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Yoong SL, Turon H, Wong CK, Grady A, Pearson N, Sutherland R. A rapid review of the scalability of interventions targeting obesity prevention in infants. Health Promot J Austr 2024; 35:365-370. [PMID: 37343544 DOI: 10.1002/hpja.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
ISSUE ADDRESSED Obesity in children is one of the most significant public health issues globally. Given the high prevalence of overweight and obesity in children, there is a need to identify effective obesity prevention efforts that can be delivered at scale to improve child health. We aimed to (i) identify obesity prevention interventions targeted at children aged 0-2 that have been scaled-up, and their relative efficacy compared to their pre-scale trial, (ii) describe adaptations made, and the extent to which factors related to scalability have been reported. METHODS We conducted a rapid review of pre-scale randomised controlled trials targeting nutrition, physical activity and obesity prevention in infants, and calculated the relative effect size for relevant outcomes in the corresponding scaled up trial. We documented adaptations made to the pre-scale trial for scale up, and explored how different components of scalability had been reported according to the Intervention Scalability Assessment Tool. RESULTS Of the 14 identified pre-scale trials, only one formal evaluation of the scale-up trial was identified. For body mass index, <10% of the effect was retained, however for nutrition and behavioural outcomes, the proportion of effect retained varied from -11.1% to 144%. Significant adaptations to modality were made in the scaled up trial primarily to reduce cost and increase reach of the intervention. Reporting of scalability components varied across the 14 trials, with only one trial reporting information for all assessed components. CONCLUSIONS The majority of effective interventions targeting obesity prevention in infants have not been evaluated in a scaled up form. The magnitude of effect retained for the single trial that was scaled up was variable. In general, reporting of components of scalability was sub-optimal. SO WHAT?: The findings suggest that there is substantial need for the development and rigorous evaluation of obesity prevention interventions in children aged 0-2 which are amenable for scale.
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Affiliation(s)
- Sze Lin Yoong
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, Australia
| | - Heidi Turon
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, Australia
| | - Carrie K Wong
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Alice Grady
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, Australia
| | - Nicole Pearson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, Australia
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Blazé KSR, Xu H, Buchanan L, Baur LA, Wen LM. Parental smoking in the first two years of a child's life and its associations with breastfeeding. Aust N Z J Obstet Gynaecol 2024; 64:28-35. [PMID: 37463865 DOI: 10.1111/ajo.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Exclusive breastfeeding for the first 6 months followed by ongoing breastfeeding to 12 months and beyond is associated with multiple benefits for both mother and child. Maternal smoking is associated with a reduction in breastfeeding. Little is known about the effect of partner smoking on breastfeeding. AIMS This study explores the smoking behaviour of mothers and their partners in the first two years of a child's life and its associations with breastfeeding practice. MATERIALS AND METHODS We performed a secondary data analysis using survey data on 1155 mothers from their third trimester of pregnancy and at six, 12 and 24 months after delivery. Survey questions included smoking status of both mother and partner and breastfeeding intention and practice. Logistic regression models were conducted at each time point. FINDINGS Where the mother or both parents smoke, babies were less likely to be breastfed at six months of age (adjusted odds ratio (aOR) 0.29, 95% CI: 0.13-0.66) compared with families where neither parent smoked. Non-smoking mothers with smoking partners were less likely to intend to breastfeed (aOR 0.29, 95% CI: 0.11-0.82) and their babies were less likely to be breastfed at six and 12 months of age (aOR 0.64, 95% CI: 0.42-0.98 and 0.64, 95% CI: 0.43-0.95 respectively). There was no difference in breastfeeding behaviour between smoking and non-smoking parents at 24 months. CONCLUSION Smoking parents are less likely to breastfeed their babies at ages six and 12 months. Breastfeeding promotion should target both smoking mothers and smoking partners.
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Affiliation(s)
- Katharine S R Blazé
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- Women's and Children's Unit, Victorian Aboriginal Health Service, Fitzroy, Melbourne, Victoria, Australia
- The Centre for Community Child Health, The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
- Victorian Forensic Paediatric Medical Service (VFPMS), The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Limin Buchanan
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH) and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH) and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, Camperdown, Sydney, New South Wales, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH) and the Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
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House E, Xu H, Taki S, Denney‐Wilson E, Baur L, Wen LM. Mothers' sociodemographic factors and use of health professionals for child feeding advice. MATERNAL & CHILD NUTRITION 2024; 20:e13586. [PMID: 37932246 PMCID: PMC10750020 DOI: 10.1111/mcn.13586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
This study examined sociodemographic factors associated with mothers seeking child feeding advice from health professionals (HPs). Cross-sectional analysis of survey data from linked randomized controlled trials was conducted. Surveys asked which sources of feeding information mothers used when their child was 6 months and 5 years old. Logistic regression was used to examine associations between sociodemographic characteristics and use of information from HPs. Here, 947 and 405 mothers completed 6-month and 5-year surveys, respectively. At 6 months, multiparous mothers were less likely to seek advice from child and family health nurses (CFHNs) (adjusted odds ratio [AOR]: 0.558, 95% confidence interval [95% CI]: 0.416-0.749) and other HPs (AOR: 0.706, 95% CI: 0.542-0.919), unmarried mothers were less likely to seek advice from other HPs (AOR: 0.582, 95% CI: 0.342-0.990). At 5 years, mothers with household income ≥$80,000 p.a. were less likely to seek advice from CFHNs (AOR: 0.514, 95% CI: 0.302-0.875) and working mothers less likely to seek advice from general practitioners (GPs) (AOR: 0.581, 95% CI: 0.374-0.905). Mothers born in Australia were less likely to seek information from CFHNs (AOR: 0.462, 95% CI: 0.257-0.833) and GPs (AOR: 0.431, 95% CI: 0.274-0.677). There was a greater likelihood that multiparous mothers (AOR: 2.114, 95% CI: 1.272-3.516) and mothers of children whose fathers had not attended university (AOR: 2.081, 95% CI: 1.256-3.449) had never sought advice from CFHNs, and that mothers who had not attended university (AOR: 1.769, 95% CI: 1.025-3.051), multiparous (AOR: 1.831, 95% CI: 1.105-3.035) and employed (AOR: 2.058, 95% CI: 1.135-3.733) mothers had never sought advice from other HPs. Understanding sociodemographic factors associated with seeking child feeding advice from HPs may inform priorities for engaging families in health promotion.
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Affiliation(s)
- Eve House
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH‐Translate)SydneyNSWAustralia
- Sydney Institute for WomenChildren and Their Families, Sydney Local Health DistrictSydneyNSWAustralia
| | - Huilan Xu
- Sydney Institute for WomenChildren and Their Families, Sydney Local Health DistrictSydneyNSWAustralia
- Health Promotion UnitPopulation Health Research & Evaluation Hub, Sydney Local Health DistrictSydneyNSWAustralia
| | - Sarah Taki
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH‐Translate)SydneyNSWAustralia
- Sydney Institute for WomenChildren and Their Families, Sydney Local Health DistrictSydneyNSWAustralia
- Health Promotion UnitPopulation Health Research & Evaluation Hub, Sydney Local Health DistrictSydneyNSWAustralia
| | - Elizabeth Denney‐Wilson
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH‐Translate)SydneyNSWAustralia
- Sydney Institute for WomenChildren and Their Families, Sydney Local Health DistrictSydneyNSWAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNSWAustralia
| | - Louise Baur
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH‐Translate)SydneyNSWAustralia
- Specialty of Child and Adolescent HealthSydney Medical School, Faculty of Medicine and Health, The University of SydneySydneyNSWAustralia
| | - Li M. Wen
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH‐Translate)SydneyNSWAustralia
- Sydney Institute for WomenChildren and Their Families, Sydney Local Health DistrictSydneyNSWAustralia
- Health Promotion UnitPopulation Health Research & Evaluation Hub, Sydney Local Health DistrictSydneyNSWAustralia
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Xu H, Buchanan L, Wang Y, Phongsavan P, Baur LA, Wen LM. Associations of dietary and sedentary behaviours of pregnant women with their children's birth weight: findings from the CHAT trial in Australia. Public Health Nutr 2023; 26:2859-2867. [PMID: 37842791 PMCID: PMC10755386 DOI: 10.1017/s1368980023002161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To examine the associations of pregnant women's dietary and sedentary behaviours with their children's birth weight. DESIGN Secondary data analysis was conducted using data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone, conducted in Australia. Information on mothers' socio-demographics, dietary and sedentary behaviours during pregnancy was collected by telephone survey at the third trimester. Birth weight data were extracted from the child's health record book. Multinomial logistic regression models were built to examine the associations of pregnant women's dietary and sedentary behaviours with children's birth weight. SETTING Participating families. PARTICIPANTS Pregnant women and their children. RESULTS A total of 1132 mother-child dyads were included in the analysis. The majority of infants (87 %, n 989) were of normal birth weight (2500 g to <4000 g), 4 % (n 50) had low birth weight (<2500 g) and 8 % (n 93) had macrosomia (≥4000 g). Mothers who ate processed meat during pregnancy were more likely to have macrosomia (adjusted risk ratio (ARR) 1·80, 95 % CI (1·12, 2·89)). The risk of macrosomia decreased as the number of dietary recommendations met by mothers increased (ARR 0·84, 95 % CI (0·71, 0·99)). Children's birth weight was not associated with mothers' sedentary time. Children's low birth weight was not associated with mothers' dietary and sedentary behaviours during pregnancy. CONCLUSION Maternal consumption of processed meat during pregnancy was associated with an increased risk of macrosomia. Increasing number of dietary recommendations met by mothers was associated with a lower risk of macrosomia. The findings suggested encouraging pregnancy women to meet dietary recommendation will benefit children's birth weight.
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Affiliation(s)
- Huilan Xu
- Health Promotion, Population Health Research & Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Limin Buchanan
- Health Promotion, Population Health Research & Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
| | - Yong Wang
- Health Promotion, Population Health Research & Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Li Ming Wen
- Health Promotion, Population Health Research & Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
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Wen LM, Xu H, Phongsavan P, Rissel C, Hayes A, Taki S, Buchanan L, Simone L, Moreton R, Baur LA. Twelve-month effectiveness of telephone and SMS support to mothers with children aged 2 years in reducing children's BMI: a randomized controlled trial. Int J Obes (Lond) 2023; 47:791-798. [PMID: 37087468 PMCID: PMC10121422 DOI: 10.1038/s41366-023-01311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND/OBJECTIVES Few quality intervention studies have assessed whether a combined telephone and short message service (SMS) intervention to mothers is effective in reducing BMI and obesity risk behaviors of children at 3 years of age. This study aimed to assess effectiveness of telephone and SMS support in reducing children's body mass index (BMI) and obesity risk behaviors. SUBJECTS/METHODS A randomized controlled trial (RCT) with 662 women of 2-year-old children (with the proportion of overweight and obesity being similar to the general population) was conducted in Sydney, Australia, March 2019-October 2020. The mothers in the intervention group received three telephone support sessions plus SMS messages and mailed-intervention-booklets over a 12 months period i.e., 24-26, 28-30, and 32-34 months of the child's age. Mothers in the control group received usual care and two mailed booklets on information not related to the intervention. The primary outcome was child's BMI at 3 years of age. Secondary outcomes were children's dietary and activity behaviors. All outcome measures were based on mothers' self-report using standardized tools due to COVID-19 pandemic restrictions. RESULTS 537 (81%) mothers completed the post-intervention assessment at 3 years with only 470 (71%) children having weight and height measures. Multiple imputation analysis showed no statistically significant difference in mean BMI between the groups. Children in the intervention group were more likely not to eat in front of the TV [AOR 1.79 (95% CI 1.17-2.73), P = 0.008], more likely to meet the dietary recommendations [AOR 1.73 (95% CI 0.99-3.02), P = 0.054] and meet the activity recommendations [AOR 1.72 (95% CI 1.11-2.67), P = 0.015] than those in the control group respectively. Among those with an annual household income ( CONCLUSIONS A staged telephone and SMS support intervention to mothers with children aged 2 years was associated with improved dietary and activity behaviors. The intervention was also associated with reduced children's BMI at age 3 years only for those from lower income households. TRIAL REGISTRATION The trial is registered with the Australian Clinical Trial Registry (ACTRN12618001571268).
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Affiliation(s)
- Li Ming Wen
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia.
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia.
| | - Huilan Xu
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- College of Medicine and Public Health, Rural and Remote Health, South Australia and Northern Territory, Flinders University, Bedford Park, SA, Australia
| | - Alison Hayes
- Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
| | - Sarah Taki
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
| | - Limin Buchanan
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa Simone
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Renee Moreton
- Population Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Ayre SK, White MJ, Harris HA, Byrne RA. 'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families. MATERNAL & CHILD NUTRITION 2023; 19:e13484. [PMID: 36808876 PMCID: PMC10019066 DOI: 10.1111/mcn.13484] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.
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Affiliation(s)
- Susannah K. Ayre
- Woolworths Centre for Childhood Nutrition Research, Faculty of HealthQueensland University of TechnologySouth BrisbaneQueenslandAustralia
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Melanie J. White
- School of Psychology & Counselling, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Holly A. Harris
- Department of Psychology, Education and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
| | - Rebecca A. Byrne
- Woolworths Centre for Childhood Nutrition Research, Faculty of HealthQueensland University of TechnologySouth BrisbaneQueenslandAustralia
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
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Cheng Y, Xu H, Rissel C, Phongsavan P, Buchanan L, Taki S, Hayes A, Baur LA, Wen LM. Estimation and feasibility of correction modelling for mother-reported child height and weight at 2 years using data from the Australian CHAT trial. Sci Rep 2022; 12:21353. [PMID: 36494386 PMCID: PMC9734091 DOI: 10.1038/s41598-022-25388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Correction modelling using reported BMI values has been employed in adolescent and adult populations to improve the accuracy of self-reporting. This study aimed to evaluate the feasibility of establishing correction modelling for mother-reported child height and weight at 2 years using data from an Australian trial in 2019. Correction modelling for BMI was conducted using mother-reported and objectively measured height and weight of 2-year-olds. Mother-reported height, weight and BMI values of 2-year-old children were adjusted based on objectively measured anthropometric data using linear regression models. 'Direct' and 'indirect' corrections were applied to the correction of BMI values. We defined the direct collection as using corrected BMI values that were predicted directly by the model and indirect correction as using corrected weight and height values to calculate corrected BMI values. Corrected BMI values via the indirect correction showed higher sensitivity or similar specificity in predicting overweight status, compared to the direct correction, and also showed higher agreement with measured values compared to the mother-reported measures. Corrected self-reported measures via an indirect correction had a better accuracy and agreement with the objectively measured data in the BMI values and classification of overweight, compared to the mother-reported values.
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Affiliation(s)
- Yan Cheng
- grid.489063.00000 0000 8855 3435Family Planning NSW, Sydney, Australia
| | - Huilan Xu
- grid.410692.80000 0001 2105 7653Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Chris Rissel
- grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Rural and Remote Health SA and NT, Flinders University, Darwin, Australia
| | - Philayrath Phongsavan
- grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Limin Buchanan
- grid.410692.80000 0001 2105 7653Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah Taki
- grid.410692.80000 0001 2105 7653Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, Australia
| | - Alison Hayes
- grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, Australia
| | - Louise A. Baur
- grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, Australia ,grid.1013.30000 0004 1936 834XSpecialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Li Ming Wen
- grid.410692.80000 0001 2105 7653Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, Australia
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Tran HNQ, Killedar A, Tan EJ, Moodie M, Hayes A, Swinburn B, Nichols M, Brown V. Cost-effectiveness of scaling up a whole-of-community intervention: The Romp & Chomp early childhood obesity prevention intervention. Pediatr Obes 2022; 17:e12915. [PMID: 35301814 PMCID: PMC9540361 DOI: 10.1111/ijpo.12915] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Given the high prevalence of early childhood overweight and obesity, more evidence is required to better understand the cost-effectiveness of community-wide interventions targeting obesity prevention in children aged 0-5 years. OBJECTIVES To assess the cost-effectiveness of the Romp & Chomp community-wide early childhood obesity prevention intervention if delivered across Australia in 2018 from a funder perspective, against a no-intervention comparator. METHODS Intervention costs were estimated in 2018 Australian dollars. The annual Early Prevention of Obesity in Childhood micro-simulation model estimated body mass index (BMI) trajectories to age 15 years, based on end of trial data at age 3.5 years. Results from modelled cost-effectiveness analyses were presented as incremental cost-effectiveness ratios (ICERs): cost per BMI unit avoided, and cost per quality-adjusted life year (QALY) gained at age 15 years. RESULTS All Australian children aged 0-5 years (n = 1 906 075) would receive the intervention. Total estimated intervention cost and annual cost per participant were AUD178 million and AUD93, respectively, if implemented nationally. The ICERs were AUD1 126 per BMI unit avoided and AUD26 399 per QALY gained (64% probability of being cost-effective measured against a AUD50 000 per QALY threshold). CONCLUSIONS Romp & Chomp has a fair probability of being cost-effective if delivered at scale.
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Affiliation(s)
- Huong Ngoc Quynh Tran
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Anagha Killedar
- Faculty of Medicine and Health, School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Eng Joo Tan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Alison Hayes
- Faculty of Medicine and Health, School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,School of Population Health, University of AucklandAucklandNew Zealand
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia,Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin UniversityGeelongVictoriaAustralia
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10
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Wen LM, Xu H, Rissel C, Kerr E, Buchanan L, Taki S, Phongsavan P, Chua RK, Hua M, Wardle K, Simone L, Hayes A, Baur LA. Demographic Predictors of Mothers' Willingness to Vaccinate Young Children Against COVID-19, Get Tested and Isolate: A Cross-Sectional Survey Before and During the Greater Sydney Lockdown 2021, Australia. Front Public Health 2022; 10:904495. [PMID: 35712281 PMCID: PMC9197072 DOI: 10.3389/fpubh.2022.904495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background and ObjectivesHaving a COVID-19 vaccination, getting tested, and self-isolating if symptomatic are some of the most important mitigation strategies for preventing the spread of COVID-19. This study aimed to investigate whether demographic factors are associated with mothers' willingness to vaccinate their 4-year-old children against COVID-19 if a suitable vaccine becomes available or to get tested and self-isolate if they themselves have COVID-19 symptoms and whether the willingness could be influenced by the Greater Sydney lockdown 2021.MethodsA cross-sectional telephone survey was conducted between 24th February and 26th October 2021. Questions from the NSW Adult Population Health Survey and from previously published studies were used to assess family demographics, mothers' willingness to vaccinate their young children, and willingness to get tested and self-isolate if symptomatic. The survey involved 604 mothers of children aged 4 years who participated in an existing trial in Sydney, Australia.ResultsMothers were more willing to vaccinate their children when the child's father had a tertiary education or higher, with an adjusted odds ratio (AOR) of 2.60 (95% CI 1.67–4.04). Mothers who were older than 30 years or who completed the survey during the lockdown were more willing to get tested if symptomatic, with AOR 2.50 (95% CI 1.17–5.36) and AOR 3.36 (95% CI 1.41–8.02), respectively. Mothers who were married or had de-facto partners were more willing to self-isolate if symptomatic [AOR 17.15 (95% CI 3.56–82.65)].ConclusionFathers' educational level, mothers' age, and marital status were associated with mothers' willingness to vaccinate their young children if a suitable vaccine were available, to get tested, and self-isolate if symptomatic respectively. The promotion of mitigation strategies for tackling the COVID-19 pandemic needs to take into account specific family demographics.
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Affiliation(s)
- Li Ming Wen
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Li Ming Wen ; orcid.org/0000-0003-1381-4022
| | - Huilan Xu
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin Kerr
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Limin Buchanan
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Taki
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Reuel Kangjie Chua
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Myna Hua
- Health Promotion Service, Population Health, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Karen Wardle
- Health Promotion Service, Population Health, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa Simone
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Alison Hayes
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Louise A. Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Wen LM, Xu H, Taki S, Buchanan L, Rissel C, Phongsavan P, Hayes AJ, Bedford K, Moreton R, Baur LA. Effects of telephone support or short message service on body mass index, eating and screen time behaviours of children age 2 years: A 3-arm randomized controlled trial. Pediatr Obes 2022; 17:e12875. [PMID: 34821063 PMCID: PMC9285384 DOI: 10.1111/ijpo.12875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few randomized controlled trial (RCT) interventions targeted children's early risk behaviours using telephone or short message service (SMS) support. OBJECTIVE To evaluate the effectiveness of telephone or SMS early intervention focusing on mothers' behaviours starting from late pregnancy to improve BMI, and eating and screen time behaviours of children aged 2 years in comparison with the control group. METHODS A 3-arm RCT was conducted in Australia, 2017-2019. Two arms involved the interventions using nurse-led telephone or SMS support, delivered in nine stages from late pregnancy to age 2 years. The third arm was control. The primary outcome was children's objectively measured BMI and BMI z-score at 2 years. Secondary outcomes included child eating and screen time behaviours as reported by parents at 2 years. RESULTS At 2 years, 797 mother-child dyads (69%) completed the telephone survey with 666 (58%) completing weight and height measurements. The study found no statistically significant difference in BMI between the groups. The mean BMI for telephone support was 16.93 (95% CI: 16.73 to 17.13), for SMS 16.92 (95% CI: 16.73 to 17.11) or for control 16.95 (95% CI: 16.73 to 17.16) with a difference of -0.02 (95% CI: -0.31 to 0.27, p = 0.907) in telephone versus control, and a difference of -0.03 (95% CI: -0.30 to 0.24, p = 0.816) in SMS versus control. Telephone support was associated with higher odds of no bottle at bedtime (adjusted odds ratio [AOR]: 2.99; 95% CI: 2.01 to 4.47), family meals (AOR: 2.05; 95% CI: 1.26 to 3.33), drinking from a cup (AOR: 1.89; 95% CI: 1.24 to 2.88), less screen time (<1 h/day) (AOR: 1.56; 95% CI: 1.10 to 2.23) and not eating dinner in front of the TV (AOR: 1.50; 95% CI: 1.09 to 2.06). SMS support was also associated with higher odds of no bottle at bedtime (AOR 2.30, 95% CI: 1.58 to 3.33) than the control. CONCLUSION The telephone or SMS support intervention had no significant effects on BMI, but was effective in increasing no bottle use at bedtime. Telephone support showed more effects than SMS on reducing screen time and eating behaviours.
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Affiliation(s)
- Li Ming Wen
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia,Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia,Sydney Institute for Women, Children and Their Families, Sydney Local Health DistrictCamperdownAustralia,Charles Perkins Centre, The University of SydneyCamperdownAustralia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia
| | - Sarah Taki
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia,Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia
| | - Limin Buchanan
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia,Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia,Sydney Institute for Women, Children and Their Families, Sydney Local Health DistrictCamperdownAustralia
| | - Chris Rissel
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia
| | - Philayrath Phongsavan
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,Charles Perkins Centre, The University of SydneyCamperdownAustralia
| | - Alison J. Hayes
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia
| | - Karen Bedford
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia
| | - Renee Moreton
- Population HealthSydney Local Health DistrictCamperdownAustralia
| | - Louise A. Baur
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia,Charles Perkins Centre, The University of SydneyCamperdownAustralia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of SydneyCamperdownAustralia
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12
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Xu H, Marshall S, Jones JM, Phongsavan P, Wen LM. Modifiable predictors of breastfeeding status and duration at 6 and 12 months postpartum. Birth 2022; 49:97-106. [PMID: 34278597 DOI: 10.1111/birt.12578] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/14/2020] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breastfeeding practices are determined by complex multilevel factors. This study assessed pregnant women's knowledge of breastfeeding and intention to breastfeed and investigated modifiable predictors for breastfeeding status (exclusive or any breastfeeding) and duration at 6 and 12 months postpartum. MATERIALS AND METHODS Longitudinal data were extracted from a trial in Sydney, Australia, 2017-19. Women (n = 1155) were recruited from antenatal clinics and followed up for telephone interviews at baseline (third trimester), then at 6 and 12 months postpartum. Data collected included mothers' demographics; knowledge of breastfeeding and intention to breastfeed; work status; support from caregivers; breastfeeding environment; breastfeeding status and duration. Multiple logistic and Cox regression models were built to identify predictors for breastfeeding. RESULTS At baseline, most mothers knew the recommendation to exclusively breastfeed until 6 months (66%) and the benefits (65%). The modifiable predictors for breastfeeding duration at 12 months included the following: mothers' knowledge of the recommendation (adjusted hazard ratio (AHR) 0.73, 95% confidence interval (CI) 0.60-0.90) and the benefits of exclusive breastfeeding (AHR 0.68, 95% CI 0.55-0.82), intention to meet the recommendation (AHR 0.76, 95% CI 0.63-0.93), and intention to breastfeed for two years (AHR 0.38, 95% CI 0.27-0.52) measured at baseline; mothers not working or studying (AHR 0.70, 95% CI 0.55-0.89), having support from other caregivers (AHR 0.64, 95% CI 0.43-0.96), and having breastfeeding women around (AHR 0.80, 95% CI 0.65-0.98) measured at 6 months. CONCLUSIONS Support for women to meet the breastfeeding recommendations should commence during pregnancy and focus on breastfeeding education and enabling environments.
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Affiliation(s)
- Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Marshall
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Camperdown, NSW, Australia
| | - Jennifer M Jones
- Child and Family Health Nursing, Sydney Local Health District, Camperdown, NSW, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Li Ming Wen
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia.,Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Camperdown, NSW, Australia.,Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia
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13
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Ekambareshwar M, Xu H, Rissel C, Baur L, Taki S, Mihrshahi S, Wen LM. Participants' Engagement With Telephone Support Interventions to Promote Healthy Feeding Practices and Obesity-Protective Behaviours for Infant Obesity Prevention. Front Endocrinol (Lausanne) 2022; 13:868944. [PMID: 35586630 PMCID: PMC9108251 DOI: 10.3389/fendo.2022.868944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Participant engagement with program interventions is vital to support intended behaviour changes and outcomes. The aim of this research was to investigate participant engagement with the Communicating Healthy Beginnings Advice by Telephone (CHAT) program, an early childhood obesity prevention program that included interventions for promoting healthy infant feeding practices and obesity-protective behaviours via telephone, and whether engagement with the telephone support program varied by participants' sociodemographic characteristics. METHODS This study used de-identified CHAT program data of participants who received the interventions via telephone. Data analysed included 1) participant engagement in telephone support from late pregnancy to 12 months of child's age, 2) demographic characteristics collected at late pregnancy and 3) intervention providers' observations and notes (qualitative data) for 10 participants from each engagement group (low, medium, high) to explore issues discussed during telephone support. RESULTS Call completion rate by participants was above sixty percent for all six stages of the telephone support program with more than half of the participants (57%) demonstrating high level of engagement. We found that participants' country of birth, employment status and annual household income were predictors of engagement with the telephone support provided in the CHAT program. The odds of participants' engagement with the telephone support program were 1.68 times higher for Australian born (95% CI 1.07 - 2.62), 1.63 times higher for participants who were employed (95% CI 1.01 - 2.66) and 1.63 times higher for participants with annual household income ≥AUD$80,000 (95% CI 1.02 - 2.60). CONCLUSIONS Participant engagement with the program interventions was good. Participants' engagement with the telephone support program was significantly associated with certain socio-demographic characteristics. Australian born participants, and participants associated with higher household income and employment engaged significantly more with the telephone support provided in the CHAT program. Additionally, the program engaged more participants older than 30 years of age and those who spoke English at home. The program provided unintended personal benefits to some participants with high engagement level due to their various psychosocial needs such as domestic violence, mental health and sleep related issues. Although not an intended benefit of the intervention, psychosocial needs of participants were met which was a likely factor for mothers' engagement with the program. This is an important factor that needs to be considered while implementing future programs or scale up of this program.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- *Correspondence: Mahalakshmi Ekambareshwar,
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
| | - Chris Rissel
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Louise Baur
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW, Australia
- Weight Management Services, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Sarah Taki
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Li Ming Wen
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
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14
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Ekambareshwar M, Taki S, Mihrshahi S, Baur L, Wen LM, Rissel C. Trial collaborators' perceptions of the process of delivering Healthy Beginnings advice via telephone calls or text messages. Health Promot J Austr 2021; 33:810-828. [PMID: 34856023 PMCID: PMC9545512 DOI: 10.1002/hpja.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/05/2021] [Accepted: 11/29/2021] [Indexed: 12/24/2022] Open
Abstract
ISSUE ADDRESSED One in four Australian children aged between the ages of two and four are affected by overweight. In New South Wales, the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial delivered an intervention to pregnant women and women with infants via telephone calls and text messages. The focus of the intervention was on infant feeding and establishing healthy habits for infants by building the capacity of mothers. This study investigates trial collaborators' perspectives concerning the implementation of this intervention, to obtain insights that will support future translation and scale-up. METHODS This research was undertaken during the intervention phase of the trial. Twenty trial collaborators involved in the planning, implementation or delivery of the CHAT trial were invited to participate. Qualitative interviews were conducted with collaborators using open-ended questions based on Steckler and Linnan's process evaluation framework and the Consolidated Framework for Implementation Research. Inductive thematic analysis was employed to identify themes from the interview data. RESULTS Fourteen trial collaborators were interviewed. Collaborators included child and family health nurses (intervention providers), nurse managers with extensive child and family health nursing experience, a paediatrician, dietitians, health promotion experts, health service managers, health and nursing executives, program personnel (project coordinator, research fellow and evaluation officer) and university researchers. Following coding of qualitative data, themes were realised from the data as a result of active co-production on the part of the researcher. Five themes were identified: (a) context (organisational support, engagement and partnerships, communication and project leadership); (b) program receipt, benefit and reach; (c) program delivery (intervention providers' experience and skills, mode of intervention delivery, referral to other services, support and training for intervention providers); (d) implementation (program delivered as planned); (e) opportunities for scale-up. Collaborators perceived that the program was implemented and delivered as planned. This specific research addresses the success of the process of implementing and delivering interventions for infant feeding and establishing healthy habits for children by building the capacity of mothers. Collaborators attributed successful program implementation to contextual factors: strong support by the host organisation; good project leadership; clear communication; collaborative internal and external partnerships; intervention provision by experienced nurses. Remote delivery was convenient to program participants and participants were able to resolve other personal concerns in addition to direct immediate benefits. Because of their capacity to influence policy decisions, the absence of policymakers at project meetings was a shortcoming. Collaborative partnerships with health and research partners, understanding of contextual issues and consumer involvement could lead to program expansion. The program has the potential to be scaled up through integration with existing services and gradual expansion into other health districts prior to state-wide rollout. CONCLUSIONS The CHAT trial delivered the Healthy Beginnings intervention which resulted in improvements in infant feeding, active play and sedentary behaviours. This evaluation demonstrated that the involvement of key stakeholders from early planning stages through to implementation of the program and the partnerships that evolved contributed to the successful implementation of the program. An unintended benefit to participants from this program was the social support that was provided. Intervention delivery via telephone and text messages enabled easy access to the program. Most importantly, the program has the potential to be scaled up through integration into existing services and gradual expansion prior to state-wide rollout. SO WHAT?: Strong internal and external partnerships, effective communication systems and integration with existing services create the context for potential translation and scaling up of the program to other health promotion settings.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louise Baur
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Li Ming Wen
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Chris Rissel
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Wen LM, Xu H, Jawad D, Buchanan L, Rissel C, Phongsavan P, Baur LA, Taki S. Ethnicity matters in perceived impacts and information sources of COVID-19 among mothers with young children in Australia: a cross-sectional study. BMJ Open 2021; 11:e050557. [PMID: 34824114 PMCID: PMC8627368 DOI: 10.1136/bmjopen-2021-050557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to investigate perceived impacts, ways of communication with professionals and information sources related to COVID-19, and explore whether these impacts or information sources were associated with ethnicity that is, language spoken at home. DESIGN A cross-sectional study. SETTING Sydney, Australia during the period from March to October 2020. PARTICIPANTS Mothers of young children participating in an existing trial. OUTCOME MEASURES Mothers were asked to respond to a set of survey questions related to COVID-19 via telephone. The questions included a mental health scale, and how they communicated with health professionals and their information sources related to COVID-19 during the COVID-19 pandemic. RESULTS Of 537 mothers who completed the survey (81% response rate), 45% reported they spoke a language other than English at home. Overall, 136 (26%) reported experiencing mental distress. 234 (44%) reported that COVID-19 affected the way they receive and communicate health-related information with health professionals, especially for those from non-English speaking backgrounds with an adjusted odds ratio (AOR) 1.58 (95% CI 1.10 to 2.27). They were less likely to use a face-to-face service (AOR 0.55, 95% CI 0.37 to 0.80) and more likely to use social media (AOR 2.11, 95% CI 1.40 to 3.17) for health-related information. Regarding sources of COVID-19-related information, mothers from non-English-speaking backgrounds were more likely to rely on family members (AOR 1.49, 95% CI 1.01 to 2.19) and social media (AOR 3.34, 95% CI 2.05 to 5.43). CONCLUSIONS COVID-19 has significantly impacted mothers with young children in regard to their mental health, means of communication with health professionals and sources of health information. Mothers from non-English-speaking communities were less likely to use a face-to-face service, and more likely to seek information from family members and social media. Appropriate health support for non-English-speaking community needs to take these factors into account. TRIAL REGISTRATION NUMBER ANZCTR:12618001571268.they.
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Affiliation(s)
- Li Ming Wen
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Population Health Research & Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), The University of Sydney, Sydney, New South Wales, Australia
| | - Huilan Xu
- Population Health Research & Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Danielle Jawad
- Population Health Research & Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Limin Buchanan
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Population Health Research & Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise A Baur
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), The University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Taki
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Population Health Research & Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), The University of Sydney, Sydney, New South Wales, Australia
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Buchanan L, Anderson E, MBiostat HX, Phongsavan P, Rissel C, Wen LM. Sources of information and the use of mobile applications for health and parenting information during pregnancy: Implications for health promotion. Health Informatics J 2021; 27:14604582211043146. [PMID: 34569327 DOI: 10.1177/14604582211043146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to examine the characteristics of pregnant women who used and intended to use mobile applications (apps) for health and parenting information. We used data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone (CHAT), conducted in Australia. Telephone surveys were conducted in 2017 to collect information on women's demographic characteristics, sources of health and parenting information and willingness to use mobile apps. Multiple logistic regression was used to examine the associations of women's socio-demographic backgrounds, their mobile apps usage and their willingness to use such apps. Data included 1155 pregnant women in their third trimester. Women from culturally and linguistically diverse backgrounds and with lower income appeared to have lower uptake of mobile apps despite high ownership of smart devices. Development of evidence-based and culturally-adapted mobile apps represent an important opportunity for healthcare providers to optimise maternal and birth outcomes.
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Affiliation(s)
- Limin Buchanan
- Sydney Local Health District, Australia.,The University of Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Australia
| | | | | | | | - Chris Rissel
- The University of Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Australia.,Flinders University, Australia
| | - Li Ming Wen
- Sydney Local Health District, Australia.,The University of Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Australia
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A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time. J Phys Act Health 2021; 18:1215-1222. [PMID: 34380110 DOI: 10.1123/jpah.2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants' health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. METHODS A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. RESULTS Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08-2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. CONCLUSIONS Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.
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Marshall S, Xu H, Taki S, Laird Y, Love P, Wen LM, Rissel C. Engagement, satisfaction, retention and behavioural outcomes of linguistically diverse mothers and infants participating in an Australian early obesity prevention trial. Health Promot J Austr 2021; 33:350-360. [PMID: 34245623 DOI: 10.1002/hpja.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. METHODS Healthy Beginnings is a nurse-led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6- and 12-month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). RESULTS Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6-month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%-65%) compared to those speaking English (70%-80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. CONCLUSIONS Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Taki
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Yvonne Laird
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Penelope Love
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li Ming Wen
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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Marshall S, Taki S, Love P, Kearney M, Tam N, Sabry M, Kuswara K, Laird Y, Wen LM, Rissel C. Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia. Women Birth 2021; 34:e346-e356. [DOI: 10.1016/j.wombi.2020.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/11/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
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Cheng H, George C, Dunham M, Whitehead L, Denney-Wilson E. Nurse-led interventions in the prevention and treatment of overweight and obesity in infants, children and adolescents: A scoping review. Int J Nurs Stud 2021; 121:104008. [PMID: 34260995 DOI: 10.1016/j.ijnurstu.2021.104008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Nurses are well-placed in primary care, school and community settings to identify and manage paediatric overweight and obesity. This scoping review examined what types of nurse-led interventions have been undertaken for the prevention, treatment and management of obesity and overweight in infants, children and adolescents. DESIGN Scoping review. DATA SOURCES CINAHL, Cochrane Library, Embase, MEDLINE, ProQuest Central, ProQuest Dissertations & Theses Global, and Scopus. Searches were undertaken from inception to 2019. METHODS Database searches and handsearching were used to identify academic and grey literature, such as scientific reports and university theses and dissertations, on nurse-led interventions undertaken in school, primary health care and community settings. Studies focused on addressing overweight and obesity in children and adolescents, for studies published from 1999 onwards. Studies included focused on experimental and quasi-experimental research that implemented interventions, and described new practice or change in practice. RESULTS 117 references encompassing 83 studies or programs were selected for inclusion. 16 trials were analysed descriptively, and 67 trials were analysed descriptively and quantitatively. The analysis structured intervention settings and outcomes using the socioecological model, encompassing intrapersonal, interpersonal, community, organisation and policy factors. Studies included were clinically heterogeneous for intervention setting and multicomponent strategies. Education for nutrition, physical activity and behaviour change was the most common strategy used, and nutrition and physical activity knowledge most consistently improved after intervention. Nursing roles focused on education; counselling and behaviour change in primary care; advocacy in school and community environments; and implementing policy in child care settings. Fifty-four studies received financial or resource funding and support to implement the study. On sustainability, seven programs and two research studies were ongoing at time of writing. CONCLUSIONS While the clinical heterogeneity of studies makes synthesis of outcomes complex, it demonstrates the breadth of nursing interventions to address paediatric overweight and obesity. Incentives that encourage routine health promotion, upskilling of nurses, and embedding food and nutrition education into the school curricula, are suitable strategies that support nurse-led interventions against paediatric obesity. REGISTRATION NUMBER Not applicable. Tweetable abstract: Scoping r/v - what interventions are led by nurses to address paediatric obesity? 83 studies investigate nurses' work in school, primary health, community care.
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Affiliation(s)
- Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building, Camperdown, NSW, 2006, Australia; Centre of Research Excellence in Early Prevention of Childhood Obesity, The University of Sydney, Australia.
| | - Cobie George
- Australian College of Nursing, 1 Napier Close, Deakin, Australian Capital Territory, 2050, Australia.
| | - Melissa Dunham
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Lisa Whitehead
- Australian College of Nursing, 1 Napier Close, Deakin, Australian Capital Territory, 2050, Australia; Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building, Camperdown, NSW, 2006, Australia; Centre of Research Excellence in Early Prevention of Childhood Obesity, The University of Sydney, Australia; Sydney Institute for Women, Children and Families, King George V Building, Sydney Local Health District, Missenden Road, Camperdown, New South Wales, 2050, Australia.
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21
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Marshall S, Taki S, Love P, Laird Y, Kearney M, Tam N, Baur LA, Rissel C, Wen LM. Feasibility of a culturally adapted early childhood obesity prevention program among migrant mothers in Australia: a mixed methods evaluation. BMC Public Health 2021; 21:1159. [PMID: 34134674 PMCID: PMC8207722 DOI: 10.1186/s12889-021-11226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Healthy Beginnings is an established nurse-led early childhood obesity prevention program that promotes healthy infant feeding practices and active play in the early years of life. To improve engagement with culturally and linguistically diverse populations, the Healthy Beginnings program delivered by telephone was culturally adapted and implemented with Arabic- and Chinese-speaking mothers in Sydney, Australia. The cultural adaptation process has been published separately. In this article, we aimed to evaluate the feasibility of the culturally adapted program. METHODS In 2018-2019, the culturally adapted Healthy Beginnings program was implemented with Arabic- and Chinese-speaking women recruited from antenatal clinics in Sydney. At four staged timepoints (from third trimester until 6 months of age), mothers were sent culturally adapted health promotion booklets and text messages and offered four support calls from bi-cultural child and family health nurses in Arabic and Chinese. A mixed methods evaluation included a) baseline and 6-month telephone surveys, followed by b) semi-structured follow-up interviews with a subset of participating mothers and program delivery staff. Main outcomes of this feasibility study were reach (recruitment and retention), intervention dose delivered (number of nurse support calls completed) and acceptability (appropriateness based on cognitive and emotional responses). RESULTS At recruitment, 176 mothers were eligible and consented to participate. Of 163 mothers who completed the baseline survey, 95% completed the program (n = 8 withdrew) and 83% completed the 6-month survey (n = 70 Arabic- and n = 65 Chinese-speaking mothers). Most mothers (n = 127, 78%) completed at least one nurse support call. The qualitative analysis of follow-up interviews with 42 mothers (22 Arabic- and 20 Chinese-speaking mothers) and 10 program delivery staff highlighted the perceived value of the program and the positive role of bi-cultural nurses and in-language resources. Mothers who completed more nurse support calls generally expressed greater acceptability. CONCLUSIONS The culturally adapted Healthy Beginnings program was feasible to deliver and acceptable to Arabic- and Chinese-speaking mothers. Our results highlight the importance of in-language resources and individualised bi-cultural nurse support by telephone for supporting culturally and linguistically diverse migrant families with infant feeding and active play. These findings support the potential for program refinements and progression to an effectiveness trial.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, 2037, Australia.
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.
| | - Sarah Taki
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, 2037, Australia
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Penny Love
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Waurn Ponds, Victoria, 3216, Australia
| | - Yvonne Laird
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Marianne Kearney
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, 2037, Australia
| | - Nancy Tam
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, 2037, Australia
| | - Louise A Baur
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Chris Rissel
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Forest Lodge, NSW, 2037, Australia
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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Mihrshahi S, Jawad D, Richards L, Hunter KE, Ekambareshwar M, Seidler AL, Baur LA. A Review of Registered Randomized Controlled Trials for the Prevention of Obesity in Infancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052444. [PMID: 33801485 PMCID: PMC7967587 DOI: 10.3390/ijerph18052444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Childhood overweight and obesity is a worldwide public health issue. Our objective was to describe planned, ongoing and completed randomized controlled trials (RCTs) designed for the prevention of obesity in early childhood. Two databases (World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) were searched to identify RCTs with the primary aim of preventing childhood obesity and at least one outcome related to child weight. Interventions needed to start in the first two years of childhood or earlier, continue for at least 6 months postnatally, include a component related to lifestyle or behaviours, and have a follow up time of at least 2 years. We identified 29 unique RCTs, implemented since 2008, with most being undertaken in high income countries. Interventions ranged from advice on diet, activity, sleep, emotion regulation, and parenting education through to individual home visits, clinic-based consultations, or group education sessions. Eleven trials published data on child weight-related outcomes to date, though most were not sufficiently powered to detect significant effects. Many trials detected improvements in practices such as breastfeeding, screen time, and physical activity in the intervention groups compared to the control groups. Further follow-up of ongoing trials is needed to assess longer-term effects.
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Affiliation(s)
- Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
- Correspondence: ; Tel.: +61-2-9850-2468
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Louise Richards
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Kylie E. Hunter
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- NHMRC Clinical Trials Centre, The University of Sydney, Locked bag 77, Camperdown, NSW 1450, Australia
| | - Mahalakshmi Ekambareshwar
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Anna Lene Seidler
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- NHMRC Clinical Trials Centre, The University of Sydney, Locked bag 77, Camperdown, NSW 1450, Australia
| | - Louise A. Baur
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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23
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Marshall S, Taki S, Love P, Laird Y, Kearney M, Tam N, Baur LA, Rissel C, Wen LM. The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia. BMC Public Health 2021; 21:284. [PMID: 33541310 PMCID: PMC7863271 DOI: 10.1186/s12889-021-10270-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/19/2021] [Indexed: 01/25/2023] Open
Abstract
Background Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia. Methods The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program. Results Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials). Conclusions This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10270-5.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia. .,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia. .,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.
| | - Sarah Taki
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Penny Love
- The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Waurn Ponds, Victoria, 3216, Australia
| | - Yvonne Laird
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Marianne Kearney
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Nancy Tam
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Louise A Baur
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Chris Rissel
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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24
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Whooten RC, Kwete GM, Farrar-Muir H, Cournoyer RN, Barth EA, Kotelchuck M, Taveras EM. Engaging fathers in the first 1000 days to improve perinatal outcomes and prevent obesity: Rationale and design of the First Heroes randomized trial. Contemp Clin Trials 2021; 101:106253. [PMID: 33340750 PMCID: PMC10138076 DOI: 10.1016/j.cct.2020.106253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early pregnancy through the first year of life represents an important period for family health promotion and obesity prevention. Overall, preventive interventions in pregnancy and infancy have insufficiently engaged fathers. We describe the rationale and design of First Heroes, an intervention to improve perinatal and obesity-related outcomes among mother-father-infant triads beginning in pregnancy. METHODS/DESIGN First Heroes is a hybrid type 1 effectiveness-implementation randomized trial of mother-father-infant triads recruited in the second trimester of pregnancy from a large Obstetric practice in eastern Massachusetts and continuing through 12 months of infant age. Triads are randomized to the intervention arm or to an enhanced safety education control group. Triads randomized to the intervention arm receive three virtual visits with a health educator, in the 3rd trimester of pregnancy, at 3-4 weeks, and 3-4 months postpartum, and receive continuous multimedia education through text messaging, print material, and videos. The educational curriculum addresses parent health behaviors, family relationships, social determinants of health, and infant feeding, sleep, and development. The primary outcome is prevalence of rapid infant weight gain from birth to 6 months of age. Secondary outcomes include parent anthropometrics, parent obesogenic behaviors, family functioning, and infant behaviors. DISCUSSION First Heroes will evaluate the extent to which intentional mother-father dyad engagement, coaching on adoption of early life health behaviors, and addressing social determinants of health, influence obesogenic behaviors and outcomes in the first year of life. Findings from this work will inform future obesity prevention efforts, especially those focused on whole family inclusion.
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Affiliation(s)
- Rachel C Whooten
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America.
| | - Gracia M Kwete
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America
| | - Haley Farrar-Muir
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America
| | - Rachel N Cournoyer
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America
| | - Elizabeth A Barth
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America
| | - Milton Kotelchuck
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States of America; Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua Street, Suite 860, Boston, MA 02114, United States of America; Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States of America
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25
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Campbell N, Farthing A, Witt S, Anderson J, Lenthall S, Moore L, Rissel C. Health Professional Student Placements and Workforce Location Outcomes: Protocol of an Observational Cohort Study. JMIR Res Protoc 2021; 10:e21832. [PMID: 33443482 PMCID: PMC7843200 DOI: 10.2196/21832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background The successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions. Objective The aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing. Methods This research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions. Results This study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment. Conclusions This study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/21832
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Affiliation(s)
| | - Annie Farthing
- Flinders University, Northern Territory, Alice Springs, Australia
| | - Susan Witt
- Flinders University, Northern Territory, Adelaide, Australia
| | - Jessie Anderson
- Flinders University, Northern Territory, Adelaide, Australia
| | - Sue Lenthall
- Flinders University, Northern Territory, Katherine, Australia
| | - Leigh Moore
- Flinders University, Northern Territory, Darwin, Australia
| | - Chris Rissel
- Flinders University, Northern Territory, Darwin, Australia
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26
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Ekambareshwar M, Ekambareshwar S, Mihrshahi S, Wen LM, Baur LA, Laws R, Taki S, Rissel C. Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review. Int J Behav Nutr Phys Act 2021; 18:10. [PMID: 33422066 PMCID: PMC7796572 DOI: 10.1186/s12966-020-01074-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders’ acceptability of interventions. Methods A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers’ behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. Results Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants’ perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. Conclusion There is limited reporting of stakeholders’ experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants’ acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. Trial registration PROSPERO registration: CRD42019108658
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.
| | - Swathi Ekambareshwar
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rachel Laws
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
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27
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Brown V, Tan EJ, Hayes A, Baur L, Campbell K, Taylor R, Byrne R, Wen LM, Hesketh KD, Moodie M. Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years. Pediatr Obes 2020; 15:e12684. [PMID: 32558343 DOI: 10.1111/ijpo.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the absence of rigorous evidence of cost-effectiveness for early childhood obesity prevention interventions, the next-best option may be for decision-makers to consider the relevant costs of interventions when allocating resources. OBJECTIVES This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0-2 years, undertaken in research settings in Australia and New Zealand. METHODS A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro-costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. RESULTS Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77-$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059-$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. CONCLUSIONS An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS-based intervention had the lowest delivery cost in this study.
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Affiliation(s)
- Vicki Brown
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Eng J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Baur
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Campbell
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rachael Taylor
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Byrne
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,School of Exercise and Nutrition Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Li Ming Wen
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kylie D Hesketh
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Marjory Moodie
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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28
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Rajan S, Jahromi L, Bravo D, Umaña-Taylor A, Updegraff K. Maternal Self-Efficacy Is Protective for Child (but Not Mother) Body Mass Index Among Mexican-Origin Children with Negative Temperament. J Dev Behav Pediatr 2020; 40:633-641. [PMID: 31169655 PMCID: PMC6800616 DOI: 10.1097/dbp.0000000000000696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Childhood obesity persists as a serious public health concern, particularly among Mexican-origin youth. Teen mothers are also at heightened obesity risk. Multiple factors may exacerbate this risk, including stressors associated with parenting. Indeed, difficult child temperaments pose unique parenting challenges, which may also be linked to physical health outcomes in mothers. The purpose of this study was to examine whether the interaction between negative child temperament and parenting self-efficacy is related to the body mass index (BMI) of young children and their adolescent mothers while controlling for important contextual factors. We also examined which pathways differed for girls versus boys. METHODS Data were from a longitudinal study spanning 5 years that included 204 Mexican-origin young mothers and their children (with data collected at birth, age 4 years, and age 5 years). A multigroup structural equation modeling framework was used. RESULTS The rate of early childhood obesity was low in comparison with national averages, whereas the rate of adolescent mother obesity was notably higher than the national average. Negative child temperament was associated with higher child BMI among those adolescent mothers with low parenting self-efficacy. Among the children with a negative temperament, their mothers' high parenting self-efficacy may have served as a protective factor against unhealthy child BMI. This significant interaction held for both boys and girls. CONCLUSION Research evaluating the potential effectiveness of interventions that promote parenting self-efficacy during early childhood as a means to reduce the rate of obesity among children of adolescent mothers should be conducted.
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Affiliation(s)
- Sonali Rajan
- Department of Health and Behavior Studies, Teachers
College, Columbia University, New York, New York
| | - Laudan Jahromi
- Department of Health and Behavior Studies, Teachers
College, Columbia University, New York, New York
| | - Diamond Bravo
- Graduate School of Education, Harvard University,
Cambridge, MA
| | | | - Kimberly Updegraff
- T. Denny Sanford School of Social and Family Dynamics,
Arizona State University, Tempe, AZ
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29
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Wen LM, Rissel C, Xu H, Taki S, Buchanan L, Bedford K, Phongsavan P, Baur LA. Effects of Telephone and Short Message Service Support on Infant Feeding Practices, "Tummy Time," and Screen Time at 6 and 12 Months of Child Age: A 3-Group Randomized Clinical Trial. JAMA Pediatr 2020; 174:657-664. [PMID: 32282034 PMCID: PMC7154951 DOI: 10.1001/jamapediatrics.2020.0215] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022]
Abstract
Importance There is limited information as to whether telephone or short message service (SMS) support is effective in improving infant feeding practices and tummy time and reducing screen time. Objective To determine the effectiveness of either nurse-led telephone or SMS support in improving infant feeding practices and tummy time and reducing screen time. Design, Setting, and Participants This study was part of a 2-year, 3-group parallel, randomized clinical trial conducted from February 23, 2017, to November 30, 2018, among 1155 women in the third trimester of pregnancy in New South Wales, Australia. It reports the main outcomes at 6 and 12 months of child age. All analyses were conducted on an intention-to-treat principle. Interventions The intervention consisted of staged information booklets mailed to the intervention groups, each followed by either a nurse-led telephone support session or SMS intervention, antenatally and at 1, 3, 5, 7, and 10 months after birth. Main Outcomes and Measures The primary outcomes were infant feeding practices at both 6 and 12 months and tummy time at 6 months. The secondary outcome was screen time at 12 months. Results Of 1155 mothers, 947 (82%; mean [SD] age, 32.5 [5.0] years) completed follow-up surveys at 6 months; 920 mothers (80%) completed follow-up surveys at 12 months. Compared with the control group, telephone support led to higher odds of appropriate timing of introducing solid foods (adjusted odds ratio [AOR], 1.68 [95% CI, 1.22-2.32]), cup use (AOR, 1.54 [95% CI, 1.12-2.13]), and early-start tummy time (AOR, 1.63 [95% CI, 1.18-2.25]) at 6 months and higher odds of having no screen time (AOR, 1.80 [95% CI, 1.28-2.53]) and no bottle at bedtime (AOR, 1.73 [95% CI, 1.23-2.42]) at 12 months. Use of SMS also led to higher odds than the control group of having no screen time (AOR, 1.28 [95% CI, 1.08-1.52]) and having no bottle at bedtime (AOR, 1.29 [95% CI, 1.10-1.51]) at 12 months. No significant differences were found in breastfeeding rates between the telephone support, SMS support, and control groups. Conclusions and Relevance Both the nurse-led telephone support and SMS interventions were effective in reducing screen time and bottle use at bedtime. Telephone support was also effective in promoting the appropriate timing of the introduction of solid foods, early-start tummy time, and cup use. Trial Registration http://anzctr.org.au Identifier: ACTRN12616001470482.
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Affiliation(s)
- Li Ming Wen
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Huilan Xu
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Sarah Taki
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Limin Buchanan
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Karen Bedford
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise A. Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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30
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Askie LM, Espinoza D, Martin A, Daniels LA, Mihrshahi S, Taylor R, Wen LM, Campbell K, Hesketh KD, Rissel C, Taylor B, Magarey A, Seidler AL, Hunter KE, Baur LA. Interventions commenced by early infancy to prevent childhood obesity-The EPOCH Collaboration: An individual participant data prospective meta-analysis of four randomized controlled trials. Pediatr Obes 2020; 15:e12618. [PMID: 32026653 DOI: 10.1111/ijpo.12618] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood obesity is a significant global problem. Childhood obesity prevention interventions may be more effective when started very early in life before metabolic and behavioural patterns are established. METHODS AND FINDINGS A prospectively planned, individual participant data meta-analysis of four randomized controlled trials. Participants were first-time mothers of term infants. Trial interventions commenced during pregnancy or early infancy and comprised education and support delivered via group sessions and/or home visits. Control group families accessed existing local well-child health care. The primary outcome was body mass index (BMI) z score at 18 to 24 months; 2196 mother-child dyads were available for analysis. Intervention children had lower BMI z scores at 18 to 24 months than control children (-0.12 adjusted mean; 95% confidence interval, -0.22 to -0.02, P = .017). There was some evidence that the BMI z score reduction was greater in settings with limited well-child health care programmes (interaction P value = .03). Improvements were also detected in television viewing time, feeding practices, and breastfeeding duration. CONCLUSIONS Parent-focused intervention programmes that commence by early infancy and which aim to establish a trajectory of healthy lifestyle behaviours produced a modest but statistically significant reduction in BMI z score, which if replicated on a wider scale may have important public health implications.
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Affiliation(s)
- Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Lynne A Daniels
- Center Child Health Research, School Exercise Nutrition Sciences, Queensland University Technology, Brisbane, Queensland, Australia
| | - Seema Mihrshahi
- School of Public Health, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Li Ming Wen
- Health Promotion Unit, Sydney Local Health District, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Barry Taylor
- Dunedin School of Medicine, Office of the Dean, University of Otago, Dunedin, New Zealand
| | - Anthea Magarey
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie E Hunter
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Louise A Baur
- Discipline of Child and Adolescent Health, University of Sydney, Clinical School, The Children's Hospital at Westmead, Camperdown, New South Wales, Australia
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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Rissel C, Elbayeh L, Xu H, Wen LM. Recall of and confidence in using the Health Star Rating system among pregnant women in New South Wales, Australia: Cross-sectional survey. Health Promot J Austr 2020; 31:354-356. [PMID: 32402093 DOI: 10.1002/hpja.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/20/2019] [Accepted: 07/14/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chris Rissel
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Linda Elbayeh
- Health Promotion Service, Sydney Local Health District, Sydney, NSW, Australia
| | - Huilan Xu
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Health Promotion Service, Sydney Local Health District, Sydney, NSW, Australia
| | - Li Ming Wen
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Health Promotion Service, Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Fudan University, Shanghai, China
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Esdaile E, Owen KB, Xu H, Baur LA, Rissel C, Wen LM. Strong support for broad policies to prevent childhood obesity among mothers in New South Wales, Australia. Health Promot J Austr 2020; 32:197-207. [PMID: 32333441 DOI: 10.1002/hpja.351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 01/06/2023] Open
Abstract
ISSUE ADDRESSED Support for broad policies to prevent childhood obesity is not clear. This study aimed to investigate the level of support for state government health promotion policies among mothers with infants and its associated factors. METHODS This secondary analysis of data from 1155 mothers in NSW assessed approval for six policy options derived from public health approaches to obesity. Descriptive statistics were used to show the extent of policy approval across the cohort. Logistic regression models tested associations between perceived susceptibility and perceived severity of childhood obesity and approval of each policy option. RESULTS The proportion of mothers who felt these policy options were 'about the right amount' (56%-68%) or 'not going far enough' (24%-36%), collectively represented 89%-95% approval of government intervention. In comparison, 5%-11% felt that these policies were 'going too far'. Factors associated with their levels of support varied between each policy option, based on mothers' characteristics and perceptions of childhood obesity. CONCLUSION These findings indicate high support for government intervention to prevent obesity among mothers in NSW and support health promotion advocacy in this area. SO WHAT?: Governments should give due consideration to implementing each of the six policy options and prioritise the implementation of restrictions on fast food advertising in publicly owned or controlled areas.
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Affiliation(s)
- Emma Esdaile
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Katherine B Owen
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Huilan Xu
- Health Promotion Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Louise A Baur
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Camperdown, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Office of Preventive Health, New South Wales Ministry of Health, Sydney, NSW, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, NSW, Australia
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Ekambareshwar M, Taki S, Mihrshahi S, Baur LA, Rissel C, Wen LM. Participant Experiences of an Infant Obesity Prevention Program Delivered via Telephone Calls or Text Messages. Healthcare (Basel) 2020; 8:E60. [PMID: 32188139 PMCID: PMC7151095 DOI: 10.3390/healthcare8010060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/01/2023] Open
Abstract
A 3-arm randomised controlled trial implemented in 2017, recruited participants from four Local Health Districts (LHDs) in New South Wales (NSW) to test an early obesity prevention program delivered via telephone calls (telephone) or text messages (SMS). This sub-study explored participants' experience and satisfaction with the program. A multimethod design was used. Quantitative satisfaction questions were completed by participants when their child was six-months old. A purposive sample of participants with varying satisfaction levels was invited for in-depth qualitative interviews. Data were analysed using Excel (quantitative) and inductive thematic analysis (qualitative). Of the 1155 participants recruited: 947 (293 telephone; 338 SMS; 316 control) completed the six-month survey; 34 (14 telephone; 13 SMS; 7 control) were interviewed. Participants' overall program satisfaction was 100% (telephone) and 85% (SMS). Participants' qualitative responses demonstrated appreciation of: personalised stage-based information; opportunity to communicate with health professionals (telephone); linked Healthy Beginnings booklets and SMS mostly as nudges (SMS). There is a clear need for stage-based information, and supplemented modes of delivery i.e., text messages along with telephone calls; with text messages solely seen as nudges or reminders. However, individual preferences vary according to information needs at any given time, time constraints on new mothers and hence, multiple modes of information provision are recommended in order to reach a wider population and for better engagement. Choice and flexibility in mode of delivery has the potential to provide equitable access to information, empowering women with infants to practice recommended health behaviours for infant obesity prevention.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Health Promotion Unit, Sydney Local Health District, Camperdown 2050, Australia
| | - Seema Mihrshahi
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
| | - Louise A. Baur
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
- Sydney Medical School, The University of Sydney, Camperdown 2006, Australia
| | - Chris Rissel
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
- New South Wales Office of Preventive Health, Ministry of Health, Liverpool 2170, Australia
| | - Li Ming Wen
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
- Health Promotion Unit, Sydney Local Health District, Camperdown 2050, Australia
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Manohar N, Hayen A, Bhole S, Arora A. Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study. Nutrients 2020; 12:E258. [PMID: 31963864 PMCID: PMC7019241 DOI: 10.3390/nu12010258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
Early introduction of complementary foods can have a detrimental impact on children's long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was 'age at which particular core and discretionary food items were first introduced'. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54-7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99-5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17-11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.
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Affiliation(s)
- Narendar Manohar
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia;
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Sameer Bhole
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW 2010, Australia;
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia
- Oral Health Alliance, Oral Health Centre, University of Queensland, Brisbane, QLD 4072, Australia
- Metro North Oral Health Services, Stafford, QLD 4053, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia;
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW 2010, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney Faculty of Medicine and Health, Westmead, NSW 2050, Australia
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36
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Hennessy M, Heary C, Laws R, van Rhoon L, Toomey E, Wolstenholme H, Byrne M. The effectiveness of health professional-delivered interventions during the first 1000 days to prevent overweight/obesity in children: A systematic review. Obes Rev 2019; 20:1691-1707. [PMID: 31478333 DOI: 10.1111/obr.12924] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022]
Abstract
Childhood obesity is a global public health challenge. Early prevention, particularly during the first 1000 days, is advocated. Health professionals have a role to play in obesity prevention efforts, in part due to the multiple routine contacts they have with parents. We synthesized the evidence for the effectiveness of obesity prevention interventions delivered by health professionals during this time period, as reviews to date have not examined effectiveness by intervention provider. We also explored what behaviour change theories and/or techniques were associated with more effective intervention outcomes. Eleven electronic databases and three trial registers were searched from inception to 04 April 2019. A total of 180 studies, describing 39 trials involving 46 intervention arms, were included. While the number of interventions has grown considerably, we found some evidence for the effectiveness of health professional-delivered interventions during the first 1000 days. Only four interventions were effective on a primary (adiposity/weight) and secondary (behavioural) outcome measure. Twenty-two were effective on a behavioural outcome only. Several methodological limitations were noted, impacting on efforts to establish the active ingredients of interventions. Future work should focus on the conduct and reporting of interventions.
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Affiliation(s)
- Marita Hennessy
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Luke van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hazel Wolstenholme
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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37
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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38
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Wu L, Yao R, Zhang Y, Wang Y, Li T, Chen M, Liu W, Han H, Bi L, Fu L. The association between digit ratio (2D:4D) and overweight or obesity among Chinese children and adolescents: A cross-sectional study. Early Hum Dev 2019; 136:14-20. [PMID: 31284129 DOI: 10.1016/j.earlhumdev.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to analyze the relationship between 2D:4D and childhood overweight or obesity, which might indirectly show the role of prenatal hormone in childhood overweight or obesity. METHODS Using stratified cluster sampling approach, a school-based cross-sectional investigation was undertaken among 687 children and adolescents aged 8-15 years. Each participant's index finger (2D) and ring finger (4D) length, height, weight, testosterone, and estradiol levels were measured, and their dietary behaviors, physical and sedentary activities were also surveyed. RESULTS The prevalence of overweight or obesity among children and adolescents aged 8- and 12-15 years was 36.0% and 25.9%, respectively (P < 0.05). There were no associations between 2D:4D and overweight or obesity in both boys and girls (P > 0.05). However, 2D and multiplying index of digit ratio and length (MIDRL) associated directly with overweight or obesity among boys (OR (95%CI) were 1.45 (1.00, 2.14), 1.46 (1.01, 2.11), respectively), and was indirectly related to overweight or obesity by testosterone (OR were 1.30, 1.26, respectively). CONCLUSIONS In boys, 2D and MIDRL were directly related to overweight or obesity, and indirectly associated with overweight or obesity by testosterone, which suggested that prenatal hormone exposure might associate with overweight or obesity among boys.
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Affiliation(s)
- Lu Wu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Rongying Yao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Yifei Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Yuan Wang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Ting Li
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Manman Chen
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Wenming Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Hui Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China
| | - Linda Bi
- Royal Adelaide Hospital, Adelaide, Australia
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, PR China.
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Rehayem A, Taki S, Brown N, Denney-Wilson E. Infant feeding beliefs and practices of Arabic mothers in Australia. Women Birth 2019; 33:e391-e399. [PMID: 31353232 DOI: 10.1016/j.wombi.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Culturally sensitive care in the health care system is imperative for optimal outcomes of all patients, especially women and their infants. For Arabic mothers in Australia, there is minimal research exploring their beliefs that could impact on their infant feeding decisions and practices. AIM The aim of this study was to explore the experiences, knowledge and influences around infant feeding in Arabic women in Australia. METHOD A qualitative descriptive approach was used. Focus groups were conducted with Arabic women in community organisations (Catholic & Islamic) in Sydney. A thematic analysis was undertaken. The Iowa Infant Feeding Attitude Scale (IIFAS) was also used to measure maternal attitudes towards infant feeding. FINDINGS A total of 17 women participated in three focus groups. Themes relating to infant feeding were identified, including (1) sources of knowledge and education, particularly, where mothers obtained their infant feeding knowledge, and how this was influenced; (2) cultural beliefs related to the support and direction of family members.; (3) religious beliefs surrounding the continuation of infant feeding practices; (4) social and personal themes as an influence on infant feeding decisions and practices, and (5) factors associated with cessation of exclusive breastfeeding, including the lack of support from health care professionals. CONCLUSION The Arabic women in this study have expressed their need for further culturally sensitive care surrounding infant feeding knowledge and practices, and for that care to be situated in their community. Further intervention-based studies in the community focusing on culturally competent and sensitive care are recommended.
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Affiliation(s)
- Amanda Rehayem
- Clinical Midwife Specialist, Midwifery Group Practice, South Eastern Sydney Local Health District, Australia.
| | - Sarah Taki
- Health Promotion Unit, Sydney Local Health District, School of Public Health, The University of Sydney, Australia
| | - Nicola Brown
- Professional Practice and Innovation Centre, Tresillian Family Care Centres, Australia
| | - Elizabeth Denney-Wilson
- Sydney Local Health District and Susan Wakil School of Nursing, The University of Sydney, Australia
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McCrabb S, Lane C, Hall A, Milat A, Bauman A, Sutherland R, Yoong S, Wolfenden L. Scaling-up evidence-based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale-up penalty. Obes Rev 2019; 20:964-982. [PMID: 30868745 DOI: 10.1111/obr.12845] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/06/2023]
Abstract
Maximizing the benefits of investments in obesity research requires effective interventions to be adopted and disseminated broadly across populations (scaled-up). However, interventions often need considerable adaptation to enable implementation at scale, a process that can reduce the effects of interventions. A systematic review was undertaken for trials that sought to deliver an obesity intervention to populations on a larger scale than a preceding randomized controlled trial (RCT) that established its efficacy. Ten scaled-up obesity interventions (six prevention and four treatment) were included. All trials made adaptations to interventions as part of the scale-up process, with mode of delivery adaptations being most common. A meta-analysis of body mass index (BMI)/BMI z score (zBMI) from three prevention RCTs found no significant benefit of scaled-up interventions relative to control (standardized mean difference [SMD] = 0.03; 95% CI, -0.09 to 0.15, P = 0.639 - I2 = 0.0%). All four treatment interventions reported significant improvement on all measures of weight status. Pooled BMI/zBMI data from prevention trials found significantly lower effects among scaled-up intervention trials than those reported in pre-scale-up efficacy trials (SMD = -0.11; 95% CI, -0.20 to -0.02, P = 0.018 - I2 = 0.0%). Across measures of weight status, physical activity/sedentary behaviour, and nutrition, the effects reported in scaled-up interventions were typically 75% or less of the effects reported in pre-scale-up efficacy trials. The findings underscore the challenge of scaling-up obesity interventions.
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Affiliation(s)
- Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alix Hall
- Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Serene Yoong
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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Wen LM, Rissel C, Xu H, Taki S, Smith W, Bedford K, Hayes AJ, Phongsavan P, Simpson JM, Shaw MJ, Moreton R, Baur LA. Linking two randomised controlled trials for Healthy Beginnings©: optimising early obesity prevention programs for children under 3 years. BMC Public Health 2019; 19:739. [PMID: 31196026 PMCID: PMC6567558 DOI: 10.1186/s12889-019-7058-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/27/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Beginning in 2017 we have conducted a 3-arm randomised controlled trial (RCT) to determine the effectiveness of an early obesity intervention in the first two years of life using either telephone or Short Message Service (SMS) support for mothers. The trial recruited 1155 mothers from their third trimester of pregnancy. This protocol is for a new trial to build on the existing trial using the mother-child dyads retained at 24 months for recruitment to the new RCT. The aim of this new trial is to test whether use of a combination of telephone and SMS interventions is effective in promoting healthy eating and physical activity, as well as reducing child body mass index (BMI) at 3 years of age. METHODS We will conduct a parallel RCT with an estimated sample of 750 mother-child dyads retained from the existing trial at 24 months. Mothers who completed the 24 months survey, including a telephone survey and measurement of child's height and weight will be invited to participate in the new trial. Informed consent will be obtained at the 24 months survey. The participating mother-child dyads will then be randomly allocated to the intervention (combined telephone and text messaging intervention) or the control group. The intervention will comprise three staged telephone consultations and text messages after each of the three intervention booklets is mailed to mothers at specific time-points between two and three years of child age. The main trial outcome measures include a) BMI and BMI z-score measured at 36 months, b) diet, physical activity and screen time c) cost-effectiveness, and d) feasibility and acceptability of the intervention. DISCUSSION This unique opportunity to link two studies will expedite project start up time, utilise existing research infrastructure and systems to run the study, and optimise the use of an already engaged population of study participants. It can address a significant knowledge gap regarding early obesity prevention for children aged 2 to 3 years. The feasibility and effectiveness of the combined telephone and SMS intervention will indicate whether this is a scaleable, broad-reach and low-cost early obesity intervention. TRIAL REGISTRATION The trial was registered with the Australian Clinical Trial Registry ( ACTRN12618001571268 ) on 20/09/2018.
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Affiliation(s)
- Li Ming Wen
- Health Promotion Unit, Population Health, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia. .,Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, the University of Sydney, Camperdown, Sydney, New South Wales, Australia. .,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia. .,Sydney Institute for Women, Children & their Families, Sydney Local Health District, Camperdown, Sydney, New South Wales, Australia.
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, the University of Sydney, Camperdown, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia.,NSW Office of Preventive Health, Ministry of Health, St Leonards, Sydney, New South Wales, Australia
| | - Huilan Xu
- Health Promotion Unit, Population Health, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Sarah Taki
- Health Promotion Unit, Population Health, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Wendy Smith
- Health Promotion Unit, Population Health, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia.,Community Health Services, Sydney Local Health District, Camperdown, Sydney, New South Wales, Australia
| | - Karen Bedford
- Health Promotion Unit, Population Health, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Alison J Hayes
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, the University of Sydney, Camperdown, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Philayrath Phongsavan
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, the University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Judy M Simpson
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, the University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Miranda J Shaw
- Community Health Services, Sydney Local Health District, Camperdown, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children & their Families, Sydney Local Health District, Camperdown, Sydney, New South Wales, Australia
| | - Renee Moreton
- Health Promotion Unit, Population Health, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, and the Charles Perkins Centre, the University of Sydney, Camperdown, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, New South Wales, Australia.,Discipline of Child & Adolescent Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia
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42
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Jiang H, Li M, Wen LM, Baur L, He G, Ma X, Qian X. A Community-Based Short Message Service Intervention to Improve Mothers' Feeding Practices for Obesity Prevention: Quasi-Experimental Study. JMIR Mhealth Uhealth 2019; 7:e13828. [PMID: 31162133 PMCID: PMC6638993 DOI: 10.2196/13828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity is increasing in China, and the effect of mobile phone short message service (SMS) interventions to prevent early childhood obesity needs to be evaluated. OBJECTIVE The objective of this study was to assess the effect of an SMS intervention on the prevention of obesity in young children. METHODS A quasi-experimental design SMS intervention was carried out in 4 community health centers (CHCs) in Shanghai, China. A total of 2 CHCs were assigned to the intervention group, and 2 CHCs were assigned to the control group. Mothers in the intervention group received weekly SMS messages on breastfeeding and infant feeding from the third trimester to 12 months postpartum. The primary outcomes were children's body mass index (BMI), BMI z-score, and weight-for-length z-score at 12 and 24 months. Factors associated with higher BMI and weight-for-length z-score at 24 months were also assessed. RESULTS A total of 582 expectant mothers were recruited at the beginning of the third gestational trimester. 477 (82.0%) and 467 (80.2%) mothers and their children were followed up to 12 and 24 months postpartum, respectively. There were no significant differences in children's BMI, BMI z-score, and weight-for-length z-score at 12 and 24 months between the 2 groups. Factors associated with higher BMI, BMI z-score, and weight-for-length z-score at 24 months included higher birth weight, introduction of solid foods before 4 months, and taking a bottle to bed at 12 months. CONCLUSIONS The SMS intervention did not show a significant effect on children's BMI, BMI z-score, or weight-for-length z-score at 12 and 24 months. Introduction of solid foods before 4 months and taking a bottle to bed at 12 months were significantly and positively correlated with a higher BMI, BMI z-score, and weight-for-length z-score at 24 months. Further studies with more rigorous design are needed to evaluate the effect of SMS interventions on preventing early childhood obesity.
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Affiliation(s)
- Hong Jiang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Mu Li
- School of Public Health, University of Sydney, Sydney, Australia.,China Studies Centre, University of Sydney, Sydney, Australia
| | - Li Ming Wen
- School of Public Health, University of Sydney, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Louise Baur
- School of Public Health, University of Sydney, Sydney, Australia.,Discipline of Child & Adolescent Health, University of Sydney, Sydney, Australia
| | - Gengsheng He
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Xiaoying Ma
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Xu Qian
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China.,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
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Ray C, Campbell K, Hesketh KD. Key Messages in an Early Childhood Obesity Prevention Intervention: Are They Recalled and Do They Impact Children's Behaviour? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1550. [PMID: 31052487 PMCID: PMC6540557 DOI: 10.3390/ijerph16091550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
Knowledge of the impact of health messages as an intervention strategy is sparse. The aim of this study was to explore recall and use of health behaviour messages among mothers, and whether recall is associated with child health behaviours. Intervention group data from the 15 months Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) were used (n = 127, children 4 months at commencement). Mothers recalled (unprompted then prompted) at 2 and 3.5 years post-intervention six key messages used in the program, and reported whether they had used them. Children's food intake was measured by three days of 24-h recall; physical activity by accelerometers; and television viewing by parent report. Unprompted recall ranged between 1-56% across messages and follow-up points, and 37-90% for prompted recall. The most commonly recalled messages "tap into water", "parents provide, kids decide" and "color every meal with fruit and veg" were also most commonly used. There were few associations between recall and children's health behaviours. Given the association between recall and reported use, it is important to plan messages so they resonate well with the target group and its needs. Messages should be used as one of multiple strategies within health promotion programs.
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Affiliation(s)
- Carola Ray
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland.
- Department of Public Health, Clinicum, University of Helsinki, 00014 Helsinki, Finland.
- Department of Food and Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland.
| | - Karen Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, VIC 3222, Australia.
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, Geelong, VIC 3222, Australia.
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Santacruz-Salas E, Aranda-Reneo I, Hidalgo-Vega Á, Blanco-Rodriguez JM, Segura-Fragoso A. The Economic Influence of Breastfeeding on the Health Cost of Newborns. J Hum Lact 2019; 35:340-348. [PMID: 30508488 DOI: 10.1177/0890334418812026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Breastfeeding provides health benefits for women and newborns. However, few studies have explored how these health benefits translate into economic savings. RESEARCH AIM This study aimed to estimate the healthcare costs savings generated by exclusive breastfeeding for healthy newborns. METHODS We designed a longitudinal two-group observational study that included healthy women and newborns ( N = 236) in Toledo, Spain. Over the first 6-months of the infants' lives, we reviewed their clinical histories to determine their consumption of healthcare resources and the type of nutrition provided. The sample was categorized into two groups: exclusive breastfeeding ( n = 46) and non-exclusive breastfeeding for 6 months ( n = 190). Two-part regression models were applied to determine whether there were differences in healthcare costs between the groups. RESULTS The average age of the women was 32 ( SD: 5.3). The average birth weight of the newborns was 3.3 kg. ( SD: 0.38). At 6 months, 19.5% ( n = 46) of the women breastfed exclusively, 28.4% ( n = 67) combined breastfeeding with formula, and 45.8% ( n = 108) used formula only. Healthcare costs during follow-up reached €785.58 (44% for specialized care, 42% for primary care, 9.8% for medical emergencies, 3% for medications and approximately 1% for medical tests). The statistical analysis estimated a lower healthcare cost of between €454.40 and €503.50 for exclusively breastfed newborns. CONCLUSION Breastfeeding generated savings in healthcare costs; therefore, it could be a cost-efficient option compared with alternatives. Researchers who evaluate the efficiency of strategies that promote breastfeeding can contribute to the sustainability of health services.
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Affiliation(s)
- Esmeralda Santacruz-Salas
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Isaac Aranda-Reneo
- 2 Faculty of Social Sciences, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Álvaro Hidalgo-Vega
- 3 Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - José M Blanco-Rodriguez
- 4 Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Antonio Segura-Fragoso
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
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Ekambareshwar M, Mihrshahi S, Wen LM, Taki S, Bennett G, Baur LA, Rissel C. Facilitators and challenges in recruiting pregnant women to an infant obesity prevention programme delivered via telephone calls or text messages. Trials 2018; 19:494. [PMID: 30219067 PMCID: PMC6139132 DOI: 10.1186/s13063-018-2871-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment of pregnant women into trials is a challenge exacerbated by a number of factors, including strict eligibility criteria. There has been little in-depth examination of the recruitment process to trials involving pregnant women. This paper presents the findings of a study conducted to identify facilitators and challenges in recruiting pregnant women to the Communicating Healthy Beginnings Advice by Telephone (CHAT) randomised controlled trial, which aims to reduce the prevalence of infant and childhood obesity. Methods Data were collected from (1) administration of a short questionnaire to women at the time of recruitment exploring women’s reasons for consent and non-consent; (2) interviews with recruiters to capture recruiters’ experiences of the recruitment process; and (3) analysis of field notes taken by recruiters on the number of women approached/recruited and reasons as to why they did not consent to participate. Data obtained were triangulated to gain insights into the process of recruiting pregnant women. Results A total of 1155 pregnant women (mean gestational age 31.5 weeks) were enrolled over 5 months. The main reasons for women consenting to participate in the study were convenience in programme delivery mode via telephone calls or text messages, altruism and because the programme was free of charge. The main reasons for women not consenting were lack of interest, language challenges/difficulty speaking English and some felt they did not need information and support due to prior experience as a mother. Facilitators included organisational support, rapport with recruiters and some women with no other children who needed advice. Despite the challenges, the mode of delivery of intervention via telephone calls or text messages, the minimal effort required of women to participate, organisational support from the lead site and recruiters’ knowledge of and commitment towards the trial contributed towards successful recruitment. Conclusion Despite some challenges in recruiting pregnant women to an infant obesity prevention programme, some of the facilitators in recruitment included mode of delivery of the intervention programme via telephone calls or text messages, the minimal effort required for women to participate, organisational support from the lead site, and recruiters’ knowledge of and commitment towards the trial. Trial registration The CHAT RCT is registered with the Australian Clinical Trial Registry (ACTRN12616001470482p); Ethics Review Committee of Sydney Local Health District (Protocol No. X16–0360 & LNR/16/RPAH/495).
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. .,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia. .,Charles Perkins Centre, University of Sydney, Sydney, Australia.
| | - Seema Mihrshahi
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Greer Bennett
- Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,Discipline of Child & Adolescent Health, University of Sydney, Sydney, Australia
| | - Chris Rissel
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,New South Wales Office of Preventive Health, Ministry of Health, Sydney, Australia
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46
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Early Infant Feeding of Formula or Solid Foods and Risk of Childhood Overweight or Obesity in a Socioeconomically Disadvantaged Region of Australia: A Longitudinal Cohort Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081685. [PMID: 30087304 PMCID: PMC6121544 DOI: 10.3390/ijerph15081685] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/15/2018] [Accepted: 07/21/2018] [Indexed: 12/12/2022]
Abstract
In southwestern Sydney the timing of introduction of formula and solids may be associated with risk of childhood overweight or obesity, and this may vary by age at breastfeeding cessation during first year. We included 346 infants from southwestern Sydney using the longitudinal study for Australian children (LSAC), who at baseline were singleton, full term, and normal weight births. The outcome risk of overweight or obesity was measured at every two-year interval of children aged 0 or 1 year at baseline until they reached age 10 or 11, defined by body mass index (BMI) ≥ 85th percentile, using the Centre for Disease Control and Prevention growth charts. Age at introduction to formula or solids was dichotomized at four months. We used mixed effects logistic regression for performing all analyses with and without adjusting for mother’s BMI, age during pregnancy, and social disadvantage index. Missing data were estimated using multivariate normal imputation having 25 imputations. The odds of overweight or obesity were significantly higher among infants introduced to formula or solids at ≤4 months compared to those introduced at >4 months in both unadjusted (odds ratio = 2.3262, p = 0.023) and adjusted (odds ratio = 1.9543, p = 0.0475) analyses. The odds of overweight or obesity when age at formula or solids introduction was held fixed at ≤4 months, increased significantly (odds ratio = 2.0856, p = 0.0215) for children stopping breastfeeding at age ≤4 months compared to >4 months. Thus, increasing the prevalence of breast-feeding without any formula or solids to 4–6 months in southwest Sydney should be a worthwhile public health measure.
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Schindler-Ruwisch JM, Roess A, Robert RC, Napolitano MA, Chiang S. Social Support for Breastfeeding in the Era of mHealth: A Content Analysis. J Hum Lact 2018; 34:543-555. [PMID: 29787686 DOI: 10.1177/0890334418773302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several barriers to successful breastfeeding exist, including a lack of support from peers or professionals. With the emergence of mobile health (mHealth) tools to provide additional breastfeeding support, a more thorough review of social support resources was needed. Research Aim: The aim of this study was to determine mHealth breastfeeding support resources and characterize the type of social support they provide. METHODS A content analysis of mHealth programs ( n = 65), including text messaging ( n = 12) and mobile applications ( n = 53), was conducted on the basis of searches of the iTunes and Google Play stores ( n = 50) and PubMed, the Cumulative Index of Nursing and Allied Health, and American Business Information/INFORM Complete Plus ( n = 15). Results were then dual-coded for key characteristics and types of support provided. RESULTS Thirty-eight apps (76%) were free to users, 14 (28%) were offered in a variety of languages, and 47 (94%) provided informational support. The mobile applications were targeted largely to postpartum women, focused on breastfeeding duration, and included troubleshooting information. Mobile applications often included media components ( n = 12 [24%]); few were tailored or personalized ( n = 5 [10%]) and interactive ( n = 15 [30%]). Text-messaging programs were available in a variety of countries ( n = 7 [58%]) and provided mostly informational support ( n = 5 [42%]), were pro-breastfeeding ( n = 12 [100%]), were targeted to both pregnant and postpartum women ( n = 6 [50%]), focused on both breastfeeding initiation and duration ( n = 9 [75%]), and had two-way interactivity ( n = 6 [50%]) and personalization ( n = 5 [42%]). CONCLUSIONS Although freely available mobile applications and text-messaging programs exist, with potential for wide reach, the majority provide only informational support. These programs would benefit from additional study of their usefulness.
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Affiliation(s)
| | - Amira Roess
- 1 The George Washington University, Washington, DC, USA
| | | | | | - Shawn Chiang
- 1 The George Washington University, Washington, DC, USA
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Prioreschi A, Brage S, Westgate K, Micklesfield LK. Describing the diurnal relationships between objectively measured mother and infant physical activity. Int J Behav Nutr Phys Act 2018; 15:59. [PMID: 29940957 PMCID: PMC6020239 DOI: 10.1186/s12966-018-0692-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/14/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Evidence for the importance of accumulating sufficient physical activity in the early years is mounting. This study aimed to determine the relationship between maternal and infant objectively measured physical activity, and to examine the diurnal interactions between these behaviours while accounting for potential covariates. METHODS Mothers and infants (n = 152 pairs; infants aged 3-24 months) were recruited from Soweto, South Africa, and physical activity was measured using a wrist worn accelerometer (Axivity AX3, Axivity Ltd., Newcastle-upon-Tyne, UK) for 3-7 days. Mothers completed sleep diaries recording night time-in-bed (used as a proxy for nocturnal sleep status) for themselves and their infant; and reported times during which their infant was in their personal care (caregiver status) for each day during the measurement period. Significant correlates of infant physical activity, as well as the interactions between mother's physical activity, day of the week, sleep status, and caregiver status, were included in panel regression analyses with infant physical activity as the outcome. RESULTS There was an equal distribution of boys and girls, and their age ranged from 2.6 to 24.5 months. The majority of mothers (73%) did not spend any time apart from their infant. During weekdays, the combined effect of mother's physical activity (β=0.11), the interactions between mother's physical activity and caregiver status (β=0.17), and sleep status (β= - 0.04) on infant physical activity was β=0.24; while during weekend days this association was β=0.21; and was largely moderated by the interaction between the mother being with the infant and her activity levels (β=0.23), but partly attenuated by mother's physical activity independent of other variables (β= - 0.04). For each hour of the day, for both mother and infant, peaks of physical activity were higher when the mother was not the primary caregiver. CONCLUSIONS Infant physical activity levels were strongly associated with their mother's activity levels particularly during the week; this relationship was stronger when mothers were more active while looking after their infant. Mothers should be encouraged to be active when looking after their children, particularly during the week, and to provide infants with as much opportunity to be active as possible.
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Affiliation(s)
- Alessandra Prioreschi
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, MRC/WITS Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Lisa K. Micklesfield
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, MRC/WITS Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
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Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Mustila T, Raitanen J, Keskinen P, Luoto R. A pragmatic controlled trial to prevent childhood obesity within a risk group at maternity and child health-care clinics: results up to six years of age (the VACOPP study). BMC Pediatr 2018; 18:89. [PMID: 29486763 PMCID: PMC5828437 DOI: 10.1186/s12887-018-1065-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 02/15/2018] [Indexed: 02/02/2023] Open
Abstract
Background Obesity in childhood appears often during the toddler years. The prenatal environment influences obesity risk. Maternal gestational diabetes, the child’s diet, and physical activity in the first few years have an important role in subsequent weight gain. A study was conducted to evaluate effectiveness of a primary health-care lifestyle counselling intervention in prevention of childhood obesity up to 6 years of age. Methods The study was a controlled pragmatic trial to prevent childhood obesity and was implemented at maternity and child health-care clinics. The participants (n = 185) were mothers at risk of gestational diabetes mellitus with their offspring born between 2008 and 2010. The prenatal intervention, started at the end of the first trimester of pregnancy, consisted of counselling on diet and physical activity by municipal health-care staff. The intervention continued at yearly appointments with a public health-nurse at child health-care clinics. The paper reports the offspring weight gain results for 2–6 years of age. Weight gain up to 6 years of age was assessed as BMI standard deviation scores (SDS) via a mixed-effect linear regression model. The proportion of children at 6 years with overweight/obesity was assessed as weight-for-height percentage and ISO-BMI. Priority was not given to power calculations, because of the study’s pragmatic nature. Results One hundred forty seven children’s (control n = 76/85% and intervention n = 71/56%) weight and height scores were available for analysis at 6 years of age. There was no significant difference in weight gain or overweight/obesity proportions between the groups at 6 years of age, but the proportion of children with obesity in both groups was high (assessed as ISO-BMI 9.9% and 11.8%) relative to prevalence in this age group in Finland. Conclusion As the authors previously reported, the intervention-group mothers had lower prevalence of gestational diabetes mellitus, but a decrease in obesity incidence before school age among their offspring was not found. The authors believe that an effective intervention should start before conception, continuing during pregnancy and the postpartum period through the developmentally unique child’s first years. Trial registration ClinicalTrials.gov NCT00970710. Registered 1 September 2009. Retrospectively registered.
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Affiliation(s)
- Taina Mustila
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
| | - Jani Raitanen
- UKK Institute for Health Promotion, Tampere, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Päivi Keskinen
- Pediatric Research Centre, 33014 University of Tampere, Tampere, Finland.,Tampere University Hospital, 33521, Tampere, Finland
| | - Riitta Luoto
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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