The Relationship between Household SNAP Participation, Parent Feeding Styles, and Child Eating Behaviors.

This cross-sectional analysis of the Minnesota Now Everybody Together for Amazing Healthful Kids (NET-Works) study evaluated whether SNAP participation was associated with specific parental feeding styles and child eating behaviors. Associations between parent-reported feeding styles and child eating behaviors and SNAP participation were examined using multiple linear regression analyses and responses from 534 parent/child dyads (49.1% female children, 91.7% female parents). SNAP participation was not associated with specific feeding styles or child eating behaviors when adjusting for food insecurity, timing in SNAP cycle, and other covariates in this large, ethnically and racially diverse sample of predominantly mothers and preschool-aged children. Other factors, such as food insecurity, not SNAP participation, may influence parental feeding and child eating behaviors, and screening by health care providers is recommended.

Applying the Behavior Change Technique Taxonomy to Four Multicomponent Childhood Obesity Interventions.

Applying the Behavior Change Technique Taxonomy has the potential to facilitate identification of effective childhood obesity intervention components. This article evaluates the feasibility of coding Childhood Obesity Prevention and Treatment Consortium interventions and compares reliability between external taxonomy-familiar coders and internal intervention-familiar coders. After training, coder pairs independently coded prespecified portions of intervention materials. An adjudication process was used to explore coding discrepancies. Reliability between internal and external coders was moderate (prevalence and bias-adjusted kappa .38 to .55). Reliability for specific target behaviors varied with substantial agreement for physical activity (.63 to .76) and moderate for dietary intake (.44 to .63). Applying the taxonomy to these interventions was feasible, but agreement was modest. Coding discrepancies highlight the importance of refining coding to capture the complexities of childhood obesity interventions, which often engage multiple recipients (e.g., parents and/or children) and address multiple behaviors (e.g., diet, physical activity, screen time).

A Bidirectional Analysis of Feeding Practices and Eating Behaviors in Parent/Child Dyads from Low-Income and Minority Households.

OBJECTIVE: To prospectively examine the bidirectional relationship between parental feeding practices (eg, instrumental feeding, encouragement to eat) and child eating behaviors (eg, food responsiveness, emotional eating) in low-income, ethnically diverse preschool children over a 3-year period. STUDY DESIGN: Parent/child (age 2-4 years at baseline) pairs (n = 222 non-Hispanics; n = 312 Hispanics) participated in NET-Works (Now Everybody Together for Amazing and Healthful Kids), a randomized controlled trial carried out in community and in-home settings in urban areas of Minnesota. Data were collected at baseline and 12, 24, and 36 months. The present study is a secondary data analysis using cross-lagged models to identify bidirectional associations between parental feeding practices and child eating behaviors. RESULTS: Three models showed significant cross-lagged effects (P < .05): model 1, parental instrumental feeding influencing later child food responsiveness; model 2, parental emotional feeding influencing later child food responsiveness; and model 3, parental emotional feeding influencing later child eating satiety. Model 1 showed significant bidirectional temporal paths, whereas models 2 and 3 showed significant unidirectional temporal paths from parental feeding practices to child eating behaviors. CONCLUSIONS: Parental instrumental and emotional feeding practices prospectively influence child food responsiveness and satiety. This study demonstrates causal temporality between parental feeding practices and child eating behaviors. Heath care providers may want to use findings regarding parent feeding practices as part of their anticipatory guidance during well-child visits with parents of preschoolers.

Multicomponent Obesity Prevention Intervention in Low-Income Preschoolers: Primary and Subgroup Analyses of the NET-Works Randomized Clinical Trial, 2012-2017.

OBJECTIVES: To evaluate a multicomponent obesity prevention intervention among diverse, low-income preschoolers. METHODS: Parent-child dyads (n = 534) were randomized to the Now Everybody Together for Amazing and Healthful Kids (NET-Works) intervention or usual care in Minneapolis, MN (2012-2017). The intervention consisted of home visits, parenting classes, and telephone check-ins. The primary outcomes were adjusted 24- and 36-month body mass index (BMI). RESULTS: Compared with usual care, the NET-Works intervention showed no significant difference in BMI change at 24 (-0.12 kg/m2; 95% confidence interval [CI] = -0.44, 0.19) or 36 months (-0.19 kg/m2; 95% CI = -0.64, 0.26). Energy intake was significantly lower in the NET-Works group at 24 (-90 kcal/day; 95% CI = -164, -16) and 36 months (-101 kcal/day; 95% CI = -164, -37). Television viewing was significantly lower in the NET-Works group at 24 (rate ratio = 0.84; 95% CI = 0.75, 0.93) and 36 months (rate ratio = 0.88; 95% CI = 0.78, 0.99). Children with baseline overweight or obesity had lower BMI in the NET-Works group than those in usual care at 36 months (-0.71 kg/m2; 95% CI = -1.30, -0.12). Hispanic children had lower BMI in the NET-Works group than those in usual care at 36 months (-0.59 kg/m2; 95% CI = -1.14, -0.04). CONCLUSIONS: In secondary analyses, NET-Works significantly reduced BMI over 3 years among Hispanic children and children with baseline overweight or obesity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01606891.

Influence of the built environment on pedestrian route choices of adolescent girls.

We examined the influence of the built environment on pedestrian route selection among adolescent girls. Portable global positioning system units, accelerometers, and travel diaries were used to identify the origin, destination, and walking routes of girls in San Diego, CA and Minneapolis, MN. We completed an inventory of the built environment on every street segment to measure the characteristics of routes taken and not taken. Route-level variables covering four key conceptual built environment domains (Aesthetics, Destinations, Functionality, and Safety) were used in the analysis of route choice. Shorter distance had the strongest positive association with route choice, while the presence of a greenway or trail, higher safety, presence of sidewalks, and availability of destinations along a route were also consistently positively associated with route choice at both sites. The results suggest that it may be possible to encourage pedestrians to walk farther by providing high quality and stimulating routes.

NET-Works: Linking families, communities and primary care to prevent obesity in preschool-age children.

Obesity prevention in children offers a unique window of opportunity to establish healthful eating and physical activity behaviors to maintain a healthful body weight and avoid the adverse proximal and distal long-term health consequences of obesity. Given that obesity is the result of a complex interaction between biological, behavioral, family-based, and community environmental factors, intervention at multiple levels and across multiple settings is critical for both short- and long-term effectiveness. The Minnesota NET-Works (Now Everybody Together for Amazing and Healthful Kids) study is one of four obesity prevention and/or treatment trials that are part of the Childhood Obesity Prevention and Treatment (COPTR) Consortium. The goal of the NET-Works study is to evaluate an intervention that integrates home, community, primary care and neighborhood strategies to promote healthful eating, activity patterns, and body weight among low income, racially/ethnically diverse preschool-age children. Critical to the success of this intervention is the creation of linkages among the settings to support parents in making home environment and parenting behavior changes to foster healthful child growth. Five hundred racially/ethnically diverse, two-four year old children and their parent or primary caregiver will be randomized to the multi-component intervention or to a usual care comparison group for a three-year period. This paper describes the study design, measurement and intervention protocols, and statistical analysis plan for the NET-Works trial.

Adolescent girls' most common source of junk food away from home.

Contextual factors associated with adolescent girls' dietary behaviors could inform future interventions to improve diet. High school girls completed a 7-day diary, recording all trips made. In places other than home or school they recorded the food eaten. Girls made an average of 11.4 trips per week other than to home or school. Snacks high in solid oils, fats and added sugars (SOFAS) were frequently consumed. Girls reported eating an average of 3.5 servings per week of snacks high in SOFAS at someone else's house compared to 3.0 servings per week at retail food outlets. Findings demonstrate that low nutrient foods are ubiquitous and efforts should be made to reduce their availability in multiple settings.

A school-based, peer leadership physical activity intervention for 6th graders: feasibility and results of a pilot study.

BACKGROUND: The aim of this study was to promote physical activity in 6th graders by developing and testing the feasibility of an enhanced Presidential Active Lifestyle Award (PALA) program comprised of a peer leadership component and innovative exercise resource toolkit including DVDs. METHODS: A racially/ethnically diverse sample of students received the standard PALA program (2 control schools, n = 61) or enhanced PALA+Peers program (2 intervention schools, n = 87) during 2006-2007 academic year. RESULTS: Compared with the control condition, the intervention was successful in increasing moderate physical activity in all students (P = .02) and moderate and hard physical activity among girls (P = .03 and P = .04, respectively). Teachers and students reported a high level of satisfaction and receptivity with the intervention. All teachers thought the DVDs were well-received, and 87% of students reported that they would recommend the enhanced program to peers. CONCLUSION: Coupling peer leadership and DVDs that promote physical activity may be an effective way to increase youth physical activity.

Out and about: association of the built environment with physical activity behaviors of adolescent females.

Locational data, logged on portable GPS units and matched with accelerometer data, was used to examine associations of the built environment with physical activity and sedentary behaviors of adolescent females. In a sample of 293 adolescent females aged 15 to 18 years old in Minneapolis and San Diego, the built environment around each GPS point and its corresponding sedentary, light, and moderate-to-vigorous intensity physical activity was examined using random intercept multinomial logistic regression models. The odds of higher physical activity intensity (3-level outcome: sedentary, light, MVPA) were higher in places with parks, schools, and high population density, during weekdays, and lower in places with more roads and food outlets. Understanding the places where physical activity and sedentary behaviors occur appears to be a promising strategy to clarify relationships and inform policy aimed at increasing physical activity and reducing sedentary behaviors.

Identifying walking trips from GPS and accelerometer data in adolescent females.

BACKGROUND: Studies that have combined accelerometers and global positioning systems (GPS) to identify walking have done so in carefully controlled conditions. This study tested algorithms for identifying walking trips from accelerometer and GPS data in free-living conditions. The study also assessed the accuracy of the locations where walking occurred compared with what participants reported in a diary. METHODS: A convenience sample of high school females was recruited (N = 42) in 2007. Participants wore a GPS unit and an accelerometer, and recorded their out-of-school travel for 6 days. Split-sample validation was used to examine agreement in the daily and total number of walking trips with Kappa statistics and count regression models, while agreement in locations visited by walking was examined with geographic information systems. RESULTS: Agreement varied based on the parameters of the algorithm, with algorithms exhibiting moderate to substantial agreement with self-reported daily (Kappa = 0.33-0.48) and weekly (Kappa = 0.41-0.64) walking trips. Comparison of reported locations reached by walking and GPS data suggest that reported locations are accurate. CONCLUSIONS: The use of GPS and accelerometers is promising for assessing the number of walking trips and the walking locations of adolescent females.

Weight-related teasing in a racially diverse sample of sixth-grade children.

Negative outcomes are associated with weight-based teasing. Among children, little research to date has explored the extent to which teasing occurs, the effects of teasing, or differences among sources of teasing. The purpose of this secondary data analysis was to assess the prevalence and frequency of weight-related teasing by peers and families in a low-income, multiracial/ethnic sample of children; to determine how bothered children were by the teasing; to evaluate whether teasing varied by overweight status and sex; and to see whether body satisfaction varied based on teasing history. In 2007, baseline data were obtained from 148 children (aged 11 to 12 years) in a classroom intervention pilot study in four public schools serving low-income communities in St Paul, MN. Participants completed a classroom survey assessing body satisfaction and weight-related teasing. Height and weight were measured. Forty percent of children reported being teased by peers and 36% reported being teased by family members about their weight. Significantly more overweight/obese children reported being teased by peers (P<0.01) and family members (P<0.05) than normal weight children. No significant differences were seen between weight status and the degree to which children were bothered by teasing. Body satisfaction was lower among children teased by family members or peers than those who were not teased (P<0.05). These results suggest that weight-related teasing is a problem for children, especially those who are overweight or obese. A better understanding is needed of the long-term effects of teasing on behavioral and psychosocial outcomes in racially/ethnically diverse samples of children.

Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: project northland Chicago.

AIMS: The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings. DESIGN AND SETTING: Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or 'delayed program' control condition. PARTICIPANTS: The study sample (n = 5812 students) was primarily African American, Hispanic and low-income. INTERVENTION: Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing). MEASUREMENTS: Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts. FINDINGS: Overall, the intervention, compared with a control condition receiving 'prevention as usual', was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06). CONCLUSIONS: Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

Cross-cultural adaptation and evaluation of a home-based program for alcohol use prevention among urban youth: the "Slick Tracy Home Team Program".

The current study describes the extensive cross-cultural adaptation of a brief home-based alcohol prevention program for racially and ethnically diverse sixth grade students and their families, using a randomized controlled trial design involving 60 public schools in the city of Chicago (N = 3,623 students). The adapted program achieved high participation levels (73%) overall, as well as in single parent families, non-English homes, and low-income students, among other at risk groups. Lower levels of factors associated with the onset of alcohol use (i.e., normative expectations and outcome expectations) were achieved in the intervention group compared to the control group. However, no differences were observed for several other protective factors or alcohol use.

Brief report: the adaptation of Project Northland for urban youth.

OBJECTIVE: Summarizes the research and intervention design of a new trial to evaluate an adaptation of Project Northland, a multicomponent, community-wide alcohol prevention program for culturally diverse youth living in a large city. The original Project Northland was successful in reducing alcohol use among a sample of mostly White, rural adolescents. METHODS: We highlight the steps taken to adapt the intervention strategies for culturally diverse inner-city youth, families, and neighborhoods. The research design is a randomized controlled trial to evaluate the effectiveness of the adapted Project Northland for reducing the early onset and prevalence of alcohol use among young urban adolescents. CONCLUSION: The information gained from this trial, including the process of adaptation of prevention strategies, will be beneficial for alcohol-use prevention efforts within diverse urban communities across the country.

Violence-related outcomes of the D.A.R.E. plus project.

The objectives of this study were to examine outcomes of the Minnesota D.A.R.E. Plus Project on violence-related behaviors among middle school students and mediation analyses that test how the intervention was effective in reducing physical and verbal violence. Twenty-four schools were randomly assigned to the D.A.R.E. middle school curriculum, the D.A.R.E. Plus multicomponent intervention, or control. The study cohort completed a self-report questionnaire at baseline and two follow-ups. The results showed that boys had higher rates of violence and victimization than girls. The D.A.R.E. Plus program was more effective in preventing violence among boys than among girls. It appears that the small behavioral effect that D.A.R.E. Plus did demonstrate on physical and verbal violence among boys was entirely mediated by a decrease of norms that support violence, an increase in outcome expectancies about being violence-free, and an increase in parental consequences for fighting.

A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. Plus programs.

OBJECTIVE: To evaluate the effect of the middle and junior high school Drug Abuse Resistance Education (D.A.R.E.) and D.A.R.E. Plus programs on drug use and violence. DESIGN: Randomized controlled trial of 24 schools, with 3 conditions: D.A.R.E. only, D.A.R.E. Plus, and delayed program control. SETTING: Schools and neighborhoods, primarily in Minneapolis-St Paul. PARTICIPANTS: All seventh-grade students in 24 schools in the academic year 1999-2000 (N = 6237 at baseline, 67.3% were white, and there was 84.0% retention at final follow-up). INTERVENTIONS: The middle and junior high school D.A.R.E. curriculum in the 16 schools that received D.A.R.E. only and D.A.R.E. Plus. In the 8 schoolts that received D.A.R.E. Plus, additional components included a peer-led parental involvement classroom program called "On the VERGE," youth-led extracurricular activities, community adult action teams, and postcard mailings to parents. The interventions were implemented during 2 school years, when the cohort was in the seventh and eighth grades. MAIN OUTCOME MEASURES: Self-reported tobacco, alcohol, and marijuana use; multidrug use; violence; and victimization, assessed at the beginning and end of seventh grade and at the end of eighth grade. Growth curve analytic methods were used to assess changes over time by condition. RESULTS: There were no significant differences between D.A.R.E. only and the controls; significant differences among boys between D.A.R.E. Plus and controls for tobacco, alcohol, and multidrug use and victimization; significant differences among boys between D.A.R.E. Plus and D.A.R.E. only in tobacco use and violence; and no significant behavioral differences among girls. CONCLUSION: D.A.R.E. Plus significantly enhanced the effectiveness of the D.A.R.E. curriculum among boys and was more effective than the delayed program controls, underscoring the potential for multiyear, multicomponent prevention programs and demonstrating sex differences in response to intervention programs.

Project Northland: long-term outcomes of community action to reduce adolescent alcohol use.

Project Northland was a randomized trial to reduce alcohol use among adolescents in 24 school districts in northeastern Minnesota. Phase 1 (1991-1994), when the targeted cohort was in grades 6-8, included school curricula, parent involvement, peer leadership and community task forces. The Interim Phase (1994-1996) involved minimal intervention. Phase 2 (1996-1998), when the cohort was in grades 11 and 12, included a classroom curriculum, parent education, print media, youth development and community organizing. Outcomes of these interventions were assessed by annual student surveys from 1991 to 1998, alcohol purchase attempts by young-looking buyers in 1991, 1994 and 1998, and parent telephone surveys in 1996 and 1998. Growth curve analysis was used to examine the student survey data over time. Project Northland was most successful when the students were young adolescents. The lack of intervention in the Interim Phase when the students were in grades 9 and 10 had a significant and negative impact on alcohol use. The intervention used with the high school students as those in grades 11 and 12 made a positive impact on their tendency to use alcohol use, binge drinking and ability to obtain alcohol. There was no impact in Phase 2 on other student-level behavioral and psychosocial factors. Developmentally appropriate, multi-component, community-wide programs throughout adolescence appear to be needed to reduce alcohol use.