What Child Oral Health-Related Behaviors Can First-time Mothers Actualize? A Pragmatic Prospective Study

INTRODUCTION

First-time pregnant women are considered to be receptive to health information, rendering the prenatal period an opportune time to provide helpful information on the importance of child-related oral health. However, little is known about pregnant women's knowledge of child oral health-related behaviors (COHBs) during pregnancy and their implementation after birth. We sought to address this knowledge gap by a prospective investigation of intended and actualized oral health behaviors among first-time pregnant women.

METHODS

We examined relationships between intended and actualized COHBs and their correlations with changes in oral health knowledge, health literacy, general self-efficacy, and dental neglect in a cohort of first-time pregnant clients at Women, Infants, and Children sites in North Carolina-participants of a large community-based study. The COHBs were related to diet (i.e., frequency of fruit juice and sweet snacks consumption and nighttime bottle-feeding) and oral hygiene practices (e.g., performance of daily oral hygiene and use of fluoridated toothpaste). Analyses relied on descriptive statistics and bivariate tests (Student's t and McNemar's). Data were collected from 48 participants (White, 44%; African American, 40%; Native American, 17%) at baseline and again at least 12 months after the birth of their first child.

RESULTS

On average, most mothers actualized 3 of 5 COHBs (range, 1 to 4). Significant differences between before and after birth were noted for frequency of sweet snacks consumption and putting the baby in bed with a bottle. No correlation was found between knowledge, literacy, self-efficacy, neglect, and sociodemographic characteristics and COHB actualization.

CONCLUSION

Our findings suggest that first-time mothers in the studied population are likely to implement some but not all positive intended COHBs during pregnancy. Interventions are needed to assist women in implementing these practices. We support that, for prenatal interventional efforts to reap positive benefits, messaging should be personalized and include specific guidance on how to implement these recommendations.

KNOWLEDGE TRANSFER STATEMENT

A knowledge gap exists in our understanding of the relationship between first-time mothers' intended and actualized child oral health behaviors, with implications in the optimal timing of infant and early childhood oral health messaging. Our findings suggest that first-time mothers are likely to implement some but not all positive behaviors that they intended to adopt during pregnancy. Interventions are needed to assist women in implementing these practices.

Should the IDEFICS outcomes have been expected?

The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study evaluated with a large sample a comprehensive carefully planned obesity prevention intervention targeting multiple levels of influence that were culturally adapted to the situations in eight European countries. Despite the great effort and attention to detail, the IDEFICS study did not achieve its targeted adiposity or behaviour change objectives. Should we be surprised that the IDEFICS trial did not have its intended effects? We think not, and would have been surprised if it did. Recent research has revealed the lack of consistent meaningful relationships between several apparently obesogenic behaviours and adiposity, weak or no relationships among behavioural change procedures, mediating variables and targeted behaviours and inadequate attention to moderating effects. Future obesity prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and the interrelationships with biological factors. While systems modelling has been proposed as providing the solution, important less complex identification of new constructs, new relationships and community interventions are still needed, both to find innovative solutions and to provide input into the systems models. We should question results from cross-sectional studies and be satisfied only with longitudinal or experimental tests of relationships.

Do adolescent vitamin-mineral supplement users have better nutrient intakes than nonusers? Observations from the CATCH tracking study

OBJECTIVE

Describe whether users of vitamin-mineral supplements differed from nonusers in micronutrient intakes or in nutrition awareness.

DESIGN

Cross-sectional, observational study.

SUBJECTS

One thousand five hundred thirty-two students now in grade 8, who participated in the Third Child and Adolescent Trial for Cardiovascular Health tracking study and who also provided a single 24-hour dietary recall.

STATISTICAL ANALYSES PERFORMED

Mixed-model analysis of covariance was used to ascertain if supplement users had higher vitamin and mineral intakes from food sources, and to examine if supplement users had better nutrition awareness than nonusers.

RESULTS

The 24-hour recall showed that 17.6% of the students reported using vitamin-mineral supplements. Users reported a mean of 1.4 supplements, of which 47% were multivitamin or multimineral preparations, 37% were single nutrients, and 16% were combinations. White persons and residents of Minnesota and California were more likely to be supplement users. Users had higher micronutrient intakes from food sources for 16 of the 20 nutrients studied after adjusting for gender, race/ethnicity, site, treatment condition, and within-school variability. Users had higher scores on a health behavior survey for food choice and slightly but not significantly higher nutrition knowledge scores.

CONCLUSIONS

Vitamin-mineral supplement use is prevalent among eighth-grade students. Users have higher nutrient intakes from foods, higher total intakes for several micronutrients, higher nutrition awareness, and differ in their demographic characteristics from nonusers.

Portion-size estimation training in second- and third-grade American Indian children

Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in adults, but there is no comparable evidence for children. To obtain this information, we studied 110 second- and third-grade American Indian schoolchildren (34 control subjects were not trained), testing the hypotheses that a 45-min portion-size estimation training session would reduce children's food quantity estimation error, and that the improvement would be dependent on food type, measurement type, or both. Training was a hands-on, 4-step estimation and measurement skill-building process. Mixed linear models (using logarithmic-transformed data) were used to evaluate within- and between-group differences from pre- to posttest. Test scores were calculated as percentage estimation errors by difference and absolute value methods. Mean within-group estimation error decreased significantly (P<0.05) from pre- to posttest for 7 of 12 foods (trained group) by both calculation methods, plus 3 additional foods by the difference method and one additional food by the absolute value method. Significant (P<0.05) between-group differences occurred for 3 foods, reflecting a greater decrease in estimation error for the trained group. Improvement was greatest for solid foods estimated by dimensions (P>0.05) or in cups (P<0.05), for liquids estimated by volume or by label reading (P<0.001), and for one amorphous food estimated in cups (P<0.01). Despite these significant improvements in estimation ability, the error for several foods remained >100% of the true quantity, indicating that more than one training session would be necessary to further increase dietary reporting accuracy.

Correspondence of self-reported fruit and vegetable intake with dietary intake data

The association between greater fruit and vegetable intake and better health outcomes is now well established, and dietary guidelines and recommendations promote increased intake of fruit and vegetables. The correspondence of self-assessed change in, and adequacy of, fruit and vegetable intake with dietary intake data was investigated using data from a food frequency questionnaire administered in 1989 and again in 1992 to 453 randomly selected adults from Dalby, Queensland. There was some accuracy in self-reported increased intake of fruit for women, although the dietary data for 44 per cent of women who reported an increase in intake did not show such an increase. Self-reported increased intake did not correspond with dietary data for men or for vegetable intake for women. Self-assessed adequacy of fruit and vegetable intake was associated significantly with mean intake and intake frequency data. The association was stronger for men for fruit and for women for vegetables. Nonetheless, high percentages of people who consumed less than two servings of fruit or three servings of vegetables daily assessed their intake as 'about right'. There is a need for clear, consistent and widely promoted messages recommending intake of two fruit and five vegetable servings daily to increase awareness of the amounts of fruit and vegetables Australians should consume.

The effects of the Child and Adolescent Trial for Cardiovascular Health upon psychosocial determinants of diet and physical activity behavior

BACKGROUND

The Child and Adolescent Trial for Cardiovascular Health is a multisite study of a school-based intervention to reduce or prevent the development of risk factors for cardiovascular disease. The purpose of this paper is to present the evaluation results of the 3-year intervention, focusing upon the psychosocial variables conceptualized as determinants of dietary and physical activity behaviors.

METHODS

A total of 96 schools across four study sites (California, Louisiana, Minnesota, and Texas) were randomized to two treatment conditions: intervention and control. Pre- and postmeasurements on the health behavior questionnaire were collected from over 6,000 students. The data analyses utilized a nested design approach in which schools served as the primary unit of analysis. Repeated-measures multivariate analyses were applied to investigate effect sizes for each determinant and to explore theoretical relationships among the determinants over time.

RESULTS

The findings indicated sustained significant effects in improved knowledge, intentions, self-efficacy, usual behavior, and perceived social reinforcement for healthy food choices (P < 0.0001 for these five variables) after 3 years. Intermittent effects were observed for perceived support and self-efficacy for physical activity. No gender by determinant interaction effects were observed, and girls reported significantly greater perceived reinforcement for healthy eating than did boys.

CONCLUSION

The CATCH program was effective in changing the psychosocial variables likely to influence a reduction in behavior for cardiovascular disease. The study is significant in that it demonstrates the viability and effectiveness of a sustained multifaceted intervention in a preadolescent population. The results point to a need for greater understanding of adolescent developmental issues and the role of community environment (particularly social support) in creating effective curricula.

Impact of fat reduction on micronutrient density of children's diets: the CATCH Study

BACKGROUND

The purpose of this study was to examine the impact of fat reduction on vitamin and mineral density in the diets of groups of children who participated in the CATCH school-based intervention study for 2 1/2 years.

METHODS

Twenty-four-hour dietary recalls were collected on 1,182 children residing in four states and with diverse ethnic backgrounds, at baseline when they were in third grade and again at follow-up when they were in fifth grade.

RESULTS

With a 2.4% reduction in total fat intake from baseline levels in the intervention group, mean changes in vitamin and mineral intakes per 1,000 kcal of this group were small yet significant compared with the control group. As mean fat intake decreased, the nutrient density of most vitamins and minerals increased; the sole exceptions were vitamin E and sodium. Mean intake of all vitamins and minerals studied exceeded 2/3 of the RDA at both baseline and follow- up for both the intervention and the control groups. No significant differences were noted between treatment groups for the percentages of children meeting 2/3 or more of the RDA at both baseline and follow-up periods.

CONCLUSIONS

CATCH was successful in maintaining mean vitamin and mineral intakes of intervention group children when total dietary fat was reduced.

Evaluation of bedside blood glucose monitoring by the phlebotomy team in an acute general care hospital

A feasibility study was undertaken to evaluate laboratory phlebotomists performing bedside glucose monitoring (BGM) over a 3-month period on a medical and surgical floor. Specific questions included: feasibility of providing testing on a 24-h basis, accuracy, appropriate utilization, effect on patient care, and an analysis of cost. In all, 1975 tests were performed on 114 patients. BGM results were within 15% of the laboratory's result 97% of the time. Patient and physician satisfaction was high. Although the cost of BGM is slightly higher than a laboratory glucose test, its use appeared to reduce the length of hospital stay by 0.47 days. Practical information on initiating a highly successful BGM program is provided.

Perspectives on the School Nutrition Dietary Assessment Study from the Child and Adolescent Trial for Cardiovascular Health

The School Nutrition Dietary Assessment Study provides current data on the nutritional quality and adequacy of the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) as well as on the dietary intakes of students participating in these programs. The study demonstrates that the NSLP and SBP meals and children's total diets do not conform to the recommendations of the US Department of Agriculture and the National Research Council and confirms the need to improve the nutritional quality of the nation's school meal program and student's overall dietary intakes. In this regard, the Child and Adolescent Trial for Cardiovascular Health (CATCH) is the first collaborative, school-based field trial that tests the effectiveness of a multi-level intervention designed to reduce the fat, saturated fat, and sodium content of school meals and student's diets. This commentary highlights the findings and questions raised by the School Nutrition Dietary Assessment Study and presents an overview of CATCH, including the implications and significant questions that can be addressed by this intervention study.

Diabetes in the elderly. Techniques in management and basic care

The diabetic patient in general faces tremendous challenges: self-medication, diet changes, exercise regime, and blood glucose monitoring. In addition, the elderly patient with diabetes has other unique needs. With education, encouragement and support, the diabetic today can lead lives as actively as persons without the disease.

Schizophrenia-primary affective disorder discrimination. I. Development of a data-based diagnostic index

A nine-variable diagnostic measure for discriminating schizophrenia and primary affective disorder was developed. The nine variables, which were selected by discriminant function analysis, reflect past and current symptomatology, duration of symptoms, and behavioral ratings. The measure was cross-validated by a jackknife procedure that accurately classified nine of ten of the cases. Such accuracy suggests that brief, data-based diagnostic instruments have considerable promise as practical checks of clinical diagnoses.

Symptoms in veterans considering compensation claims

The symptomatology of 56 male veterans considering compensation claims was compared to the symptomatology seen in 163 veterans not considering such claims. Antisocial behaviors, somatic/neurotic complaints, and persecutory ideas were all positively correlated with consideration of a claim. Although the symptom profile is consistent with diagnosis of antisocial personality, a correlation with this diagnosis was not established. Nonetheless, the clinical profile does suggest a link between noncompensable disorders and consideration of a claim. The implications of this finding for military and Veterans Administration psychiatry are discussed.