1
|
Cox DN, Campbell KJ, Cobiac L, Gardner C, Hancock L, Hendrie GA, Kelaart A, Lausen M, Poelman AA, Sambell R, Tikellis KM, Wiggins B. Working together to increase Australian children's liking of vegetables: a position statement by the Vegetable Intake Strategic Alliance (VISA). Public Health Nutr 2023; 26:2271-2275. [PMID: 37519225 DOI: 10.1017/s1368980023001398] [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] [Indexed: 08/01/2023]
Abstract
Children need to be repeatedly and consistently exposed to a variety of vegetables from an early age to achieve an increase in vegetable intake. A focus on enjoyment and learning to like eating vegetables at an early age is critical to forming favourable lifelong eating habits. Coordinated work is needed to ensure vegetables are available and promoted in a range of settings, using evidence-based initiatives, to create an environment that will support children’s acceptance of vegetables. This will help to facilitate increased intake and ultimately realise the associated health benefits. The challenges and evidence base for a new approach are described.
Collapse
Affiliation(s)
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC3000, Australia
| | - Lynne Cobiac
- CSIRO Health & Biosecurity, Adelaide, SA5000, Australia
| | - Claire Gardner
- Caring Futures Institute, Flinders University, Bedford Park, SA5042, Australia
| | - Lucinda Hancock
- Nutrition Australia (Vic, SA Tas, WA), Melbourne, VIC3000, Australia
| | | | - Amber Kelaart
- Nutrition Australia (Vic, SA Tas, WA), Melbourne, VIC3000, Australia
| | - Michelle Lausen
- Nutrition Australia (Vic, SA Tas, WA), Melbourne, VIC3000, Australia
| | | | - Ros Sambell
- Edith Cowan University, Joondalup, WA6027, Australia
| | | | | |
Collapse
|
2
|
Park SY, Love P, Zheng M, Campbell KJ, Lacy KE. Breakfast consumption trends among young Australian children aged up to 5 years: results from InFANT program. Front Endocrinol (Lausanne) 2023; 14:1154844. [PMID: 37635972 PMCID: PMC10448523 DOI: 10.3389/fendo.2023.1154844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 08/29/2023] Open
Abstract
Breakfast is considered a healthy dietary habit which can track over time from childhood to adulthood. The breakfast meal has the potential to improve daily dietary quality, particularly if it includes a range of food groups and adequate nutrient intakes. However, research on breakfast consumption trends among young Australian children aged up to 5 years is currently limited. This study assessed children's usual breakfast food group and nutrient intakes at ages 1.5 (n = 369), 3.5 (n = 242), and 5.0 (n =240) years using three 24-hour dietary recalls from the Melbourne InFANT program. Tracking of food groups at breakfast across the three ages was assessed by Pearson correlation of energy-adjusted food intake residuals. The main food groups consumed at breakfast were grains, milk/alternatives and discretionary items, with vegetables rarely consumed at any age. Our study found that while breakfast contributed about 20% of total daily energy, this provided 20%-29.1% of total daily intake across all ages for carbohydrates, total sugars, calcium and potassium. For the contribution to daily recommendations, breakfast contributed more than about a third of daily recommended intakes for some micronutrients (e.g., iron, calcium and zinc), and a large proportion (over 40%) of sodium intake. Children consumed 11.9% -15.2% of their energy at breakfast from saturated fat, which is higher than the recommended total energy contribution of saturated fat (no more than 10% from saturated fat). For tracking of most food groups and nutrients, tracking was found to be low or moderate over time. Given the contribution that breakfast can make to ensure children achieve their daily dietary intakes, early interventions for young Australian children should focus on practical strategies to increase vegetable intake while reducing sodium and saturated fat intake at breakfast.
Collapse
Affiliation(s)
- Seon Y. Park
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, Geelong, VIC, Australia
| | | | | | | | | |
Collapse
|
3
|
Alexandrou C, Henriksson H, Henström M, Henriksson P, Delisle Nyström C, Bendtsen M, Löf M. Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized controlled trial. Int J Behav Nutr Phys Act 2023; 20:22. [PMID: 36810069 PMCID: PMC9942425 DOI: 10.1186/s12966-023-01405-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/02/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Childhood overweight and obesity is a public health priority. We have previously reported the efficacy of a parent-oriented mobile health (mHealth) app-based intervention (MINISTOP 1.0) which showed improvements in healthy lifestyle behaviors. However, the effectiveness of the MINISTOP app in real-world conditions needs to be established. OBJECTIVE To evaluate the real-world effectiveness of a 6-month mHealth intervention (MINISTOP 2.0 app) on children's intake of fruits, vegetables, sweet and savory treats, sweet drinks, moderate-to-vigorous physical activity, and screen time (primary outcomes), and on parental self-efficacy (PSE) for promoting healthy lifestyle behaviors, and children's body mass index (BMI) (secondary outcomes). METHODS A hybrid type 1 effectiveness-implementation design was utilized. For the effectiveness outcomes, a two-arm, individually randomized controlled trial was conducted. Parents (n = 552) of 2.5-to-3-year-old children were recruited from 19 child health care centers across Sweden, and, randomized to either a control (standard care) or intervention group (MINISTOP 2.0 app). The 2.0 version was adapted and translated into English, Somali and Arabic to increase reach. All recruitment and data collection were conducted by the nurses. Outcomes were assessed at baseline and after six months, using standardized measures (BMI) and a questionnaire (health behaviors, PSE). RESULTS Among the participating parents (n = 552, age: 34.1 ± 5.0 years), 79% were mothers and 62% had a university degree. Twenty-four percent (n = 132) of children had two foreign-born parents. At follow-up, parents in the intervention group reported lower intakes of sweet and savory treats (-6.97 g/day; p = 0.001), sweet drinks (-31.52 g/day; p < 0.001), and screen time (-7.00 min/day; p = 0.012) in their children compared to the control group. The intervention group reported higher total PSE (0.91; p = 0.006), PSE for promoting healthy diet (0.34; p = 0.008) and PSE for promoting physical activity behaviors (0.31; p = 0.009) compared to controls. No statistically significant effect was observed for children's BMI z-score. Overall, parents reported high satisfaction with the app, and 54% reported using the app at least once a week. CONCLUSION Children in the intervention group had lower intakes of sweet and savory treats, sweet drinks, less screen time (primary outcomes) and their parents reported higher PSE for promoting healthy lifestyle behaviors. Our results from this real-world effectiveness trial support the implementation of the MINISTOP 2.0 app within Swedish child health care. TRIAL REGISTRATION Clinicaltrials.gov NCT04147039; https://clinicaltrials.gov/ct2/show/NCT04147039.
Collapse
Affiliation(s)
- Christina Alexandrou
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83, Linköping, Sweden. .,Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Huddinge, 141 83, Sweden.
| | - Hanna Henriksson
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden
| | - Maria Henström
- grid.4714.60000 0004 1937 0626Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Huddinge, 141 83 Sweden
| | - Pontus Henriksson
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden
| | - Christine Delisle Nyström
- grid.4714.60000 0004 1937 0626Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Huddinge, 141 83 Sweden
| | - Marcus Bendtsen
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden
| | - Marie Löf
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden ,grid.4714.60000 0004 1937 0626Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Huddinge, 141 83 Sweden
| |
Collapse
|
4
|
Zheng M, Silva M, Heitkonig S, Abbott G, McNaughton SA, Campbell KJ. Evaluation of a Food Frequency Questionnaire for Capturing Free Sugars Intake in Australian Young Children: The InFANT FFQ. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1557. [PMID: 36674312 PMCID: PMC9864467 DOI: 10.3390/ijerph20021557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Excess free sugars intake contributes to dental caries and obesity in children. Food frequency questionnaires (FFQ) that assess free sugars intake in young children are limited. This study evaluated the utility of a 68-item FFQ to assess free sugars intake in Australian young children against three 24-h recalls at ages 1.5, 3.5, and 5.0 years. Free sugars intakes estimated from two methods were compared using group- and individual-level validation tests. Group-level tests revealed that mean free sugars intakes estimated from two methods were similar and Bland-Altman tests revealed no presence of proportional bias at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ underestimated the free sugars intake compared to the recalls, and Bland-Altman tests revealed proportional bias. For individual-level tests, the deattenuated correlation (R) between free sugars intakes estimated from two methods exhibited good agreement across three time-points (R: 0.54-0.62), as were the percentage agreement (68.5-73.6%) and weighted kappa (Kw: 0.26-0.39). The FFQ showed good validity at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ showed good validity for individual-level tests only. The FFQ provided stronger validity in the ranking of individuals according to free sugars intake than comparing absolute free sugars intake at group level.
Collapse
Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Mihiri Silva
- Murdoch Childrens Research Institute, Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Melbourne Dental School, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Stephanie Heitkonig
- Murdoch Childrens Research Institute, Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| |
Collapse
|
5
|
Marshall S, Johnson BJ, Hesketh KD, Campbell KJ, Fraser K, Love P, Denney-Wilson E, Salmon J, McCallum Z, Laws R. Mapping intervention components from a randomized controlled trial to scale-up of an early life nutrition and movement intervention: The INFANT program. Front Public Health 2023; 10:1026856. [PMID: 36711339 PMCID: PMC9880042 DOI: 10.3389/fpubh.2022.1026856] [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: 08/24/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Early life parent-focused interventions can effectively improve infant and child nutrition and movement (physical activity and sedentary behavior) as well as parents' health behaviors. Scale-up of such interventions to real-world settings is essential for population-wide benefits. When progressing to scale-up, intervention components may be modified to reflect contextual factors and promote feasibility of scale-up. The INFANT program, an efficacious early life nutrition and movement behavioral intervention began as a randomized controlled trial (RCT), was modified after a small-scale translation, and is currently being scaled-up in Victoria, Australia. This study mapped and compared discrete intervention components of both the original RCT and the scaled-up version of INFANT to examine modifications for scaling up. Methods Discrete intervention components, specifically the target behaviors (child-related and parent-related behaviors), delivery features and behavior change techniques (BCTs) from the RCT and the scaled-up program were coded and mapped using established frameworks and taxonomies. Publications and unpublished materials (e.g., facilitator notes, handouts, videos, app) were coded. Coding was performed independently in duplicate, with final coding validated in a meeting with interventionists. Interventionists reported the rationale for modifications made. Results The INFANT RCT and scaled-up version targeted the same obesity prevention-related nutrition and movement behaviors. Key modified delivery features at scale-up included reduced number of sessions, a broader range of professionals facilitating groups, the addition of a mobile app for parents replacing hard-copy materials and tangible tools (e.g., pedometers), and broadening of content (e.g., early feeding, updated 24-h movement guidelines). BCTs used across the RCT and scale-up sessions were unchanged. However, the BCTs identified in the between-session support materials were almost double for the scale-up compared with the RCT, primarily due to the reduced number of sessions and the app's capacity to include more content. Conclusions INFANT is one of few early life nutrition and movement behavioral interventions being delivered at scale. With INFANT as an example, this study provides critical understanding about what and why intervention components were altered as the RCT was scaled-up. Unpacking these intervention modifications provides important insights for scale-up feasibility, outcome effects, and how to optimize implementation strategies for population-level benefits.
Collapse
Affiliation(s)
- Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Brittany J. Johnson
- Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration, Sydney, NSW, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Kylie Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Elizabeth Denney-Wilson
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Zoe McCallum
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| |
Collapse
|
6
|
Griffiths A, Brooks R, Haythorne R, Kelly G, Matu J, Brown T, Ahmed K, Hindle L, Ells L. The impact of Allied Health Professionals on the primary and secondary prevention of obesity in young children: A scoping review. Clin Obes 2022; 13:e12571. [PMID: 36451267 DOI: 10.1111/cob.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine 'contact points', as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomized controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under 5 years old). AHP-related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g. lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g. body mass index (BMI) z-score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine 'contact points' in the prevention of obesity in young children. AHP interventions could be effective in optimizing weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.
Collapse
Affiliation(s)
- Alex Griffiths
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Rob Brooks
- School of Health Studies, University of Bradford, Bradford, UK
| | - Rebecca Haythorne
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Gill Kelly
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Jamie Matu
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Tamara Brown
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Kanar Ahmed
- Department of Health and Social Care, Office for Health Improvement and Disparities, England, UK
| | - Linda Hindle
- Department of Health and Social Care, Office for Health Improvement and Disparities, England, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| |
Collapse
|
7
|
Love P, Laws R, Taki S, West M, Hesketh KD, Campbell KJ. Factors contributing to the sustained implementation of an early childhood obesity prevention intervention: The INFANT Program. FRONTIERS IN HEALTH SERVICES 2022; 2:1031628. [PMID: 36925886 PMCID: PMC10012774 DOI: 10.3389/frhs.2022.1031628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
Background The INFANT Program is an efficacious, group-based program for first-time parents, delivered at three-monthly intervals when INFANT are aged 3-18 months through an existing universal care service in Victoria, Australia. Many lessons have been learnt from its origins as a cluster randomized control trial to its small-scale, community-level implementation. This study aimed to describe factors contributing to its sustained implementation to inform large-scale implementation across Australia. Methods This study used a multi-site qualitative exploratory approach. INFANT facilitators trained between 2013 and 2017 were sent an online survey, with optional telephone interviews. The Consolidated Framework for Implementation Research (CFIR) was selected as the underpinning theoretical framework as it offered the opportunity to explore a breadth of possible barriers and enablers across patterns of implementation (never, discontinued, ongoing). Results All participants were female (n = 31), the majority were Maternal and Child Health Nurses (48%), representing five regional and nine metro local government areas (LGAs), across all patterns of implementation (never implemented n = 4; discontinued implementation n = 5; ongoing implementation n = 5). All consenting participants were interviewed (n = 11) representing four regional and seven metro LGAs, across all patterns of implementation (never implemented n = 3; discontinued implementation n = 4; ongoing implementation n = 4). The main reason for attending INFANT Program training was to become skilled to implement the program. Mapping identified barriers and enablers to the CFIR revealed the inner and outer settings and implementation process to be of greatest influence. Main differences between LGAs with ongoing and discontinued implementation related to funding availability, organizational management support and endorsement, organizational resourcing and capacity, integration into routine practice and establishing role clarity with partner organizations, and planning for sustained implementation from the start. Conclusion This study provides important insights into the barriers and enablers to the sustained implementation of an evidence-based intervention (the INFANT Program) during small scale community-level implementation. The authors therefore contend that the pre-requisite for scale-up of a population health intervention is not just proof of effectiveness but also proof of sustained implementation at the local/organizational level. Study findings have broad transferability given their similarity to those identified for health promotion interventions implemented globally, in healthcare, education and community settings.
Collapse
Affiliation(s)
- Penelope Love
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Rachel Laws
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Madeline West
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Karen J. Campbell
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| |
Collapse
|
8
|
Seidler AL, Hunter KE, Baur L, Espinoza D, Taylor RW, Wen LM, Hesketh KD, Campbell K, Daniels L, Mihrshahi S, Rissel C, Taylor B, Askie LM. Examining the sustainability of effects of early childhood obesity prevention interventions: Follow-up of the EPOCH individual participant data prospective meta-analysis. Pediatr Obes 2022; 17:e12919. [PMID: 35396815 PMCID: PMC9541553 DOI: 10.1111/ijpo.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although early childhood obesity prevention has become an important issue internationally, little evidence exists regarding longer term effects (i.e., sustainability) of early interventions. OBJECTIVE To determine whether intervention benefits at 2 years of age were sustained at 3.5 and 5 years. METHODS Follow-up of the Early Prevention of Obesity in Children (EPOCH) individual participant data prospective meta-analysis of four randomized controlled trials including 2196 mother-child dyads at baseline. Interventions were home- or community-based, commenced within 6 months of birth, ended by 2 years of age, and comprised multiple sessions. Controls received standard care. BMI z-score (primary outcome), other anthropometric measures and weight-related behaviours were initially measured at 1.5-2 years and followed up at 3.5 and 5 years. RESULTS Positive intervention effects on BMI z-scores at 1.5-2 years of age were not apparent by 3.5 years (-0.04 adjusted mean difference; 95% CI:-0.14, 0.06; p = 0.424), and 5 years (0.03; 95% CI: -0.08, 0.14; p = 0.60). While prolonged intervention benefits were detected for a few, but not the majority of, weight-related behaviours at 3.5 years, these effects diminished over time. CONCLUSION This meta-analysis found that initial positive effects of childhood obesity interventions faded out after interventions ended, pointing toward the importance of a suite of interventions implemented at multiple stages across childhood.
Collapse
Affiliation(s)
- Anna Lene Seidler
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kylie E. Hunter
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Louise Baur
- Specialty of Child and Adolescent HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - David Espinoza
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | | | - Li Ming Wen
- Health Promotion Unit, Sydney Local Health District, School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kylie D. Hesketh
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Karen Campbell
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Lynne Daniels
- Centre Child Health Research, School Exercise Nutrition SciencesQueensland University TechnologyBrisbaneQueenslandAustralia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human SciencesMacquarie UniversityNew South WalesAustralia
| | - Chris Rissel
- Sydney School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Barry Taylor
- Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
| | - Lisa M. Askie
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| |
Collapse
|
9
|
Flynn AC, Suleiman F, Windsor‐Aubrey H, Wolfe I, O'Keeffe M, Poston L, Dalrymple KV. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. MATERNAL & CHILD NUTRITION 2022; 18:e13354. [PMID: 35333450 PMCID: PMC9218326 DOI: 10.1111/mcn.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/01/2023]
Abstract
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
Collapse
Affiliation(s)
- Angela C. Flynn
- Department of Women and Children's HealthKing's College LondonLondonUK
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Fatma Suleiman
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Hazel Windsor‐Aubrey
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Ingrid Wolfe
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Majella O'Keeffe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Lucilla Poston
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Kathryn V. Dalrymple
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| |
Collapse
|
10
|
Hesketh KD, Downing KL, Galland BC, Nicholson JM, Taylor R, Orellana L, Abdelrazek M, Koorts H, Brown V, Haines J, Campbell KJ, Barnett LM, Löf M, Moodie M, Carson V, Salmon J. Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers. BMJ Open 2022; 12:e057521. [PMID: 35351726 PMCID: PMC8961153 DOI: 10.1136/bmjopen-2021-057521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception. METHODS AND ANALYSIS A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T0), mid-intervention (T1; 6 months post baseline), at intervention conclusion (T2; 12 months post baseline) and 1-year post intervention (T3; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted. ETHICS AND DISSEMINATION The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media. TRIAL REGISTRATION NUMBER ACTRN12620001280998; U1111-1252-0599.
Collapse
Affiliation(s)
- Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Liliana Orellana
- Faculty of Health Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lisa M Barnett
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- School of Health & Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Marie Löf
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| |
Collapse
|
11
|
Flannery C, Shea C, O’Brien Y, O’Halloran J, Matvienko-Sikar K, Kelly C, Toomey E. Investigating group-based classes ('weaning workshops') to support complementary infant feeding in Irish primary care settings: a cross-sectional survey. Public Health Nutr 2022; 25:1-12. [PMID: 35260219 PMCID: PMC9991655 DOI: 10.1017/s1368980022000477] [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: 11/26/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aims to (1) investigate current practice regarding 'weaning workshops' to support complementary infant feeding delivered within Irish primary care, (2) explore the experiences and opinions of community dietitians regarding optimal content and modes of delivery of weaning workshops and (3) identify the key factors to be considered in the development and implementation of weaning workshops delivered within primary care. DESIGN Cross-sectional survey. SETTING Irish primary care. PARTICIPANTS Forty-seven community-based dietitians. RESULTS Sixteen dietitians reported that workshops were run in their area with variable frequency, with ten reporting that workshops were never run in their area. Participants reported that mostly mothers of medium socio-economic status (SES) attended weaning workshops when infants were aged between 4 and 7 months, and that feedback from workshop attendees was predominantly positive. Dietitians identified that key factors to be considered in future development and delivery of weaning workshops are (1) workshop characteristics such as content, timing and venue, (2) organisational characteristics such as availability of resources and multidisciplinary involvement and (3) attendee characteristics such as SES. CONCLUSIONS This study highlights substantial variability regarding provision of weaning workshops in Ireland, and a lack of standardisation regarding the provider, content and frequency of workshops where workshops are being delivered. The study also provides unique insights into the experiences and opinions of primary care community dietitians regarding the development and delivery of weaning workshops in terms of optimal content and delivery options. These perspectives will make a valuable contribution given the dearth of evidence in this area internationally.
Collapse
Affiliation(s)
- Caragh Flannery
- School of Public Health, University College Cork, CorkT12 K8AF, Ireland
- INFANT Centre, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Caroline Shea
- School of Public Health, University College Cork, CorkT12 K8AF, Ireland
| | - Yvonne O’Brien
- Community Nutrition and Dietetic Service, Cork Kerry Community Healthcare, HSE, Cork, Ireland
| | - Joanne O’Halloran
- Primary Care Centre, Mountkennedy Town Centre, Newtownmountkennedy, Co Wicklow, Ireland
| | | | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- School of Allied Health, University of Limerick, Co. Limerick, Ireland
- Health Research Institute, University of Limerick, Co. Limerick, Ireland
| |
Collapse
|
12
|
Zheng M, Hesketh KD, McNaughton SA, Salmon J, Crawford D, Cameron AJ, Lioret S, Campbell KJ. Quantifying the overall impact of an early childhood multi-behavioural lifestyle intervention. Pediatr Obes 2022; 17:e12861. [PMID: 34658152 DOI: 10.1111/ijpo.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The overall impact of interventions targeting multiple behaviours remains largely unexplored. OBJECTIVES This study adopted an integrative lifestyle pattern analysis approach to assess the overall effectiveness of an early childhood intervention on change across multiple behaviours. METHODS The Melbourne INFANT program was a 15-month cluster-randomized controlled trial involving 4-month-old infants and their parents at baseline in 2008 (n = 542). The intervention included six education sessions helping parents to promote a healthy diet, physical activity and limit sedentary behaviour in their infants. Participants were followed-up twice post-intervention, at ages 3.6 (2011) and 5 years (2013), to assess sustained effects of the intervention. Previous principal component analyses identified two lifestyle patterns from dietary intake, outdoor time and television viewing time. Random effect linear regression models were conducted to assess the impact of the intervention on lifestyle patterns. RESULTS The intervention group had a lower 'Discretionary consumption and TV' lifestyle pattern score than the control group at all time points with adjusted mean difference: -0.29, 95% CI -0.49, -0.09, p = 0.004 post-intervention at age 1.5 years; -0.29, 95% CI -0.54, -0.04, p = 0.02 at the first follow-up (age 3.6 years); and -0.21, 95% CI -0.43, 0.01, p = 0.06 at the second follow-up (age 5.0 years). No evidence of between-group differences was found for the 'Fruit, vegetables and outdoor' lifestyle pattern score. CONCLUSION This early childhood intervention designed to promote change in more than one obesity-related behaviour was effective in improving correlated unhealthy lifestyle behaviours. Lifestyle pattern analysis is a useful and interpretable approach for evaluating multi-behavioural interventions.
Collapse
Affiliation(s)
- Miaobing Zheng
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Sarah A McNaughton
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - David Crawford
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Sandrine Lioret
- INSERM, INRAE, Université de Paris, Research Center in Epidemiology and Biostatistics (CRESS), Paris, France
| | - Karen J Campbell
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| |
Collapse
|
13
|
Parental feeding and childhood genetic risk for obesity: exploring hypothetical interventions with causal inference methods. Int J Obes (Lond) 2022; 46:1271-1279. [PMID: 35306528 PMCID: PMC9239906 DOI: 10.1038/s41366-022-01106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Parental-feeding behaviors are common intervention targets for childhood obesity, but often only deliver small changes. Childhood BMI is partly driven by genetic effects, and the extent to which parental-feeding interventions can mediate child genetic liability is not known. Here we aim to examine how potential interventions on parental-feeding behaviors can mitigate some of the association between child genetic liability and BMI in early adolescence, using causal inference methods. METHODS Data from the Avon Longitudinal Study of Parents and Children were used to estimate an interventional disparity measure for a child polygenic score for BMI (PGS-BMI) on BMI at 12 years. The approach compares counterfactual outcomes for different hypothetical interventions on parental-feeding styles applied when children are 10-11 years (n = 4248). Results are presented as adjusted total association (Adj-Ta) between genetic liability (PGS-BMI) and BMI at 12 years, versus the interventional disparity measure-direct effect (IDM-DE), which represents the association that would remain, had we intervened on parental-feeding under different scenarios. RESULTS For children in the top quintile of genetic liability, an intervention shifting parental feeding to the levels of children with lowest genetic risk, resulted in a difference of 0.81 kg/m2 in BMI at 12 years (Adj-Ta = 3.27, 95% CI: 3.04, 3.49; versus IDM-DE = 2.46, 95% CI: 2.24, 2.67). CONCLUSIONS Findings suggest that parental-feeding interventions have the potential to buffer some of the genetic liability for childhood obesity. Further, we highlight a novel way to analyze potential interventions for health conditions only using secondary data analyses, by combining methodology from statistical genetics and social epidemiology.
Collapse
|
14
|
Burnett AJ, Lamb KE, Spence AC, Lacy KE, Worsley A. Parenting style as a predictor of dietary score change in children from 4 to 14 years of age. Findings from the Longitudinal Study of Australian Children. Public Health Nutr 2021; 24:6058-6066. [PMID: 34296665 PMCID: PMC11148571 DOI: 10.1017/s1368980021003062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine associations between parenting style and changes in dietary quality score across childhood. DESIGN This longitudinal analysis included the child's frequency of consumption for twelve food and drink items reported by mothers of children (aged 4-8 years) and children (aged 10-14 years) during face-to-face interviews biennially. These items were combined into dietary scores based on the Australian Dietary Guidelines. Parenting styles were classified at baseline as authoritative, authoritarian, permissive and disengaged. Multilevel modelling was used to examine changes in diet quality score over time by maternal parenting styles. SETTING The Longitudinal Study of Australian Children. PARTICIPANTS A total of 4282 children aged 4 to 14 years. RESULTS Children's diet quality score declined over time between 4 and 14 years of age (β = -0·10, 95 % CI (-0·11, -0·08)). There was strong evidence to suggest that change in diet quality differed dependent on baseline maternal parenting style, although diet quality declined for all groups. Children with authoritative mothers had the greatest decline in diet quality score over time (β = -0·13; 95 % CI (-0·18, -0·08)), while children with disengaged mothers had the lowest decline (β = -0·03; 95 % CI (-0·07, 0·01)). However, it is important to note that children with authoritative mothers had a better dietary quality score than children of permissive or disengaged mothers for most of their childhood. CONCLUSION These findings question the previous assumptions that early exposure to an authoritative parenting style has lasting positive effects on the dietary intake of children.
Collapse
Affiliation(s)
- Alissa J Burnett
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC3125, Australia
| | - Karen E Lamb
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC3125, Australia
- Murdoch Children's Research Institute, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison C Spence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC3125, Australia
| | - Kathleen E Lacy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC3125, Australia
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC3125, Australia
| |
Collapse
|
15
|
Love P. How prepared is the dietetic profession for today's wicked childhood nutrition problems? Nutr Diet 2021; 78:383-385. [PMID: 34542223 DOI: 10.1111/1747-0080.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Penelope Love
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
16
|
How to Support Child Healthcare Nurses in Sweden to Promote Healthy Lifestyle Behaviors from the Start of Life. CHILDREN-BASEL 2021; 8:children8080696. [PMID: 34438588 PMCID: PMC8392879 DOI: 10.3390/children8080696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Child healthcare (CHC) nurses have a key role in promoting and supporting healthy lifestyle behaviors from a young age. Thus, this study aims to investigate the perspectives of CHC nurses regarding discussing food introduction, physical activity/active play, and screen time with parents; explore facilitators and barriers influencing the discussion of healthy lifestyle behaviors with parents; and explore the perspectives of CHC nurses regarding a complementary program to promote healthy lifestyle behaviors from the start of life. A total of fifteen nurses participated in semi-structured interviews, which were recorded, transcribed verbatim, and analyzed using thematic analysis. There were four themes that were generated: parental needs; facilitators and barriers; parental groups; and future working methods. This study found that CHC nurses have seen an increase in the need for support among today’s parents. Time, the need to tailor information, and confidence to address sensitive topics were perceived as the largest barriers during daily work for the nurses. Furthermore, large variations in parental groups were found. Finally, the CHC nurses displayed a willingness and openness to change and develop current working methods using digital solutions. These solutions could possibly ease the workload and at the same time, support parents to create healthy lifestyle behaviors from the start of their child’s life.
Collapse
|
17
|
Infant media use: A harm reduction approach. Infant Behav Dev 2021; 64:101610. [PMID: 34298189 DOI: 10.1016/j.infbeh.2021.101610] [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] [Received: 07/31/2020] [Revised: 05/28/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022]
Abstract
There are a myriad of potentially harmful developmental outcomes associated with infant digital media use. Studies revealing risk associated with early media use have informed the current American Academy of Pediatrics (AAP) recommendations that discourage most digital media use among children under 18 months of age. Recent research advances, however, suggest potential benefits of technology engagement in this age group. Additionally, surveys of parents reveal that most infants engage with digital media for at least 30 min a day, exceeding the AAP recommendations. In response to these discoveries and cultural trends, some scholars have made compelling cases to adapt the AAP guidelines for infants. A helpful model for developing infant digital media use guidelines for families may be the harm reduction approach. The intent of this review is to suggest adaptations to the AAP guidelines for infant media engagement using a harm reduction framework. This review describes the challenge of restrictive guidelines, briefly summarizes the harm reduction approach, provides a review of risks and benefits associated with infant media use in each developmental domain (physical, cognitive, and socioemotional), summarizes correlates of infant screen media use, and examines intervention strategies for reducing screen time. The paper concludes with examples of possible adaptations to current AAP infant media use recommendations using harm reduction and bioecological frameworks.
Collapse
|
18
|
Zheng M, Lioret S, Hesketh KD, Spence A, Taylor R, Campbell KJ. Association Between Longitudinal Trajectories of Lifestyle Pattern and BMI in Early Childhood. Obesity (Silver Spring) 2021; 29:879-887. [PMID: 33899335 DOI: 10.1002/oby.23136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the association between longitudinal trajectories of lifestyle patterns (LPs) and BMI z score in early childhood. METHODS Data of children (n = 439) who participated in the 18-, 42-, and 60-month follow-ups of the Melbourne InFANT Program were used. Multitrajectory modeling identified groups of children following similar LPs and BMI z score trajectories, and multinomial logistic regression assessed the determinants of the trajectory groups. RESULTS Three trajectory groups of child LPs and BMI z scores were identified: "Unhealthy LP, Low BMIz" (30%), "Healthy LP, Mid BMIz" (53%), and "Unhealthy LP, High BMIz" (17%). Relative to the "Unhealthy LP, Low BMIz" group, the maternal "Fruit and vegetables" dietary pattern was associated with higher odds (odds ratio [OR] 1.22, 95% CI: 1.01-1.47) of children following the "Healthy LP, Mid BMIz" group. Maternal prepregnancy BMI (≥25 kg/m2 ) (OR 2.50, 95% CI: 1.31-4.75) and maternal TV-viewing time ≥130 min/d (OR 2.55, 95% CI: 1.13, 5.72) increased the odds of children following the "Unhealthy LP, High BMIz" group. Child sex, breastfeeding duration, and maternal physical activity were not associated with the identified trajectory groups. CONCLUSIONS Three trajectory groups of LPs and BMI z scores in early childhood were revealed, with maternal prepregnancy BMI, dietary pattern, and TV-viewing time being identified as significant determinants.
Collapse
Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sandrine Lioret
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Early Origin of the Child's Health and Development ORCHAD team, Villejuif, France
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Alison Spence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
19
|
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: 9] [Impact Index Per Article: 3.0] [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.
Collapse
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
| |
Collapse
|
20
|
What Factors Help Young Children Develop Positive Perceptions of Their Motor Skills? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020759. [PMID: 33477407 PMCID: PMC7830558 DOI: 10.3390/ijerph18020759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
A positive perception of motor skills is important for physical activity participation. The aim was to investigate which modifiable factors predict children’s perceived motor skills. Mothers completed questionnaires when their child was 3.5 and 5 years old. At 5 years old, the children’s perceived motor competence (PMC) was assessed. Separate linear regression models (up to 300 children) examined which factors at each time point predicted children’s PMC, adjusted for relevant confounders. Multivariate models were then run with factors associated (p < 0.10) with perception. At 3.5 years, the time spent with same age and older children (both higher tertiles) and parental physical activity facilitation (sum of facilitation in last month, e.g., taking child to park) were initially associated with higher perception. Dance/gymnastics participation were associated with lower perceptions. Other child behaviours, maternal beliefs, play equipment, and swimming lessons were non-significant. In the final prospective model (n = 226), parental physical activity facilitation when child was 3.5 years old was the only factor to predict PMC. No factors were significant for the cross-sectional analyses at 5 years. Perceptions are formed based on past experiences which may explain why factors at 3.5 years rather than current experiences (when children were 5 years old) were associated with childhood perceptions.
Collapse
|
21
|
Variation in outcomes of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) according to maternal education and age 2 and 3·5 years post-intervention. Public Health Nutr 2021; 24:1460-1468. [PMID: 33427160 DOI: 10.1017/s1368980021000045] [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] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age. DESIGN Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children's BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years). SETTING Population based. PARTICIPANTS Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old. RESULTS At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively. CONCLUSIONS Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother's education level or age, which is important in community-based interventions.
Collapse
|
22
|
Laws R, Love P, Hesketh KD, Koorts H, Denney-Wilson E, Moodie M, Brown V, Ong KL, Browne J, Marshall S, Lioret S, Orellana L, Campbell KJ. Protocol for an Effectiveness-Implementation Hybrid Trial to Evaluate Scale up of an Evidence-Based Intervention Addressing Lifestyle Behaviours From the Start of Life: INFANT. Front Endocrinol (Lausanne) 2021; 12:717468. [PMID: 34975744 PMCID: PMC8715861 DOI: 10.3389/fendo.2021.717468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents' knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children's diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life; 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia. METHODS AND ANALYSIS A hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the 'Outcomes for Implementation Research' and 'RE-AIM' frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a sample of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age. IMPACT This is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally. CLINICAL TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry https://www.anzctr.org.au/, identifier ACTRN12620000670976.
Collapse
Affiliation(s)
- Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- *Correspondence: Rachel Laws,
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Kok-Leong Ong
- La Trobe Analytics Lab, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer Browne
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | | | | | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
23
|
Delisle Nyström C, Abbott G, Cameron AJ, Campbell KJ, Löf M, Salmon J, Hesketh KD. Maternal knowledge explains screen time differences 2 and 3.5 years post-intervention in INFANT. Eur J Pediatr 2021; 180:3391-3398. [PMID: 34075476 PMCID: PMC8502736 DOI: 10.1007/s00431-021-04134-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
Very few early childhood interventions have observed sustained effects regarding television viewing and none have examined the mechanisms behind sustained intervention effects at long-term follow-ups. Thus, the aim of this study was to investigate potential mechanisms relating to the maintained intervention effect on television viewing at two long-term follow-ups in the Melbourne Infant Feeding Activity and Nutrition Trial (INFANT). INFANT was a cluster-randomised controlled trial. At the 2- and 3.5-year follow-ups, a total of 262 infant/mother pairs had complete information. Television viewing was assessed via a questionnaire at both follow-ups and six potential mediators were measured post-intervention (i.e. 15 months after baseline). Causal mediation analysis was conducted. At the 2- and 3.5-year follow-ups, the positive impacts of INFANT on maternal television viewing knowledge were maintained (B = 0.34 units; 95% confidence interval (CI95): 0.21, 0.48). An indirect effect of the intervention on reducing children's television viewing time was observed at the 2- and 3.5-year follow-ups (B = -11.73 min/day; CI95: -22.26, -3.28 and B = -4.78 min/day; CI95: -9.48, -0.99, respectively) via improved maternal television viewing knowledge.Conclusion: The positive impacts of INFANT on maternal television viewing knowledge were maintained at both follow-ups, with better maternal knowledge associated with less television viewing time in their children. These results have implications for paediatricians and healthcare professionals as educating new parents early on regarding screen time may lead to the development of healthier screen time habits that are sustained through to the pre-school years. What is Known: • Lifestyle behaviours inclusive of screen time have been found to be established before the pre-school years and track. • Few trials have evaluated the long-term mechanisms related to maintained intervention effectiveness. What is New: • This study shows the positive impacts of a low-dose intervention on maternal television viewing knowledge at two long-term follow-ups. • Better maternal television viewing knowledge was associated with less television viewing time in their children.
Collapse
Affiliation(s)
- Christine Delisle Nyström
- Department of Biosciences and Nutrition, Karolinska Institutet, Neo, 141 83, Huddinge, Sweden. .,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125, Australia.
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| | - Adrian J. Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, 3125 Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Neo, 141 83 Huddinge, Sweden ,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia ,Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 53 Linköping, Sweden
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| |
Collapse
|
24
|
Henström M, Müssener U, Campbell KJ, Hesketh KD, Rosell M, Delisle Nyström C. The Need for an Evidence-Based Program in Sweden to Support Parents to Create Healthy Lifestyle Behaviors from the Start of Life-Parental Perceptions. Nutrients 2020; 12:nu12123823. [PMID: 33327562 PMCID: PMC7765081 DOI: 10.3390/nu12123823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022] Open
Abstract
In Sweden, there have been no interventions promoting the development of healthy lifestyle behaviors starting in infancy. Thus this paper aims to: (i) investigate Swedish parents’ experiences regarding feeding of solid foods, screen time, and physical activity in healthy infants; (ii) investigate parents’ needs and perceptions regarding information/support provided in primary child healthcare (CHC) and (iii) explore whether a parenting program focused on child diet and active play would be relevant and utilized. Semi-structured interviews were conducted with 20 parents. These were recorded, transcribed verbatim and analyzed using thematic analysis. Seven themes emerged: Feeling excited to enter a new phase; Parents’ responsibility of doing it “right” can be stressful; Motivated to learn during specific time windows; Information to trust; The importance of social support from peers; Experiences of support received from CHC; and the Infant, Feeding, Activity, and Nutrition Trial (INFANT) for a Swedish context. Parents were excited to enter new phases in their child’s development. However, this came with worry they were doing things “right”, leading parents to want more information/support. Overall, Swedish parents were very positive about the prospects of engaging in a primary CHC delivered program to support them to promote healthy lifestyle behaviors from birth and felt this could complement the care currently provided.
Collapse
Affiliation(s)
- Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Group MLÖ, 141 83 Huddinge, Sweden; (M.H.); (M.R.)
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83 Linköping, Sweden;
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3125, Australia; (K.J.C.); (K.D.H.)
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3125, Australia; (K.J.C.); (K.D.H.)
| | - Magdalena Rosell
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Group MLÖ, 141 83 Huddinge, Sweden; (M.H.); (M.R.)
| | - Christine Delisle Nyström
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Group MLÖ, 141 83 Huddinge, Sweden; (M.H.); (M.R.)
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3125, Australia; (K.J.C.); (K.D.H.)
- Correspondence: ; Tel.: +46-76-401-4500
| |
Collapse
|