating was associated with lower total body fat percentage (ß = -6.77, p < 0.0001) and lower abdominal adiposity (ß = -0.09, p = 0.0005). Higher scores on eating for physical reasons and reliance on internal hunger and satiety cues were associated with lower total body fat and lower abdominal adiposity. CONCLUSIONS: Our findings suggest that higher intuitive eating is associated with lower total body fat percentage and lower abdominal adiposity. These results may have public health implications to promote intuitive eating in midlife women, a population at risk of weight gain and changes to body fat distribution.

The Facilitators and Barriers to Digital Health for Managing Nutrition in People With Parkinson's Disease and Their Caregivers: A Formative, Qualitative Study.

OBJECTIVE: Identify techniques to assist in designing digital health platforms for nutrition services for people with Parkinson's disease and caregivers to improve their quality of life. DESIGN: Semistructured, dyadic interviews with 20 dyads (20 people with Parkinson's disease and 20 caregivers). SETTING: Home visits were conducted in the northeast US. PARTICIPANTS: People with Parkinson's disease and their caregivers were recruited via email, flyers, news articles and announcements at support groups. PHENOMENON OF INTEREST: Identification of facilitators and barriers to using digital health platforms to inform future digital nutrition services. ANALYSIS: Interviews were recorded, transcribed and double-coded using a framework analysis method. RESULTS: Reported digital health platforms utilization facilitators were: knowledge acquisition, convenience, intention to use, socializing, enjoyment, and forced adoption. Barriers included: negative feelings toward technology, lack of access or knowledge, disinterest, product design, frustration and functional reliability, and applying health information. CONCLUSIONS AND IMPLICATIONS: Although dyads often lack knowledge on both how to use technology and nutrition, they are willing to use digital health platforms to increase their nutrition knowledge if platforms are convenient. Based on the identified facilitators and barriers, the added benefits of access and training nutrition digital health platforms must be clearly communicated to end-users to improve their quality of life.

Effect of Applying Best Practices for Physical Activity and Screen Time to Family Childcare Homes.

INTRODUCTION: Early childcare has been identified as an influential setting for children's physical activity. Our objective was to determine whether children aged 2 to 5 years had more accelerometer-measured minutes of physical activity when caregivers in their family childcare home (FCCH) adhered to best practices for physical activity and screen time. METHODS: We analyzed baseline 2-day observation data collected by using the Environment and Policy Assessment and Observation measure from a cluster-randomized trial. Multilevel linear regression models assessed the association between caregivers' meeting best practices for physical activity and screen time and children's time spent sedentary or in moderate-to-vigorous physical activity (MVPA). RESULTS: All FCCH caregivers (N = 120) in our study were female, and 67.5% were Hispanic. Participating children (N = 349) were 52.1% female and 57.4% Hispanic. A higher score among caregivers for physical activity best practices was associated with more MVPA (B = 0.79; 95% CI, 0.02 to 1.56; P = .04) for children and less sedentary time (B = -2.07; 95% CI, -3.94 to -0.19; P = .04). A higher caregiver score for screen time best practices was associated with less sedentary time (B = -2.07; 95% CI, -3.94 to -0.19; P = .04) and more MVPA time (B = 0.65; 95% CI, 0.03 to .27; P = .04). Children in homes where caregivers offered them 60 minutes or more of outdoor play and participated in outdoor physical activity had more MVPA and less sedentary time. We found no association between various screen-time best practices and children's sedentary time. DISCUSSION: Children with caregivers who used more best practices for physical activity and screen time had higher activity levels and spent less time sedentary. These findings could help policy makers and people caring for young children modify existing policies and develop programs to help early childhood caregivers implement best practices to promote children's physical activity.

Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality.

OBJECTIVE: To examine the relationship between the diet quality of children aged 2-5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices. DESIGN: Cross-sectional analysis. PARTICIPANTS: Family child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial. MAIN OUTCOME MEASURES: Data were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index-2015. ANALYSIS: Multilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons. RESULTS: Children in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12-1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02-34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29-12.23; P = 0.001) had higher total Healthy Eating Index scores. CONCLUSIONS AND IMPLICATIONS: Future interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.

Dietary magnesium intakes among women of reproductive age in Ghana-A comparison of two dietary analysis programs.

BACKGROUND: Despite the importance of magnesium to health and most importantly to women of reproductive age who are entering pregnancy, very few surveys have investigated the magnesium status of women of reproductive age, particularly in Africa. Additionally, the software and programs used to analyze dietary intake vary across countries in the region. OBJECTIVE: To assess the dietary magnesium intake of women of reproductive age in Ghana and to compare the estimate of magnesium intake obtained from two commonly used dietary analysis programs. METHODS: We collected magnesium intake from 63 Ghanaian women using a semiquantitative 150-item food frequency questionnaire. Dietary data was analyzed using two different dietary analysis programs, Nutrient Data Software for Research (NDSR) and the Elizabeth Stewart Hands and Associates (ESHA) Food Processor Nutrition Analysis software. We used the Wilcoxon signed rank test to compare the mean differences between the two dietary programs. RESULTS: There were significant differences between the average dietary magnesium intake calculated by the two dietary programs, with ESHA estimating higher magnesium intake than NDSR (M±SE; ESHA: 200 ± 12 mg/day; NDSR: 168 ± 11 mg/day; p<0. 05). The ESHA database included some ethnic foods and was flexible in terms of searching for food items which we found to be more accurate in assessing the magnesium intake of women in Ghana. Using the ESHA software, 84% of the study women had intake below the recommended dietary allowances (RDA) of 320mg/day. CONCLUSION: It is possible that the ESHA software provided an accurate estimate of magnesium in this population because it included specific ethnic foods. Concerted efforts such as magnesium supplementation and nutrition education should be considered to improve the magnesium intake of women of reproductive age in Ghana.

Control and Chaos: Caregiver's Basic Psychological Need Frustration is Associated With the Socioemotional Climate When Feeding.

OBJECTIVE: The socioemotional climate when feeding is a focus in childhood obesity prevention efforts. However, little is known about why caregivers create nonsupportive or supportive climates. This cross-sectional study used a Self-Determination Theory perspective to identify factors associated with the socioemotional climate when feeding in ethnically diverse families with low income. METHODS: Caregivers of children aged 2-5 years (n = 66) completed the Parent Socioemotional Context of Feeding Questionnaire, the Basic Psychological Need (BPN) Satisfaction and Frustration Scale, and demographic surveys at baseline. Multivariable regressions assessed the association between BPN satisfaction/frustration with autonomy-supportive, structured, controlling, and chaotic feeding climates. RESULTS: Participants were predominately Hispanic/Latinx (86.6%), women (92.5%), and born outside the US (60%). Their BPN frustration was positively associated with controlling (ß = 0.96; SE = 0.26; P = 0.001) and chaotic (ß = 0.79; SE = 0.27; P = 0.01) feeding. CONCLUSIONS AND IMPLICATIONS: This analysis suggests that BPN frustration is associated with controlling and chaotic feeding and may be important to consider when encouraging responsive feeding.

Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study.

BACKGROUND: Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments. METHODS: We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis. RESULTS: Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003). CONCLUSION: SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.