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1.
Contemp Clin Trials Commun ; 16: 100452, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650072

RESUMO

Background: The purpose of this study was to conduct a qualitative evaluation of a behavioral intervention to prevent and treat childhood obesity in minority children. Using qualitative methods to augment understanding of intervention success may be one way to gain insight into the types of behavior change strategies that are most effective in childhood obesity interventions. Methods: COACH was a randomized controlled trial of 117 Latino parent-child (ages 3-5) pairs in Nashville, TN that resulted in improved child BMI in intervention vs. control families at 1-year follow-up. All participant parents were invited to focus groups after the trial. Discussions were audiotaped, transcribed, and translated into English. A hierarchical coding scheme was generated, and qualitative analysis done using an inductive/deductive approach. Both theme saturation and consensus between the coders were achieved. Responses were compared between intervention and control groups. Results: We conducted seven focus groups with 43 participants. 4 themes emerged from the intervention group: 1) perceived barriers to health behavior change; 2) strategies learned to overcome perceived barriers; 3) behavioral changes made in response to the program; and 4) knowledge, skills, and agency for family health behaviors. 4 themes emerged from the control group: 1) a desire to engage in health behaviors without specific strategies; 2) common set of barriers to health behavior change; 3) engagement in literacy activities, including creative problem-solving strategies; and 4) changes made in response to study visits. Analysis of coded data showed the intervention increased healthy behaviors (e.g., fruit/vegetable consumption) despite barriers (e.g., time, cost, culture, family dynamics). Intervention participants described using specific behavior change strategies promoted by the intervention including: substituting ingredients in culturally-normative recipes; avoiding grocery shopping when hungry; and coping with inability to meet goals with acceptance and problem-solving. Control participants reported little success in achieving healthy changes for their family. Intervention participants described successful health behavior changes that were shared across generations and were maintained after the program. Intervention participants reported increased awareness of their own agency in promoting their health. Conclusions: Qualitative evaluation of COACH provides a more detailed understanding of the intervention's quantitative effectiveness: child and adult health behaviors and personal agency were improved.

2.
Child Obes ; 15(8): 519-531, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31381365

RESUMO

Background: Health behavior change interventions that target childhood obesity in minority populations have led to inconsistent and short-lived results. The purpose of this study was to test a novel intervention that was personalized and family-based in a Latino population to reduce childhood obesity. Methods: Competency-Based Approaches to Community Health (COACH) was a randomized controlled trial. Latino parent-child pairs were recruited from community settings in Nashville, TN. Child eligibility criteria included age 3-5 years and a BMI ≥50th percentile. The intervention included 15 weekly, 90-minute sessions followed by 3 months of twice-monthly health coaching calls. The control group was a twice-monthly school readiness curriculum for 3 months. Sessions were conducted by a health coach in local community centers, with groups of 8-11 parent-child pairs. The primary outcome was child BMI trajectory across 12 months, measured at four times. The intervention's effect was assessed by using a longitudinal, linear mixed-effects growth model, adjusting for child gender, baseline child and parent age, and baseline parent BMI and education. Results: Of the 305 parent-child pairs assessed for eligibility, 117 were randomized (59 intervention, 58 control). Child BMI was available for 91.5% at 1-year follow-up. Mean baseline child age was 4.2 [standard deviation (SD) = 0.8] years, and 53.8% of children were female. Mean baseline child BMI was 18.1 (SD = 2.6) kg/m2. After adjusting for covariates, the intervention's effect on linear child BMI growth was -0.41 kg/m2 per year (95% confidence interval -0.82 to 0.01; p = 0.05). Conclusions: Over 1-year follow-up, the intervention resulted in slower linear BMI growth for Latino preschool-aged children from poverty.

3.
J Pediatr ; 213: 115-120, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31353040

RESUMO

OBJECTIVE: To determine the magnitude of risk of factors that contribute to the emergence of childhood obesity among low-income minority children. STUDY DESIGN: We conducted a prospective cohort analysis of parent-child pairs with children aged 3-5 years who were nonobese (n = 605 pairs) who participated in a 3-year randomized controlled trial of a healthy lifestyle behavioral intervention. After baseline, height and weight were measured 5 times over 3 years to calculate body mass index (BMI) percentiles and classify children as normal, overweight, or obese. Multivariable logistic regression was used to estimate the odds of obesity after 36 months. Predictors included age, sex, birth weight, gestational age, months of breastfeeding, ethnicity, baseline child BMI, energy intake, physical activity, food security, parent baseline BMI, and parental depression. RESULTS: Among this predominantly low-income minority population, 66% (398/605) of children were normal weight at baseline and 34% (n = 207/605) were overweight. Among normal weight children at baseline, 24% (85/359) were obese after 36 months; among overweight children at baseline, 55% (n = 103/186) were obese after 36 months. Age at enrollment (OR 2.11, 95% CI 1.64-2.72), child baseline BMI (OR 3.37, 95% CI 2.51-4.54), and parent baseline BMI (OR for a 6-unit change 1.36, 95% CI 1.09-1.70) were significantly associated with the odds of becoming obese for children. CONCLUSIONS: The combination of child age, parent BMI, and child overweight as predictors of child obesity suggest a paradigm of family-centered obesity prevention beginning in early childhood, emphasizing the relevance of child overweight as a phenotype highly predictive of child obesity. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01316653.

4.
J Gen Intern Med ; 34(4): 544-551, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30684202

RESUMO

BACKGROUND: There is much attention to recruitment of diverse populations in research, but little is known about the influence of health literacy and numeracy skills. OBJECTIVE: To determine if health literacy and numeracy affect individuals' interest to participate in research studies. DESIGN: Cross-sectional survey data were pooled from 3 large studies conducted in the Mid-South Clinical Data Research Network. PARTICIPANTS: Adult patients enrolled in 1 of 3 Mid-South Clinical Data Research Network studies. MAIN MEASURES: The survey domains included demographic items, the 3-item Brief Health Literacy Screen (range 3-15), and the 3-item Subjective Numeracy Scale (range 3-18). The outcome was a sum index measure of a 7-item instrument (range 7-21) assessing individuals' interest in participating in different types of research, including research that involves taking surveys, giving a blood sample, participating via phone or internet, taking an investigational medication, meeting at a local community center or school, including family, or staying overnight at a hospital. KEY RESULTS: Respondents (N = 15,973) were predominately women (65.5%), White (81.4%), and middle aged (M = 52.8 years, SD = 16.5); 32.4% previously participated in research. Self-reported health literacy was relatively high (M = 13.5 out of 15, SD = 2.1), and subjective numeracy skills were somewhat lower (M = 14.3 out of 18, SD = 3.6). After adjustment for age, gender, race, income, education, and other characteristics, lower health literacy and numeracy skills were each independently associated with less interest in research participation (p < 0.001 for each). Prior research participation was associated with greater interest in future research participation (p < 0.001). CONCLUSIONS: After adjustment for factors known to be predictive of interest, individuals with lower health literacy or numeracy scores were less interested in participating in research. Additional work is needed to elucidate reasons for this finding and to determine strategies to engage these populations.

5.
Int J Obes (Lond) ; 43(6): 1202-1209, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30670848

RESUMO

OBJECTIVE: The benefits of antibiotic treatment during pregnancy are immediate, but there may be long-term risks to the developing child. Prior studies show an association between early life antibiotics and obesity, but few have examined this risk during pregnancy. SUBJECTS: To evaluate the association of maternal antibiotic exposure during pregnancy on childhood BMI-z at 5 years, we conducted a retrospective cohort analysis. Using electronic health record data from seven health systems in PCORnet, a national distributed clinical research network, we included children with same-day height and weight measures who could be linked to mothers with vital measurements during pregnancy. The primary independent variable was maternal outpatient antibiotic prescriptions during pregnancy (any versus none). We examined dose response (number of antibiotic episodes), spectrum and class of antibiotics, and antibiotic episodes by trimester. The primary outcome was child age- and sex-specific BMI-z at age 5 years. RESULTS: The final sample was 53,320 mother-child pairs. During pregnancy, 29.9% of mothers received antibiotics. In adjusted models, maternal outpatient antibiotic prescriptions during pregnancy were not associated with child BMI-z at age 5 years (ß = 0.00, 95% CI -0.03, 0.02). When evaluating timing during pregnancy, dose-response, spectrum and class of antibiotics, there were no associations of maternal antibiotics with child BMI-z at age 5 years. CONCLUSION: In this large observational cohort, provision of antibiotics during pregnancy was not associated with childhood BMI-z at 5 years.

6.
Clin Pediatr (Phila) ; 58(2): 191-198, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30362824

RESUMO

To understand how parents and physicians make decisions regarding antibiotics and whether a potential associated risk of obesity would alter decisions, we conducted a qualitative study of parents and physicians who care for children. Parent focus groups and physician interviews used a guide focused on experience with antibiotics and perceptions of risks and benefits, including obesity. Content analysis was used to understand how a risk of obesity would influence antibiotic decisions. Most parents (n = 59) and physicians (n = 22) reported limited discussion about any risks at the time of antibiotic prescriptions. With an acute illness, most parents prioritized symptomatic improvement and chose to start antibiotics. Physicians' treatment preferences were varied. An obesity risk did not change most parents' or physicians' preferences. Given that parent-physician discussion at the time of acute illness is unlikely to change preferences, public health messaging may be a more successful approach to counter obesity and antibiotics overuse.


Assuntos
Antibacterianos , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Obesidade Pediátrica/psicologia , Médicos/psicologia , Adolescente , Adulto , Tomada de Decisão Clínica , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Padrões de Prática Médica , Risco , Adulto Jovem
7.
Contemp Clin Trials ; 73: 1-7, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30144630

RESUMO

Competency-Based Approaches to Community Health (COACH) is a randomized controlled trial of a family-centered, community-based, and individually-tailored behavioral intervention for childhood obesity among Latino pre-school children. COACH focuses on improving personal agency for health behavior change by tailoring content to overcome contextual barriers. The intervention focuses on diet, physical activity, sleep, media use, and engaged parenting. The content is individually adapted based on routine assessments of competency in specific health behaviors using a mobile health platform and novel measurement tools developed by our team. In response to these regular assessments, health coaches provide tailored health behavior change strategies to help families focus on the areas where they decide to improve the most. The intervention consists of a 15-week group-based intensive phase, with weekly sessions delivered by health coaches in community centers. Following weekly sessions, a 3-month maintenance phase of the intervention consists of twice monthly coaching calls for participants to focus on individual health goals for their families. The primary outcome of the trial is child body mass index trajectory over 1 year. Secondary outcomes include parent body mass index change, child waist circumference, child diet, child physical activity, and other psychosocial mediators of child health behavior change. The control arm consists of a school readiness intervention, delivered by the Nashville Public Library. By applying a personalized approach to child behavior change, in the setting of both family and community, COACH aims to develop sustainable solutions for childhood obesity by supporting healthy childhood growth in low-income, minority preschool children.


Assuntos
Dieta , Exercício Físico , Poder Familiar , Pais , Obesidade Pediátrica/terapia , Índice de Massa Corporal , Pré-Escolar , Família , Comportamentos Relacionados com a Saúde , Hispano-Americanos , Humanos , Tempo de Tela , Sono , Circunferência da Cintura
8.
JAMA ; 320(5): 450-460, 2018 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-30088008

RESUMO

Importance: Prevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest. Objective: To test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity. Design, Setting, and Participants: A randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017. Interventions: The intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library. Main Outcomes and Measures: The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons. Results: Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, -99.4 kcal [95% CI, -160.7 to -38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006). Conclusions and Relevance: A 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research. Trial Registration: ClinicalTrials.gov Identifier: NCT01316653.


Assuntos
Índice de Massa Corporal , Comportamentos Relacionados com a Saúde , Educação em Saúde , Pais/educação , Obesidade Pediátrica/prevenção & controle , Pré-Escolar , Dieta , Ingestão de Energia , Feminino , Humanos , Masculino , Área Carente de Assistência Médica , Grupos Minoritários , Tennessee
9.
BMC Public Health ; 18(1): 498, 2018 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-29653529

RESUMO

BACKGROUND: Expanding the use of evidence-based behavioral interventions in community settings has met with limited success in various health outcomes as fidelity and dose of clinical interventions are often diluted when translated to communities. We conducted a pilot implementation study to examine adoption of the rigorously evaluated Healthier Families Program by Parks and Recreation centers in 3 cities across the country (MI, GA, NV) with diverse socio-cultural environments. METHODS: Using the RE-AIM framework, we evaluated the program both quantitatively (pre/post surveys of health behavior change; attendance & fidelity) and qualitatively (interviews with Parks and Recreation staff and participants following the program). RESULTS: The 3 partner sites recruited a total of 26 parent-child pairs. REACH: Among the 24 participants who completed pre/post surveys, 62.5% were 25-34 years old, and average child age was 3.6 (SD 0.7) years. The distribution of self-reported race/ethnicity was 54% non-Hispanic White, 38% non-Hispanic Black, and 8% Latino. EFFECTIVENESS: Qualitative interviews with participants demonstrated increased use of the built environment for physical activity and continued use of key strategies for health behavior change. ADOPTION: Three of five (60%) collaborating sites proceeded with implementation of the program. IMPLEMENTATION: The average attendance for the 12-week program was 7.6 (SD 3.9) sessions, with 71% attending > 50% of sessions. Average fidelity for the 12 weekly sessions was 25.2 (SD 1.2; possible range 9-27). MAINTENANCE: All 3 partner sites continued offering the program after grant funding was complete. CONCLUSIONS: This pilot is among the first attempts to scale-out an evidence-based childhood obesity intervention in community Parks and Recreation centers. While this pilot was not intended to confirm the efficacy of the original trial on Body Mass Index (BMI) reduction, the effective and sustained behavior change among a geographically and ethnically diverse population with high attendance and fidelity demonstrates an effective approach on which to base future large-scale implementation efforts to reduce childhood obesity in community settings.


Assuntos
Terapia Comportamental/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prática Clínica Baseada em Evidências/organização & administração , Comportamentos Relacionados com a Saúde , Obesidade Pediátrica/prevenção & controle , Adulto , Pré-Escolar , Feminino , Humanos , Masculino , Parques Recreativos , Obesidade Pediátrica/psicologia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Inquéritos e Questionários
10.
BMC Obes ; 5: 10, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29507737

RESUMO

Background: Since 2014 the Patient Centered Outcomes Research Institute (PCORI) has funded 13 Clinical Data Research Networks (CDRNs) around the country to support large-scale comparative effectiveness research and pragmatic clinical trials. To provide guidance for future recruitment efforts among CDRNs this study described differential willingness to participate in weight-related research by body mass index (BMI) and sociodemographic characteristics. Methods: During 2014-2016 we surveyed participants from three CDRNs including the Mid-South CDRN, REACHnet, and the PaTH Network, representing 14 medical centers. Participants were eligible if they were ≥18 years, had ≥2 weights and ≥1 height in the electronic health record. Respondents were recruited face-to-face in primary care and specialty clinics, and via email from doctors' offices, patient registries and health systems' patient portals. Data was collected on willingness to participate in weight-related research (four items combined into a single scale; range 4-12), BMI, and sociodemographics (age, sex, number of people in household, marital status, education level, race, and ethnicity). Adjusted ordinal regression models tested associations between participant characteristics and willingness to participate in weight-related research. Results: Among 11,624 respondents, mean BMI was 29.6 (SD 7.6) kg/m2. Mean willingness to participate in weight-related research was 7.1 (SD 2.5). More respondents were willing to participate in studies with lower burden: healthy lifestyles (82.2%), genetics (71.3%), medication (52.2%), and surgery (22.6%). In adjusted models, higher BMI was associated with greater willingness to participate in weight-related research (OR = 1.13) as were younger age (OR = 0.98), being a woman (OR 1.59), and college education (OR = 1.72) (all p < 0.001). Conclusions: Associations among BMI, age, sex, and education level with willingness to participate in weight-related research highlight the need for future research to reduce barriers for populations less willing to engage in weight-related research.

11.
Health Res Policy Syst ; 16(1): 2, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29334972

RESUMO

BACKGROUND: This article reports on the development of a systematic approach to assess for community readiness prior to implementation of a behavioural intervention for childhood obesity. Using the Consolidated Framework for Implementation Research (CFIR), we developed research tools to evaluate local community centres' organisational readiness and their capacity to implement the intervention. METHODS: Four community Parks and Recreation centres from different states expressed interest in piloting an approach for dissemination and implementation of an evidence-based obesity prevention program for families with young children (Healthier Families). We conducted a mixed methods pre-implementation evaluation using the CFIR to evaluate the alignment of organisational priorities with the Healthier Families programme. Written surveys assessed organisational readiness for change amongst organisational leaders, recreation programmers, and staff (N = 25). Key informant interviews were conducted among staff to assess organisational readiness and with community members to assess community readiness (N = 64). Surveys were analysed with univariate statistics. Interviews were transcribed, coded and analysed using inductive and deductive methods of analysis. RESULTS: Mixed-methods analysis led to the identification of three key domains on which to assess the organisational readiness to adopt a childhood obesity intervention, namely the physical infrastructure, the knowledge infrastructure, and the social infrastructure. The most critical measure of compatibility was the social infrastructure, since obstacles in the knowledge and physical infrastructures could be overcome by the strength of social resources, including the staff's ingenuity and commitment to a healthier community. This approach guided an assessment of organisational readiness prior to community organisations adopting and preparing to disseminate an obesity prevention community-based program in a wide-range of social and environmental contexts. CONCLUSIONS: Using a comprehensive pre-implementation assessment of the knowledge, physical and social infrastructures in a community is an essential step in effective dissemination for community-based behavioural interventions. Our research found that, when evaluating readiness and alignment, a responsive social infrastructure could provide the capacity to overcome potential barriers to implementation in either the knowledge or physical infrastructures.


Assuntos
Fortalecimento Institucional , Saúde da Família , Promoção da Saúde/métodos , Pesquisa sobre Serviços de Saúde/métodos , Organizações , Obesidade Pediátrica/terapia , Características de Residência , Criança , Medicina Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Liderança , Parques Recreativos , Projetos Piloto , Pesquisa Qualitativa , Meio Social , Inquéritos e Questionários
12.
Nutr Res ; 49: 107-112, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29224793

RESUMO

Understanding the contribution of parental feeding practices to childhood obesity among Latino children is a solution-oriented approach that can lead to interventions supporting healthy childhood growth and lowering rates of obesity. The purpose of this study was to confirm the reliability and validity of the Toddler Feeding Questionnaire (TFQ) to measure parental feeding practices among a sample of Spanish-speaking parent-preschool child pairs (n = 529), and to test the hypothesis that parent characteristics of body mass index (BMI), stress, and health literacy are associated with more indulgent and less authoritative feeding practices. Standardized parent-report questionnaires were completed during baseline interviews in a randomized controlled trial of an obesity prevention intervention. The TFQ includes subscales for indulgent practices (11 items), authoritative practices (7 items), and environmental influences (6 items) with response options scored on a 5-point Likert scale and averaged. Factor analysis confirmed a three-factor structure. Internal consistency was good for indulgent (α = 0.66) and authoritative (α = 0.65) practices but lower for environmental (α = 0.48). Spearman correlation showed indulgent practices and environmental influences were associated with unhealthy child diet patterns, whereas authoritative practices were associated with a healthier child diet. Multivariate linear regression showed higher parent stress was associated with higher indulgent and lower authoritative scores; higher parent health literacy was positively associated with indulgent scores. These results indicate the TFQ is a valid measure of authoritative and indulgent parent feeding practices among Spanish-speaking parents of preschool-age children and that stress and health literacy, potentially modifiable parent characteristics, could be targeted to support healthy feeding practices.


Assuntos
Comportamento Alimentar , Letramento em Saúde , Hispano-Americanos , Relações Pais-Filho , Pais , Estresse Psicológico , Inquéritos e Questionários/normas , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pais/psicologia , Obesidade Pediátrica/etiologia , Obesidade Pediátrica/prevenção & controle , Reprodutibilidade dos Testes
14.
Health Psychol ; 37(2): 132-138, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28967775

RESUMO

OBJECTIVE: Interventions to support healthy gestational weight gain are often ineffective. The objective was to develop a model of how pregnant Latinas-who have a higher risk of poor maternal and neonatal weight-related outcomes-conceptualize healthy gestational weight gain, providing guidance for future interventions. METHOD: Ten focus groups with 50 pregnant Latinas were conducted by a native Spanish-speaking female moderator. On the basis of participant responses, we used grounded theory to inductively develop a personal conceptual framework for gestational weight gain. RESULTS: Commonly identified barriers to being active and healthy eating included negative emotions, body image, physical discomfort, low energy, and lack of motivation. Women identified sociocultural issues such as a sense of isolation from family (among immigrants) and the degree of perceived social support as important contributors to health behaviors. Two personal health schemas emerged from participant responses. The "mother-child health schema" describes the degree to which participants recognized the interrelatedness of health needs for baby and for themselves. The "attention to gestational weight gain schema" describes how a respondent's attention to and perceived importance of gestational weight gain influences health-related behaviors during pregnancy. CONCLUSIONS: Women's sociocultural and interpersonal context influence weight-related behaviors through the lens of personal health schemas. Understanding how cognitive aspects relate to traditional behavioral determinants suggests several opportunities for intervention, such as focusing on healthy behaviors instead of numerical targets for healthy weight gain. Although derived from Spanish-speaking Latin-American women, these results may also be potential leverage points for other minority groups. (PsycINFO Database Record


Assuntos
Ganho de Peso na Gestação/etnologia , Hispano-Americanos/genética , Adulto , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Apoio Social
15.
Int J Behav Nutr Phys Act ; 14(1): 157, 2017 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-29141651

RESUMO

BACKGROUND: A better understanding of the optimal "dose" of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development. METHODS: A systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2-18 years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score). RESULTS: Of the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (# sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size. CONCLUSIONS: This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose. TRIAL REGISTRATIONS: The protocol was registered on PROSPERO (Registration # CRD42016036124 ).


Assuntos
Comportamentos Relacionados com a Saúde , Obesidade Pediátrica/prevenção & controle , Obesidade Pediátrica/terapia , Adolescente , Criança , Pré-Escolar , Dieta , Exercício Físico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Public Health Nutr ; 20(18): 3275-3284, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28903804

RESUMO

OBJECTIVE: Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children's overall diet quality (HEI-2010) and BMI percentile. DESIGN: Cross-sectional baseline data (2012-2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together. SETTING: Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA. SUBJECTS: Parent-child (ages 2-5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study. RESULTS: Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children. CONCLUSIONS: Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile.


Assuntos
Índice de Massa Corporal , Dieta , Comportamento Alimentar , Peso Corporal , Desjejum , Pré-Escolar , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Almoço , Masculino , Refeições , Minnesota , Obesidade Pediátrica/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Socioeconômicos , Inquéritos e Questionários , Tennessee , População Urbana
17.
Contemp Clin Trials ; 62: 50-55, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28823925

RESUMO

PURPOSE: The objective of this study was to report survey response rates and demographic characteristics of eight recruitment approaches to determine acceptability and effectiveness of large-scale patient recruitment among various populations. METHODS: We conducted a cross sectional analysis of survey data from two large cohorts. Patients were recruited from the Mid-South Clinical Data Research Network using clinic-based recruitment, research registries, and mail, phone, and email approaches. Response rates are reported as patients who consented for the survey divided by the number of eligible patients approached. RESULTS: We contacted more than 90,000 patients and 13,197 patients completed surveys. Median age was 56.3years (IQR 40.9, 67.4). Racial/ethnic distribution was 84.1% White, non-Hispanic; 9.9% Black, non-Hispanic; 1.8% Hispanic; and 4.0% other, non-Hispanic. Face-to-face recruitment had the highest response rate of 94.3%, followed by participants who "opted-in" to a registry (76%). The lowest response rate was for unsolicited emails from the clinic (6.1%). Face-to-face recruitment enrolled a higher percentage of participants who self-identified as Black, non-Hispanic compared to other approaches (18.6% face-to-face vs. 8.4% for email). CONCLUSIONS: Technology-enabled recruitment approaches such as registries and emails are effective for recruiting but may yield less racial/ethnic diversity compared to traditional, more time-intensive approaches.


Assuntos
Sistemas de Informação em Saúde/estatística & dados numéricos , Seleção de Pacientes , Adulto , Idoso , Grupos de Populações Continentais , Estudos Transversais , Correio Eletrônico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
18.
J Nutr Educ Behav ; 49(5): 415-421.e1, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28363804

RESUMO

OBJECTIVE: To identify eating styles from 6 eating behaviors and test their association with body mass index (BMI) among adults. DESIGN: Cross-sectional analysis of self-report survey data. SETTING: Twelve primary care and specialty clinics in 5 states. PARTICIPANTS: Of 11,776 adult patients who consented to participate, 9,977 completed survey questions. VARIABLES MEASURED: Frequency of eating healthy food, frequency of eating unhealthy food, breakfast frequency, frequency of snacking, overall diet quality, and problem eating behaviors. The primary dependent variable was BMI, calculated from self-reported height and weight data. ANALYSIS: k-Means cluster analysis of eating behaviors was used to determine eating styles. A categorical variable representing each eating style cluster was entered in a multivariate linear regression predicting BMI, controlling for covariates. RESULTS: Four eating styles were identified and defined by healthy vs unhealthy diet patterns and engagement in problem eating behaviors. Each group had significantly higher average BMI than the healthy eating style: healthy with problem eating behaviors (ß = 1.9; P < .001), unhealthy (ß = 2.5; P < .001), and unhealthy with problem eating behaviors (ß = 5.1; P < .001). CONCLUSIONS AND IMPLICATIONS: Future attempts to improve eating styles should address not only the consumption of healthy foods but also snacking behaviors and the emotional component of eating.


Assuntos
Índice de Massa Corporal , Dieta/estatística & dados numéricos , Comportamento Alimentar/fisiologia , Adulto , Idoso , Análise por Conglomerados , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/fisiopatologia
19.
Matern Child Health J ; 21(5): 1156-1165, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28092060

RESUMO

Objectives Childhood obesity prevention and treatment depends, in part, on parents acting as agents of change for their children. Our objective was to measure the associations between parenting self-efficacy, parent depressive symptoms, and preschool child behaviors that support healthy growth. Methods We performed a cross-sectional analysis of baseline data from a randomized controlled trial. Parenting self-efficacy was measured using a 5-item version of the Parenting Sense of Competence (PSOC-5) scale (α= 0.8). Parent depressive symptoms were measured using the Center for Epidemiological Studies-Depression (CESD) scale. Child outcomes included diet (24 h diet recall), physical activity (accelerometry), sleep (parent-report), and media use during meals (parent-report). We performed separate multiple linear regressions for each outcome controlling for other covariates. Results The sample consisted of 601 parent-child pairs. Median child age was 4.3 (IQR 3.6-5.1) years; median child body mass index (BMI) percentile was 79.1% (IQR 66.8-88.5%); 90% of children were Hispanic/Latino, and 6% of children were non-Hispanic Black. Median parent age was 31.5 (IQR 27.6-36.0) years; 22% of parents met criteria for depression. Parenting self-efficacy (median PSOC-5 25; IQR 24-28) was negatively correlated with depressive symptoms (ρ = -0.16; p < 0.001). In adjusted models, higher parenting self-efficacy was associated with duration of child's sleep and fewer meals eaten in front of a TV (p < 0.001). There was a significant interaction of parenting self-efficacy and parental depressive symptoms on child sleep duration (p < 0.001). Parenting self-efficacy and depressive symptoms were not significantly associated with child physical activity or child diet. Conclusions In this minority population, higher parenting self-efficacy was associated with longer child sleep and fewer meals in front the TV, but parent depressive symptoms mitigated that protective effect for child sleep duration.


Assuntos
Depressão/etnologia , Grupos Minoritários/psicologia , Pais/psicologia , Pobreza/psicologia , Autoeficácia , Adulto , Afro-Americanos/etnologia , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Grupos Minoritários/estatística & dados numéricos , Análise Multivariada , Poder Familiar/etnologia , Poder Familiar/psicologia , Obesidade Pediátrica/epidemiologia , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Autorrelato , Televisão/estatística & dados numéricos , Tennessee/epidemiologia , Tennessee/etnologia
20.
Prev Med ; 95 Suppl: S68-S74, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27939263

RESUMO

Crime and safety are commonly cited barriers to physical activity (PA). We had three objectives, 1) describe the association between objective crime measures and perceptions of crime, 2) analyze the relationships between each type of crime and accelerometer-measured physical activity in caretakers and young children (ages 3-5years), and 3) explore for early gender differences in the relationship between crime and physical activity in young children. Data are from the cross-sectional baseline data of an ongoing randomized controlled trial in Nashville, Tennessee spanning September 2012 through May 2014. Data was analyzed from 480 Hispanic dyads (adult caretaker and 3-5year old child). Objective crime rate was assessed in ArcGIS and perception of crime was measured by caretaker agreement with the statement "The crime rate in my neighborhood makes it unsafe to go on walks." The primary outcome was accelerometer-measured physical activity over seven consecutive days. Objective and perceived crime were significantly positively correlated. Caretaker vigorous PA was significantly related to perceptions of crime; however, its relationship to objective crime was not significant. Child PA was not significantly related to caretaker perceptions of crime. However, interactions suggested that the relationship between crime rate and PA was significantly more negative for girls than for boys. Objective and subjective measures of crime rate are expected to be important correlates of PA, but they appear to have complex relationships that are different for adults than they are for young children, as well as for young girls compared to boys, and research has produced conflicting findings.


Assuntos
Acelerometria/métodos , Cuidadores/psicologia , Crime , Planejamento Ambiental , Exercício Físico , Hispano-Americanos , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Características de Residência , Segurança , Fatores Sexuais , Tennessee
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