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Sharma SV, Senn M, Zieba A, Tang M, Chuang RJ, Byrd-Williams C, Pomeroy M, Gaminian A, Cox J, French K, Ranjit N. Design, protocol and baseline data of Nurturing Healthy Teachers, a cluster non-randomized controlled trial to improve the health, well-being, and food security of preschool and elementary school teachers in Houston, Texas. Prev Med Rep 2024; 40:102674. [PMID: 38464420 PMCID: PMC10924131 DOI: 10.1016/j.pmedr.2024.102674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
Background We present the conceptual framework, design, and study measures of Nurturing Healthy Teachers, a quasi-experimental study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among preschool and elementary school teachers. Methods A convenience sample of 28 elementary schools with pre-kindergarten and elementary classrooms were recruited in Houston, Texas. Nurturing Healthy Teacher intervention includes Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education, and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. The primary outcome is food insecurity. Secondary outcomes include diet quality, mental health, and cardiometabolic health. Metabolic markers and skin carotenoid levels were assessed using in-person assessments, while all other measures were obtained via questionnaire. Results At baseline, most of the participants were female, 63 % identified as Hispanic, were highly educated, and had a mean age of 42.6 years. Overall, 50 % of teachers were classified as being obese and 20 % had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6 %. Moderate to severe depression was experienced by 18 % of teachers and 23 % of teachers experienced moderate to severe anxiety. Conclusions The results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.
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Affiliation(s)
- Shreela V. Sharma
- Department of Epidemiology, Center for Health Equity, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Mackenzie Senn
- Department of Epidemiology, Center for Health Equity, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Angela Zieba
- Department of Epidemiology, Center for Health Equity, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Miao Tang
- Department of Epidemiology, Center for Health Equity, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Ru-Jye Chuang
- Department of Health Promotion and Behavioral Sciences, Center for Health Equity, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Courtney Byrd-Williams
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe St., Austin, TX, USA
| | | | | | - Jill Cox
- Penn State Extension Better Kid Care, 103 Innovation Blvd., Suite 214, State College, PA 16803, USA
| | - Katherine French
- Penn State Extension Better Kid Care, 103 Innovation Blvd., Suite 214, State College, PA 16803, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe St., Austin, TX, USA
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Saroukhani S, Samms-Vaughan M, Bressler J, Lee M, Byrd-Williams C, Hessabi M, Grove ML, Shakespeare-Pellington S, Loveland KA, Rahbar MH. Additive or Interactive Associations of Food Allergies with Glutathione S-Transferase Genes in Relation to ASD and ASD Severity in Jamaican Children. J Autism Dev Disord 2024; 54:704-724. [PMID: 36436147 DOI: 10.1007/s10803-022-05813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/29/2022]
Abstract
To investigate additive and interactive associations of food allergies with three glutathione S-transferase (GST) genes in relation to ASD and ASD severity in Jamaican children. Using data from 344 1:1 age- and sex-matched ASD cases and typically developing controls, we assessed additive and interactive associations of food allergies with polymorphisms in GST genes (GSTM1, GSTP1 and GSTT1) in relation to ASD by applying conditional logistic regression models, and in relation to ASD severity in ASD cases as measured by the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2) total and domains specific comparison scores (CSs) by fitting general linear models. Although food allergies and GST genes were not associated with ASD, ASD cases allergic to non-dairy food had higher mean ADOS-2 Restricted and Repetitive Behaviors (RRB) CS (8.8 vs. 8.0, P = 0.04). In addition, allergy to dairy was associated with higher mean RRB CS only among ASD cases with GSTT1 DD genotype (9.9 vs. 7.8, P < 0.01, interaction P = 0.01), and GSTP1 Val/Val genotype under a recessive genetic model (9.8 vs. 7.8, P = 0.02, interaction P = 0.06). Our findings are consistent with the role for GST genes in ASD and food allergies, though require replication in other populations.
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Affiliation(s)
- Sepideh Saroukhani
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Maureen Samms-Vaughan
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston 7, Kingston, Jamaica
| | - Jan Bressler
- Department of Epidemiology, Human Genetics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Courtney Byrd-Williams
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, School of Public Health Regional Campus at Austin, The University of Texas Health Science Center at Houston, Austin, TX, 78701, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Megan L Grove
- Department of Epidemiology, Human Genetics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Sydonnie Shakespeare-Pellington
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston 7, Kingston, Jamaica
| | - Katherine A Loveland
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, 77030, Houston, USA
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Department of Epidemiology, Human Genetics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
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Koepp AE, Lanza K, Byrd-Williams C, Bryan AE, Gershoff ET. Ambient Temperature Increases and Preschoolers' Outdoor Physical Activity. JAMA Pediatr 2023; 177:539-540. [PMID: 36939692 PMCID: PMC10028534 DOI: 10.1001/jamapediatrics.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/29/2022] [Indexed: 03/21/2023]
Abstract
This cross-sectional study evaluates the association of high outdoor temperatures with children’s engagement in physical activity during play.
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Affiliation(s)
- Andrew E. Koepp
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas
| | - Kevin Lanza
- Michael and Susan Dell Center for Healthy Living at The University of Texas Health Science Center, Houston School of Public Health Austin Campus, Austin, Texas
| | - Courtney Byrd-Williams
- Michael and Susan Dell Center for Healthy Living at The University of Texas Health Science Center, Houston School of Public Health Austin Campus, Austin, Texas
| | - Amy E. Bryan
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas
| | - Elizabeth T. Gershoff
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas
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Sharma SV, Kelder S, Yamal JM, Chuang RJ, Byrd-Williams C, Bona G, Bajaj N, Brito F, Neumann AS. Development and Feasibility Testing of CATCH Healthy Smiles, an Oral Health Promotion Intervention for Prevention of Dental Caries Among Elementary School Children. J Sch Health 2022; 92:20-30. [PMID: 34788893 DOI: 10.1111/josh.13100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/09/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We present results of the development and feasibility testing of CATCH Healthy Smiles, a school-based oral health program, among children in grades K-2 in Houston, Texas. METHODS Study design was cross-sectional (N = 2 schools; N = 125 parent-child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016-2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent-reported 24-hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. RESULTS Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02-1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05-0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09-275.14), greater frequency of consuming sugar-sweetened beverages (AdjOR = 11.53, 95% CI: 2.10-87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74-119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02-0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. CONCLUSIONS These data will be used to conduct a subsequent fully powered cluster randomized controlled trial.
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Affiliation(s)
- Shreela V Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS E643, Houston, TX, 77030, USA
| | - Steven Kelder
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center, School of Public Health, Austin Regional Campus, 1616 Guadalupe St., Suite 6300, Austin, TX, 78701, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS W817, Houston, TX, 77030, USA
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, RAS E615, Houston, TX, 77030, USA
| | - Courtney Byrd-Williams
- Department of Health Promotion and Behavior Sciences, Director, Maternal and Child Health Training Program, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center, School of Public Health, Austin Regional Campus, 1616 Guadalupe, Austin, TX, 78701, USA
| | - Gisela Bona
- Pediatric Dentistry, Pre-doctoral Clinical Director Pediatric Dentistry, Department of Pediatric Dentistry, 7500 Cambridge St, Suite 5403, Houston, TX, 77054, USA
| | - Nimit Bajaj
- Henry M. Goldman School of Dental Medicine, Boston University, 635 Albany St, Boston, MA, 02118, USA
| | - Frances Brito
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Ana S Neumann
- Department of General Practice and Dental Public Health, Director of Dental Public Health, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge St, Suite 5423, Houston, TX, 77054, USA
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Byrd-Williams C, Ewing M, Rosenthal EL, St. John JA, Menking P, Redondo F, Sieswerda S. Training Needs of Community Health Workers Facing the COVID-19 Pandemic in Texas: A Cross-Sectional Study. Front Public Health 2021; 9:689946. [PMID: 34195172 PMCID: PMC8236534 DOI: 10.3389/fpubh.2021.689946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has required the professional healthcare workforce not only to adjust methods of delivering care safely but also act as a trusted sources of information during a time of uncertainty and rapid research and discovery. The Community Health Worker COVID-19 Impact Survey is a cross-sectional study developed to better understand the impact of COVID-19 on this sector of the healthcare workforce, including training needs of those working through the pandemic. The survey was distributed in Texas, New Mexico, and Arizona. This study focuses on Texas, and the data presented (n = 693) is a sub-set of qualitative data from the larger survey. Results of the content analysis described in this paper are intended to inform current COVID-19-related CHW training curriculum, in addition to future infectious disease prevention and preparedness response trainings.
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Affiliation(s)
- Courtney Byrd-Williams
- Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - Mollie Ewing
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - E. Lee Rosenthal
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, United States
| | - Julie Ann St. John
- Julia Jones Matthews Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Paige Menking
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Stephanie Sieswerda
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
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Sharma SV, Chuang RJ, Byrd-Williams C, Vandewater E, Butte N, Hoelscher DM. Using Process Evaluation for Implementation Success of Preschool-Based Programs for Obesity Prevention: The TX Childhood Obesity Research Demonstration Study. J Sch Health 2019; 89:382-392. [PMID: 30932206 DOI: 10.1111/josh.12745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 04/26/2018] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Through the Texas Childhood Obesity Research Demonstration study, we implemented and evaluated a system-oriented model of primary and secondary prevention approaches to mitigate obesity among low-income Texas children aged 2 to 12 years. Primary prevention included implementing the Coordinated Approach To Child Health Early Childhood (CATCH EC) program in Head Start preschools. In this paper, we describe the methods and results of CATCH EC program process evaluation over 2 years of implementation. METHODS We used a quasi-experimental design with serial cross-sectional data collected from Head Start centers across intervention and comparison catchment areas in Houston and Austin, Texas (intervention: N = 12 centers in 2012-2013 [Year 1], N = 12 in 2013-2014 [Year 2]; comparison: N = 13 centers in Year 1, N = 12 in Year 2). Process evaluation included center director and teacher surveys conducted in both years of implementation. We developed indices for implementation of CATCH EC and non-CATCH health events at the centers. RESULTS Implementation scores were higher among intervention centers as compared to comparison centers across both years of implementation, and these differences were statistically significant (p < .01). There was also high variability in program implementation in intervention centers across both years ranging from 55% to 95%. CONCLUSION These implementation index strategies may inform future evaluation of preschool-based obesity prevention program implementation.
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Affiliation(s)
- Shreela V Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS E603, Houston, TX 77030
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS E603, Houston, TX 77030
| | - Courtney Byrd-Williams
- Health Promotion & Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health in Austin, 1616 Guadalupe, UTA 6.304, Austin, TX 78701
| | - Elizabeth Vandewater
- Data Science and Research Services, University of Texas at Austin, 116 Inner Campus Drive, CLA 2.608, Austin, TX 78712
| | - Nancy Butte
- Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX
| | - Deanna M Hoelscher
- Health Promotion & Behavioral Sciences, Chair, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health in Austin, 1616 Guadalupe, UTA 6.310, Austin, Texas 78701
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Wilson TA, Liu Y, Adolph AL, Sacher PM, Barlow SE, Pont S, Sharma S, Byrd-Williams C, Hoelscher DM, Butte NF. Behavior Modification of Diet and Parent Feeding Practices in a Community- Vs Primary Care-Centered Intervention for Childhood Obesity. J Nutr Educ Behav 2019; 51:150-161.e1. [PMID: 30139562 DOI: 10.1016/j.jneb.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate behavior modification of diet and parent feeding practices in childhood obesity interventions. DESIGN Secondary analysis of randomized, controlled trial comparing Mind, Exercise, Nutrition … Do It! (MEND2-5 and MEND/Coordinated Approach to Child Health [CATCH6-12]) vs Next Steps at baseline and 3 and 12 months. SETTING Austin and Houston, TX. PARTICIPANTS A total of 549 Hispanic and black children randomized to programs by age groups (2-5, 6-8, and 9-12 years) INTERVENTIONS: Twelve-month MEND2-5 and MEND/CATCH6-12 vs Next Steps. MAIN OUTCOME MEASURE(S) Diet (MEND-friendly/unfriendly food groups and Healthy Eating Index-2010) and parent feeding practices (parental overt control, discipline, limit setting, monitoring, reinforcement, modeling, and covert control; and food neophobia). ANALYSIS Mixed-effects linear regression. RESULTS Changes in diet quality, consumption of MEND-unfriendly foods, and parent feeding practices did not differ between programs. In both interventions, MEND-unfriendly vegetables, grains, dairy and protein, added fat and desserts/sugar-sweetened beverages declined in 2-5- and 6-8-year-olds (P < .001). Healthy Eating Index-2010 improved in 2-5- (treatment; P = .002) and 6-8-year-olds (P = .001). Parental overt control decreased and limit setting, discipline, monitoring, reinforcement, and covert control increased with both interventions in 2-5- and 6-8-year-olds (P < 0.01-0.001). CONCLUSIONS Diet quality, consumption of MEND-unfriendly foods, and parent feeding practices were altered constructively in 2 pediatric obesity interventions, especially in 2-5- and 6-8-year-olds.
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Affiliation(s)
- Theresa A Wilson
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Yan Liu
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Anne L Adolph
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Paul M Sacher
- Childhood Nutrition Research Centre, University College London, London, UK
| | - Sarah E Barlow
- Children's Health, GI Practice, University of Texas Southwestern Medical Center, Dallas, TX
| | - Stephen Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center University of Texas at Austin Dell Medical School, Austin, TX
| | - Shreela Sharma
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Courtney Byrd-Williams
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, TX
| | - Deanna M Hoelscher
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, TX.
| | - Nancy F Butte
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Sharma SV, Vandewater E, Chuang RJ, Byrd-Williams C, Kelder S, Butte N, Hoelscher DM. Impact of the Coordinated Approach to Child Health Early Childhood Program for Obesity Prevention among Preschool Children: The Texas Childhood Obesity Research Demonstration Study. Child Obes 2019; 15:1-13. [PMID: 30226991 DOI: 10.1089/chi.2018.0010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND This study presents the impact of a 2-year implementation of Coordinated Approach to Child Health Early Childhood (CATCH EC), a preschool-based healthy nutrition and physical activity program, on child BMI z-scores, BMI percentiles, diet, physical activity, and sedentary behaviors among 3- to 5-year old children across Head Start centers in Houston and Austin, Texas. METHODS We used a quasi-experimental study design with serial cross-sectional data collection (Intervention catchment area: n = 12 centers, 353 parent-child dyads in Year 1; n = 12 centers, 365 parent-child dyads; Comparison catchment area: n = 13 centers in year 1, 319 parent child dyads; and n = 12 centers, 483 parent-child dyads in year 2). Child height and weight were measured and parent self-report surveys were conducted at year 1 (fall 2012) and year 2 (spring 2014). RESULTS In year 1, 34.8% of the children were overweight or obese, 74% were Hispanic, and >80% reported an annual household income of <$25,000. In year 2, 32.2% were overweight or obese, 72% were Hispanic, and 82.3% reported an annual income of <$25,000. Results demonstrated significantly lower child BMI z-scores [β = -0.26 (95% confidence interval, CI: -0.50 to -0.01), p = 0.041] and BMI percentiles [β = -6.5 (95% CI: -12.4 to -0.69), p = 0.028] from year 1 to 2 follow-up among those in intervention Head Start centers, compared to those in the comparison centers. There were no significant between-group changes in child dietary, physical activity, or screen time behaviors. CONCLUSION Implementation of a preschool-based obesity prevention program can be modestly effective in lowering the prevalence of child overweight in low-income populations.
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Affiliation(s)
- Shreela V Sharma
- 1 Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Elizabeth Vandewater
- 2 Data Science and Research Services Unit, University of Texas at Austin, Austin, TX
| | - Ru-Jye Chuang
- 1 Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Courtney Byrd-Williams
- 3 Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Austin, TX
| | - Steven Kelder
- 1 Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Nancy Butte
- 4 USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Deanna M Hoelscher
- 3 Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Austin, TX
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Sharma SV, Chuang RJ, Byrd-Williams C, Danho M, Upadhyaya M, Berens P, Hoelscher DM. Pilot evaluation of HEAL - A natural experiment to promote obesity prevention behaviors among low-income pregnant women. Prev Med Rep 2018; 10:254-262. [PMID: 29868377 PMCID: PMC5984221 DOI: 10.1016/j.pmedr.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/16/2018] [Accepted: 04/06/2018] [Indexed: 11/27/2022] Open
Abstract
Instituting interventions during the prenatal period is optimal for early obesity prevention in the child. Healthy Eating Active Living (HEAL) is a six-week, multi-component program to promote breastfeeding, healthy dietary habits, cooking skills and physical activity among Medicaid-eligible pregnant-women in Texas. HEAL is integrated into the healthcare system and offered as a standard-of-care for eligible patients. METHODS Preliminary evaluation of this natural experiment conducted from March 2015 through October 2016 informs the initial feasibility, acceptability and effects of the program on participant diet, home nutrition environment, physical activity, and breastfeeding self-efficacy and intentions measured using self-report surveys. Analysis of covariance (ANCOVA) was conducted to evaluate pre- and post-intervention changes, controlling for participants' ethnicity, age, and income level. Interaction effects of session attendance on the outcomes were further assessed. RESULTS Of the 329 women who enrolled in HEAL, 210 women completed the pre-post assessment (64% retention rate). Pre-to-post intervention, there were significant increases in availability and intake of fruits and vegetables, self-efficacy towards consuming more fruits and vegetables, and cooking frequency and skills (p < 0.05), and decreased frequency of eating heat and serve foods (p < 0.05). Significant improvements in physical activity, duration of breastfeeding, perceived benefits and intentions to breastfeed were also observed (p < 0.05). Higher attendance of HEAL sessions was associated with better outcomes. Process evaluation demonstrated 95% fidelity of program implementation. CONCLUSION HEAL operationalizes clinic-community linkages and shows promise in improving behaviors during pregnancy. Future research warrants the use of a stringent study design with a control group to determine program efficacy.
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Affiliation(s)
- Shreela V. Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Courtney Byrd-Williams
- Department of Health Promotion & Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, United States
| | - Melisa Danho
- Maternal Neonatal/Healthy Eating Active Living Program, University of Texas McGovern Medical School, Houston, TX, United States
| | - Mudita Upadhyaya
- Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Pam Berens
- Department of Obstetrics & Gynecology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Deanna M. Hoelscher
- Department of Health Promotion & Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, United States
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Byrd-Williams C, Dooley EE, Sharma SV, Chuang RJ, Butte N, Hoelscher DM. Best Practices and Barriers to Obesity Prevention in Head Start: Differences Between Director and Teacher Perceptions. Prev Chronic Dis 2017; 14:E139. [PMID: 29267155 PMCID: PMC5743025 DOI: 10.5888/pcd14.170297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Practices and barriers to promoting healthy eating and physical activity at Head Start centers may influence children’s energy balance behaviors. We examined differences between directors’ and teachers’ perspectives on best practices and barriers to promoting healthy eating and physical activity in Head Start centers. Methods We conducted a cross-sectional study of directors (n = 23) and teachers (n = 113) at 23 Head Start centers participating in the baseline assessment of the Texas Childhood Obesity Research Demonstration study. Participants completed surveys about practices and barriers to promoting healthy eating and physical activity. Multilevel regression models examined differences between director and teacher responses. Results More than half of directors and teachers reported meeting most best practices related to nutrition and physical activity; few directors or teachers (<25%) reported conducting physical activity for more than 60 minutes a day, and less than 40% of teachers helped children attend to satiety cues. Significantly more directors than teachers reported meeting 2 nutrition-related best practices: “Teachers rarely eat less healthy foods (especially sweets, salty snacks, and sugary drinks) in front of children” and “Teachers talk to children about trying/enjoying new foods” (P < .05). No barrier to healthy eating or physical activity was reported by more than 25% of directors or teachers. Significantly more teachers than directors reported barriers to healthy eating, citing lack of food service staff support, limited time, and insufficient funds (P < .05). Conclusion More barriers to healthy eating were reported than were barriers to physical activity indicating that more support may be needed for healthy eating. Differences between responses of directors and teachers may have implications for future assessments of implementation of best practices and barriers to implementation related to nutrition and physical activity in early care and education centers.
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Affiliation(s)
- Courtney Byrd-Williams
- Michael & Susan Dell Center for Healthy Living at UTHealth, School of Public Health in Austin, 1616 Guadalupe St, Ste 6.300, Austin, TX, 78701.
| | - Erin E Dooley
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, Austin, Texas
| | - Shreela V Sharma
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Houston, Houston, Texas
| | - Ru-Jye Chuang
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Houston, Houston, Texas
| | - Nancy Butte
- US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, Austin, Texas
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Butte NF, Hoelscher DM, Barlow SE, Pont S, Durand C, Vandewater EA, Liu Y, Adolph AL, Pérez A, Wilson TA, Gonzalez A, Puyau MR, Sharma SV, Byrd-Williams C, Oluyomi A, Huang T, Finkelstein EA, Sacher PM, Kelder SH. Efficacy of a Community- Versus Primary Care-Centered Program for Childhood Obesity: TX CORD RCT. Obesity (Silver Spring) 2017; 25:1584-1593. [PMID: 28703504 DOI: 10.1002/oby.21929] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This randomized controlled trial was conducted to determine comparative efficacy of a 12-month community-centered weight management program (MEND2-5 for ages 2-5 or MEND/CATCH6-12 for ages 6-12) against a primary care-centered program (Next Steps) in low-income children. METHODS Five hundred forty-nine Hispanic and black children (BMI ≥ 85th percentile), stratified by age groups (2-5, 6-8, and 9-12 years), were randomly assigned to MEND2-5 (27 contact hours)/MEND/CATCH6-12 (121.5 contact hours) or Next Steps (8 contact hours). Primary (BMI value at the 95th percentile [%BMIp95 ]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase). RESULTS For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMIp95 than Next Steps during the Intensive Phase. Effect size (95% CI) was -1.94 (-3.88, -0.01) percentage points (P = 0.05). For age group 9-12, effect size was -1.38 (-2.87, 0.16) percentage points for %BMIp95 (P = 0.07). MEND2-5 did not differentially affect %BMIp95 . Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMIp95 during the Intensive Phase (P < 0.05). In the Transition Phase, %BMIp95 was maintained or rebounded in both programs (P < 0.05). CONCLUSIONS MEND/CATCH6-12 was more efficacious for BMI reduction at 3 months but not 12 months compared to Next Steps in underserved children. Intervention compliance influenced outcomes, emphasizing the need for research in sustaining family engagement in low-income populations.
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Affiliation(s)
- Nancy F Butte
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Sarah E Barlow
- Children's Health, GI Practice, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Casey Durand
- Center for Systems and Community Design; Department of Community Health and Social Sciences; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Elizabeth A Vandewater
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Yan Liu
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anne L Adolph
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Theresa A Wilson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandra Gonzalez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Maurice R Puyau
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Shreela V Sharma
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Courtney Byrd-Williams
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Abiodun Oluyomi
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Terry Huang
- Center for Systems and Community Design; Department of Community Health and Social Sciences; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Eric A Finkelstein
- Duke University Global Health Institute, Durham, North Carolina, USA, and Duke-NUS Medical School, Singapore
| | - Paul M Sacher
- Childhood Nutrition Research Centre, University College-London, London, UK
| | - Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
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Dev DA, Byrd-Williams C, Ramsay S, McBride B, Srivastava D, Murriel A, Arcan C, Adachi-Mejia AM. Engaging Parents to Promote Children's Nutrition and Health. Am J Health Promot 2017; 31:153-162. [PMID: 28423928 DOI: 10.1177/0890117116685426] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers' (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children's health. DESIGN Qualitative. SETTING State-licensed center-based childcare programs. PARTICIPANTS Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. METHODS In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. RESULTS Two overarching themes were barriers and strategies to communicate with parents about children's nutrition. Barriers to communication included-(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included-(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. CONCLUSION Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children's nutrition and health.
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Affiliation(s)
- Dipti A Dev
- 1 Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA.,2 Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | - Samantha Ramsay
- 4 School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA
| | - Brent McBride
- 5 Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Deepa Srivastava
- 1 Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Ashleigh Murriel
- 6 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Chrisa Arcan
- 7 Family, Population, and Preventive Medicine at Stony Brook University, NY, USA
| | - Anna M Adachi-Mejia
- 8 Health Promotion Research Center at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH, USA
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Sharma SV, Rashid T, Ranjit N, Byrd-Williams C, Chuang RJ, Roberts-Gray C, Briley M, Sweitzer S, Hoelscher DM. Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: A group-randomized controlled trial. Prev Med 2015; 81:1-8. [PMID: 26190371 PMCID: PMC4996076 DOI: 10.1016/j.ypmed.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG). METHOD A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011 to 2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at p<0.05. RESULTS At baseline, parent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β=0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β=0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication. CONCLUSION Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG.
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Affiliation(s)
- Shreela V Sharma
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, 1200 Hermann Pressler, RAS E603, Houston, TX 77030, United States.
| | - Tasnuva Rashid
- The University of Texas School of Public Health, 1200 Hermann Pressler, Houston, TX 77030, United States.
| | - Nalini Ranjit
- Health Promotion/Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin Regional Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States.
| | - Courtney Byrd-Williams
- Health Promotion/Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin Regional Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States.
| | - Ru-Jye Chuang
- UT School of Public Health, Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, 1200 Hermann Pressler, RAS E611, Houston, TX 77030, United States.
| | | | - Margaret Briley
- Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin, TX 78746, United States.
| | - Sara Sweitzer
- Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, 1 University Station, A2700, Austin, TX 78712, United States.
| | - Deanna M Hoelscher
- Department of Health Promotion/Behavioral Sciences, University of Texas School of Public Health, Austin Regional Campus, 1616 Guadalupe Street, 6.300, Austin, TX 78701, United States.
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Oluyomi AO, Byars A, Byrd-Williams C, Sharma SV, Durand C, Hoelscher DM, Butte NF, Kelder SH. The utility of Geographical Information Systems (GIS) in systems-oriented obesity intervention projects: the selection of comparable study sites for a quasi-experimental intervention design--TX CORD. Child Obes 2015; 11:58-70. [PMID: 25587670 PMCID: PMC4696445 DOI: 10.1089/chi.2014.0054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Texas Childhood Obesity Research Demonstration project (TX CORD) uses a systems-oriented approach to address obesity that includes individual and family interventions, community-level action, as well as environmental and policy initiatives. Given that randomization is seldom possible in community-level intervention studies, TX CORD uses a quasi-experimental design. Comparable intervention and comparison study sites are needed to address internal validity bias. METHODS TX CORD was designed to be implemented in low-income, ethnically diverse communities in Austin and Houston, Texas. A three-stage Geographical Information System (GIS) methodology was used to establish and ascertain the comparability of the intervention and comparison study sites. Census tract (stage 1) and school (stage 2) data were used to identify spatially exclusive geographic areas that were comparable. In stage 3, study sites were compared on demographic characteristics, socioeconomic status (SES), food assets, and physical activity (PA) assets. Student's t-test was used to examine significant differences between the selected sites. RESULTS The methodology that was used resulted in the selection of catchment areas with demographic and socioeconomic characteristics that fit the target population: ethnically diverse population; lower-median household income; and lower home ownership rates. Additionally, the intervention and comparison sites were statistically comparable on demographic and SES variables, as well as food assets and PA assets. CONCLUSIONS This GIS approach can provide researchers, program evaluators, and policy makers with useful tools for both research and practice. Area-level information that allows for robust understanding of communities can enhance analytical procedures in community health research and offer significant contributions in terms of community assessment and engagement.
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Affiliation(s)
- Abiodun O. Oluyomi
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
| | - Allison Byars
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
| | - Courtney Byrd-Williams
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
| | - Shreela V. Sharma
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
| | - Casey Durand
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
| | - Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
| | - Nancy F. Butte
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Steven H. Kelder
- Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX
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Hoelscher DM, Butte NF, Barlow S, Vandewater EA, Sharma SV, Huang T, Finkelstein E, Pont S, Sacher P, Byrd-Williams C, Oluyomi AO, Durand C, Li L, Kelder SH. Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study. Child Obes 2015; 11:71-91. [PMID: 25555188 PMCID: PMC4696423 DOI: 10.1089/chi.2014.0084] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. METHODS Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. RESULTS Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. CONCLUSIONS Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.
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Affiliation(s)
- Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Nancy F. Butte
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Sarah Barlow
- Department of Pediatric Medicine, GI, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elizabeth A. Vandewater
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Shreela V. Sharma
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Houston, TX
| | - Terry Huang
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Eric Finkelstein
- Program in Health Services Systems Research, Duke University Global Health Institute, Singapore
| | - Stephen Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas Southwestern–Austin, Austin, TX
| | - Paul Sacher
- Childhood Nutrition Research Center, University College, London, United Kingdom
| | - Courtney Byrd-Williams
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Abiodun O. Oluyomi
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Casey Durand
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Houston, TX
| | - Linlin Li
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Steven H. Kelder
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
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Sharma SV, Upadhyaya M, Schober DJ, Byrd-Williams C. A conceptual framework for organizational readiness to implement nutrition and physical activity programs in early childhood education settings. Prev Chronic Dis 2014; 11:E190. [PMID: 25357258 PMCID: PMC4215571 DOI: 10.5888/pcd11.140166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Across multiple sectors, organizational readiness predicts the success of program implementation. However, the factors influencing readiness of early childhood education (ECE) organizations for implementation of new nutrition and physical activity programs is poorly understood. This study presents a new conceptual framework to measure organizational readiness to implement nutrition and physical activity programs in ECE centers serving children aged 0 to 5 years. The framework was validated for consensus on relevance and generalizability by conducting focus groups; the participants were managers (16 directors and 2 assistant directors) of ECE centers. The framework theorizes that it is necessary to have “collective readiness,” which takes into account such factors as resources, organizational operations, work culture, and the collective attitudes, motivation, beliefs, and intentions of ECE staff. Results of the focus groups demonstrated consensus on the relevance of proposed constructs across ECE settings. Including readiness measures during program planning and evaluation could inform implementation of ECE programs targeting nutrition and physical activity behaviors.
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Affiliation(s)
- Shreela V Sharma
- Division of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas School of Public Health, 1200 Hermann Pressler, RAS E603, Houston, TX 77030. E-mail:
| | - Mudita Upadhyaya
- Michael and Susan Dell Center for Healthy Living, The University of Texas, School of Public Health, Houston, Texas
| | - Daniel J Schober
- Gretchen Swanson Center for Nutrition and University of Nebraska Medical Center, Omaha, Nebraska
| | - Courtney Byrd-Williams
- Michael and Susan Dell Center for Healthy Living, The University of Texas, School of Public Health, Houston, Texas
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Davis JN, Ventura EE, Tung A, Munevar MA, Hasson RE, Byrd-Williams C, Vanni AK, Spruijt-Metz D, Weigensberg M, Goran MI. Effects of a randomized maintenance intervention on adiposity and metabolic risk factors in overweight minority adolescents. Pediatr Obes 2012; 7:16-27. [PMID: 22434736 PMCID: PMC3313084 DOI: 10.1111/j.2047-6310.2011.00002.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 09/09/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effects of a maintenance programme (monthly newsletters vs. monthly group classes and telephone behavioural sessions) on obesity and metabolic disease risk at 1 year in overweight minority adolescents. METHODS After a 4-month nutrition and strength training intervention, 53 overweight Latino and African-American adolescents (15.4 ± 1.1 years) were randomized into one of two maintenance groups for 8 months: monthly newsletters (n = 23) or group classes (n = 30; monthly classes + individualized behavioural telephone sessions). The following outcomes were measured at months 4 (immediately following the intense intervention) and 12: height, weight, blood pressure, body composition via BodPod™ (Life Measurement Instruments, Concord, CA, USA), lipids and glucose/insulin indices via frequently sampled intravenous glucose tolerance test. RESULTS There were no significant group by time interactions for any of the health outcomes. There were significant time effects in several outcomes for both groups from months 4 to 12: bench press and leg press decreased by 5% and 14%, respectively (P = 0.004 & P = 0.01), fasting insulin and acute insulin response decreased by 26% and 16%, respectively (P < 0.001 & P = 0.046); while high-density lipoprotein cholesterol and insulin sensitivity improved by 5% and 14% (P = 0.042 & P = 0.039). CONCLUSIONS Newsletters as opposed to group classes may suffice as follow-up maintenance programmes to decrease type 2 diabetes and cardiovascular risk in overweight minority adolescents.
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Affiliation(s)
- J N Davis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9008, USA.
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Abstract
OBJECTIVE To examine the dietary and activity correlates of sugar-sweetened beverage consumption by children in middle and high school. METHODS Data were obtained from a cross-sectional survey of 15,283 children in middle and high schools in Texas. Consumption of sodas and noncarbonated flavored and sports beverages (FSBs) were examined separately for their associations with the level of (1) unhealthy food (fried meats, French fries, desserts) consumption, (2) healthy food (vegetables, fruit, and milk) consumption, (3) physical activity including usual vigorous physical activity and participation in organized physical activity, and (4) sedentary activity, including hours spent watching television, using the computer, and playing video games. RESULTS For both genders, consumption of soda and FSBs was systematically associated with a number of unhealthy dietary practices and with sedentary behaviors. However, consumption of FSBs showed significant positive graded associations with several healthy dietary practices and level of physical activity, whereas soda consumption showed no such associations with healthy behaviors. CONCLUSIONS Consumption of FSBs coexists with healthy dietary and physical activity behaviors, which suggests popular misperception of these beverages as being consistent with a healthy lifestyle. Assessment and obesity-prevention efforts that target sugar-sweetened beverages need to distinguish between FSBs and sodas.
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Affiliation(s)
- Nalini Ranjit
- Michael & Susan Dell Center for Health Living, University of Texas School of Public Health, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701, USA.
| | | | - Courtney Byrd-Williams
- UT School of Public Health (Austin Regional Campus) and the Dell Center for Advancement of Healthy Living
| | - Alexandra E. Evans
- UT School of Public Health (Austin Regional Campus) and the Dell Center for Advancement of Healthy Living
| | - Deanna M. Hoelscher
- UT School of Public Health (Austin Regional Campus) and the Dell Center for Advancement of Healthy Living
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Belcher BR, Byrd-Williams C, Hsu YW, McClain A, Emken BA, Chou CP, Spruijt-Metz D. Moderate To Vigorous Physical Activity (mvpa) Declines With Age In Minority Female Youth. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385288.18206.d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ventura E, Davis J, Byrd-Williams C, Alexander K, McClain A, Lane CJ, Spruijt-Metz D, Weigensberg M, Goran M. Reduction in risk factors for type 2 diabetes mellitus in response to a low-sugar, high-fiber dietary intervention in overweight Latino adolescents. ACTA ACUST UNITED AC 2009; 163:320-7. [PMID: 19349560 DOI: 10.1001/archpediatrics.2009.11] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine if reductions in added sugar intake or increases in fiber intake in response to a 16-week intervention were related to improvements in metabolic outcomes related to type 2 diabetes mellitus risk. DESIGN Secondary analysis of a randomized control trial. SETTING Intervention classes at a lifestyle laboratory and metabolic measures at the General Clinical Research Center. PARTICIPANTS Fifty-four overweight Latino adolescents (mean [SD] age, 15.5 [1] years). Intervention Sixteen-week study with 3 groups: control, nutrition, or nutrition plus strength training. MAIN OUTCOME MEASURES Body composition by dual-energy x-ray absorptiometry; visceral adipose tissue by magnetic resonance imaging; glucose and insulin incremental area under the curve by oral glucose tolerance test; insulin sensitivity, acute insulin response, and disposition index by intravenous glucose tolerance test; and dietary intake by 3-day records. RESULTS Fifty-five percent of all participants decreased added sugar intake (mean decrease, 47 g/d) and 59% increased fiber intake (mean increase, 5 g/d), and percentages were similar in all intervention groups, including controls. Those who decreased added sugar intake had an improvement in glucose incremental area under the curve (-15% vs +3%; P = .049) and insulin incremental area under the curve (-33% vs -9%; P = .02). Those who increased fiber intake had an improvement in body mass index (-2% vs +2%; P = .01) and visceral adipose tissue (-10% vs no change; P = .03). CONCLUSIONS Individuals who reduced added sugar intake by the equivalent of 1 can of soda per day or increased fiber intake by the equivalent of a cup of beans showed improvements in key risk factors for type 2 diabetes, specifically in insulin secretion and visceral fat. Improvements occurred independent of group assignment and were equally likely to occur in control group participants.
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Affiliation(s)
- Emily Ventura
- Department of PreventiveMedicine, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Los Angeles, CA 90089-9008, USA
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Byrd-Williams C, Kelly LA, Davis JN, Spruijt-Metz D, Goran MI. Influence of gender, BMI and Hispanic ethnicity on physical activity in children. ACTA ACUST UNITED AC 2008; 2:159-66. [PMID: 17999281 DOI: 10.1080/17477160701369167] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between overweight status and physical activity (PA) among gender and ethnic (Hispanic vs. non-Hispanic) sub-groups in elementary school-age children. METHODS PA was assessed over five days using the Actigraph accelerometer in 169 fourth grade students (mean age 9.4 years; 50% female; 63% Hispanic; and 43% overweight, defined as body mass index, BMI > or = 85th percentile for age and gender) from four elementary schools in Los Angeles County, California. RESULTS In the total sample, boys and normal weight students had higher levels of total PA (counts per minute, cpm; p<0.05). Boys spent less time in sedentary PA (p=0.02) and more time in combined moderate to vigorous PA (MVPA, p=0.01). There was a significant gender, ethnicity, and overweight interaction for total PA and MVPA (both p<0.01). MVPA and counts per minute were significantly lower in overweight non-Hispanic girls and Hispanic boys (p<0.05) and marginally lower in overweight non-Hispanic boys (p=0.10) when compared with non-overweight students, while overweight Hispanic girls were more physically active than Hispanic non-overweight girls, though the difference was non-significant (p>0.05). CONCLUSIONS Data from the present study does not consistently support the prevailing hypothesis that overweight subjects engage in less PA. Results show overweight students engage in less PA than non-overweight students, with the exception that non-overweight Hispanic girls do not engage in more PA than their overweight peers. These results suggest the need for further investigation into the role that ethnicity and overweight status plays in PA levels, particularly among ethnic and gender sub-groups.
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Affiliation(s)
- Courtney Byrd-Williams
- University of Southern California, Department of Preventive Medicine, Keck School of Medicine, & Institute for Prevention Research, Los Angeles, California 90033, USA
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Koebnick C, Shaibi GQ, Kelly LA, Roberts CK, Lane CJ, Toledo-Corral C, Davis JN, Byrd-Williams C, Weigensberg MJ, Goran MI. Leptin-to-adiponectin ratio as independent predictor of insulin sensitivity during growth in overweight Hispanic youth. J Endocrinol Invest 2007; 30:RC13-6. [PMID: 17848833 DOI: 10.1007/bf03346344] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Because leptin and adiponectin are counter-regulated in vivo and exert opposing effects on glucose metabolism, fat oxidation and insulin sensitivity, the ratio of leptin-to-adiponectin has been investigated as a potential atherogenic index, suggesting that the index is a better biomarker for atherosclerotic risk in obese Type 2 diabetic patients than either leptin or adiponectin alone. However, no information is available regarding the leptin-to-adiponectin ratio during adolescence in Hispanic adolescents. Therefore, the present study was designed to investigate the leptin-to-adiponectin ratio during growth and to establish whether the leptin-to-adiponectin ratio is a better predictor for insulin sensitivity compared to leptin and adiponectin alone in a regression model. From the age of 8 to 14, the leptin-to-adiponectin ratio increased from 2.0+/-0.8 to 5.8+/-2.2 in girls, with no significant change noted in boys (gender x age interaction p=0.007). In a multiple regression analysis, including both adiponectin and leptin as independent variables, leptin and adiponectin explained 5% of the variation in insulin sensitivity independent of gender, age, Tanner stage, total fat mass and lean body mass (p for R2-change <0.001). The leptin-to-adiponectin ratio also explained 5% of the variation in insulin sensitivity, after controlling for the same covariates (p for R2-change <0.001). These data indicate that the leptin-to-adiponectin ratio is not a better predictor of insulin sensitivity during growth than the additive effects of leptin and adiponectin levels.
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Affiliation(s)
- C Koebnick
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9008, USA
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