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

Sociodemographic factors are related to hair sample collection in economically marginalized families

Aim: Limited research has explored factors influencing participants' decisions to consent to and complete hair sample collection. This study examined the relationships of sociodemographics, perceived stress and coping with hair sample collection among children aged 3-5 years and parents.Research design & methods: Data were analyzed from 188 parent-child dyads. Among these, 78% of parents provided consent to hair sample collection. Hair samples were collected from 81% children and 68% parents.Results: Parents who provided consent reported higher levels of stress and used more avoidant coping strategies compared with those who did not. Parents who provided a hair sample engaged in less problem-focused coping. Children who were girls, non-Hispanic and White had higher odds of completing hair sample collection. Additionally, children were more likely to complete hair sample collection if their parents were married, employed full-time, or had an annual family income of ≥$20,000. Pregnant women and full-time employed parents also had higher odds of completing hair sample collection.Conclusion: The study identified important sociodemographic factors that may influence hair sample collection in research. To improve participation, tailored approaches such as at-home self-collection, sensitive hair cutting approaches to maintain participants' hair style, and addressing participants' unique barriers are recommended.

Effects of the dyadic FirstStep2Health intervention on parents' behaviour and anthropometric outcomes: a secondary analysis of a cluster randomised trial

OBJECTIVES

This study aimed to examine the preliminary efficacy of the FirstStep2Health versus usual care control on improving parents' lifestyle behaviours (moderate to vigorous physical activity, screen time, fruit/vegetable and fibre intake, skin carotenoids), nutrition and physical activity knowledge, self-efficacy, support, parenting style, feeding practices, home environment, anthropometric outcomes (body mass index, % body fat) and blood pressure from baseline to postintervention after adjusting for random cluster effects.

DESIGN

A cluster randomised controlled trial with 10 Head Start daycare centres (five intervention, five control) was conducted using computer-generated randomisation after baseline data collection.

SETTING

US Head Start daycare centres.

PARTICIPANTS

95 parent-child dyads (53 intervention, 42 control).

INTERVENTIONS

The 16-week, dyadic, FirstStep2Health intervention included: (1) a daycare-based child programme on healthy mindful eating and physical activity, (2) child letters to parents to connect school learning with home practice, (3) social media-based parent programme to assist parents to promote healthy eating and physical activity at home, (4) virtual group parent meetings via Zoom on topics related to healthy eating and physical activity and (5) weekly motivational messages to increase parental motivation to build a healthy home environment.

RESULTS

Mixed-effect models were used to examine intervention effects, adjusting for baseline outcome and cluster effects at the daycare and classroom levels. Intervention parents engaged in more moderate to vigorous physical activity (B=0.49, p=0.874) postintervention than controls, although not significantly. However, intervention parents showed significantly higher nutrition knowledge (B=0.87, p=0.009), physical activity knowledge (B=0.95, p=0.049), nutrition self-efficacy (B=0.74, p=0.025) and physical activity self-efficacy (B=0.86, p=0.013) compared with controls at postintervention. Fibre intake was also significantly higher (B=2.99, p=0.049), and intervention parents had lower % body fat (B=-2.56, p=0.005) and systolic blood pressure (B=-10.98, p=0.005) postintervention. No significant effects were found for fruits/vegetables intake, parental support for healthy behaviours, home physical activity environment or authoritative parenting style.

CONCLUSIONS

Future endeavours to proactively engage parents in a dyadic childhood obesity prevention approach such as the FirstStep2Health intervention are warranted to improve outcomes among both children and parents.

TRIAL REGISTRATION NUMBER

NCT04164277.

The Overflow Effects of Movement Behaviour Change Interventions for Children and Adolescents: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND

Considering the finite time within a 24-h day, the distribution of time spent on movement behaviours has been found to be associated with health outcomes.

OBJECTIVES

This systematic review and meta-analysis aimed to summarise and evaluate the overflow effects of interventions targeting a single behaviour (physical activity, sedentary behaviour/screen time, or sleep) on other non-targeted behaviours among children and adolescents.

METHODS

Six databases (MEDLINE [Ovid], PsycINFO [ProQuest], EMBASE [Ovid], PubMed, Web of Science and SPORTDiscus [EBSCO]) were searched for relevant studies published before 13 May, 2024. Randomised controlled trials and clustered randomised controlled trials that targeted a single behaviour and also assessed the effects on non-targeted behaviours, comprised of healthy children under the age of 18 years, were included. Movement behaviours can be measured either objectively or subjectively. The revised Cochrane risk-of-bias tool for randomised trials was adopted to evaluate the risk of bias.

RESULTS

A total of 102 studies with 45,998 participants from 21 countries were identified, and 60 of them with 26,183 participants were incorporated into the meta-analysis. The meta-analysis demonstrated that physical activity interventions led to a reduction in the proportion of each day spent in sedentary behaviour (mean difference =  - 0.95% of wear time, 95% confidence interval - 1.44, - 0.45, I2 = 39%). Sedentary behaviour interventions resulted in increased standing time (mean difference = 3.87%, 95% confidence interval 1.99, 5.75, I2 = 0%). Interventions targeting screen time did not yield changes in physical activity or sleep. The findings on the effectiveness of sleep interventions on non-targeted behaviours and of physical activity interventions on sleep were inconclusive.

CONCLUSIONS

Overall, the findings suggested that interventions aimed at increasing physical activity or reducing sedentary behaviour had overflow effects on non-targeted behaviours, but the effect sizes were small. Additional evidence is needed to reach definitive conclusions regarding the impact of behaviour change interventions on sleep and of the overflow effects of sleep interventions.

Coping strategies mediated the relationship between perceived stress and hair cortisol among socioeconomically marginalized parents

Objective

This study aimed to (1) examine coping strategies and their relationship with demographics, perceived stress, and hair cortisol; and (2) explore whether coping partially mediated the relationship between perceived stress and hair cortisol.

Methods

Baseline data from 191 socioeconomically marginalized parents enrolled in two community-based clinical trials were used. The IBM SPSS Statistics Version 27 and Mplus Version 8 were used for data analyses.

Results

Parents' engagement in various coping strategies differed by age, ethnicity, race, marital status, education level, and number of children living in the household. Parents' use of problem-focused (instrumental support, planning), emotion-focused (venting, self-blame), and avoidant coping (self-distraction, denial, behavioral disengagement) increased from having low to moderate stress. However, when perceived stress increased from moderate to high, their use of emotion-focused and avoidant coping increased significantly, but problem-focused coping did not. Emotion-focused coping lowered the influence of perceived stress on hair cortisol, while avoidant coping increased the relationship between perceived stress and hair cortisol.

Conclusions

Although needing future investigation with longitudinal studies, the results suggest the need of promoting adaptive emotion-focused coping (emotional support, venting, and humor) to help socioeconomically marginalized parents manage their appraised overwhelming and uncontrollable stressors of food, house, and income insecurity.

Baseline higher hair cortisol moderated some effects in a healthy lifestyle intervention

Children and families from socioeconomically marginalized background experience high levels of stress, especially persistent chronic stress, due to unstable housing, employment, and food insecurity. Although consistent evidence supports a stress-obesity connection, little research has examined the potential moderation role of stress in childhood obesity interventions. Therefore, this study aimed to explore how chronic stress (hair cortisol) moderated the effects of a healthy lifestyle intervention on improving behavioral and anthropometric outcomes among 95 socioeconomically marginalized parent-child dyads. Data were collected in a cluster randomized controlled trial with 10 Head Start childcare centers being randomized into intervention and control. The child sample (3-5 years old) included 57.9 % female, 12.6 % Hispanic, and 40.0 % Black. For the parents, 91.6 % were female, 8.4 % were Hispanic, 36.8 % were Black, and 56.8 % were single. Parent baseline hair cortisol significantly moderated the intervention effects on child fruit intake (B = -1.56, p = .030) and parent nutrition self-efficacy (B = 1.49, p = .027). Specifically, higher parent hair cortisol lowered the increases in child fruit intake but improved the increases in parent nutrition self-efficacy in the intervention group compared to control group. Child higher baseline hair cortisol was significantly associated with the decreases in child fruit intake (B = -0.60, p = .025). Child baseline hair cortisol significantly moderated the intervention effects on parent physical activity (PA) self-efficacy (B = -1.04, p = .033) and PA parental support (B = -0.50, p = .016), with higher child hair cortisol decreasing the improvement on these two outcomes in the intervention group compared to control group. Results from this study shed lights on the moderation role of chronic stress on impacting healthy lifestyle intervention effects. Although needing further investigation, the adverse effects of chronic stress on intervention outcomes should be considered when developing healthy lifestyle interventions for preschoolers and their families.