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Natale R, Schladant M, Bloyer MH, Hernandez J, Palenzuela J, Agosto Y, Peng Y, Messiah SE. A Randomized Controlled Cluster Trial of an Obesity Prevention Program for Children with Special Health Care Needs: Methods and Implications. Nutrients 2024; 16:1274. [PMID: 38732520 PMCID: PMC11085216 DOI: 10.3390/nu16091274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Children with disabilities have higher prevalence estimates of obesity than typically developing children. The Healthy Caregivers-Healthy Children Phase 3 (HC3) project implemented an obesity prevention program adapted for children with special health care needs (CSHCN) that includes dietary intake and physical activity (PA) components. The primary outcome was a change in dietary intake, PA, and the body mass index (BMI) percentile. Ten childcare centers (CCCs) serving low-resource families with ≥30 2- to 5-year-olds attending were randomized to either the intervention (n = 5) or control (n = 5). The HC3 CCCs received (1) snack, beverage, PA, and screen time policies via weekly technical assistance; (2) adapted lesson plans for CSHCN; and (3) parent curricula. The control CCCs received a behavioral health attention curriculum. HC3 was delivered over three school years, with data collected at five different timepoints. It was delivered weekly for six months in year one. To ensure capacity building, the HC3 tasks were scaled back, with quarterly intervention delivery in year 2 and annually in year 3. Adaptations were made to the curriculum to ensure appropriate access for CSHCN. Given that the program was being delivered during the COVID-19 pandemic, special modifications were made to follow CDC safety standards. The primary outcome measures included the Environment and Policy Assessment and Observation (EPAO) tool, standardized dietary intake and PA assessments, and the child BMI percentile. CCCs are an ideal setting for targeting CSHCN for obesity prevention efforts as they provide an opportunity to address modifiable risk factors.
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Affiliation(s)
- Ruby Natale
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Michelle Schladant
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Martha H. Bloyer
- Department of Physical Therapy, University of Miami, Coral Gables, FL 33136, USA;
| | - Julieta Hernandez
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Joanne Palenzuela
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Yaray Agosto
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Youmeizi Peng
- Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33136, USA; (M.S.); (J.H.); (J.P.); (Y.A.)
| | - Sarah E. Messiah
- University of Texas Health Science Center at Houston School of Public Health, Dallas, TX 75207, USA;
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX 75207, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX 77030, USA
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Natale RA, Cardenas EPV, Varanloo P, Ma R, Agosto Y, Palenzuela J, Hernandez J, Schladant M, Bloyer M, Messiah SE. Social Challenges as a Consequence of the COVID-19 Pandemic among South Florida Preschool Children with Disability and Obesity. Children (Basel) 2023; 10:619. [PMID: 37189868 PMCID: PMC10137173 DOI: 10.3390/children10040619] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023]
Abstract
The COVID-19 pandemic has negatively impacted the childcare industry over the past two years. This study examined how pandemic-related challenges impacted preschool-aged children by disability and obesity status. Participants were 216 children (80% Hispanic, 14% non-Hispanic Black) aged 2 to 5 years in 10 South Florida childcare centers. In November/December 2021, parents completed a COVID-19 Risk and Resiliency Questionnaire, and body mass index percentile (BMI) was collected. Multivariable logistic regression models examined the association of COVID-19 pandemic-related social challenges (transportation, employment) and child BMI and disability status. As compared to normal-weight children, those families with a child who was obese were more likely to report pandemic-related transportation (OR: 2.51, 95% CI: 1.03-6.28) challenges and food insecurity (OR: 2.56, 95% CI: 1.05-6.43). Parents of children with disabilities were less likely to report that food did not last (OR: 0.19, 95% CI: 0.07-0.48) and that they could not afford balanced meals (OR: 0.33, 95% CI: 0.13-0.85). Spanish-speaking caregivers were more likely to have a child who was obese (OR: 3.04, 95% CI: 1.19-8.52). The results suggest that COVID-19 impacts obese preschool children from Hispanic backgrounds, while disability was a protective factor.
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Affiliation(s)
- Ruby A. Natale
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Erika Paola Viana Cardenas
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Parisa Varanloo
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Science, University of Miami School of Medicine, Miami, FL 33136, USA
| | - Yaray Agosto
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Joanne Palenzuela
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Julieta Hernandez
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Michelle Schladant
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, Miami, FL 33130, USA
| | - Martha Bloyer
- Department of Physical Therapy, University of Miami, Coral Gables, FL 33146, USA
| | - Sarah E. Messiah
- University of Texas Health Science Center, School of Public Health, Dallas Campus, Dallas, TX 75390, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UT Health School of Public Health, Dallas, TX 75390, USA
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Natale R, Weerakoon S, Woody MT, Kolomeyer E, Pena K, Schladant M, Bulotsky-Shearer RJ, Messiah SE. Parent concerns regarding paediatric obesity in community-based programmes serving children with developmental disabilities. Child Care Health Dev 2020; 46:733-740. [PMID: 32803796 DOI: 10.1111/cch.12803] [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: 05/06/2020] [Revised: 07/18/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies show a higher prevalence of obesity among preschool-age children with developmental disabilities (DDs) versus children who are typically developing (TD). Little is known about parent concerns about obesity in young children with DD. The purpose of this study was to examine concerns regarding paediatric obesity among parents who had a preschool-age child with DD compared with parents with a child who is TD. METHODS A cross-sectional analysis occurred at baseline entry into one of three community-based programmes. Parents of a child with DD (n = 815) or TD (n = 563) were asked obesity-related questions about their child and in general. Multinomial and logistic regression unadjusted and adjusted models were run to generate the odds of obesity concerns based on disability status. RESULTS The average child age was 38 months. Parent concerns about paediatric obesity differed by disability status. Unadjusted odds of parents 'doing anything to control their child's weight' was 38% lower among parents of a child with DD versus TD (OR: 0.62, 95% CI: 0.48, 0.82). The adjusted odds of perceiving that their child was underweight was 83% higher among parents of a child with DD compared with parents of a child who is TD (aOR: 1.83, 95% CI: 1.27, 2.64). Parents of a child with DD were 179% more likely to believe that childhood obesity is a public health problem (aOR: 2.79, 95% CI: 1.88, 3.96). The models were adjusted for age, sex and race/ethnicity. CONCLUSIONS Findings indicate that parents of preschool-age children with DD are more likely to acknowledge that obesity is a public health concern. Because some parents of children with DD are concerned about their child's weight, families of preschool-age children with DD may be receptive to the delivery of healthy weight strategies in community-based programs.
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Affiliation(s)
- Ruby Natale
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sitara Weerakoon
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Malaika T Woody
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ellen Kolomeyer
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kristyna Pena
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | | | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
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Schladant M, Dowling M. Parent Perspectives on Augmentative and Alternative Communication Integration for Children With Fragile X Syndrome: It Starts in the Home. Intellect Dev Disabil 2020; 58:409-421. [PMID: 33032315 DOI: 10.1352/1934-9556-58.5.409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/29/2019] [Indexed: 06/11/2023]
Abstract
Many children with fragile X syndrome (FXS) have complex communication needs and may benefit from augmentative and alternative communication (AAC). This qualitative study explored how four mother-child dyads used AAC in the home. Data were collected using participant observations, open-ended interviews, and record reviews, and analyzed using grounded theory methods. Findings revealed that mothers found AAC to be a useful tool for addressing their children's complex communication needs, but practical and personal factors impacted its use in the home. This study sheds light on how mothers of children with FXS view and utilize AAC as a way to promote communication at home. Understanding parental perspectives can help to guide professionals in planning appropriate AAC interventions specific to FXS.
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Affiliation(s)
| | - Monica Dowling
- Michelle Schladant and Monica Dowling, University of Miami, FL
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