Mental health and lifestyle behavior changes during COVID-19 among families living in poverty: A descriptive phenomenological study.

PROBLEM: Families living in poverty may be particularly vulnerable to the deleterious effects of the coronavirus disease (COVID-19). The current study focuses on caregivers of preschoolers aged 3-5 years old who lived in poverty to explore how COVID-19 affected mental health and lifestyle behaviors and what coping strategies were helpful for dealing with challenges induced by COVID-19. METHODS: A qualitative study was conducted using individual semi-structured interviews with 17 caregivers. FINDINGS: Both caregivers and preschoolers experienced high levels of stress, anxiety, and depression and reported unhealthy eating habits and excessive screen time. Physical activity increased in preschoolers, but declined among caregivers during COVID-19. Caregivers' coping strategies included taking short walks, seeking professional and social support, and praying; avoidant caregiver coping strategies including eating when stressed and increased screen time. CONCLUSIONS: Future interventions are warranted to empower caregivers who live in poverty with the skills needed to maintain optimal physical and mental health, as well as assisting them to cope with challenges that may continue post-COVID-19.

Using the Theory of Planned Behavior to determine COVID-19 vaccination intentions and behavior among international and domestic college students in the United States.

Vaccination is the most effective strategy for preventing infectious diseases such as COVID-19. College students are important targets for COVID-19 vaccines given this population's lower intentions to be vaccinated; however, limited research has focused on international college students' vaccination status. This study explored how psychosocial factors from the Theory of Planned Behavior (TPB; attitudes, perceived behavioral control, subjective norms, and behavioral intentions) related to students' receipt of the full course of COVID-19 vaccines and their plans to receive a booster. Students were recruited via Amazon mTurk and the Office of the Registrar at a U.S. state university. We used binary logistic regression to examine associations between students' psychosocial factors and full COVID-19 vaccination status. Hierarchical multiple regression was employed to evaluate relationships between these factors and students' intentions to receive a booster. The majority of students in our sample (81% of international students and 55% of domestic students) received the complete vaccination series. Attitudes were significantly associated with all students' full vaccination status, while perceived behavioral control was significantly associated with domestic students' status. Students' intentions to receive COVID-19 vaccines were significantly correlated with their intentions to receive a booster, with international students scoring higher on booster intentions. Among the combined college student population, attitudes, intentions to receive COVID-19 vaccines, and subjective norms were significantly related to students' intentions to receive a booster. Findings support the TPB's potential utility in evidence-based interventions to enhance college students' COVID-19 vaccination rates. Implications for stakeholders and future research directions are discussed.

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis.

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.

Stress management interventions among socioeconomically disadvantaged parents: A meta-analysis and moderation analysis.

BACKGROUND: Socioeconomically disadvantaged parents experience high levels of stress, anxiety, and depression. Many interventions have been tested to reduce parental stress, but no meta-analysis has been conducted to quantitatively summarize the effects and explore the moderators of intervention effects among socioeconomically disadvantaged parents. OBJECTIVE: This meta-analysis aimed to (1) quantitatively examine the intervention effects of prior stress management interventions among socioeconomically disadvantaged parents on reducing stress, depression, and anxiety; and (2) explore the potential moderators of intervention effects. METHODS: Six databases, including CINAHL, PubMed, PsycINFO, Sociological Abstracts, Web of Science, and Cochrane, were searched in February 2021. After a two-step literature screening by two independent reviewers, 45 eligible articles were retained. Two evaluators independently assessed each eligible study's quality using the Evidence Project risk of bias tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the report. Meta-analyses (random-effects model) and moderation analyses (mixed-effects model) were performed. RESULTS: Previous stress management interventions had a small effect of -0.24 in reducing parental stress (95% confidence interval [CI]: -0.33, -0.15) with a 7.6-month follow-up effect of -0.12 (95% CI: -0.27, 0.04). The pooled effects on reducing depression were -0.15 (95% CI: -0.26, -0.04) with a 9-month follow-up effect of 0.02 (95% CI: -0.21, 0.26). Two studies measured anxiety, and the average effects were -0.03 (95% CI: -0.16, 0.11). Intervention effects on stress were significantly moderated by country (p = .005), study design (p < .001), and intervention duration (p = .030). Interventions conducted in developing countries (g = -0.52) had a significantly larger effect in reducing stress than those conducted in developed countries (g = -0.19). Studies using a quasi-experimental design (g = -0.47) resulted in a significantly greater effect in reducing stress than RCTs (g = -0.12). Interventions with a duration of 1-3 months (g = -0.36) had a greater effect in reducing stress than those with a longer duration (g = -0.11 for 3-6 months, -0.20 for >6 months). Intervention effects on reducing depression were significantly moderated by intervention component (p = .030). Cognitive behavioral therapy (g = -0.20) and mindfulness-based interventions (g = -0.16) resulted in greater effects in reducing depression than interventions focusing on parenting/life/self-care skills (g  =  0.003). CONCLUSIONS: Previous stress management interventions have short-term beneficial effects on reducing parental stress and depression, but long-term follow-up effects are limited. Short-duration (1-3 months) mindfulness-based interventions and cognitive behavioral therapy in clinical settings are recommended for socioeconomically disadvantaged parents to reduce stress and depression.

Relationships among perceived stress, emotional eating, and dietary intake in college students: Eating self-regulation as a mediator.

This study aimed to examine the relationships among perceived stress, eating self-regulation, emotional eating, and dietary intake among undergraduate college students. This cross-sectional study was conducted with 523 students recruited from Amazon Mechanical Turk. All participants completed an online survey that assessed perceived stress, eating self-regulation, emotional eating, dietary intake, and demographics. The study sample was 47% female, 30% Hispanic, 8% Black, and 33% Asian. The overweight and obesity rate was 33%. Nearly 83% reported having moderate to high levels of stress, and over 80% had low to medium levels of eating self-regulation skills. On average, students consumed fruits and vegetables 2.42 times per day and sweets and soft drinks about once every other day. Perceived stress was positively correlated with emotional eating (ß = 0.12, p = .005), and negatively correlated with eating self-regulation (ß = -0.40, p < .001). Eating self-regulation partially mediated the relationship between perceived stress and emotional eating (ß = 0.11, p < .001). Emotional eating was positively related to intake of sweets and soft drinks. Eating self-regulation was negatively related to sweet intake (ß = -0.19, p < .001). Eating self-regulation and emotional eating fully mediated the relationship between perceived stress and sweet intake (ß = 0.09, p < .001). Although warranting further investigation, this study's results emphasize the significant protective role of eating self-regulation for controlling college students' intake of sweets and soft drinks, and the negative effects of perceived stress and emotional eating on their dietary intake. Future interventions could consider strategies focusing on stress management and eating self-regulation to improve dietary intake among this young population.

Parental Perceived Facilitators for and Barriers to Participating in a Lifestyle Intervention to Reduce Early Childhood Obesity: A Qualitative Evaluation.

This study aimed to examine low-income mothers' perceived facilitators for and barriers to participating in a lifestyle intervention. A phenomenography approach was used to individually interview 14 mothers from Midwestern U.S. The data were analyzed using content analysis. Drawing on the socio-ecological model, mothers' perceived facilitators included (a) intrapersonal factors including providing helpful information, being accommodating, motivating, and novel; (b) interpersonal factors, including two-way communication between mothers and preschoolers, social connectedness among mothers, and a positive relationship between mothers and researchers; and (c) environmental factors, including kid-friendly, and pleasant and comfortable intervention sites. Mothers' reported barriers were intrapersonal factors including (a) use of technology due to unreliable Wi-Fi access and unfamiliarity of electronic device, (b) being "busy moms" due to busy schedules and stressful daily lives, and (c) lack of reliable transportation. Future interventions to reduce early childhood obesity among low-income families should consider these identified facilitators and barriers.

Dose-Response Relationship in a Healthy Habits Study for Head Start Preschoolers.

BACKGROUND: Understanding the dose-response relationship in behavioral interventions is critical to guide future research efforts. However, only few studies have fully examined the dose-response relationship especially among children. OBJECTIVE: The aim of the study was to examine the relationships between level of participation and intervention effects. METHODS: The study used data from 39 Head Start parent-preschooler dyads participating in a 10-week lifestyle intervention. The intervention included daily center-based preschooler program, preschooler weekly letters to parents, parent meetings, and weekly Facebook-based program. Height, weight, waist circumference (WC), moderate-to-vigorous physical activity (MVPA), screen time, and fruit/vegetable intake were assessed. RESULTS: Preschooler program average daily attendance was 79%, and Facebook-based program average completion rate was 80%. About 49% attended all three parent meetings. Parent meeting attendance was significantly and positively related to preschoolers' vegetable intake (p = .023) and MVPA (p < .001) and parents' MVPA (p = .016). Preschooler letters were significantly and negatively related to preschoolers' screen time (p = .002) and parents' WC (p = .027) and positively correlated with parents' MVPA (p = .01). Preschooler program attendance was not significantly correlated with their body mass index (ρ = -.31) or WC (ρ = -.16). DISCUSSION: The study provides important information for designing effective interventions among low-income families. The findings imply that (a) parent-only interventions and parent-child interventions may result in similar effects, (b) future behavioral interventions should focus on the bidirectional parent-child relationship, and (c) it is important to include face-to-face contacts in lifestyle interventions. In addition, it highlights the need to examine the dose-response relationship in multicomponent lifestyle interventions.

Conflict of Interest Mitigation Procedures May Have Little Influence on the Perceived Procedural Fairness of Risk-Related Research.

Two between-subject experiments explored perceived conflict of interest (COI)-operationalized as perceived procedural unfairness-in a hypothetical public-private research partnership to study the health risks of trans fats. Perceived fairness was measured as subjects' perceptions that health researchers would be willing to listen to a range of voices and minimize bias (i.e., COI) in the context of a research project. Experiment 1 (n = 1,263) randomly assigned research subjects to a partnership that included (1) a combination of an industry partner, a university partner, and a nongovernmental organization (NGO) partner; and (2) one of three processes aimed at mitigating the potential for COI to harm the quality of the research. The procedures included an arm's-length process meant to keep the university-based research team from being influenced by the other partners, an independent advisory board to oversee the project, and a commitment to making all data and analyses openly available. The results suggest that having an industry partner has substantial negative effects on perceived fairness and that the benefit of employing a single COI-mitigation process may be relatively small. Experiment 2 (n = 1,076) assessed a partnership of (1) a university and either an NGO or industry partner and (b) zero, one, two, or three of the three COI-mitigation procedures. Results suggest there is little value in combining COI-mitigation procedures. The study has implications for those who aim to foster confidence in scientific findings for which the underlying research may benefit from industry funding.

Dietary Intake Among Head Start Preschooler-caregiver Dyads.

PURPOSE: The purpose of this study was to examine the relationship between Head Start preschooler-caregiver dyad's dietary intake and factors influencing dietary intake. DESIGN AND METHODS: A cross-sectional, correlational design was used. Height and weight were measured. Caregivers completed an online survey assessing demographics, dietary intake, feeding practices, and psychosocial factors. RESULTS: Seventy dyads, recruited from two urban Head Start centers in the Midwestern U.S., participated. The mean age for preschoolers and caregivers was 3.90 (63% female) and 28.97 years (94% female), respectively. About 43% of preschoolers and 81% of caregivers were overweight/obese. Sixty-seven percent of caregivers, but only 9% of preschoolers, met the fruit/vegetable (F/V) recommendation. Preschoolers' F/V intake was not significantly correlated with their caregivers' F/V intake after adjusting for demographics and psychosocial factors (B = 0.05, p = .607). Caregiver race (B = -0.71, p = .05), nutrition knowledge (B = -0.35, p = .017), perceived caregiver weight (B = -0.85, p = .035), perceived child weight (B = 1.09, p = .029), and concerns of preschoolers' weight (B = 0.79, p = .004) were significantly correlated with preschoolers' F/V intake, after adjusting for demographics, caregiver F/V intake, and other psychosocial factors. CONCLUSIONS: The study findings indicate the critical need to improve preschoolers' dietary intake and the important influence of caregivers on their preschoolers' dietary intake. Given the few limitations of the study (e.g., small sample size, food frequency questionnaire), interpretation and application of the study's findings warrant caution. PRACTICE IMPLICATIONS: Pediatric practitioners and researchers need to design effective programs to improve low-income Head Start preschoolers' dietary intake, thereby helping to curb the current childhood obesity epidemic.

Perceived conflict of interest in health science partnerships.

University scientists conducting research on topics of potential health concern often want to partner with a range of actors, including government entities, non-governmental organizations, and private enterprises. Such partnerships can provide access to needed resources, including funding. However, those who observe the results of such partnerships may judge those results based on who is involved. This set of studies seeks to assess how people perceive two hypothetical health science research collaborations. In doing so, it also tests the utility of using procedural justice concepts to assess perceptions of research legitimacy as a theoretical way to investigate conflict of interest perceptions. Findings show that including an industry collaborator has clear negative repercussions for how people see a research partnership and that these perceptions shape people's willingness to see the research as a legitimate source of knowledge. Additional research aimed at further communicating procedures that might mitigate the impact of industry collaboration is suggested.

Content Analysis of Diet-Related Mobile Apps: A Self-Regulation Perspective.

Diet-related mobile apps hold promise in helping individuals self-regulate their eating behaviors. Nevertheless, little is known about the extent to which diet-related mobile apps incorporate the established behavior change theories and evidence-based practices that promote dietary self-regulation. Guided by the self-regulation aspect of Bandura's social cognitive theory and the Dietary Guidelines for Americans 2010 of the U.S. Department of Agriculture, this study conducts a content analysis of diet-related mobile apps for iPhone (N = 400). In terms of the adherence to the self-regulation aspect of the social cognitive theory, results show that although 72.5% of the apps incorporate at least one theoretical construct, few apps tap all three processes of self-regulation (i.e., self-observation/monitoring, judgment process, and self-reaction). Additionally, outcome expectation is manifested in a majority of the diet-related apps. In terms of the Dietary Guidelines for Americans 2010, while the diet-related apps equally emphasize setting goals for calorie intake or nutrient consumption, more apps feature nutrient tracking than calorie tracking. Implications and limitations are discussed.