Faculty Bibliography

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.

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.

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.

BACKGROUND:Incidence estimates of post-acute sequelae of SARS-CoV-2 infection, also known as long-COVID, have varied across studies and changed over time. We estimated long-COVID incidence among adult and pediatric populations in three nationwide research networks of electronic health records (EHR) participating in the RECOVER Initiative using different classification algorithms (computable phenotypes). METHODS:This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and two control groups-- contemporary COVID-19 negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long-COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative (N3C), National Patient-Centered Clinical Research Network (PCORnet), and PEDSnet) implemented its own long-COVID definition. We introduced a harmonized definition for adults in a supplementary analysis. RESULTS:Overall, 4% of children and 10-26% of adults developed long-COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5-6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. CONCLUSION/CONCLUSIONS:Our findings indicate that preventing and mitigating long-COVID remains a public health priority. Examining temporal patterns and risk factors of long-COVID incidence informs our understanding of etiology and can improve prevention and management.

BACKGROUND/UNASSIGNED:Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. METHODS/UNASSIGNED:We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.S, using electronic health record (EHR) data. Our cohort included those with a positive SARS-CoV-2 molecular, serology or antigen test, or with a COVID-19, multisystem inflammatory disease in children, or PASC diagnosis from February 29, 2020 to August 1, 2022. We identified children/youth with at least 2 codes associated with respiratory and neurologic PASC. We measured associations between sociodemographic and clinical characteristics and respiratory and neurologic PASC using odds ratios and 95% confidence intervals estimated from multivariable logistic regression models adjusted for other sociodemographic characteristics, social vulnerability index or area deprivation index, time period of cohort entry, presence and complexity of chronic respiratory (respectively, neurologic) condition and healthcare utilization. FINDINGS/UNASSIGNED:Among 771,725 children in the cohort, 203,365 (26.3%) had SARS-CoV-2 infection. Among children with documented infection, 3217 children had respiratory PASC and 2009 children/youth had neurologic PASC. In logistic regression models, children <5 years (Odds Ratio [OR] 1.78, 95% CI 1.62-1.97), and of Hispanic White descent (OR 1.19, 95% CI 1.05-1.35) had higher odds of having respiratory PASC. Children/youth living in regions with higher area deprivation indices (OR 1.25, 95% CI 1.10-1.420 for 60-79th percentile) and with chronic complex respiratory conditions (OR 3.28, 95% CI 2.91-3.70) also had higher odds of respiratory PASC. In contrast, older (OR 1.57, 95% CI 1.40-1.77 for those aged 12-17 years), non-Hispanic White individuals and those with chronic pre-existing neurologic conditions (OR 2.04, 95% CI 1.78-2.35) were more likely to have a neurologic PASC diagnosis. INTERPRETATION/UNASSIGNED:Racial and ethnic differences in healthcare utilization for neurologic and respiratory PASC may reflect social drivers of health and inequities in access to care. FUNDING/UNASSIGNED:National Institutes of Health.

Although it is known that caregiver dietary behaviors influence child eating patterns, a gap remains in addressing the diet of a caregiver as much as their child in pediatric practice. A dyadic (caregiver-child) dietary approach would enhance the promotion of healthy eating patterns in children (and their caregivers) and achieve the population health goal of healthy eating across demographic groups. This study aimed to understand factors influencing dyadic dietary patterns (concordance, discordance) and contexts. Twenty professionals who provide nutrition-related expertise for families were recruited via maximum variation sampling. Qualitative thematic analysis of semi-structured interviews revealed 3 themes: (1) variable professional perspectives on what constitutes "healthy eating," (2) eating patterns of a child in the setting of variable caregiver eating practices, and (3) challenges to the promotion of a healthy caregiver-child dyadic diet within a social context. The results offer insight for future interventions that promote positive intergenerational transmission of health.

Access to an academic clinical research center (CRC) in health professional shortage areas (HPSA) can help address healthcare disparities and increase research accessibility and enrollment. Here we describe the development of a community-centered CRC in the underserved area of Sunset Park, Brooklyn, New York, centered within a larger academic health network and the evaluation of its outcomes within the first two years. In addition to resources and space, establishment of the CRC required a culturally competent and multilingual team of healthcare professionals and researchers and buy-in from the community. Between 1/2022 and 12/2023, the CRC opened 21 new trials (10 interventional and 11 noninterventional) with greater than 500 participant visits that reflect the racial and ethnic diversity of the community. These participants represent 110 distinct zip codes; 76% of these zip codes are underserved and designated HPSA. 60% self-identified as non-White and 20% identified as Hispanic, with 12 other distinct ethnicities represented. 28% of participants speak 11 languages other than English. Community-based CRCs can be created with sustainable growth to align with the mission of the National Institutes of Health and U.S. Food and Drug Administration to meet the ever-growing clinical, social, and research needs of the communities they serve.

IMPORTANCE/UNASSIGNED:Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups. OBJECTIVE/UNASSIGNED:To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024. INTERVENTIONS/UNASSIGNED:In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449). MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity. RESULTS/UNASSIGNED:Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]). CONCLUSIONS AND RELEVANCE/UNASSIGNED:A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT04042467.