FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers.

OBJECTIVE: To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers. METHODS: A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme. RESULTS: A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity. CONCLUSIONS: Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

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.

Intervention to increase physical activity and healthy eating among under-represented adolescents: GOAL trial protocol.

INTRODUCTION: To reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition recommendations is important. To address the problem, a 16-week intervention called Guys/Girls Opt for Activities for Life (GOAL) was designed. The purpose of this randomised controlled trial is to evaluate any effect of the intervention, compared with a control condition, on improving: (1) adolescents' % body fat (primary outcome), moderate-to-vigorous PA (MVPA), diet quality and cardiorespiratory fitness from 0 to 4 months; (2) body mass index (BMI), overweight/obesity percentage and quality of life from 0 to 4 months and to 13 months; and (3) perceived social support, self-efficacy and motivation from 0 to 4 months with evaluation of any mediating effect on adolescent PA and diet quality. An exploratory aim is to evaluate any effect of the intervention, compared with the control, on improving parents'/guardians' home environment, MVPA and diet quality from 0 to 4 months; and BMI from 0 to 4 months and to 13 months. METHODS AND ANALYSIS: Adolescents (fifth to eighth grade) in 14 schools located in underserved urban communities are randomly assigned to the intervention or usual school offerings. One parent per adolescent is enrolled (882 dyads total). Cohort 1 includes four schools (2022-2023). Cohorts 2 and 3 include 5 schools in 2023-2024 and 2024-2025, respectively. The 16-week intervention has three components: (1) after-school GOAL club for adolescents to engage in PA and healthy eating/cooking activities; (2) three parent-adolescent meetings to empower parents to assist adolescents; and (3) GOAL social networking website for parents to share how they helped their adolescent. ETHICS AND DISSEMINATION: The Michigan State University Biomedical Institutional Review Board provided ethical approval for the study. Findings will be shared via the trial registration database, peer-reviewed publications, conferences and community-oriented strategies. TRIAL REGISTRATION NUMBER: NCT04213014.

Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis.

BACKGROUND: Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed. AIMS: The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents. METHODS: Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators. RESULTS: The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17). CONCLUSIONS: These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

The role of psychosocial factors and biological sex on rural Thai adolescents' drinking intention and behaviours: A structural equation model.

AIMS: To examine the contributions of psychosocial factors (attitude towards drinking, perceived drinking norms [PDNs], perceived behavioural control [PBC]), and biological sex on drinking intention and behaviours among rural Thai adolescents. DESIGN: A cross-sectional study design. METHODS: In 2022, stratified by sex and grade, we randomly selected 474 rural Thai adolescents (Mage = 14.5 years; SD = 0.92; 50.6% male) from eight public district schools in Chiang Mai Province, Thailand, to complete a self-administered questionnaire. Structural equation modelling with the weighted least square mean and variance adjusted was used for data analysis. RESULTS: All adolescents' psychosocial factors contributed significantly to the prediction of drinking intention, which subsequently influenced their drinking onset, current drinking and binge drinking pattern in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention, followed by PBC. Rural adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviours either fully or partially. The path coefficient between drinking attitude and drinking intention was significantly different between males and females. CONCLUSION: Different from previous studies focus on adolescents' drinking attitude, rural Thai adolescents' PDNs play a significant role on their drinking intention and subsequently their drinking onset and patterns. This nuanced understanding supports a paradigm shift to target adolescents' perceived drinking norms as a means to delay their drinking onset and problematic drinking behaviours. IMPACT: Higher levels of perceived drinking norms significantly led to the increase in drinking intention among adolescents. Minimizing adolescents' perceptions of favourable drinking norms and promoting their capacity to resist drinking, especially due to peer pressure, are recommended for nursing roles as essential components of health education campaigns and future efforts to prevent underage drinking. PATIENT OR PUBLIC CONTRIBUTION: In this study, there was no public or patient involvement.

Happy Family, Healthy Kids: A Healthy Eating and Stress Management Program in Low-Income Parent-Preschooler Dyads.

BACKGROUND: Substantial effort has been invested to combat childhood obesity, but overall effects are disappointing, especially in low-income racial minority children. One possible reason is a lack of focus on the important stress-eating connection. Stress can negatively influence eating behaviors, leading to an increased appetite for high-fat and energy-dense foods. OBJECTIVE: This study aimed to evaluate the preliminary effects of a healthy eating and stress management program targeting multiple theoretical variables on improving eating behavior (dyads' fruit/vegetable intake, emotional eating), food insecurity, anthropometric characteristics (dyads' body mass index, % body fat), cardiovascular health (dyads' blood pressure), and mental well-being (parental stress). METHODS: A one-group, quasi-experimental pilot study was conducted among 107 low-income parent-preschooler dyads. The 14-week program included a parent component, a parent-preschooler learning component, and a day care-based preschooler component. RESULTS: The program had positive effects on improving dyads' fruit/vegetable intake, food insecurity, body mass index, and blood pressure and parents' nutrition knowledge, self-efficacy, support, food resource management behavior, problem-focused coping, and home eating environment. The overall satisfaction rate was 95.2%, and 88.1% stated that the program assisted their families with having a healthy lifestyle. DISCUSSION: Results support the preliminary effects of the program on improving health outcomes in rural and urban low-income families. Although warranting further investigation with a more rigorous randomized controlled trial, the healthy eating and stress management program provides a potential solution to the current coexistence of an obesity epidemic and mental health crisis.

Anaesthesia-related cognitive dysfunction following cardiothoracic surgery in late middle-age and younger adults: A scoping review.

AIM: This review aimed to evaluate factors associated with anaesthesia-related postoperative cognitive dysfunction (POCD) among adults younger than 65 years who underwent cardiothoracic surgeries. STUDY DESIGN: A systematic keyword search, following the scoping review framework, was performed in the PubMed and CINAHL databases. Original English-language studies that included adults younger than 65 years and addressed cognitive function after surgery along with anaesthesia management were included. Retrospective studies, animal research and in vitro and in vivo studies were excluded. RESULTS: Twenty-three articles were included (65.2% interventional studies). All studies lacked theoretical or conceptual frameworks. Ketamine's neuroprotective potential is questionable, and intravenous lidocaine may be considered a possible early agent for preventing POCD, but long-term effectiveness is uncertain. Compared to inhalational anaesthesia, total intravenous anaesthesia (TIVA) may be related to a decreased incidence of POCD. Variation in POCD assessment impacted the lack of homogeneity in obtained data. Moreover, the shorter-term timing of POCD evaluation such as in early days after surgery could be greatly influenced by medication and delirium. CONCLUSION: Although strategies such as TIVA, the use of neuroprotective anaesthetics and comprehensive preoperative assessments are suggested to prevent POCD, this multifactorial phenomenon cannot be explicitly attributed solely to anaesthetics or anaesthesia-related techniques. Use of standardized, reliable and valid tools for POCD assessment is encouraged for cross-study comparison. RELEVANCE TO CLINICAL PRACTICE: Nurses and certified nurse anaesthetists must be aware of risk factors for postoperative delirium and POCD so they can assess patients before and after surgery. Patients and caregivers need to be educated about cognitive changes after surgery and advised to report them to their health care provider if they occur.

Elevated parent and child hair cortisol moderated the efficacy of a mindful eating intervention.

To explore whether elevated baseline hair cortisol moderated effects of a mindful eating intervention on anthropometrics, blood pressure (BP), household food insecurity, eating behaviour, and various psychosocial outcomes. The 14-week intervention included a parent Facebook-based programme, 3 parent meetings, preschooler letters connecting school learning to home practices, and a preschool-based mindful eating programme. Among 107 parent-preschooler dyads, mean age was 47.32 months for preschoolers and 30.12 years for parents. Among preschoolers, 54.2% were female, 8.4% were Hispanic, and 19.6% were Black. Among parents, 95.3% were female, 6.5% were Hispanic, 15.0% were Black, 39.4% were single, and 43.4% were unemployed. Preschoolers' elevated hair cortisol was related to a smaller reduction in preschoolers' % body fat (r =.31) and smaller increases in parents' perceived responsibility for child feeding (r = -.37). Parents' elevated hair cortisol was associated with smaller decreases in preschoolers' emotional eating (r = .39) and household food insecurity (r = .44). Relationships between baseline hair cortisol and post-intervention outcomes (BP, emotional eating, fruit/vegetable intake, food insecurity, and coping) varied by baseline values of outcome variables. Given that stress may attenuate intervention effects, a stress management component may be necessary to foster positive behavioural changes. Moreover, interventions should be tailored according to participants' characteristics to achieve optimal effects.

Perceptions of families with adolescents utilizing augmentative and alternative communication technology: A qualitative approach.

PURPOSE: Although family involvement is critical to successful augmentative and alternative communication (AAC) device utilization, little is known about how families adapt to technology. The aim of this qualitative study was to explore parent-reported factors contributing to family adaptation among families with adolescents diagnosed with autism and/or Down syndrome (DS) utilizing AAC technology. This study describes families' experiences related to several interacting variables of the Resiliency Model, including demand, type, appraisal, resources, and problem-solving/coping, that helped shape the outcome of adaptation to AAC technology. Nurses are well-positioned in a variety of practice settings to assess vulnerable families and assist with identifying resources and navigating complex service systems. DESIGN AND METHODS: Semi-structured interviews were conducted with eight parents of adolescents with autism and/or DS (aged 13-18) recruited through online research registries, support organizations, and a social networking site. Recorded interviews were transcribed, and two independent reviewers coded and analyzed the data. Comparisons across all families' thematic summaries were examined for patterns. RESULTS: Five themes described aspects of family adaptation: Contextual Strains and Influences, Continuum of Person-First Approach, Opening Doors, Facilitators of Support, and Planning Is Key. CONCLUSIONS: Findings highlighted the challenges and demands associated with raising an adolescent using an AAC device, as well as the attributes, resources, perceptions, and strategies that either contributed or hindered family adaptation. PRACTICE IMPLICATIONS: AAC technology is readily available for adolescents with developmental disabilities. It is essential that nurses assess key adaptation components to support families in integrating and using the technology.

Associations between hair cortisol and blood pressure: a systematic review and meta-analysis.

OBJECTIVE: Stress is widely considered to be a risk factor for high blood pressure (BP), but evidence on the associations between biomarkers of chronic stress and BP is inconsistent. This systematic review and meta-analysis assessed the current state of the science on relationships between measures of cortisol concentration reflecting chronic stress exposure [hair cortisol concentration (HCC), nail cortisol concentration)] and BP. METHODS: PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, and Embase were searched. Random effects models were used to assess the pooled effect size. Exploratory moderation analysis was performed. RESULTS: Out of 34 014 identified, 16 articles met eligibility criteria and were included in the review, while 14 were included in the meta-analysis. No articles were reported on the association between nail cortisol concentration and BP. Small, positive associations were observed between HCC and SBP [ r  = 0.19 (95% confidence interval (CI): 0.08-0.29)] and HCC and DBP [ r  = 0.13 (95% CI: 0.04-0.22)]. Cortisol analysis method was identified as a significant moderator of the association between HCC and DBP. HCC was largely, positively associated with hypertension status [odds ratio = 3.23 (95% CI: 2.55-4.09), P  < 0.001]. CONCLUSIONS: Current evidence suggests that higher HCC may be associated with elevated BP and a potential risk factor for hypertension. However, results should be interpreted with caution because HCC can be affected by hair color, hair care products, and analytic methods. Given the limitations of studies included in this review, further research is needed.

Psychometric properties of the Arabic version of Physical Activity Questionnaire for Adolescents (PAQ-A).

AIM: To evaluate the psychometric properties of the Arabic version of the Physical Activity Questionnaire for Adolescents (PAQ-A). BACKGROUND: Physical inactivity is a major risk factor for becoming overweight or obese and developing chronic conditions that lead to an increase in mortality globally. Inadequate physical activity (PA) has been a problem among Arabic-speaking populations, including female adolescents in Saudi Arabia. Unfortunately, psychometrically sound measures to assess PA among female adolescents in Saudi Arabia are lacking, indicating that a reliable, valid and feasible self-report measure is urgently needed for use with this young Arabic-speaking population. METHODS: A cross-sectional study approved by a university institutional review board was conducted with 383 Saudi female adolescents, 13-18 years of age, who were recruited from 10 all-female public schools in Jeddah, Saudi Arabia. Physical activity was measured via the PAQ-A, which assesses the level of PA engagement during the school year for 7 days. Internal consistency was estimated. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the measure's construct validity and the Pearson correlation coefficient was used to assess convergent validity. RESULTS: Cronbach's alpha was 0.81, indicating acceptable internal consistency. Item-total correlation coefficients ranged from 0.11 to 0.61. Both EFA and CFA indicated a single-factor. The scale was significantly correlated with other cognitive and affective variables that reflected the physical activity perceptions among the female adolescents, such as enjoyment of PA, PA self-efficacy and social support for PA. CONCLUSIONS: The Arabic version of the PAQ-A is reliable and valid measure for assessing PA among Arabic-speaking female adolescents.

Psychosocial Determinants of Recommended Lifestyle Behaviors among Hypertensive Patients: An Integrative Literature Review.

Healthy lifestyle levels are low among adults with hypertension (HTN). Unfortunately, psychosocial factors contributing to patients' inability to meet healthy lifestyle recommendations are not well-understood. This integrative review examined the relationships of three psychosocial factors (self-efficacy, outcome expectancy, and social support) with dietary adherence (DA) and physical activity (PA) among adults with HTN. In total, 24 peer-reviewed studies were assessed. Results showed self-efficacy had small-to-large relationships with PA (r = 0.02-0.46) and DA (r = 0.06-0.79), with the strength of the associations varying by the assessed domain and country of origin. However, few studies reported a small relationship between the remaining factors (outcome expectancy and social support) and PA and DA. Thus, more efforts are needed to delineate the contributions of social support and outcome expectancies on DA or PA. When designing an intervention that focuses on improving PA or DA among adults with HTN, these psychosocial factors should be targeted.

Organized Physical Activity Program Participation, Physical Activity, and Related Psychosocial Factors Among Urban Adolescents.

The study purpose was to examine whether adolescents who participated in organized physical activity (PA) programs differed from nonparticipants in motivation, social support, and self-efficacy related to PA; PA (min/hr); and sedentary screen time behavior. Thirty-nine 5th-7th grade adolescents participated in organized PA programs; 41 did not. Approximately 56.3% were Black, and 52.5% had annual family incomes <$20,000. Compared to nonparticipants, those who participated reported significantly higher social support (M = 2.32 vs. 3.13, p < .001) and fewer hours watching television or movies on a usual weekend day (M = 2.49 vs. 1.59, p = .016); and had higher accelerometer-measured vigorous PA (M = 0.58 vs. 1.04, p = .009) and moderate-to-vigorous PA (M = 2.48 vs. 3.45, p = .035). Involving adolescents in organized PA programs may be important for improving their moderate-to-vigorous PA, vigorous PA, and related psychosocial factors, as well as reducing sedentary screen time behavior.

Family lifestyle is related to low-income preschoolers' emotional well-being during COVID-19 pandemic.

PROBLEM: COVID-19 has profoundly impacted children's behavioral and psychosocial development, especially young children from low-income families. This study examined how caregivers' and preschoolers' lifestyle behaviors (sleep, screen time, physical activity, eating behavior) were related to preschoolers' emotional well-being (sadness, fear, anger, and positive affect). METHODS: Using a cross-sectional design, we recruited low-income caregivers from Head Start organizations and the Qualtrics panel. Participants provided consent and completed an online survey. FINDINGS: A total of 408 caregivers (mean age = 31) participated: 17% Hispanic, 21% Black, 49% separated/single, 44% unemployed, and 39% with ≤high school education. After adjusting for demographics and preschoolers' lifestyle behaviors, caregivers' sleep disturbance was positively correlated with preschoolers' anger, fear, and sadness, while negatively related to positive affect. Similarly, caregivers' sleep time was positively correlated with preschoolers' sadness and negatively related to positive affect. Preschoolers' sleep time was negatively related to fear and positively related to positive affect. Likewise, preschoolers' physical activity was negatively correlated with fear, sadness, and positively correlated with positive affect. Additionally, preschoolers' fruit/vegetable intake was negatively associated with anger, fear, sadness, and positively associated with positive affect. CONCLUSIONS: The identified behavior-emotion connection provides a foundation for developing family-based lifestyle interventions in promoting mental health among preschoolers.

Enjoyment of Physical Activity among Children and Adolescents: A Concept Analysis.

Although enjoyment has been linked to participation in physical activity (PA), a thorough analysis of the concept is lacking. Health-related behavior research emphasizes the necessity of focusing on individual psychological requirements, such as enjoyment in PA, to boost children and adolescents' motivation for PA. The current paper is a report on a conceptual analysis of the enjoyment of PA among children and adolescents. We adopted the concept analysis procedure by Walker and Avant. Several databases (PubMed, CINAHL, ERIC, PsychInfo, and Sport Discus) were searched and used to extract relevant articles about the enjoyment of PA. The review process yielded a final set of 72 papers. A refined definition of enjoyment in PA, attributes, cases, antecedents, and consequences of enjoyment in PA were presented. A conceptual understanding of enjoyment in PA can enable nurses to plan interventions that help children and adolescents get appropriate PA and improve their health habits.

Food Insecurity and Mental Well-Being Among Low-Income Families During COVID-19 Pandemic.

PURPOSE: To examine the interaction effects of adult and child food insecurity on parents' and children's mental well-being. DESIGN: An online survey study was conducted. SETTING: Two Head Start organizations and the Qualtrics Panel. SUBJECTS: Four hundred and eight parents under poverty level and having a child aged 3-5 years participated. MEASURES: Food insecurity was assessed by the U.S. Household Food Security Survey Module. Parents' stress, anxiety and depression; and children's sadness, fear, anger, and positive affect were measured using instruments from HealthMeasures. ANALYSIS: Multivariate general linear models were performed in SPSS. RESULTS: Mean age was 31 years, 17% Hispanic, 21% Black. About 51% parents and 37% children were food insecure. After adjusting for demographics and child food insecurity, parents with adult food insecurity had higher stress (B = 2.65, p = .002), anxiety (B = 3.02, p = .001), and depression (B = 3.66, p = .001); and fear in their children (B = 5.03, p = .002) than those without adult food insecurity. Similarly, parents reporting child food insecurity had greater depression than those having no child food insecurity (B = 4.61, p = .020). Black parents had lower stress (B = -1.91, p = .018), anxiety (B = -2.26, p = .012), and depression (B = -4.17, p < .001) than their White counterparts. CONCLUSIONS: The study's results underscore the importance of reducing food insecurity in both parents and children as a whole family system to promote mental well-being of low-income families.

Motivational interviewing to reduce anthropometrics among children: A meta-analysis, moderation analysis and Grading of Recommendations Assessment, Development and Evaluation assessment.

BACKGROUND: Limited systematic reviews exist to evaluate the effects of motivational interviewing (MI) on children's anthropometric factors. OBJECTIVE: This review examined the effects of MI interventions for children and/or parents on children's anthropometric factors and included moderation analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched Cochrane Library, PubMed, CINAHL, EMBASE, PsycINFO, Sociological Abstracts, SPORTDiscus, Education Resources Information Center, and Web of Science in December 2020. A two-step double screening approach was applied: (1) screening titles and abstracts, and (2) screening full-text articles obtained in step 1. At each step, discussion occurred until reaching consensus. The Cochrane risk-of-bias tool was used to evaluate risk of bias, and GRADE system was applied to assess overall quality of evidence. We performed meta-analyses using the Comprehensive Meta-Analysis software. RESULTS: A total of 2209 records were found, and 45 eligible articles were retained. MI interventions had a pooled effect of -0.15 on body mass index (BMI; 95% confidence interval [CI]: -0.24 to -0.06), -0.36 on waist circumference (WC; 95% CI: -0.71 to -0.01) and -0.22 on percent body fat (95% CI: -0.41 to -0.03). Child baseline weight status and percent low-income families were identified as significant intervention moderators. According to the GRADE assessment, the quality of evidence on BMI percentile, BMI z-score and percent body fat was moderate, while quality on BMI and WC was low. CONCLUSIONS: In conclusion, culturally appropriate clinic- or home-based MI interventions with adequate duration, dose and active parental involvement are promising in reducing anthropometrics among children.

Psychosocial Factors Affecting the Association between a Healthy Lifestyle Behavior Intervention and Depressive Symptoms in Low-Income Overweight or Obese Mothers with Young Children: A Mediational Analysis.

BACKGROUND: Depressive symptoms are particularly prevalent among low-income overweight or obese mothers with young children, indicating the importance of understanding and addressing this serious health condition. Although lifestyle behavior interventions are promising for alleviating depressive symptoms in low-income overweight or obese mothers with young children, mechanisms underlying the association between these interventions and depressive symptoms in this priority population remain unknown. OBJECTIVE: A secondary analysis of data from a randomized controlled trial that tested a 16-week community-based lifestyle behavior intervention for low-income overweight or obese mothers with young children was conducted to examine whether autonomous motivation, coping self-efficacy, and emotional coping mediated the association between the intervention and depressive symptoms. METHODS: The analysis included 338 participants who completed data collection at baseline and immediately after the intervention. Participants responded to validated surveys measuring autonomous motivation, coping self-efficacy, emotional coping, and depressive symptoms. To test mediation effects, composite indicator structural equation modeling was performed adjusting for baseline measures. The proportion of maximum possible (POMP) scores in the outcome variable per unit change in the predictor variables was used to calculate effect size. RESULTS: The intervention alleviated depressive symptoms (B = -2.42, p = 0.015, POMP = -4.31%), and coping self-efficacy negatively and fully mediated the association between the intervention and depressive symptoms (B = -1.42, p = 0.002, POMP = -2.53%). Autonomous motivation and emotional coping were not significant mediators. CONCLUSIONS: Interventions aimed to alleviate depressive symptoms in low-income overweight or obese mothers with young children should include strategies to improve coping self-efficacy. However, continued research is needed to identify other mechanisms that may be contributing to the effect of lifestyle behavior interventions on depressive symptoms in this at-risk group. This information can then be used to simplify and strengthen the interventions and potentially lead to effective dissemination and implementation.

Lifestyle Behaviors and Parents' Mental Well-Being Among Low-Income Families During COVID-19 Pandemic.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has negatively altered many families' lifestyles and the mental well-being of parents, especially those who have a low income and young children. To improve low-income parents' mental well-being, especially during a pandemic, understanding parents' and children's lifestyle behaviors and the relationship between their lifestyle behaviors and parents' mental well-being is essential. OBJECTIVE: This cross-sectional study examined relationships between lifestyle behaviors (sleep, physical activity, screen time, and eating behavior of parents and children) and low-income parents' well-being (stress, anxiety, and depression) during COVID-19. METHODS: Parents were recruited from two Michigan Head Start organizations as well as across the United States; 408 parents completed an online survey. Demographic characteristics were assessed, along with parents' sleep, physical activity, screen time, and dietary intake; stress, anxiety, and depression were also examined. Children's sleep time, physical activity, screen time, and fruit/vegetable intake were assessed. Descriptive statistics, correlations, and the multivariate general linear model procedure were used. RESULTS: Approximately 69.4% of parents reported moderate stress levels, and 17.2% reported high levels. Most parents had sleep disturbances, attained minimal physical activity, and consumed <5 fruits/vegetables per day; average screen time was >2 hours per day. Only 41% of preschoolers were active 7 days a week and slept ≥10 hours per day. Two thirds had >2 hours per day of screen time, and less than one fifth consumed ≥5 fruits/vegetables per day. After adjusting for parents' demographics and children's lifestyle behaviors, parents' sleep disturbance was positively correlated with their levels of stress, anxiety, and depression. After controlling for parents' demographics and lifestyle behaviors, child sleep time was negatively associated with parents' stress levels. Family demographics and parents' and children's lifestyle behaviors explained 33.4%, 29.8%, and 28.1% of the variances in parents' stress, anxiety, and depression, respectively. DISCUSSION: Most parents and preschoolers were not meeting many lifestyle behavior recommendations, indicating a need for interventions. Improving parents' sleep quality and reducing bedtime challenges involving their preschoolers may be necessary for enhancing parental mental well-being.

Adolescents' Perceived Drinking Norms Toward Alcohol Misuse: An Integrative Review.

The purpose of this integrative review is to synthesize prior research on the relationship between adolescents' perceived subjective and descriptive drinking norms and their drinking intention and behaviors. Four databases (CINAHL, PubMed, Cochrane, and Sociological Abstracts) were searched to identify relevant articles. Thirty-one peer-reviewed articles published from 2010 to 2020 were reviewed. The results highlight that adolescents' perceived drinking norms derived from their parents and peers, such as approving or disapproving attitudes, significantly influence adolescents' drinking intention and behaviors. Moreover, pro-drinking messages, advertisements, and postings from electronic media (i.e., TV, movies, and the Internet) and online social networks (e.g., Facebook, Instagram, and Twitter) shape adolescents' drinking intention and encourage adolescents to initiate alcohol consumption early and/or escalate their drinking. Thus, future interventions should focus on subjective drinking norms that stem from interpersonal relationships in combination with perceived descriptive drinking norms derived from various media exposure.