Linguistic Modification When Developing Case Studies: An Integrative Review

BACKGROUND

Students from culturally and linguistically diverse backgrounds experience language barriers that influence their progression through nursing programs. Linguistic modification is a strategy that eliminates unnecessary wording and cultural bias to improve learning outcomes for students from diverse backgrounds. This integrative review adds to the knowledge of best practices in linguistic modification that can be applied to designing case studies for nursing students with diverse backgrounds.

METHOD

A comprehensive review of the literature was conducted in scholarly scientific databases from 2002 to the present.

RESULTS

Twenty-three articles discussed linguistic modification or summarized previous literature. Only four research studies were found pertaining to linguistic modification for culturally and linguistically diverse nursing students. Faculty and student practices that ameliorated language barriers were identified.

CONCLUSION

The use of linguistic modification throughout a nursing curriculum creates an inclusive learning environment. Further research is needed on linguistic modification in nursing education. [J Nurs Educ. 2023;62(9):495-501.].

Familial Factors in the Development of Social Anxiety Disorder

The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].

Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials

OBJECTIVE

The goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.

METHODS

Intervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.

RESULTS

The intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.

CONCLUSIONS

Weight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients.

Use of an Online Diet Goal-Setting Tool: Relationships With Gestational Weight Gain

OBJECTIVES

To describe (1) the use of a diet goal-setting tool in a self-directed online intervention aimed at promoting a healthy lifestyle, and (2) the association of tool use with gestational weight gain (GWG).

DESIGN

Cross-sectional analysis of data from the intervention group in a randomized effectiveness trial.

SETTING

An urban county in the northeastern US.

PARTICIPANTS

A total of 898 healthy pregnant women aged 18-35 years with body mass indexes of (BMI) ≥18.5 and <35; 39.1% were low-income.

MAIN OUTCOME MEASURES

Physical, sociodemographic, and psychosocial characteristics; use of tool features; and GWG.

ANALYSIS

Frequencies, chi-square tests of independence, and regression analysis.

RESULTS

Use of the online dietary tool was 45.1% completed the assessment, 35.3% set a goal, and 22.6% engaged in self-monitoring. Among women with normal BMI, setting ≥2 goals and engaging in self-monitoring were significantly (P < .05) associated with less GWG. Among women with higher BMI, setting ≥2 goals was significantly associated with greater GWG.

CONCLUSIONS AND IMPLICATIONS

Although online diet goal setting is a potentially effective weight management tool for pregnant women with normal BMI, findings suggest that it may not be for higher-BMI women. Additional research is needed to explain this finding.

The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial

BACKGROUND

Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG.

METHODS

This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided).

RESULTS

In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses.

CONCLUSION

The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations.

TRIAL REGISTRATION

NCT01331564 , ClinicalTrials.gov.

Association between consistent weight gain tracking and gestational weight gain: Secondary analysis of a randomized trial

OBJECTIVE

The effective components of interventions for reducing excessive gestational weight gain (GWG) remain to be identified. This study investigated the sociodemographic, physical, psychosocial, and environmental correlates of online GWG tracking and its independent association with GWG outcomes.

METHODS

Eight hundred ninety-eight women in the intervention arms of a randomized trial assessing the effectiveness of an integrated online and mobile phone behavioral intervention to decrease the prevalence of excessive GWG were included in this secondary analysis. Data were analyzed using χ2 analysis and modified Poisson and linear regression approaches.

RESULTS

Only 16.5% of low-income (Medicaid-eligible) women consistently tracked GWG, as did 34.2% of not-low-income women. More highly educated, older, and white women were more likely to be consistent GWG trackers. Among not-low-income women, consistent GWG tracking was associated with 2.35 kg less GWG (95% CI: -3.23 to -1.46 kg; P < 0.0001) and a reduced risk of excessive GWG (RR 0.73; 95% CI: 0.59 to 0.89; P = 0.002).

CONCLUSIONS

Electronic tracking of GWG is an effective component of electronic and mobile health interventions aiming to decrease the prevalence of excessive GWG in not-low-income women. Income group-specific motivators are needed to increase the prevalence of GWG tracking.

The theory, development, and implementation of an e-intervention to prevent excessive gestational weight gain: e-Moms Roc

BACKGROUND

Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (e-Moms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women.

MATERIALS AND METHODS

Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant's use of e-intervention features.

RESULTS

An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools.

CONCLUSIONS

To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.

Behavioral Nutrition Interventions Using e- and m-Health Communication Technologies: A Narrative Review

e- and m-Health communication technologies are now common approaches to improving population health. The efficacy of behavioral nutrition interventions using e-health technologies to decrease fat intake and increase fruit and vegetable intake was demonstrated in studies conducted from 2005 to 2009, with approximately 75% of trials showing positive effects. By 2010, an increasing number of behavioral nutrition interventions were focusing on body weight. The early emphasis on interventions that were highly computer tailored shifted to personalized electronic interventions that included weight and behavioral self-monitoring as key features. More diverse target audiences began to participate, and mobile components were added to interventions. Little progress has been made on using objective measures rather than self-reported measures of dietary behavior. A challenge for nutritionists is to link with the private sector in the design, use, and evaluation of the many electronic devices that are now available in the marketplace for nutrition monitoring and behavioral change.

eMoms: Electronically-mediated weight interventions for pregnant and postpartum women. Study design and baseline characteristics

BACKGROUND

The influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women.

OBJECTIVE

To present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18-35 years of diverse income and racial/ethnic backgrounds in an urban setting.

DESIGN

Randomized double blind clinical trial. A total of 1722 women at or below 20 weeks of gestation were recruited primarily from obstetric practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12 months postpartum.

CONCLUSION

This study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetric practices and/or health insurances. ClinicalTrials.gov #NCT01331564.

Breastfeeding duration and weight gain trajectory in infancy

BACKGROUND AND OBJECTIVES

Short breastfeeding duration may exacerbate accelerated early growth, which is linked to higher obesity risk in later life. This study tested the hypothesis that infants at higher risk for obesity were more likely to be members of a rising weight-for-length (WFL) z score trajectory if breastfed for shorter durations.

METHODS

This prospective, observational study recruited women from an obstetric patient population in rural central New York. Medical records of children born to women in the cohort were audited for weight and length measurements (n = 595). We identified weight gain trajectories for infants' WFL z scores from 0 to 24 months by using maximum likelihood latent class models. Individual risk factors associated with weight gain trajectories (P ≤ .05) were included in an obesity risk index. Logistic regression analysis was performed to investigate whether the association between breastfeeding duration (<2 months, 2-4 months, >4 months) and weight gain trajectory varied across obesity risk groups.

RESULTS

Rising and stable weight gain trajectories emerged. The obesity risk index included maternal BMI, education, and smoking during pregnancy. High-risk infants breastfed for <2 months were more likely to belong to a rising rather than stable weight gain trajectory (odds ratio, 2.55; 95% confidence interval, 1.14-5.72; P = .02).

CONCLUSIONS

Infants at the highest risk for rising weight patterns appear to benefit the most from longer breastfeeding duration. Targeting mothers of high-risk infants for breastfeeding promotion and support may be protective against overweight and obesity during a critical window of development.

The EARLY trials: a consortium of studies targeting weight control in young adults

Young adulthood has been identified as a high-risk period for the development of obesity but few interventions have been tested in this population. One way to escalate our learning about effective interventions is to test a number of interventions simultaneously as a consortium of research trials. This paper describes the Early Adult Reduction of weight through LifestYle intervention (EARLY) trials. Seven research sites were funded to conduct intervention trials, agreeing to test similar primary outcomes and cooperating to use a set of common measurement tools. The EARLY consortium was able to work cooperatively using an executive committee, a steering committee, workgroups and subcommittees to help direct the common work and implement a set of common protocol and measurement tools for seven independent but coordinated weight-related intervention trials. Using a consortium of studies to help young adults reach or maintain a healthy weight will result in increased efficiency and speed in understanding the most effective intervention strategies.

Weight-related self-efficacy in relation to maternal body weight from early pregnancy to 2 years post-partum

Excessive gestational weight gain may lead to long-term increases in maternal body weight and associated health risks. The purpose of this study was to examine the relationship between maternal body weight and weight-related self-efficacy from early pregnancy to 2 years post-partum. Women with live, singleton term infants from a population-based cohort study were included (n = 595). Healthy eating self-efficacy and weight control self-efficacy were assessed prenatally and at 1 year and 2 years post-partum. Body weight was measured at early pregnancy, before delivery, and 6 weeks, 1 year and 2 years post-partum. Behavioural (smoking, breastfeeding) and sociodemographic (age, education, marital status, income) covariates were assessed by medical record review and baseline questionnaires. Multi-level linear regression models were used to examine the longitudinal associations of self-efficacy measures with body weight. Approximately half of the sample (57%) returned to early pregnancy weight at some point by 2 years post-partum, and 9% became overweight or obese at 2 years post-partum. Body weight over time was inversely related to healthy eating (β = -0.57, P = 0.02) and weight control (β = -0.99, P < 0.001) self-efficacy in the model controlling for both self-efficacy measures as well as time and behavioural and sociodemographic covariates. Weight-related self-efficacy may be an important target for interventions to reduce excessive gestational weight gain and post-partum weight gain.

Chronic health conditions and depressive symptoms strongly predict persistent food insecurity among rural low-income families

Longitudinal studies of food insecurity have not considered the unique circumstances of rural families. This study identified factors predictive of discontinuous and persistent food insecurity over three years among low-income families with children in rural counties in 13 U.S. states. Respondents reported substantial knowledge of community resources, food and finance skills, and use of formal public food assistance, yet 24% had persistent food insecurity, and another 41% were food insecure for one or two years. Multivariate multinomial regression models tested relationships between human capital, social support, financial resources, expenses, and food insecurity. Enduring chronic health conditions increased the risk of both discontinuous and persistent food insecurity. Lasting risk for depression predicted only persistent food insecurity. Education beyond high school was the only factor found protective against persistent food insecurity. Access to quality physical and mental health care services are essential to ameliorate persistent food insecurity among rural, low-income families.

Changes in family income status and the development of overweight and obesity from 2 to 15 years: a longitudinal study

Background

An emerging body of research suggests the trajectory of a family’s income affects children’s health and development more profoundly than the often-measured income at a single time point. The purpose of this study was to examine the associations between changes in family income status, early-life risk factors, and body mass index (BMI) z-score trajectory from age 2 to 15 years.

Methods

This longitudinal study employed a birth cohort (n = 595) located in a rural region of New York State. Data were collected through an audit of medical records and mailed questionnaires. Family low-income and BMI z-score trajectories were identified using latent-class modeling techniques that group children based on similar trends across time. We examined five early-life risk factors in relation to income and BMI z-score trajectories: maternal overweight/obesity, maternal gestational weight gain, maternal smoking during pregnancy, breastfeeding duration, and early-life weight gain trajectory. We used multinomial logistic regression models to estimate the odds of being in a BMI z-score trajectory group based on income trajectory and early-life risk factors.

Results

Children who remain low-income throughout childhood were more likely to maintain overweight (AOR = 2.55, 95% CI = 1.03, 5.42) and children who moved into low-income during childhood were more likely to be obese (AOR = 2.36, 95% CI = 1.12, 5.93) compared to children who were never low-income. Maternal overweight/obesity was significantly associated with a child become obese (AOR = 8.31, 95% CI = 3.80, 18.20), become overweight (AOR = 2.37, 95% CI = 1.34, 4.22), and stay overweight (AOR = 1.79, 95% CI = 1.02, 3.14). Excessive gestational weight gain was associated with increased likelihood of a child becoming overweight trajectory (AOR = 2.01, 95% CI = 1.01, 4.00).

Conclusions

Our findings further supports the growing evidence that there are several preventable early-life risk factors that could be targeted for intervention. This study provides new evidence that remaining in low-income and moving into low-income increases risk for adolescent overweight and obesity.

Nutrient Inadequacy Is Prevalent in Pregnant Adolescents, and Prenatal Supplement Use May Not Fully Compensate for Dietary Deficiencies

A longitudinal study was undertaken in 156 pregnant adolescents (≤18 years old) to characterize dietary intake and to determine the degree to which prenatal supplement use compensates for dietary deficits. The adequacy of dietary intake was assessed by comparing self-reported intake from up to three 24-hour dietary recalls with the dietary reference intakes. The majority of teens did not meet the estimated average requirements (EAR) for vitamin D (93%), vitamin E (94%), Mg (90%), Fe (76%), and Ca (74%). More than half of the adolescents in each gestational window (<23 weeks; 23-30 weeks; and ≥31 weeks of gestation) self-reported daily use of prenatal supplements, but the additional supplement contributions were not sufficient to meet the EAR for Mg (90%) or Ca (54%). Pregnant adolescents are at risk for insufficient intake of several essential nutrients from diet alone in spite of adequate or excessive energy intakes. Daily use of prenatal supplements reduces the prevalence of dietary inadequacy for many nutrients but may not be sufficient to meet the requirements for Mg and Ca. Practitioners should identify motivators and barriers to adequate diet and prenatal supplement use in order to address key nutrients of concern.

The healthy start partnership: an approach to obesity prevention in young families

This article investigates the impact of community-based interventions developed by the Healthy Start Partnership (HSP) to promote healthy body weights in families. Intercept surveys were conducted to monitor community exposure. A nonconcurrent, no treatment control design was used to assess population-level weight outcomes. Control (n = 219) and intervention (n = 276) cohorts of pregnant women were recruited and followed until 6 months postpartum. Data were collected through 2 self-administered questionnaires and medical record audits. Results indicate community residents were exposed to interventions. However, little evidence of positive effects of interventions on weight outcomes was found for mothers or infants.

School meals participation and weekday dietary quality were associated after controlling for weekend eating among U.S. school children aged 6 to 17 years

Prior research has shown positive associations between participation in school meals and some dietary measures, but the evidence is equivocal. Few prior studies have used methodological approaches that address underlying differences in food preferences and health beliefs between school meals participants and nonparticipants, resulting in the potential for selection bias to influence results. This study estimated relationships among school meals participation and weekday energy intake and dietary quality, controlling for weekend dietary intake as a proxy for food preferences and health beliefs. Further, this paper explored how family income moderated these relationships. NHANES data (2003-2008) were analyzed for children aged 6-17 y with reliable dietary recalls for one weekday and one weekend day (n = 2376). Using multivariate linear regression models, we examined weekday-weekend differences in energy intake as a percentage of the estimated energy requirement (%EER) and differences in Healthy Eating Index-2005 (HEI) scores for breakfast and lunch and for the entire day. Overall, school meals participants and nonparticipants had equivalent %EERs and total HEI scores, but participants scored higher for milk and lower for saturated fat and sodium after adjustment for weekend eating. Family income moderated the relationship between school meals participation and HEI. Low-income children who ate school breakfast and lunch had significantly higher total HEI, and total grain, and meat and beans component scores. Conversely, higher income participants had significantly lower scores for total grains, whole grains, and saturated fat. Changes to the content of school meals may differentially affect weekday dietary intake of low-income and higher income participants.

Moving beyond quantity of participation in process evaluation of an intervention to prevent excessive pregnancy weight gain

Background

Few lifestyle interventions have successfully prevented excessive gestational weight gain. Understanding the program processes through which successful interventions achieve outcomes is important for the design of effective programs. The objective of this study was to evaluate the effect of the quantity and quality of participation in a healthy lifestyle intervention on risk of excessive gestational weight gain.

Findings

Pregnant women (N = 179) received five newsletters about weight, nutrition, and exercise plus postcards on which they were asked to set related goals and return to investigators. The quantity of participation (dose) was defined as low for returning few or some vs. high for many postcards (N = 89, 49.7%). Quality of participation was low for setting few vs. high for some or many appropriate goals (N = 92, 51.4%). Fisher’s exact tests and multivariate logistic regression were used to analyze the effect of participation variables on the proportion with excessive weight gain. Quantity and quality of participation alone were each not significantly associated with excessive gestational weight gain, while quality of participation among those with high-levels of participation approached significance (p = 0.07). The odds of gaining excessively was decreased when women had both a high quantity and quality of participation (OR = 0.04, 95% CI = 0.005, 0.30).

Conclusions

Both quantity and quality of participation are important program process measures in evaluations of lifestyle interventions to promote healthy weight gain during pregnancy.

The web of risk factors for excessive gestational weight gain in low income women

The objective of this study is to gain an in-depth understanding of issues related to gestational weight gain (GWG) including general health, diet, and physical activity among high and low income women and to elucidate socio-ecological and psychosocial risk factors that increase risk for excessive GWG. We conducted 9 focus groups with high (n = 4 groups) and low (n = 5 groups) income pregnant women aged 18-35 years to discuss health, GWG, diet and physical activity following a discussion guide. The constant comparative method was used to code focus group notes and to identify emergent themes. Themes were categorized within the integrative model of behavioral prediction. Low income women, in contrast to high income women, had higher BMIs, had more children, and were African American. Diet and physical activity behaviors reported by low income women were more likely to promote positive energy balance than were those of high income women. The underlying behavioral, efficacy, and normative beliefs described by both groups of women explained most of these behaviors. Experiencing multiple risk factors may lead to (1) engaging in several behavior changes during pregnancy unrelated to weight and (2) holding more weight gain-promoting beliefs than weight maintaining beliefs. These factors could inhibit diet and physical activity behaviors and/or behavior changes that promote energy balance and in combination, result in excessive GWG. Low income women experience multiple risk factors for excessive GWG and successful interventions to prevent excessive GWG and pregnancy related weight gain will need to recognize the complex web of influences.

Parity and Body Weight in the United States: Differences by Race and Size of Place of Residence

OBJECTIVE

In women, parity has been studied in relation to body weights. This study examined whether and how relationships between parity and body weight differ by race and size of place of residence, adjusting for sociodemographic factors (age, income, education, working status, and marital status) and health behaviors (alcohol consumption, birth control pills, diet, physical activity, and smoking).

RESEARCH METHODS AND PROCEDURES

A U.S. national sample of 3398 white and black women from the Third National Health and Nutrition Examination Survey was used to study the relationships using multiple linear regression analysis.

RESULTS

The parity-weight relationships varied by race and size of place of residence. After adjusting for the covariates, significant relationships between parity and body weight were found only in black women in metropolitan areas and white women in non-metropolitan areas. Compared with women with no children, white women with two children living in non-metropolitan areas tended to have lower BMIs, whereas black women in metropolitan areas with one or two children showed higher BMIs.

DISCUSSION

Overall, the parity-weight relationships in these groups of women were not strong or linear. The parity-weight relationships of black women in non-metropolitan areas warrant further examination.

Evaluation of public health professionals' capacity to implement environmental changes supportive of healthy weight

Community-based interventions to promote healthy weights by making environmental and policy changes in communities may be an important strategy in reversing the obesity epidemic. However, challenges faced by local public health professionals in facilitating effective environmental and policy change need to be better understood and addressed. To better understand capacity-building needs, this study evaluated the efforts of the Healthy Start Partnership, a university-community project to promote healthy weights in young families in a rural eight-county area of upstate New York. Qualitative interviews (n=30) and pre/post surveys (n=31) were conducted over three years of the intervention. Challenges faced by partners significantly slowed progress of environmental interventions in some communities. First, many partners did not feel their "regular" jobs afforded them sufficient time to do community work. Second, many partners did not feel they had the personal political power to work on broader environmental, policy, or system change issues. Third, facilitating and policy change and reaching out to non-traditional partners, like businesses, required developing a new set of public health skills. Fourth, the long-time frame of environmental and policy work meant that many efforts would exceed the grant period. Building local public health leaders for environmental and policy change necessitates that these challenges are acknowledged and addressed.

Maternal weight change between 1 and 2 years postpartum: the importance of 1 year weight retention

Pregnancy weight gain may lead to long-term increases in maternal BMI for some women. The objective of this study was to examine maternal body weight change 1y-2y postpartum, and to compare classifications of 2y weight retention with and without accounting for 1y-2y weight gain. Early pregnancy body weight (EPW, first trimester) was measured or imputed, and follow-up measures obtained before delivery, 1 year postpartum (1y) and 2 years postpartum (2y) in an observational cohort study of women seeking prenatal care in several counties in upstate New York (n = 413). Baseline height was measured; demographic and behavioral data were obtained from questionnaires and medical records. Associations of 1y-2y weight change (kg) and 1y-2y weight gain (≥2.25 kg) with anthropometric, socioeconomic, and behavioral variables were evaluated using linear and logistic regressions. While mean ± SE 1y-2y weight change was 0.009 ± 4.6 kg, 1y-2y weight gain (≥2.25 kg) was common (n = 108, 26%). Odds of weight gain 1y-2y were higher for overweight (OR(adj) = 2.63, CI(95%) = 1.43-4.82) and obese (OR(adj) = 2.93, CI(95%) = 1.62-5.27) women than for women with BMI <25. Two year weight retention (2y-EPW ≥2.25 kg) was misclassified in 38% (n = 37) of women when 1y-2y weight gain was ignored. One year weight retention (1YWR) (1y-EPW) was negatively related to 1y-2y weight change (β(adj) ± SE = -0.28 ± 0.04, P < 0.001) and weight gain (≥2.25 kg) (OR(adj) = 0.91, CI(95%) = 0.87-0.95). Relations between 1y weight retention and 1y-2y weight change were attenuated for women with higher early pregnancy BMI. Weight change 1y-2y was predicted primarily by an inverse relation with 1y weight retention. The high frequency of weight gain has important implications for classification of postpartum weight retention.

Gestational weight gain in adolescents: a comparison to the new Institute of Medicine recommendations

STUDY OBJECTIVE

To examine the gestational weight gain distributions of healthy adolescents with optimal birth outcomes and compare them to the current 2009 Institute of Medicine (IOM) recommendations.

DESIGN

Secondary data analysis to conduct a population-based, cross-sectional study.

SETTING

The Central and Finger Lakes regions of New York state (Perinatal Database System).

PARTICIPANTS

6995 adolescents with healthy singleton pregnancies (1996 to 2002).

MAIN OUTCOME MEASURES

Percentiles of the gestational weight gain distributions were compared within body mass index (BMI) groups categorized using 2 different classification schemes: adolescent BMI percentiles and adult BMI cut-points. We compared these distributions overall and within racial and age groups.

RESULTS

The gestational weight gain distribution does not differ considerably when BMI is classified using adolescent or adult cutoffs. Adolescents have good birth outcomes across a wider gestational weight gain range than recommended by the Institute of Medicine regardless of how pre-pregnancy weight status is categorized. For example, overweight adolescents by adult cutoffs have a range of gestational weight gain from 5.0 kg to 30.0 kg, and overweight adolescents by percentile cutoffs have a range from 5.4 kg to 29.5 kg, whereas the IOM range is 7.5-11.5 kg. Black and young adolescents have a similar distribution to their white and older counterparts.

CONCLUSION

Practitioners can safely use the new IOM gestational weight gain ranges to monitor weight gain in pregnant adolescent patients using adult BMI classifications. Future research should examine the range of gestational weight gain in adolescents considering a broader scope of birth and maternal outcomes.

Online course increases nutrition professionals' knowledge, skills, and self-efficacy in using an ecological approach to prevent childhood obesity

OBJECTIVE

To assess the impact of an online continuing education course on the knowledge, skills, and self-efficacy of nutrition professionals to use an ecological approach to prevent childhood obesity.

DESIGN

Quasi-experimental design using intervention and delayed intervention comparison groups with pre/post-course assessments.

SETTING

Online continuing education course.

PARTICIPANTS

Nutrition and health professionals in an online course (n = 105) and a delayed intervention comparison group (n = 37).

INTERVENTION

A 6-week, facilitated online course titled, Preventing Childhood Obesity: An Ecological Approach.

MAIN OUTCOME MEASURES

Changes in knowledge, skills, and self-efficacy in using an ecological approach to address childhood obesity.

ANALYSIS

Paired and independent sample t tests, factor analysis, regression analysis.

RESULTS

In contrast to a comparison group, nutrition and health professionals who participated in a 6-week online course had statistically significant increases (P < .01) in their knowledge, skills, and self-efficacy related to using an ecological approach to prevent childhood obesity.

CONCLUSIONS AND IMPLICATIONS

A facilitated online course can be effective at increasing the knowledge, skills, and self-efficacy of community-based nutrition and health professionals in using an ecological approach to prevent childhood obesity in their communities.

Associations Between Mothers' and Their Children's Weights at 4 Years of Age

OBJECTIVES: To examine the importance of maternal weight characteristics as predictors of overweight (BMI ≥85th percentile and <95th percentile) and obesity (BMI ≥ 95th percentile) in offspring at age 4 years. METHODS: Chi-square and logistic regression analyses were conducted on a sample of 321 mother/child pairs from an earlier observational cohort study on mothers' postpartum weight retention. RESULTS: Maternal early pregnancy BMI and infant birth weight were each positively and significantly (p <0.05) associated with increased risk of obesity in offspring at age 4 years. A significant interaction was found between these two variables in predicting children's risk of obesity. It was driven by the high proportion of obese children among obese women who had infants weighing < 3 kg at birth. Net gestational weight gain was not associated with obesity risk in children, but was positively associated with infant birth weight among normal weight and overweight women. CONCLUSIONS: Reducing maternal BMI in the preconception period among overweight and obese women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.

Selecting the right polymer

Choosing the correct polymer for a medical device requires a comprehensive look at many aspects of performance and economy. This decision-making process is illustrated here with approaches to choosing materials for an injection moulded steam sterilisation tray for surgical instruments and goods.

Maternal mental health and the persistence of food insecurity in poor rural families

BACKGROUND

Little is known about the causal relationship between and the mechanisms linking depression and food insecurity. Our purpose was to examine these knowledge gaps.

METHODS

Chi-squared analysis of longitudinal data from 29 rural upstate New York families followed for three years and qualitative analysis of interviews were used to identify associations and mechanisms.

RESULTS

Depressive symptoms (p=.009) and poor mental health (p=.01) in mothers limited the likelihood families would leave food insecurity. This relationship was mediated through limiting the employment of adult family members and operated in three ways: preventing the depressed household member from working, preventing a different household member from working, and limiting access to childcare for depressed children so adults could work.

CONCLUSIONS

Poor mental health is associated with keeping families food-insecure by limiting their employment. High-quality, accessible mental health care is needed for poverty-associated food insecurity to be alleviated.

Racial, ethnic, and socioeconomic differences in the incidence of obesity related to childbirth

OBJECTIVES

We investigated the relationship between childbirth and 5-year incidence of obesity.

METHODS

We performed a prospective analysis of data on 2923 nonobese, nonpregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compared with women who did not have children.

RESULTS

The 5-year incidence of obesity was 11.3 per 100 parous women, compared with 4.5 per 100 nulliparous women (relative risk [RR] = 3.5; 95% confidence interval [CI] = 2.4, 4.9; P < .001). The 5-year incidence of obesity was 8.6 for primiparous women (RR = 2.8; 95% CI = 1.5, 5.0) and 12.2 for multiparous women (RR = 3.8; 95% CI = 2.6, 5.6). Among parous women, White women had the lowest obesity incidence (9.1 per 100 vs 15.1 per 100 for African Americans and 12.5 per 100 for Hispanics).

CONCLUSIONS

Parous women have a higher incidence of obesity than do nulliparous women, and minority women have a higher incidence of parity-related obesity than do White women. Thus, efforts to reduce obesity should target postpartum women and minority women who give birth.

Achieving a healthy weight gain during pregnancy

This review uses the 1990 U.S. Institute of Medicine (IOM) gestational weight gain recommendations to examine the question, what is a healthy pregnancy weight gain? The relationship of gestational weight gain to infant size at birth; pregnancy, labor, and delivery complications; neonatal, infant, and child outcomes; and maternal weight and health outcomes in U.S. and European populations are discussed. Pregnancy weight gains within the IOM recommendations are associated with better outcomes. The possible exception is very obese women, who may benefit from weight gains less than the 7 kg (15 pounds) recommended. Only about 33% to 40% of U.S. women gain within IOM recommendations. Excessive gestational weight gain is more prevalent than inadequate gain. Women's gestational weight gains tend to follow the recommendations of health care providers. Current interventions demonstrate efficacy in influencing gestational weight gain in low-income women with normal and overweight body mass index in the United States and obese women in Scandinavia.

The relationship between food insecurity and obesity in rural childbearing women

CONTEXT

While food insecurity and obesity have been shown to be positively associated in women, little is known about the direction of the causal relationship between these 2 constructs.

PURPOSE

To clarify the direction of the causal relationship between food insecurity and obesity.

METHODS

Chi-square and logistic regression analysis of data from a cohort of 622 healthy childbearing women living in a 10-county rural area of upstate New York and followed from early pregnancy until 2 years postpartum.

FINDINGS

Obesity in early pregnancy was associated with increased risk of food insecurity at 2 years postpartum. Initial food insecurity was not associated with increased risk of obesity at 2 years postpartum. Women who were both obese and food insecure in early pregnancy were at greatest risk of major weight gain over the pregnancy and postpartum period.

CONCLUSIONS

Obesity appears to lead to food insecurity rather than the converse. Obesity combined with food insecurity present the greatest risk for major weight gain in this sample of childbearing women.

Growing up poor: Long-term implications for eating patterns and body weight

This study aimed to understand how poverty-associated food deprivation in childhood contributes to the well-known relationship between low socioeconomic status (SES) in childhood and obesity in the adult years. Thirty low-income, rural women with at least one child were followed for over three years with annual semi-structured interviews collecting quantitative and qualitative data. For the quantitative portion, the measures of interest were body mass index (BMI), food insecurity, eating patterns, and SES. For the qualitative portion, text from the interviews was analyzed using the constant comparative method. Growing up in a poor household was associated with increased risk of overweight and obesity in adulthood. Experiences of poverty-associated food deprivation in childhood appeared to super-motivate some women to actively avoid food insecurity in adulthood. It also influenced the women's current food preferences. Tremendous excitement accompanied the availability of food after periods of deprivation in both the women and their children. Some women had used food to meet emotional needs in childhood and overeating had become a generalized response to negative emotional states in the adult years. Food deprivation in childhood and associated attitudes and behaviors towards food are one possible mechanism for explaining the association between childhood poverty and adult obesity.