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Child Obesity Prevention From Pregnancy: Long-Term Follow-Up of the Starting Early Program Trial

Kim, Christina N; Messito, Mary Jo; Katzow, Michelle; Duh-Leong, Carol; Gross, Rachel S
OBJECTIVE:Assess postintervention and dose effects of a child obesity prevention program, delivered from pregnancy through the age of 3 years, on child weight outcomes at the ages of 4 and 5 years among low-income Hispanic families. METHODS:As postintervention follow-up of the Starting Early Program (StEP) randomized controlled trial, StEP enrolled pregnant people in the third trimester to standard care control or the StEP intervention, which provided 15 nutrition and parenting support sessions. We analyzed differences in weight-for-age z scores (WFAz) and obesity status by group within intervention group analyses of program dose and moderation by adverse social drivers of health (SDoH). RESULTS:Weight data were available for 312 and 264 children aged 4 and 5 years, respectively. Mean WFAz (0.59 [1.08] vs 0.52 [1.16], P = .55; 0.60 [1.07] vs 0.58 [1.22], P = .86) and proportion with obesity (15.2% vs 15.6%, P = .90; 16.2% vs 19.5%, P = .47) were not different by intervention status at the ages of 4 and 5 years. The mean (SD) number of sessions attended was 8.7 (4.2) with the highest tertile attending 11 sessions or more. Lower WFAz and obesity prevalence were found for families with top tertile attendance. In moderation analysis, impacts on weight in children aged 5 years were greater for families with low social support compared high social support. CONCLUSION/CONCLUSIONS:Participation in StEP was not associated with postintervention differences in child weight. Higher attendance was associated with lower obesity prevalence, while treatment effects were greater for families with low social support. This highlights the need to evaluate program dose on long-term outcomes, especially for those with adverse SDoH.
PMID: 40164193
ISSN: 1098-4275
CID: 5818832

Heart Healthy Routines in Young Children With Sesame Workshop: A Qualitative Study of Latina Mothers With Economic Hardship

Duh-Leong, Carol; Messito, Mary Jo; Kim, Leah; Cohen, David I; Betancourt, Jeanette; Ortiz, Robin; Astudillo, Jessica; Nagpal, Nikita; Katzow, Michelle W; Gross, Rachel S
OBJECTIVE:To explore how Sesame Workshop resources are perceived by Latino families with economic hardship and to highlight approaches for early heart healthy routine promotion. METHODS:We performed a purposive sampling of Latina mothers (n = 40) with young children experiencing economic hardship. Using an interview guide informed by the Consolidated Framework for Implementation Research, we recorded Spanish and English semistructured interviews, which were translated and transcribed verbatim. Partnering with Sesame Workshop, we iteratively incorporated Sesame Resources into interviews to query for acceptability. Using reflexive thematic analysis, we coded transcripts through textual analysis until saturation, prioritizing in vivo coding to capture participant voices. RESULTS:We constructed 3 themes. Parents connected with resources that 1) Reflect lived and multicultural experiences containing recognizable family scenes that can serve as tools to transfer a parent's own early routines or cultural rituals to their child. They appreciated resources that 2) Engage caregivers and children together, featuring elements for both children and adult caregivers with activities to highlight important caregivers and encourage shared play. Participants also reflected on how 3) Routines amplify family strengths and foster resilient reactions with feelings of decreased stress when daily practices become routines, promoting resilient reactions and supporting long-term goals when facing setbacks. CONCLUSIONS:An interdisciplinary partnership leveraged strengths of pediatric practitioners and Sesame Workshop to align future initiatives with the values and priorities of mothers of young children at risk for early obesity. Resultant themes inform strategies to promote heart healthy routines and relational health in young children with economic hardship.
PMID: 39313066
ISSN: 1876-2867
CID: 5738732

Feasibility of an Obesity Prevention Program for Latino Families from First Trimester of Pregnancy to Child Age 18 Months and Predictors of Program Attendance

Katzow, Michelle W; Messito, Mary Jo; Bancayan, Janneth; Kim, Christina N; Duh-Leong, Carol; Marcone, Alessandra L; Denny, Colleen; Scott, Marc A; Gross, Rachel S
PMID: 39612164
ISSN: 2153-2176
CID: 5773252

Behavioural components and delivery features of early childhood obesity prevention interventions: intervention coding of studies in the TOPCHILD Collaboration systematic review

Johnson, Brittany J; Chadwick, Paul M; Pryde, Samantha; Seidler, Anna Lene; Hunter, Kylie E; Aberoumand, Mason; Williams, Jonathan G; Lau, Hei In; Libesman, Sol; Aagerup, Jannik; Barba, Angie; Baur, Louise A; Morgillo, Samantha; Sanders, Lee; Taki, Sarah; Hesketh, Kylie D; Campbell, Karen; Manson, Alexandra; Hayes, Alison; Webster, Angela; Wood, Charles; O'Connor, Denise A; Matvienko-Sikar, Karen; Robledo, Kristy; Askie, Lisa; Wolfenden, Luke; Taylor, Rachael; Yin, H Shonna; Brown, Vicki; Fiks, Alexander; Ventura, Alison; Ghaderi, Ata; Taylor, Barry J; Stough, Cathleen; Helle, Christine; Palacios, Cristina; Perrin, Eliana M; Reifsnider, Elizabeth; Rasmussen, Finn; Paul, Ian M; Savage, Jennifer S; Thomson, Jessica; Banna, Jinan; Larsen, Junilla; Joshipura, Kaumudi; Ong, Ken K; Karssen, Levie; Wen, Li Ming; Vitolo, Márcia; Røed, Margrethe; Bryant, Maria; Rivera, Maribel Campos; Messito, Mary Jo; Golova, Natalia; Øverby, Nina Cecilie; Gross, Rachel; Lakshman, Rajalakshmi; Byrne, Rebecca; Rothman, Russell L; O'Reilly, Sharleen; Anzman-Frasca, Stephanie; Verbestel, Vera; Maffeis, Claudio; de la Haye, Kayla; Salvy, Sarah-Jeanne; Mihrshahi, Seema; Ramachandran, Janani; Baratto, Paola Seffrin; Golley, Rebecca K; ,
BACKGROUND:Early childhood obesity prevention interventions that aim to change parent/caregiver practices related to infant (milk) feeding, food provision and parent feeding, movement (including activity, sedentary behaviour) and/or sleep health (i.e. target parental behaviour domains) are diverse and heterogeneously reported. We aimed to 1) systematically characterise the target behaviours, delivery features, and Behaviour Change Techniques (BCTs) used in interventions in the international Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration, and 2) explore similarities and differences in BCTs used in interventions by target behaviour domains. METHODS:Annual systematic searches were performed in MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, and two clinical trial registries, from inception to February 2023. Trialists from eligible randomised controlled trials of parent-focused, behavioural early obesity prevention interventions shared unpublished intervention materials. Standardised approaches were used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials. Validation meetings confirmed coding with trialists. Narrative syntheses were performed. RESULTS:Thirty-two trials reporting 37 active intervention arms were included. Interventions targeted a range of behaviours. The most frequent combination was targeting all parental behaviour domains (infant [milk] feeding, food provision and parent feeding, movement, sleep health; n[intervention arms] = 15/37). Delivery features varied considerably. Most interventions were delivered by a health professional (n = 26/36), included facilitator training (n = 31/36), and were interactive (n = 28/36). Overall, 49 of 93 unique BCTs were coded to at least one target behaviour domain. The most frequently coded BCTs were: Instruction on how to perform a behaviour (n[intervention arms, separated by domain] = 102), Behavioural practice and rehearsal (n = 85), Information about health consequences (n = 85), Social support (unspecified) (n = 84), and Credible source (n = 77). Similar BCTs were often used for each target behaviour domain. CONCLUSIONS:Our study provides the most comprehensive description of the behaviour change content of complex interventions targeting early childhood obesity prevention available to date. Our analysis revealed that interventions targeted multiple behaviour domains, with significant variation in delivery features. Despite the diverse range of BCTs coded, five BCTs were consistently identified across domains, though certain BCTs were more prevalent in specific domains. These findings can be used to examine effectiveness of components and inform intervention development and evaluation in future trials. TRIAL REGISTRATION/BACKGROUND:PROSPERO registration no. CRD42020177408.
PMCID:11796048
PMID: 39910407
ISSN: 1479-5868
CID: 5784162

Economic hardships during COVID-19 and maternal mental health: Combining samples with low incomes across three cities

Martin, Anne; Miller, Elizabeth B; Gross, Rachel S; Morris-Perez, Pamela A; Shaw, Daniel S; da Rosa Piccolo, Luciane; Hill, Jennifer; Scott, Marc A; Messito, Mary Jo; Canfield, Caitlin F; O'Connell, Lauren; Sadler, Richard C; Aviles, Ashleigh I; Krug, Chelsea Weaver; Kim, Christina N; Gutierrez, Juliana; Shroff, Ravi; Mendelsohn, Alan L
The COVID-19 pandemic increased maternal depression and anxiety, imperiling both mothers' own wellbeing and that of their children. To date, however, little is known about the extent to which these increases are attributable to economic hardships commonly experienced during the pandemic: income loss, job loss, and loss of health insurance. Few studies have examined the individual impacts of these hardships, and none have lasted beyond the first year of the pandemic. This study harmonizes data from six evaluations of pediatric-based parenting programs for women with young children and low incomes across three U.S. cities (N = 1,254). Low-income mothers are of special interest because their families have been disproportionately affected by economic shocks due to COVID-19, and mothers of young children have been more distressed than other mothers by COVID-19. The studies' combined window of observation lasted from the onset of the pandemic to over three years later. Results indicate that income loss, job loss, and health insurance loss were all significantly associated with depression and anxiety. When each hardship was assessed net of the others, lost income was associated with more than a two-fold increase in the odds of anxiety, and a lost job and lost health insurance were associated with 50% and 90% greater odds of depression, respectively. Associations between hardships and maternal mental health did not diminish over time during the window of observation. These associations are likely to have been even greater in the absence of generous social policies enacted during the pandemic.
PMID: 39731866
ISSN: 1873-5347
CID: 5767972

Prenatal and Pediatric Primary Care-Based Child Obesity Prevention: Effects of Adverse Social Determinants of Health on Intervention Attendance and Impact

Duh-Leong, Carol; Messito, Mary Jo; Katzow, Michelle W; Kim, Christina N; Mendelsohn, Alan L; Scott, Marc A; Gross, Rachel S
PMID: 38301173
ISSN: 2153-2176
CID: 5627302

The effects of parent-child dysfunctional interactions on early childhood weight: A serial mediation model through emotional feeding and child appetite traits

Kim, Christina N; Messito, Mary Jo; Duh-Leong, Carol; Katzow, Michelle; Teli, Radhika; Gross, Rachel S
Parent-child dysfunctional interactions (PCDI) are known to contribute to children's weight status. However, the underlying mechanisms in how dysfunctional interactions between parent and child influence child weight are not clear. This study investigates the impact of PCDI on toddlers' weight, focusing on the potential serial mediation by maternal emotional feeding and child appetite traits. We conducted a secondary analysis of longitudinal data from a larger intervention trial to prevent childhood obesity in low-income Hispanic families. A total of 241 mother-child dyads were included in these analyses. Measurements were taken at various stages: PCDI at child age 19 months, maternal emotional feeding at 28 months, and both child appetite traits and weight-for-age z-score (WFAz) at 36 months. Serial mediation analyses revealed a significant indirect effect of early PCDI on later child WFAz through maternal emotional feeding and two child food approach traits (food responsiveness, emotional overeating) out of the eight child appetite traits assessed. PCDI at 19 months was associated with increased use of emotional feeding in mothers at 28 months, which was associated with heightened food responsiveness and emotional overeating in children at 36 months, which in turn was linked to greater child WFAz at 36 months. The findings of this study expand the understanding of the mechanisms underlying PCDI and child weight, emphasizing the interplay between maternal feeding practices and child appetite in the context of adverse parent-child interactions during early childhood.
PMID: 38897417
ISSN: 1095-8304
CID: 5672182

Prenatal Dietary Patterns and Associations With Weight-Related Pregnancy Outcomes in Hispanic Women With Low Incomes

Berube, Lauren T; Deierlein, Andrea L; Woolf, Kathleen; Messito, Mary Jo; Gross, Rachel S
PMID: 37126780
ISSN: 2153-2176
CID: 5476182

Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance

Duh-Leong, Carol; Ortiz, Robin; Messito, Mary Jo; Katzow, Michelle W; Kim, Christina N; Teli, Radhika; Gross, Rachel S
OBJECTIVE:To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake. DESIGN/METHODS:Application of a life-course framework to an analysis of a longitudinal dataset. SETTING/METHODS:Early childhood obesity prevention program at a New York City public hospital. PARTICIPANTS/METHODS:One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino. VARIABLES MEASURED/METHODS:Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module. ANALYSIS/METHODS:Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association. RESULTS:Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.
PMID: 38142387
ISSN: 1878-2620
CID: 5623412

Prolonged Early Food Insecurity and Child Feeding Practices among a Low-Income Hispanic Population: Role of Parenting Stress

Teli, Radhika; Messito, Mary Jo; Kim, Christina N; Duh-Leong, Carol; Katzow, Michelle; Gross, Rachel
OBJECTIVE:To examine associations between prolonged early household food insecurity (FI) during pregnancy, infancy, and toddlerhood, and child feeding practices, and the mediating role of dysfunctional parent-child interactions. METHODS:We conducted secondary longitudinal analyses of data from the Starting Early Program (StEP) randomized controlled trial, which studied a primary care-based child obesity prevention program for low-income Hispanic families. Our independent variable was FI, using the USDA Food Security Module, during the third trimester of pregnancy and at child ages 10- and 19-months. Frequency of reported FI was defined by the number of periods with FI (0, 1, 2, or 3). Our dependent variables were feeding practices at child age 28-months using the Comprehensive Feeding Practices Questionnaire. Our mediating variable was dysfunctional parent-child interactions using the Parenting Stress Index subscale at age 19-months. We used linear regression to determine associations between frequency of reported FI and feeding practices adjusting for covariates, and mediation analyses to determine if dysfunctional parent-child interactions mediate these associations. RESULTS:Three hundred and forty four mothers completed assessments at child age 28-months. Of the 12 feeding practices examined, higher frequency of reported FI was positively associated with using food as a reward, restriction of food for weight control, and using food for emotional regulation, and was negatively associated with monitoring of less healthy foods. There was a significant indirect effect of frequency of reported FI on these practices through dysfunctional parent-child interactions. CONCLUSION/CONCLUSIONS:Higher frequency of reported FI was associated with four feeding practices, through dysfunctional parent-child interactions. Understanding these pathways can inform preventive interventions.
PMID: 38945524
ISSN: 1876-2867
CID: 5678082