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A School-Based Intervention Using Health Mentors to Address Childhood Obesity by Strengthening School Wellness Policy

Narayanan, Nisha; Nagpal, Nikita; Zieve, Hillary; Vyas, Aashay; Tatum, Jonathan; Ramos, Margarita; McCarter, Robert; Lucas, Candice Taylor; Mietus-Snyder, Michele
PURPOSE AND OBJECTIVES/UNASSIGNED:The objective of our study was to strengthen wellness policy in Title 1 schools by implementing a mentored behavior-change model that extends the continuum of care from academic to community settings and mobilizes existing public resources in accordance with US Preventive Services Task Force screening guidelines for childhood obesity management. INTERVENTION APPROACH/UNASSIGNED:Team Kid POWER! (KiPOW!) health mentors (students and trainees in medical and health-related fields) in 2 geographically and demographically distinct school districts, the District of Columbia and Orange County, California, delivered standardized health curricular modules to fifth grade classrooms, modeled healthy eating behaviors during school lunchtime, and engaged in active play at recess. EVALUATION METHODS/METHODS:Initial interventions in the the District of Columbia and Orange County delivered 10 sessions in which all participants received the intervention. Two subsequent interventions in Orange County, for 5 weeks (Lite) and 10 weeks (Full), included controls. Pre-post measurements of body mass index (BMI) and blood pressure were documented in all participants. A mixed linear regression model, which included a random effect for each school, estimated differences between Full and Lite interventions compared with controls, adjusting for site, sex, and baseline status of the dependent variable. RESULTS:KiPOW! Full, but not KiPOW! Lite, was associated with a modest reduction in BMI percentile compared with control (KiPOW! Full, P = .04; KiPOW! Lite, P = .41), especially in Orange County (P < .001). Systolic blood pressure improved in Full (P < .046) more than in Lite interventions (P = .11), and diastolic blood pressure improved in both Full (P = .02) and Lite (P = .03) interventions. Annual renewal of the school and volunteer commitment needed to maintain KiPOW! was found to be sustainable. IMPLICATIONS FOR PUBLIC HEALTH/UNASSIGNED:KiPOW! is a generalizable academic-community partnership promoting face-to-face contact between students and trusted health mentors to reinforce school wellness policies and foster youth confidence in decision-making about nutrition- and activity-related behaviors to achieve reduced BMI percentile and lowered blood pressure.
PMID: 31753082
ISSN: 1545-1151
CID: 4195002

Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families

Duh-Leong, Carol; Messito, Mary Jo; Katzow, Michelle W; Tomopoulos, Suzy; Nagpal, Nikita; Fierman, Arthur H; Gross, Rachel S
OBJECTIVE:To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families. METHODS:We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (e.g., later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association. RESULTS:In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B=-0.59 hours, 95% CI: -1.04, -0.14; and B=-0.54 hours, 95% CI: -1.00, -0.08). Housing disrepair was associated with decreased 24-hour sleep (B=-0.64 hours, 95% CI: -1.29, -0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B=-0.19 hours, 95% CI: -0.29, -0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (p<0.001), with greater increases for those with food insecurity or multiple hardships. CONCLUSION/CONCLUSIONS:Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.
PMID: 32650047
ISSN: 1876-2867
CID: 4517472

Psychopathology Symptoms are Associated with Prenatal Health Practices in Pregnant Women with Heavy Smoking Levels

Nagpal, Nikita; Ramos, Amanda M; Hajal, Nastassia; Massey, Suena H; Leve, Leslie D; Shaw, Daniel S; Ganiban, Jody M; Reiss, David; Neiderhiser, Jenae M
PURPOSE/OBJECTIVE:Smoking during pregnancy may be linked to other problematic prenatal health behaviors in women. We examined interrelationships among prenatal smoking, prenatal health behaviors and mental health. The objective of this study was to examine factors that may contribute to variations in prenatal health practices among women who smoke during pregnancy. METHODS:Birth mothers from an adoption study (N = 912) were interviewed about prenatal smoking, health behaviors, and mental health symptoms at 5 months postpartum. RESULTS:One-quarter of participants (N = 222) reported smoking 6 or more cigarettes daily for at least 1 trimester. For mothers who smoked more than 6 cigarettes daily, higher levels of antisocial behaviors (β =  - .14, p = .03) and depressive symptoms (β =  - .17, p = .03) were associated with less frequent prenatal folate use; antisocial behaviors and depressive symptoms were not associated for prenatal folate use among women who did not smoke more than 6 cigarettes daily. For mothers who did not smoke more than 6 cigarettes daily, more depressive symptoms were associated with fewer prenatal care visits (β = .12, p = .01). Antisocial behaviors and anxiety symptoms were not associated with prenatal care visits in either group of mothers. CONCLUSIONS FOR PRACTICE: Maternal antisocial behaviors and depressive symptoms during pregnancy may be markers for poorer adherence to recommendations for folate supplementation among women who smoke 6 or more cigarettes daily during pregnancy, independent of adequacy of prenatal care.
PMID: 33417106
ISSN: 1573-6628
CID: 4762752

How do patient-provider relationship continuity, gender, and language affect pediatric HPV vaccine acceptance?

Polonijo, Andrea N; Lee, Stephanie S; Nagpal, Nikita; Barros, Rebecca; Hopfer, Suellen; Brown, Brandon; Pellman, Harry; Singh, Jasjit
Increasing human papillomavirus (HPV) vaccine uptake remains a challenge. We compared reasons for HPV vaccine acceptance between two Southern California pediatric clinics serving diverse populations: an academically affiliated resident clinic that offered little continuity of care (n = 53) and a private-practice clinic with well-established physician-patient relationships (n = 200). We found strong doctor recommendation and information dissemination about the importance of HPV vaccination were the most important drivers of acceptance across these distinct settings. The top-cited reasons for vaccine acceptance also varied by gender, language (English vs. Spanish), and clinic type. Findings point to the need for (1) robust provider education on vaccines, vaccine-preventable diseases, and vaccine hesitancy and (2) increased efforts to raise public awareness of the importance of HPV vaccination.
PMID: 34643482
ISSN: 2164-554x
CID: 5045982

Children with high BMI, female sex, and no-sports participation show differential health benefits from a 20-week school-based, mentored, behavioral change model program-Team Kipow! [Meeting Abstract]

Nguyen, A Q; Zieve, H; Li, L; Nam, J; Nagam, H; Phong, C; Chalmers, C; Nguyen, T; Zhang, L; Narayanan, N; Nagpal, N; Mietus-Snyder, M; Lucas, C T
Background/Purpose: According to the California Department of Education, in Orange County (OC), California, almost 37% of 5th graders are overweight or obese, and low-income and minority youth are most impacted. Obesity causes long-term health issues and has intergenerational implications [Wang et al., 2019]. Team Kid PowerOC (KiPOWOC) is an academic-community partnership initiated in 2015 to support school health policies and coach 5th graders in Title I elementary schools through on-site mentorship for behavioral change during lunch and recess. In 2017, KiPOWOC began an annual 20-week program at Thorman Elementary (75% of students enrolled in the Free or Reduced Lunch program, and 95% Latinx).
Method(s): Quasi-experimental pretest posttest design, without a control site, implemented over two academic years. Annually, volunteer health coaches spend 700-minutes with 5th graders (Weekly: 25-min lessons, 20-min meal coaching, and 25- min active play sessions). Pre- and post-test assessments included BMI percentile (BMI%), blood pressure (BP), mile-run, and health behaviors (HABITS questionnaire). Unadjusted analyses: Two-sample paired t-test. Adjusted analyses: Bonferroni correction.
Result(s): n=142; All: Ages 9-11 years, 37.3% with overweight or obese BMI, 56% female, 73% no-sports participation; BMI%, mean(SD): pre 64.25(30.28), post 60.86(30.69), p=0.0009, sBP change -5 mm Hg, p<0.0001, change in mile run time -0.65 minutes, p<0.0001. Subgroup analyses: Obese BMI (BMI >95th percentile): BMI% change -1.88%, p=0.0011; Females: BMI% change -5.5%, p=0.0003, sBP change -5 mm Hg, p=0.0002; No sports participation: BMI% change -4.1%, p=0.0009, sBP change -5 mm Hg, p<0.0001. No significant findings were identified in health behaviors consistently across subgroups. All significant results held significance after Bonferroni correction for multiple comparisons, except sBP among children with obese BMI.
Conclusion(s): Overall, KiPOWOC demonstrated a significant impact on participants' BMI%, sBP, and mile run. In subgroup analyses, findings held significance among children with obese BMI, female sex, and no-sports participation for BMI% and mile run. A significant difference was also noted in sBP for children with female sex, and no-sports participation. Although identifying subgroup differences was not the initial goal of KiPOWOC, findings highlight that KiPOWOC may have greater impact among low-income children with these characteristics. This is of particular interest when considering that children from lowincome communities have higher risk of obesity and face barriers to sports participation [Towne et al., 2018]. Future studies of KiPOWOC will further explore the subgroup findings identified, analyze study impact with the use of a comparison site, and grow partnerships with Title I OC schools
ISSN: 1098-4275
CID: 4849472