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Blaine RE, Blaine KP, Cheng K, Banuelos C, Leal A. Priorities, barriers, and facilitators for nutrition-related care for autistic children: a qualitative study comparing interdisciplinary health professional and parent perspectives. Front Pediatr 2023; 11:1198177. [PMID: 37650046 PMCID: PMC10465129 DOI: 10.3389/fped.2023.1198177] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Children with autism spectrum disorder often face nutrition-related challenges, such as food selectivity, gastrointestinal issues, overweight and obesity, and inadequate nutrient intake. However, the role of routine nutrition-related screening or care by interdisciplinary health professionals is not well understood. This study aimed to compare the beliefs of health professionals with those of parents of autistic children regarding high-priority nutrition-related challenges, barriers and facilitators to care, and desired education and resources related to nutrition for autistic children. Participants Interdisciplinary health professionals (n = 25) (i.e., pediatricians, occupational therapists, speech-language pathologists, board certified behavior analysts, registered dietitians) and parents of autistic children (n = 22). Methods The study used semi-structured phone interviews, which were recorded, transcribed, verified, and double-coded using the Framework Method. Results Thematic analysis of transcripts revealed that while health professionals and parents of autistic children shared some perspectives on nutrition-related challenges and care, they also had distinct viewpoints. Parents emphasized the importance of addressing food selectivity, behavioral eating challenges, sensory issues, and sleep disturbances affecting appetite. Both groups acknowledged the need for tailored support, access to an interdisciplinary care team, and reasonable expectations. Some health professionals perceived parents as lacking motivation or the ability to make changes. In contrast, many parents felt that health professionals lacked the knowledge and motivation to take nutrition or growth concerns seriously. Health professionals acknowledged that their lack of knowledge or capacity to provide nutrition education or referrals was a common barrier to care, particularly given limited community resources. Discussion Health professionals who serve autistic children are motivated to address nutrition-related challenges but lack resources related to nutrition. To promote better health outcomes for autistic children, professionals should identify and support parent motivations around nutrition-related care. Both groups expressed interest in accessing autism-specific resources for education, referral, and screening guidance. Future research could explore the development of healthcare training models that improve the competency of health professionals in providing nutrition care and referral for autistic children.
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Affiliation(s)
- Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
| | - Kevin P. Blaine
- Research Institute, Children’s Hospital of Orange County, Orange, CA, United States
| | - Katie Cheng
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
| | - Cynthia Banuelos
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
| | - Aaron Leal
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
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Blaine RE, Bowling A, Kaur R, Davison KK. Promoting Sleep and Balanced Screen Time among School-Aged Children with Neurodevelopmental and Mental Health Disorders: A Parent Perspective. Child Obes 2021; 17:329-341. [PMID: 33877906 DOI: 10.1089/chi.2020.0335] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Children with neurodevelopmental and mental health disorders (N/MHD), such as autism spectrum, mood disorders, and anxiety, are more likely to engage in excessive screen time, receive insufficient sleep, and to have obesity than neurotypical peers. However, little is known about how parents of these children approach promoting sleep and balanced screen time. Methods: We conducted semistructured interviews with 24 parents of children aged 8-15 years with a diagnosis of N/MHD to assess barriers and facilitators to promoting sleep and balanced screen time. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11. Results: Many parents described children's chronic sleep challenges, often compounded by screen use and no clear solutions. When feeling overwhelmed, some parents reluctantly reported co-sleeping or allowing gaming devices in bed. Nearly all participants reported chronic, occasionally severe, conflict when managing children's screen time, with some parents experiencing opposition and physical aggression. Parents struggled to weigh the benefits of screen use (i.e., behavior management, learning, and social connection) with the costs (i.e., reduced self-care and limited physical activity). To combat barriers, parents described firm routines (i.e., "screens off" time and consistent bedtime on weekdays and weekends), moderating access (i.e., shutting down internet and no device in bedroom), verbal priming, and coping strategies (i.e., music and books). Conclusions: Parents of children with N/MHD face unique challenges in promoting sleep and balanced screen time. Given these behaviors may impact weight status and mental health, future interventions should examine ways to support parents in reducing conflict while promoting healthy habits.
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Affiliation(s)
- Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA, USA
| | - April Bowling
- Merrimack College School of Health Sciences, North Andover, MA, USA
| | - Raghbir Kaur
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ledoux T, Thompson D, O'Connor T, Avery D, Kochi C, O'Connor DP, Lin SF, Binggeli-Vallarta A, Blaine RE, Sharma S, Hoelscher DM. Cross-Site Process Evaluation Results for the Early Childhood Education Center Setting: CORD Study. Child Obes 2020; 16:350-357. [PMID: 32471316 DOI: 10.1089/chi.2019.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/12/2022]
Abstract
Background: The Childhood Obesity Research Demonstration project aimed to deliver evidence-based obesity prevention interventions to at-risk families at three demonstration sites. The interventions were delivered in multiple settings, including early childhood education centers (ECECs), public schools, and primary care clinics. An evaluation center conducted cross-site process, impact, and sustainability evaluations. Results of the cross-site process evaluation for the ECECs will be described. Methods: Reach (proportion of the target population who participated), dose delivered (materials and interventions that were distributed), and fidelity (proportion of planned intervention components delivered) were assessed at two levels (researcher-to-provider and provider-to-family levels). Standardized data forms were completed by research team members at each demonstration site with assistance from the evaluation center. Results: The Childhood Obesity Research Demonstration project reached 5174 children and 390 teachers in 58 ECECs. The centers delivered an average of 3.9 hours of training to teachers. A total of 1382 different types of materials were distributed to providers, and from 1.3 to 4.3 hours of technical support were delivered to centers monthly. For fidelity at the researcher-to-provider level, 49.5% (n = 370) of eligible teachers completed all training sessions. Considerable variations across demonstration sites in reach, dose delivered, and fidelity across were observed. Conclusion: The Childhood Obesity Research Demonstration project reached large numbers of children, families, teachers, and ECECs. Maintaining intervention fidelity while reaching large numbers of at-risk individuals proved to be a challenge.
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Affiliation(s)
- Tracey Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Dana Avery
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Camila Kochi
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Shih-Fan Lin
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, USA
| | | | - Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, USA
| | - Shreela Sharma
- Michael & Susan Dell Center for Health Living, University of Texas Health Science Center, School of Public Health, Houston, TX, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin Campus, Austin, TX, USA
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Bowling A, Blaine RE, Kaur R, Davison KK. Shaping healthy habits in children with neurodevelopmental and mental health disorders: parent perceptions of barriers, facilitators and promising strategies. Int J Behav Nutr Phys Act 2019; 16:52. [PMID: 31242904 PMCID: PMC6595579 DOI: 10.1186/s12966-019-0813-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/12/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Prevalence of pediatric neurodevelopmental and mental health disorders (ND/MHD) is increasing in the United States and globally. ND/MHD are associated with higher risk of poor dietary, physical activity (PA), screen, and sleep habits in youth, contributing to elevated lifetime chronic disease risk. ND/MHD symptoms can present unique challenges to parenting, create competing parenting priorities, and may decrease parental capacity to instill healthy habits. Unfortunately, literature characterizing parenting of health habits in youth with ND/MHD is sparse. The objective of this study was to describe barriers to, facilitators of, and practical strategies for parenting healthy lifestyle habits in children and teens with ND/MHD. METHODS We conducted semi-structured interviews with parents whose children with diagnosed ND/MHD were attending a Boston-area therapeutic day school serving K-10th grade. Interviews allowed parents to focus on parenting PA, diet, sleep, and/or screen habits as context for questions. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11. RESULTS We interviewed 24 parents; average age of their child with ND/MHD was 11.2 years (range: 8-15). Most had a son (75%) with multiple ND/MHD (88%); diagnoses included autism spectrum disorder (50%), attention deficit-hyperactivity disorder (67%), anxiety (67%), and other mood disorders (58%). Major barriers to parenting all types of health habits included depleted parent resources, child dysregulation, lack of supportive programming available to children with ND/MHD, and medication side effects. Major facilitators included participation in specialized therapeutic options, adaptive community programs and schools, as well as parents' social capital. Effective parenting strategies included setting clear, often structural boundaries, using positive reinforcement, allowing agency by presenting healthy choices, and use of role modeling to promote healthy habits. Almost one third of parents extensively discussed the role of pets or therapy animals as key to establishing and maintaining healthy routines, particularly PA and screen-time management. CONCLUSIONS Parenting healthy habits in children with ND/MHD is difficult and is undermined by competing demands on parenting resources. To reduce chronic disease disparities and promote health in this population, future research must better adapt existing health promotion materials and programs to more practically support parents in multiple settings including home, schools and community organizations.
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Affiliation(s)
- April Bowling
- Department of Public Health and Nutrition, Merrimack College School of Health Sciences, 315 Turnpike Street, Office 401, O'Reilly Hall, North Andover, MA, 01845, USA. .,Harvard T.H. Chan School of Public Health, Boston, USA.
| | | | - Raghbir Kaur
- Harvard T.H. Chan School of Public Health, Boston, USA
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Sorensen SA, Rock CR, Moore DM, Blaine RE, Costa CB. A Behavioral Assessment of College Students’ Knowledge, Awareness, and Consumption on Snack Foods That May Contain Probiotics. ACTA ACUST UNITED AC 2019. [DOI: 10.5539/jfr.v8n3p16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With the increasing variety of snack foods containing probiotics infiltrating the market, it is important that consumers become more aware and knowledgeable about these products. The aim of the current study was to investigate potential consumers’ behavior by assessing knowledge about probiotics, awareness of snack foods containing probiotics, and frequently consumed snacks among student college departments within a university setting. Participants included 125 college students (n = 34 male, n = 91 female), all 18 years and older, and evaluated via a 19-item questionnaire using descriptive statistics, one-way analysis of variance (ANOVA) and Gabriel’s post hoc test. Level of significance was set at p ≤ 0.05. There was a statistically significant difference in knowledge about probiotics among the student college departments, p = 0.012. Specifically, students in the College of Health and Human Services (CHHS) were statistically significantly more knowledgeable than those in the Science, Technology, Engineering and Mathematics (STEM) college, p = 0.010. There was no statistically significant difference in awareness of snack foods containing probiotics, p = 0.262. On average, participants’ knowledge about probiotics was low (48.1%) and awareness of snack foods containing probiotics was very low (2.5%), though, a majority of participants (94.1%) were aware that yogurt may contain probiotics. Overall, these findings should guide food product developers and marketers to create products that are relevant and messages that enhance consumers’ knowledge and awareness to the existence of the probiotics in that product.
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Davison KK, Blake CE, Kachurak A, Lumeng JC, Coffman DL, Miller AL, Hughes SO, Power TG, Vaughn AF, Blaine RE, Younginer N, Fisher JO. Corrigendum to "Development and preliminary validation of the Parenting around SNAcking Questionnaire (P-SNAQ)" Appetite 125 (2018) 323-332. Appetite 2019; 132:282. [PMID: 30314836 DOI: 10.1016/j.appet.2018.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K K Davison
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 665 Huntington Ave, Boston, MA 02445, USA; Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 665 Huntington Ave, Boston, MA 02445, USA.
| | - C E Blake
- University of South Carolina, Department of Health Promotion, Education and Behavior, 915 Greene Street, Columbia, SC 29208, USA
| | - A Kachurak
- Temple University, Center for Obesity Research and Education, 3323 N Broad St, Suite 175, Philadelphia, PA 19140, USA
| | - J C Lumeng
- University of Michigan, Department of Pediatrics, Medical School, Department of Nutritional Sciences, School of Public Health, 300 North Ingalls Street, 10th Floor, University of Michigan, Ann Arbor, MI, 48109, USA
| | - D L Coffman
- Temple University, Center for Obesity Research and Education, 3323 N Broad St, Suite 175, Philadelphia, PA 19140, USA
| | - A L Miller
- University of Michigan, Department of Health Behavior and Health Education, School of Public Health, 1415 Washington Heights, University of Michigan, Ann Arbor, MI, 48109, USA
| | - S O Hughes
- USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, Department of Pediatrics, 1100 Bates Ave, Houston, TX 77030, USA
| | - T G Power
- Washington State University, Department of Human Development, PO Box 644852, Pullman, WA 99164-4852, USA
| | - A F Vaughn
- University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention, 1700 Martin L. King Jr. Blvd, CB 7426, Chapel Hill, NC 27599-7426, USA
| | - R E Blaine
- California State University, Long Beach, Department of Family and Consumer Sciences, 1250 Bellflower Blvd, Long Beach, CA 90840-0501, USA
| | - N Younginer
- University of South Carolina, Department of Health Promotion, Education and Behavior, 915 Greene Street, Columbia, SC 29208, USA
| | - J O Fisher
- Temple University, Center for Obesity Research and Education, 3323 N Broad St, Suite 175, Philadelphia, PA 19140, USA
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Criss S, Blaine RE, Palamé M, Perkins M, Davison K, Kwass JA, Taveras EM. Health Marketing for the Massachusetts Childhood Obesity Research Demonstration Study: A Case Study. Health Promot Pract 2018; 20:282-291. [PMID: 29566576 DOI: 10.1177/1524839918760842] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. This case study describes the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) health marketing campaign, examines the strategies used in such campaigns, and offers lessons learned to improve health marketing for future interventions. MA-CORD Health Marketing Components and Implementation. The three main components were an outdoor printed advertisement and texting campaign, social media with a focus on Facebook, and the Summer Passport Program, an event-based initiative in parks for children. The advertisements consisted of billboards, bus advertisements, and handouts. The text messaging component, which required families to actively text a keyword to join, had a low opt-in rate. Facebook page "likes" increased from 1,024 to 1,453 in New Bedford and from 175 to 1,091 in Fitchburg. Fitchburg received technical assistance and paid for ads on Facebook. The Summer Passport participation in parks ranged from 120 to 875 children with participation in the free park lunch program doubling in Fitchburg. Discussion. Key lessons learned are engage communication experts from each community at the beginning of the project, use text messaging components with in-person staff onsite to assist participants in the opt-in process, build momentum for a Facebook presence through purchasing Facebook advertisements, and partner with local park departments for programming.
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Affiliation(s)
| | | | | | | | | | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Boston, MA, USA
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Davison KK, Blake CE, Kachurak A, Lumeng JC, Coffman DL, Miller AL, Hughes SO, Power TG, Vaughn AF, Blaine RE, Younginer N, Fisher JO. Development and preliminary validation of the Parenting around SNAcking Questionnaire (P-SNAQ). Appetite 2018; 125:323-332. [PMID: 29475073 DOI: 10.1016/j.appet.2018.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/22/2017] [Accepted: 01/28/2018] [Indexed: 01/03/2023]
Abstract
Snacking makes significant contributions to children's dietary intake but is poorly understood from a parenting perspective. This research was designed to develop and evaluate the psychometrics of a theoretically grounded, empirically-informed measure of snack parenting. The Parenting around SNAcking Questionnaire (P-SNAQ) was developed using a conceptual model derived from current theory and mixed-methods research to include 20 hypothesized snack parenting practices along 4 parenting dimensions (autonomy support, structure, coercive control and permissiveness). Expert panel evaluation and cognitive interviews were used to refine items and construct definitions. The initial instrument of 105 items was administered to an ethnically diverse, low-income sample of 305 parents (92% mothers) of children aged 1-6 y participating in three existing cohort studies. The sample was randomly split into two equal samples. Exploratory factor analysis was conducted with the first sample to identify snack parenting practices within each parenting dimension, followed by confirmatory factor analysis with the second sample to test the hypothesized factor structure. Internal consistency of sub-scales and associations with existing measures of food parenting practices and styles and child weight status were evaluated. The final P-SNAQ scale included 51 items reflecting 14 snack parenting practices across four parenting dimensions. The factor structure of the P-SNAQ was consistent with prior theoretical frameworks. Internal consistency coefficients were good to very good for 12 out of 14 scales and subscale scores were moderately correlated with previously validated measures. In conclusion, initial evidence suggests that P-SNAQ is a psychometrically sound measure for evaluating a wide range of snack parenting practices in young children.
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Affiliation(s)
- K K Davison
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 665 Huntington Ave, Boston, MA 02445, USA; Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 665 Huntington Ave, Boston, MA 02445, USA.
| | - C E Blake
- University of South Carolina, Department of Health Promotion, Education and Behavior, 915 Greene Street, Columbia, SC 29208, USA
| | - A Kachurak
- Temple University, Center for Obesity Research and Education, 3323 N Broad St, Suite 175, Philadelphia, PA 19140, USA
| | - J C Lumeng
- University of Michigan, Department of Pediatrics, Medical School, Department of Nutritional Sciences, School of Public Health, 300 North Ingalls Street, 10th Floor, Ann Arbor, MI, 48109, USA
| | - D L Coffman
- Temple University, Center for Obesity Research and Education, 3323 N Broad St, Suite 175, Philadelphia, PA 19140, USA
| | - A L Miller
- University of Michigan, Department of Health Behavior and Health Education, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - S O Hughes
- USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, Department of Pediatrics, 1100 Bates Ave, Houston, TX 77030, USA
| | - T G Power
- Washington State University, Department of Human Development, PO Box 644852, Pullman, WA 99164-4852, USA
| | - A F Vaughn
- University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention, 1700 Martin L. King Jr. Blvd, CB 7426, Chapel Hill, NC 27599-7426, USA
| | - R E Blaine
- California State University, Long Beach, Department of Family and Consumer Sciences, 1250 Bellflower Blvd, Long Beach, CA 90840-0501, USA
| | - N Younginer
- University of South Carolina, Department of Health Promotion, Education and Behavior, 915 Greene Street, Columbia, SC 29208, USA
| | - J O Fisher
- Temple University, Center for Obesity Research and Education, 3323 N Broad St, Suite 175, Philadelphia, PA 19140, USA
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Franckle RL, Falbe J, Gortmaker S, Barrett JL, Giles C, Ganter C, Blaine RE, Buszkiewicz J, Taveras EM, Kwass JA, Land T, Davison KK. Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project. Obesity (Silver Spring) 2017; 25:1175-1182. [PMID: 28653502 PMCID: PMC5488705 DOI: 10.1002/oby.21867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. METHODS MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention. RESULTS Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01). CONCLUSIONS This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.
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Affiliation(s)
- Rebecca L. Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - James Buszkiewicz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Blaine RE, Franckle RL, Ganter C, Falbe J, Giles C, Criss S, Kwass JA, Land T, Gortmaker SL, Chuang E, Davison KK. Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012-2014. Prev Chronic Dis 2017; 14:E03. [PMID: 28084989 PMCID: PMC5234440 DOI: 10.5888/pcd14.160381] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 11/10/2022] Open
Abstract
Introduction Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts’ capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing “Eat Well and Keep Moving” and “Planet Health” behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts. Methods The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability. Results MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district’s staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers. Conclusion Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.
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Affiliation(s)
- Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd. FCS FA-15, Long Beach, California 90840.
| | - Rebecca L Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Jennifer Falbe
- University of California, Berkeley, Berkeley, California
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shaniece Criss
- Health Sciences Department, Furman University, Greenville, South Carolina
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emmeline Chuang
- University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ganter C, Aftosmes-Tobio A, Chuang E, Blaine RE, Land T, Davison KK. Community Stakeholders' Perceptions of Major Factors Influencing Childhood Obesity, the Feasibility of Programs Addressing Childhood Obesity, and Persisting Gaps. J Community Health 2017; 41:305-14. [PMID: 26433725 DOI: 10.1007/s10900-015-0097-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/23/2022]
Abstract
Prior research has identified numerous factors contributing to increased rates of childhood obesity. However, few studies have focused explicitly on the experience of community stakeholders in low-income communities. This study sought to capture the perspectives of these on-the-ground experts regarding major factors contributing to childhood obesity as well as gaps in current prevention and control efforts. We conducted semi-structured interviews with 39 stakeholders from different community sectors (e.g., healthcare providers, childcare providers, teachers). Data were drawn from the Massachusetts Childhood Obesity Research Demonstration project, a multi-level, multi-sector intervention designed to reduce childhood obesity being implemented in two low-income communities in Massachusetts. Interviews were conducted at baseline, transcribed, coded using grounded theory approach, and analyzed in NVivo 10.0. The vast majority of stakeholders had recently participated in obesity prevention strategies, and nearly all of them identified gaps in prevention efforts either within their organizations or in the broader community. In addition to factors previously identified in the literature, several themes emerged including the need to change policies to increase physical activity during school, offer healthier snacks in schools and afterschool programs, and increase communication and collaboration within the community in prevention efforts. Community stakeholders can impact the success of interventions by bridging the gap between science and lived experience. The results of this study can guide future research by highlighting the importance of including stakeholders' frontline experiences with target populations, and using information on identified gaps to augment intervention planning efforts.
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Affiliation(s)
- Claudia Ganter
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 3rd Floor, Boston, MA, 02115, USA. .,Department of Health Care Management, Technical University Berlin, Strasse des 17. Juni 135, Berlin, 10623, Germany.
| | - Alyssa Aftosmes-Tobio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 3rd Floor, Boston, MA, 02115, USA
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr. South, Los Angeles, CA, 90095-1772, USA
| | - Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd, FCS-FA 15, Long Beach, CA, 90840-0501, USA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108-4619, USA
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 3rd Floor, Boston, MA, 02115, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Khandpur N, Charles J, Blaine RE, Blake C, Davison K. Diversity in fathers' food parenting practices: A qualitative exploration within a heterogeneous sample. Appetite 2016; 101:134-45. [PMID: 26930383 DOI: 10.1016/j.appet.2016.02.161] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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] [Received: 10/08/2015] [Revised: 01/23/2016] [Accepted: 02/25/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Food parenting practices (FPPs) are important in shaping children's dietary behaviors. However, existing FPP knowledge is largely based on research with mothers. PURPOSE This study (1) identified fathers' FPPs; (2) described differences in FPP use by fathers' education and residential status. METHODS Semi-structured interviews were conducted with 40 fathers (39 ± 9.1 years; 37.5% non-residential; 40% ≥college education). Interviews were audio-recorded and transcribed. NVivo 10 was used for theme detection, categorization and classification using inductive and deductive approaches. FPPs were identified and their relative distribution was examined across education and residential status. RESULTS Twenty FPPs were identified - 13 responsive practices and 7 unresponsive practices. Having food rules was the most common responsive FPP (81.5%), followed by feeding on schedule (60%) and making healthy food accessible (60%). Common unresponsive FPPs were letting child dictate preferences (70%), incentivizing food consumption (60%) and pressuring the child to eat (35%). Compared to fathers with a college education, more fathers without a college education reported letting child dictate preferences (92% vs. 37%), educating their children about food (37% vs 12%), fewer reported feeding on schedule (50% vs. 75%), modeling healthy practices (29% vs. 50%), and using distraction to feed (4% vs. 37%). Compared to residential fathers, more non-residential fathers monitored (60% vs. 40%) or encouraged (60% vs. 36%) child food intake and let child dictate preferences (87% vs. 60%). CONCLUSIONS Fathers used an extensive variety of FPPs, similar to those identified in mothers. Further study on the influence of fathers' education and residential status on FPP use is warranted.
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Affiliation(s)
- Neha Khandpur
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 677 Huntington Ave, Boston, MA 02115, USA.
| | - Jo Charles
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 677 Huntington Ave, Boston, MA 02115, USA
| | - Rachel E Blaine
- California State University, Long Beach, Department of Family and Consumer Sciences, 1250 Bellflower Blvd, Long Beach, CA 90840, USA
| | - Christine Blake
- University of South Carolina, Department of Health Promotion, Education, and Behavior, 915 Greene Street, Columbia, SC 29208, USA
| | - Kirsten Davison
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 677 Huntington Ave, Boston, MA 02115, USA; Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Ave, Boston, MA 02115, USA
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Davison KK, Blake CE, Blaine RE, Younginer NA, Orloski A, Hamtil HA, Ganter C, Bruton YP, Vaughn AE, Fisher JO. Parenting around child snacking: development of a theoretically-guided, empirically informed conceptual model. Int J Behav Nutr Phys Act 2015; 12:109. [PMID: 26377320 PMCID: PMC4573676 DOI: 10.1186/s12966-015-0268-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Snacking contributes to excessive energy intakes in children. Yet factors shaping child snacking are virtually unstudied. This study examines food parenting practices specific to child snacking among low-income caregivers. METHODS Semi-structured interviews were conducted in English or Spanish with 60 low-income caregivers of preschool-aged children (18 non-Hispanic white, 22 African American/Black, 20 Hispanic; 92% mothers). A structured interview guide was used to solicit caregivers' definitions of snacking and strategies they use to decide what, when and how much snack their child eats. Interviews were audio-recorded, transcribed verbatim and analyzed using an iterative theory-based and grounded approach. A conceptual model of food parenting specific to child snacking was developed to summarize the findings and inform future research. RESULTS Caregivers' descriptions of food parenting practices specific to child snacking were consistent with previous models of food parenting developed based on expert opinion [1, 2]. A few noteworthy differences however emerged. More than half of participants mentioned permissive feeding approaches (e.g., my child is the boss when it comes to snacks). As a result, permissive feeding was included as a higher order feeding dimension in the resulting model. In addition, a number of novel feeding approaches specific to child snacking emerged including child-centered provision of snacks (i.e., responding to a child's hunger cues when making decisions about snacks), parent unilateral decision making (i.e., making decisions about a child's snacks without any input from the child), and excessive monitoring of snacks (i.e., monitoring all snacks provided to and consumed by the child). The resulting conceptual model includes four higher order feeding dimensions including autonomy support, coercive control, structure and permissiveness and 20 sub-dimensions. CONCLUSIONS This study formulates a language around food parenting practices specific to child snacking, identifies dominant constructs, and proposes a conceptual framework to guide future research.
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Affiliation(s)
- Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02445, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02445, USA.
| | - Christine E Blake
- Department of Health Promotion, Education and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Rachel E Blaine
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02445, USA
- Department of Family and Consumer Sciences, California State University, Long Beach, , 1250 Bellflower Blvd, Long Beach, CA, 90840-0501, USA
| | - Nicholas A Younginer
- Department of Health Promotion, Education and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Alexandria Orloski
- Center for Obesity Research and Education, Temple University, 3323 N Broad St, Suite 175, Philadelphia, PA, 19140, USA
| | - Heather A Hamtil
- Center for Obesity Research and Education, Temple University, 3323 N Broad St, Suite 175, Philadelphia, PA, 19140, USA
| | - Claudia Ganter
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02445, USA
| | - Yasmeen P Bruton
- Center for Obesity Research and Education, Temple University, 3323 N Broad St, Suite 175, Philadelphia, PA, 19140, USA
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd, CB 7426, Chapel Hill, NC, 27599-7426, USA
| | - Jennifer O Fisher
- Center for Obesity Research and Education, Temple University, 3323 N Broad St, Suite 175, Philadelphia, PA, 19140, USA
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Blaine RE, Davison KK, Hesketh K, Taveras EM, Gillman MW, Benjamin Neelon SE. Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study. Child Obes 2015; 11:304-13. [PMID: 25918873 PMCID: PMC4485887 DOI: 10.1089/chi.2014.0099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 12/18/2022]
Abstract
BACKGROUND Identifying characteristics associated with the Institute of Medicine's (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity. METHODS In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation. RESULTS In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2-21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7-6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8-6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09-0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51-32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34-9.16), and avoid serving sugary (OR, 8.74; 95% CI, 3.05-25.06) or fast foods (OR, 11.56; 95% CI, 3.20-41.80). CONCLUSIONS CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods.
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Affiliation(s)
- Rachel E. Blaine
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kathryn Hesketh
- University College London Institute of Child Health, London, United Kingdom
| | - Elsie M. Taveras
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Matthew W. Gillman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Sara E. Benjamin Neelon
- Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC
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Blaine RE, Pbert L, Geller AC, Powers EM, Mitchell K. Parent preferences for telephone coaching to prevent and manage childhood obesity. Postgrad Med J 2015; 91:206-11. [PMID: 25814510 DOI: 10.1136/postgradmedj-2014-132928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 02/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess parent preferences for utilisation of a parent-focused, telephone-based coaching service, or 'FITLINE,' to prevent or manage childhood obesity. METHODS A cross-sectional survey of parents of children aged 2-12 years was conducted at a paediatric practice in Greater Boston, Massachusetts, USA, between July 2012 and May 2013. Parents received questionnaires with clinic visit paperwork and opted-in to the study by returning them to clinic staff or by mail. The anonymous pen-to-paper questionnaire assessed parents' potential FITLINE utilisation, preferences regarding educational content and logistics, and parent/child demographics. Simple logistical regression was used to assess associations between parent and child factors and FITLINE interest. RESULTS Among n=114 participants, most parents reported being very likely (n=53, 48%) or somewhat likely (n=44, 40%) to use a FITLINE-promoting healthy habits for children if it was made available. Interest in a FITLINE was greatest among overweight or obese parents (OR 3.12, CI 1.17 to 8.30) and those with children aged <5 years (OR 2.42, CI 1.02 to 5.73). Parents desired to discuss their own health and fitness goals (84%) along with educational topics such as healthy food shopping on a budget (91%) and how to meet children's physical activity needs (81%). Most parents preferred to obtain a FITLINE referral from a paediatrician or nurse (73%), instead of a school nurse (42%) or child-care provider (26%). CONCLUSIONS Given strong interest among parents in a FITLINE and the urgency of the youth obesity epidemic, implementation of a pilot phone-based service should be strongly considered.
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Affiliation(s)
- Rachel E Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Lori Pbert
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Alan C Geller
- Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - E Michael Powers
- Vanderbilt University School of Medicine, Nashville, Tennessee USA
| | - Kathleen Mitchell
- Department of Pediatrics, Harvard Vanguard Medical Associates, Watertown, Massachusetts, USA
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Ganter C, Chuang E, Aftosmes-Tobio A, Blaine RE, Giannetti M, Land T, Davison KK. Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013. Prev Chronic Dis 2015; 12:E42. [PMID: 25811497 PMCID: PMC4375987 DOI: 10.5888/pcd12.140371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 02/04/2023] Open
Abstract
Introduction The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social–ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). Methods From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Results Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. Conclusion The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.
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Affiliation(s)
- Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Landmark Center, 401 Park Drive, 3rd floor East, Boston, MA 01225. . Ms. Ganter is also affiliated with the Technical University of Berlin, Department of Health Care Management, Berlin, Germany
| | - Emmeline Chuang
- University of California, Los Angeles, Los Angeles, California (Dr. Chuang was at University of California, San Diego, at the time this article was written)
| | | | | | - Mary Giannetti
- Montachusett Opportunity Council, Fitchburg, Massachusetts
| | - Thomas Land
- Massachusetts Department of Public Health, Boston, Massachusetts
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Hesketh KR, van Sluijs EMF, Blaine RE, Taveras EM, Gillman MW, Benjamin Neelon SE. Assessing care providers' perceptions and beliefs about physical activity in infants and toddlers: baseline findings from the Baby NAP SACC study. BMC Public Health 2015; 15:100. [PMID: 25886506 PMCID: PMC4334406 DOI: 10.1186/s12889-015-1477-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/27/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As children now spend increasing amounts of time in out-of-home care, care providers play an important role in promoting positive health behaviors. Little is currently known about providers' perceptions and beliefs about physical activity, particularly for very young children. This study describes providers' perceptions and beliefs about infants' and toddlers' physical activity, and assesses their knowledge of physical activity guidelines, to establish if and where providers may need support to promote physical activity in child care settings. METHODS We analyzed baseline data from a pilot randomized-controlled trial conducted in 32 child care centers in Massachusetts, USA. Providers completed physical activity-related questionnaires from which we compared twenty perception and belief questions for infant and toddler care providers. RESULTS 203 care providers (96% female, mean ± SD age: 32.7 ± 11.2 years) from 29 centers completed questionnaires. A large proportion of providers (n = 114 (61.9%)) believed that infants should be active for 45 minutes or less each day, and only 56 providers (29.7%) perceived toddlers to require more than 90 minutes of activity per day. 97% of providers perceived it was their job to ensure children engaged in a healthy amount of physical activity and most (94.1%) perceived physical activity to be important to own their health, despite 13.3% finding it hard to find the energy to be physically active. CONCLUSIONS This study is the first to assess the physical activity perceptions and attitudes of providers caring for infants and toddlers. Though all providers believed toddlers should engage in more physical activity than infants, most providers believed that young children require only a short amount of physical activity each day, below recommended guidelines. How provider perceptions influence children's physical activity behavior requires investigation.
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Affiliation(s)
- Kathryn R Hesketh
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N1EH, UK.
| | - Esther M F van Sluijs
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Rachel E Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Elsie M Taveras
- Division of General Pediatrics, Pediatric Population Health Management, Mass General Hospital for Children, Boston, MA, USA.
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Sara E Benjamin Neelon
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC, USA.
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Davison KK, Falbe J, Taveras EM, Gortmaker S, Kulldorff M, Perkins M, Blaine RE, Franckle RL, Ganter C, Woo Baidal J, Kwass JA, Buszkiewicz J, Smith L, Land T. Evaluation overview for the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project. Child Obes 2015; 11:23-36. [PMID: 25575095 PMCID: PMC5915219 DOI: 10.1089/chi.2014.0059] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 01/05/2023]
Abstract
BACKGROUND The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a 2-year, multilevel, multisector community intervention to prevent and control obesity among children 2-12 years of age from two predominantly low-income communities in Massachusetts. MA-CORD includes evidence-based interventions in multiple sectors, including community health centers, early care and education centers, schools, afterschool programs, the Special Supplemental Nutrition Program for Women, Infants and Children, and the broader community. Currently, implementation of MA-CORD is complete and the final year of data collection is in progress. Here, the MA-CORD evaluation plan is described and baseline data are presented. METHODS/DESIGN The impact of MA-CORD on children's BMI, lifestyle behaviors, obesity-related care, and quality of life will be assessed using sector-specific, pre/post, time-series, and quasi-experimental designs. Change in the primary outcomes will be compared for intervention and comparison communities. Additionally, change in mean BMI and obesity prevalence in intervention school districts will be compared to similar districts throughout the state. RESULTS At baseline in 2012, approximately 16% of preschool-aged and 25% of school-aged children were obese. Moreover, 15-40% of children consumed no vegetables on the previous day, 25-75% drank a sugar-sweetened beverage on the previous day, up to 87% had insufficient physical activity, 50-75% had a television in the room where they slept, and 50-80% obtained insufficient sleep. CONCLUSIONS There is ample room for improvement in BMI and health behaviors in children in MA-CORD communities. If successful, MA-CORD may serve as a model for multilevel, multisector approaches to childhood obesity prevention and control.
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Affiliation(s)
- Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Steve Gortmaker
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Martin Kulldorff
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rebecca L. Franckle
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - James Buszkiewicz
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Health Quality, Boston, MA
| | - Thomas Land
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
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Taveras EM, Blaine RE, Davison KK, Gortmaker S, Anand S, Falbe J, Kwass JA, Perkins M, Giles C, Criss S, Colchamiro R, Woo Baidal J, Land T, Smith L. Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study. Child Obes 2015; 11:11-22. [PMID: 25469676 PMCID: PMC4322791 DOI: 10.1089/chi.2014.0031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 11/13/2022]
Abstract
BACKGROUND Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies. METHODS/DESIGN The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years. CONCLUSIONS MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Shikha Anand
- National Initiative for Children's Healthcare Quality, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Shaniece Criss
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Rachel Colchamiro
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA
| | - Thomas Land
- Office of the Commissioner, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Healthcare Quality, Boston, MA
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Blake CE, Fisher JO, Ganter C, Younginer N, Orloski A, Blaine RE, Bruton Y, Davison KK. A qualitative study of parents' perceptions and use of portion size strategies for preschool children's snacks. Appetite 2014; 88:17-23. [PMID: 25447008 DOI: 10.1016/j.appet.2014.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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] [Received: 08/14/2014] [Revised: 09/23/2014] [Accepted: 11/03/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Increases in childhood obesity correspond with shifts in children's snacking behaviors and food portion sizes. This study examined parents' conceptualizations of portion size and the strategies they use to portion snacks in the context of preschool-aged children's snacking. METHODS Semi-structured qualitative interviews were conducted with non-Hispanic white (W), African American (AA), and Hispanic (H) low-income parents (n = 60) of preschool-aged children living in Philadelphia and Boston. The interview examined parents' child snacking definitions, purposes, contexts, and frequency. Verbatim transcripts were analyzed using a grounded theory approach. Coding matrices compared responses by race/ethnicity, parent education, and household food security status. RESULTS Parents' commonly referenced portion sizes when describing children's snacks with phrases like "something small." Snack portion sizes were guided by considerations including healthfulness, location, hunger, and timing. Six strategies for portioning snacks were presented including use of small containers, subdividing large portions, buying prepackaged snacks, use of hand measurement, measuring cups, scales, and letting children determine portion size. Differences in considerations and strategies were seen between race/ethnic groups and by household food security status. CONCLUSIONS Low-income parents of preschool-aged children described a diverse set of considerations and strategies related to portion sizes of snack foods offered to their children. Future studies should examine how these considerations and strategies influence child dietary quality.
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Affiliation(s)
- Christine E Blake
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Columbia, South Carolina 29208, United States.
| | - Jennifer Orlet Fisher
- Department of Public Health, Center for Obesity Research and Education, Temple University, 3223 N. Broad Street, Philadelphia, Pennsylvania 19140, United States
| | - Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Nicholas Younginer
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Columbia, South Carolina 29208, United States
| | - Alexandria Orloski
- Department of Public Health, Center for Obesity Research and Education, Temple University, 3223 N. Broad Street, Philadelphia, Pennsylvania 19140, United States
| | - Rachel E Blaine
- Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Yasmeen Bruton
- Department of Public Health, Center for Obesity Research and Education, Temple University, 3223 N. Broad Street, Philadelphia, Pennsylvania 19140, United States
| | - Kirsten K Davison
- Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
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Khandpur N, Blaine RE, Fisher JO, Davison KK. Fathers' child feeding practices: a review of the evidence. Appetite 2014; 78:110-21. [PMID: 24667152 DOI: 10.1016/j.appet.2014.03.015] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/18/2014] [Accepted: 03/12/2014] [Indexed: 01/01/2023]
Abstract
Despite their expanding role in child rearing, fathers are underrepresented in child feeding research. To address this knowledge gap and encourage father-focused research, this review compiles child feeding research that has included fathers and (i) documents characteristics of studies assessing fathers' feeding practices including study design, setting, recruitment strategies, participant characteristics, theoretical models utilized and measures of child feeding, (ii) outlines general patterns in fathers' feeding practices along with similarities and differences in mothers' and fathers' feeding practices, (iii) summarizes evidence on child and parent correlates of fathers' feeding practices and (iv) generates future research recommendations. A literature review of relevant articles published up to February 2014 was conducted. Studies were eligible for inclusion if they: (i) included fathers, or primary male caregivers, of children 2-18 years of age, (ii) measured fathers' child feeding practices or perceived role in child feeding through objective (e.g., meal observations) or subjective (i.e., fathers' self-report) methods, (iii) analyzed and presented data on fathers separately from mothers and (iv) were published in a peer reviewed journal in the English language. Twenty studies met eligibility criteria. Few studies included an operational definition of "father". Samples were generally small and focused on white, well-educated fathers, cohabiting with the child's mother. Most studies utilized self-report measures of child feeding practices that have not been validated specifically for use with fathers. Pressuring children to eat was a common feeding strategy adopted by fathers. Some differences were noted in mothers' and fathers' feeding practices; fathers were generally less likely to monitor children's food intake and to limit access to food compared with mothers. Child adiposity and a range of child and parent characteristics were associated with fathers' feeding practices. The literature on fathers' child feeding practices is scant. This review consolidates what is known to date and highlights focal areas for future research including the need to recruit diverse samples of fathers and utilize measures validated for use with fathers.
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Affiliation(s)
- Neha Khandpur
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Rachel E Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | | | - Kirsten K Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
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Gehre C, Chuang E, Blaine RE, Frankle RL, Aftosmes A, Smith LA, Davison KK. Barriers to engage parents in child obesity prevention and control: a multiple stakeholder analysis using the Family Ecological Model. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.lb353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claudia Gehre
- Department of NutritionHarvard School of Public HealthBostonMA
- Technical University BerlinBerlinGermany
| | - Emmeline Chuang
- Division of Health Management and PolicySan Diego State UniversitySan DiegoCA
| | | | | | - Alyssa Aftosmes
- Department of NutritionHarvard School of Public HealthBostonMA
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Falbe J, Davison KK, Taveras EM, Gortmaker SL, Anand SG, Blaine RE, Criss SR, Perkins M, Kwass J, Land T, Smith LA. Evaluating Mass in Motion Kids (MiM Kids): A Multi‐Sector Intervention to Reduce Childhood Obesity Using a Community‐Clinical Partnership. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.36.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Shikha G. Anand
- National Initiative for Children's Healthcare QualityBostonMA
| | | | | | | | - Jo‐Ann Kwass
- Massachusetts Department of Public HealthBostonMA
| | - Thomas Land
- Massachusetts Department of Public HealthBostonMA
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