Publications by authors named "Bridget Armstrong"

33 Publications

Impact of a year-round school calendar on children's BMI and fitness: Final outcomes from a natural experiment.

Pediatr Obes 2021 Mar 25:e12789. Epub 2021 Mar 25.

Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA.

Background: Structure may mitigate children's accelerated summer BMI gain and cardiorespiratory-fitness (CRF) loss.

Objectives: Examine BMI and CRF change during school and summer for year-round and traditional calendar school children.

Methods: Three schools (N = 2279, 1 year-round) participated in this natural experiment. Children's BMI z-score (zBMI) and CRF (PACER laps) were measured from 2017 to 2019 each May/August. Mixed effects regression estimated monthly zBMI and CRF change during school/summer. Secondary analyses examined differences by weight status and race. Spline regression models estimated zBMI and CRF growth from kindergarten-sixth grade.

Results: Compared to traditional school, children attending a year-round school gained more zBMI (difference = 0.015; 95CI = 0.002, 0.028) during school, and less zBMI (difference = -0.029; 95CI = -0.041, -0.018), and more CRF (difference = 0.834; 95CI = 0.575, 1.093) monthly during summer. Differences by weight status and race were observed during summer and school. Growth models demonstrated that the magnitude of overall zBMI and CRF change from kindergarten-sixth grade was similar for year-round or traditional school children.

Conclusions: Contrary to traditional school children zBMI increased during the traditional 9-month school calendar and zBMI decreased during the traditional summer vacation for year-round school children. Structured summer programming may mitigate accelerated summer BMI gain and CRF loss especially for overweight or obese, and/or Black children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijpo.12789DOI Listing
March 2021

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

Int J Behav Nutr Phys Act 2021 02 10;18(1):28. Epub 2021 Feb 10.

MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12966-021-01095-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877033PMC
February 2021

The impact of summer vacation on children's obesogenic behaviors and body mass index: a natural experiment.

Int J Behav Nutr Phys Act 2020 11 26;17(1):153. Epub 2020 Nov 26.

Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ, USA.

Background: Children's BMI gain accelerates during summer. The Structured Days Hypothesis posits that the lack of the school day during summer vacation negatively impacts children's obesogenic behaviors (i.e., physical activity, screen time, diet, sleep). This natural experiment examined the impact of summer vacation on children's obesogenic behaviors and body mass index (BMI).

Methods: Elementary-aged children (n = 285, 5-12 years, 48.7% male, 57.4% African American) attending a year-round (n = 97) and two match-paired traditional schools (n = 188) in the United States participated in this study. Rather than taking a long break from school during the summer like traditional schools, year-round schools take shorter and more frequent breaks from school. This difference in school calendars allowed for obesogenic behaviors to be collected during three conditions: Condition 1) all children attend school, Condition 2) year-round children attend school while traditional children were on summer vacation, and Condition 3) summer vacation for all children. Changes in BMI z-score were collected for the corresponding school years and summers. Multi-level mixed effects regressions estimated obesogenic behaviors and monthly zBMI changes. It was hypothesized that children would experience unhealthy changes in obesogenic behaviors when entering summer vacation because the absence of the school day (i.e., Condition 1 vs. 2 for traditional school children and 2 vs. 3 for year-round school children).

Results: From Condition 1 to 2 traditional school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 24.2, 95CI = 10.2, 38.2), screen time minutes (∆ = 33.7, 95CI = 17.2, 50.3), sleep midpoint time (∆ = 73:43, 95CI = 65:33, 81:53), and sleep efficiency percentage (-∆ = 0.7, 95CI = -1.1, - 0.3) when compared to year-round school children. Alternatively, from Condition 2 to 3 year-round school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 54.5, 95CI = 38.0, 70.9), light physical activity minutes (∆ = - 42.2, 95CI = -56.2, - 28.3) MVPA minutes (∆ = - 11.4, 95CI = -3.7, - 19.1), screen time minutes (∆ = 46.5, 95CI = 30.0, 63.0), and sleep midpoint time (∆ = 95:54, 95CI = 85:26, 106:22) when compared to traditional school children. Monthly zBMI gain accelerated during summer for traditional (∆ = 0.033 95CI = 0.019, 0.047) but not year-round school children (∆ = 0.004, 95CI = -0.014, 0.023).

Conclusions: This study suggests that the lack of the school day during summer vacation negatively impacts sedentary behaviors, sleep timing, and screen time. Changes in sedentary behaviors, screen time, and sleep midpoint may contribute to accelerated summer BMI gain. Providing structured programming during summer vacation may positively impact these behaviors, and in turn, mitigate accelerated summer BMI gain.

Trial Registration: ClinicalTrials.gov Identifier: NCT03397940 . Registered January 12th 2018.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12966-020-01052-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690133PMC
November 2020

Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families.

Ann Behav Med 2020 Nov 16. Epub 2020 Nov 16.

University of Maryland Baltimore School of Medicine, Department of Pediatrics, Baltimore, MD, USA.

Background: Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families.

Purpose: To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight.

Methods: Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score.

Results: Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score.

Conclusions: Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities.

Trial Registration Number: NCT02615158.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/abm/kaaa100DOI Listing
November 2020

Comparison of multichannel and single-channel wrist-based devices with polysomnography to measure sleep in children and adolescents.

J Clin Sleep Med 2021 Apr;17(4):645-652

Department of Exercise Science, University of South Carolina, Columbia, South Carolina.

Study Objectives: To compare sleep parameters produced by the Fitbit Charge 3 (Fitbit) and Actigraph GT9X accelerometer (Actigraph) to polysomnography in children and adolescents.

Methods: Participants (n = 56, ages 9.2 ± 3.3 years) wore a Fitbit and an Actigraph on their nondominant wrist concurrently with polysomnography during an overnight observation at a children's sleep laboratory. Total sleep time, sleep efficiency, wake after sleep onset, sleep onset, and sleep offset were extracted from the Fitabase and Actilife software packages, respectively, with the Sadeh algorithm. Bland-Altman plots were used to assess the agreement between wearable devices and polysomnography.

Results: Seventy-nine percent of participants were diagnosed with OSA. Compared with polysomnography, the Fitbit and the Actigraph underestimated total sleep time by 6.1 minutes (absolute mean bias [AMB] = 27.7 minutes) and 31.5 minutes (AMB = 38.2 minutes), respectively. The Fitbit overestimated sleep efficiency by 3.0% (AMB = 6.3%), and the Actigraph underestimated sleep efficiency by 12.9% (AMB = 13.2%). The Fitbit overestimated wake after sleep onset by 18.8 minutes (AMB = 23.9 minutes), and the Actigraph overestimated wake after sleep onset by 56.1 minutes (AMB = 54.7 minutes). In addition, the Fitbit and the Actigraph underestimated sleep onset by 1.2 minutes (AMB = 13.9 minutes) and 10.2 minutes (AMB = 18.1 minutes), respectively. Finally, the Fitbit and the Actigraph overestimated sleep offset by 6.0 minutes (AMB = 12.0 minutes) and 10.5 minutes (AMB = 12.6 minutes). Linear regression indicated significant trends, with the Fitbit underestimating wake after sleep onset and sleep efficiency at higher values.

Conclusions: The Fitbit provided comparable and in some instances better sleep estimates with polysomnography compared to the Actigraph. Findings support the use of multichannel devices to measure sleep in children and adolescents. Additional studies are needed in healthy children over several nights and in free-living settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8980DOI Listing
April 2021

Dynamics of sleep, sedentary behavior, and moderate-to-vigorous physical activity on school versus nonschool days.

Sleep 2021 Feb;44(2)

Department of Exercise Science, University of South Carolina, Columbia, SC.

Study Objectives: Studies examining time-use activity behaviors (sleep, sedentary behavior, and physical activity) on school days compared with nonschool days have examined these behaviors independently, ignoring their interrelated nature, limiting our ability to optimize the health benefits of these behaviors. This study examines the associations of school-day (vs. nonschool day) with time-use activity behaviors.

Methods: Time series data (6,642 days) from Fitbits (Charge-2) were collected (n = 196, 53% female, 5-10 years). We used a variable-centered dynamic structural equation modeling approach to estimate day-to-day associations of time-use activity behaviors on school days for each child. We then used person-centered cluster analyses to group individuals based on these estimates.

Results: Within-participant analysis showed that on school days (vs. nonschool days), children (1) slept less (β = -0.17, 95% CI = -0.21, -0.13), (2) were less sedentary (β = -0.05, 95% CI = -0.09, -0.02), and (3) had comparable moderate-to-vigorous physical activity (MVPA; β = -0.05, 95% CI = -0.11, 0.00). Between-participant analysis showed that, on school days, children with higher sleep carryover experienced greater decreases in sleep (β = 0.44, 95% CI = 0.08, 0.71), children with higher body mass index z-score decreased sedentary behavior more (β = -0.41, 95% CI = -0.64, -0.13), and children with lower MVPA increased MVPA more (β = -0.41, 95% CI -0.64, -0.13). Cluster analysis demonstrated four distinct patterns of connections between time-use activity behaviors and school (High Activity, Sleep Resilient, High Sedentary, and Dysregulated Sleep).

Conclusions: Using a combination of person-centered and more traditional variable-centered approaches, we identified patterns of interrelated behaviors that differed on school, and nonschool days. Findings can inform targeted intervention strategies tailored to children's specific behavior patterns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsaa174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982135PMC
February 2021

Validity of Wrist-Worn photoplethysmography devices to measure heart rate: A systematic review and meta-analysis.

J Sports Sci 2020 Sep 19;38(17):2021-2034. Epub 2020 Jun 19.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.

Heart rate (HR), when combined with accelerometry, can dramatically improve estimates of energy expenditure and sleep. Advancements in technology, via the development and introduction of small, low-cost photoplethysmography devices embedded within wrist-worn consumer wearables, have made the collection of heart rate (HR) under free-living conditions more feasible. This systematic review and meta-analysis compared the validity of wrist-worn HR estimates to a criterion measure of HR (electrocardiography ECG or chest strap). Searches of PubMed/Medline, Web of Science, EBSCOhost, PsycINFO, and EMBASE resulted in a total of 44 articles representing 738 effect sizes across 15 different brands. Multi-level random effects meta-analyses resulted in a small mean difference (beats per min, bpm) of -0.40 bpm (95 confidence interval (CI) -1.64 to 0.83) during sleep, -0.01 bpm (-0.02 to 0.00) during rest, -0.51 bpm (-1.60 to 0.58) during treadmill activities (walking to running), while the mean difference was larger during resistance training (-7.26 bpm, -10.46 to -4.07) and cycling (-4.55 bpm, -7.24 to -1.87). Mean difference increased by 3 bpm (2.5 to 3.5) per 10 bpm increase of HR for resistance training. Wrist-worn devices that measure HR demonstrate acceptable validity compared to a criterion measure of HR for most common activities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02640414.2020.1767348DOI Listing
September 2020

Hunger in the household: Food insecurity and associations with maternal eating and toddler feeding.

Pediatr Obes 2020 10 15;15(10):e12637. Epub 2020 Apr 15.

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, US.

Background: Research is needed to identify how food insecurity affects maternal eating behavior and child feeding practices, factors that may pose intergenerational risks for obesity.

Objectives: This longitudinal study investigated whether maternal restrained eating mediated the association between household food insecurity and feeding practices.

Methods: Participants included 277 WIC-eligible mothers (69% below the poverty line, 70% African American) and their toddlers (M = 20.11 months, SD = 5.50) participating in a childhood obesity prevention trial. Maternal reports of household food insecurity, restrained eating, and child feeding practices (restrictive and responsive) were collected at baseline, 6 and 12 months and analyzed using multilevel mediation.

Results: Forty percent of mothers reported some degree of household food insecurity over 12 months. Within-person analyses showed that relative increases in household food insecurity were indirectly related to increases in restrictive and decreases in responsive child feeding practices, mediated through increases in mothers' own restrained eating.

Conclusions: Relative change in household food insecurity (rather than overall severity) appears to have indirect effects on toddler feeding practices, through mothers' own eating. Stable household food security without transient food insecurity may improve health and wellbeing for both mothers and children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijpo.12637DOI Listing
October 2020

CHAMP: A cluster randomized-control trial to prevent obesity in child care centers.

Contemp Clin Trials 2019 11 13;86:105849. Epub 2019 Sep 13.

University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America; RTI International, Department of Pediatrics, United States of America. Electronic address:

Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cct.2019.105849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985456PMC
November 2019

Bed Sharing in Toddlerhood: Choice Versus Necessity and Provider Guidelines.

Glob Pediatr Health 2019 24;6:2333794X19843929. Epub 2019 Jul 24.

University of Maryland, School of Medicine, Baltimore, MD, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2333794X19843929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657124PMC
July 2019

Prenatal Special Supplemental Nutrition Program for Women, Infants, and Children Participation: A Step Toward Human Capital Development.

JAMA Pediatr 2019 Jul 1. Epub 2019 Jul 1.

Department of Pediatrics, University of Maryland School of Medicine, Baltimore.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamapediatrics.2019.1682DOI Listing
July 2019

Objective sleep and physical activity using 24-hour ankle-worn accelerometry among toddlers from low-income families.

Sleep Health 2019 10 3;5(5):459-465. Epub 2019 Jun 3.

University of Maryland School of Medicine 737 W Lombard St, Baltimore, MD 21201; RTI International 3040 E Cornwallis Rd, PO Box 12194 Research Triangle Park, NC, United States 27709. Electronic address:

Objectives: Poverty is a risk for short sleep duration and limited physical activity. This study describes sleep, physical activity, and sedentary behavior of Women, Infants, and Children-eligible toddlers and the proportion of toddlers meeting recommendations for sleep and physical activity, and examines associations with body mass index z scores and poverty.

Participants/measurements: A total of 101 toddlers (12-32 months) from low-income families (62% African American) wore 24-hour ankle accelerometers over 3-7 consecutive days. Concurrent validity for daytime napping was assessed using parent-reported toddler wake/sleep between 08:00 and 20:00 collected using Ecological Momentary Assessment. Logistic regressions predicted odds of meeting guidelines.

Results: Toddlers averaged 10.56 hours of sleep in 24 hours. All toddlers averaged ≥180 minutes of total activity per day, 38% had ≥60 minutes of moderate/vigorous physical activity per day, 32% of toddlers slept between 11 and 14 hours over 24 hours, and 26% had a bedtime before 9:00 pm. Body mass index z score was not associated with meeting guidelines. Poverty was associated with less than 60 minutes of moderate/vigorous physical activity.

Conclusions: Most toddlers were not meeting sleep guidelines. This study provides objective data on sleep and activity among a diverse sample of low-income toddlers. Objective measures of sleep and physical activity facilitate surveillance of children meeting guidelines for sleep and physical activity. Such norms are needed to examine disparities among children from varying racial and economic backgrounds. Future research should examine if meeting guidelines is related to other health indicators.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.sleh.2019.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801033PMC
October 2019

Rethinking Behavioral Approaches to Compliment Biological Advances to Understand the Etiology, Prevention, and Treatment of Childhood Obesity.

Child Obes 2019 09 29;15(6):353-358. Epub 2019 May 29.

Arnold School of Public Health, University of South Carolina, Columbia, SC.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/chi.2019.0109DOI Listing
September 2019

Toddler Bedtime Routines and Associations With Nighttime Sleep Duration and Maternal and Household Factors.

J Clin Sleep Med 2019 06 15;15(6):865-871. Epub 2019 Jun 15.

Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland.

Study Objectives: The aims of this study were to examine (1) relationships among implementing a bedtime routine, nighttime awakenings, and nighttime sleep duration in toddlers from low-income, minority families and (2) differences in maternal and household characteristics between mothers who did versus those who did not implement a nightly bedtime routine for their toddler.

Methods: Data were collected from mothers of toddlers on maternal and household characteristics and toddler sleep, measured using the Children's HealthWatch Survey and the Extended Brief Infant Sleep Questionnaire (BISQ). A path analysis model was tested to investigate whether nighttime awakenings mediated the relation between implementing a bedtime routine and toddlers' nighttime sleep duration. Chi-square tests were conducted to examine differences in maternal and household characteristics (ie, maternal depressive symptoms, food, housing and energy insecurity) between mothers who did versus those who did not implement nightly bedtime routines over the past 2 weeks.

Results: Implementing a bedtime routine was associated with longer toddler sleep duration through a decrease in nighttime awakenings (β = 5.04, 95% confidence interval = 0.61 to 11.35). More consistent sleep routine implementation was associated with fewer nighttime awakenings and longer sleep duration. Maternal depressive symptoms, housing insecurity, and food insecurity were associated with decreased likelihood of implementing a nightly bedtime routine.

Conclusions: Maternal depressive symptoms, food insecurity, and household insecurity (factors associated with low socioeconomic status) may be associated with a negative sleep environment and poor toddler sleep quality, potentially because of decreased implementation of bedtime routines.

Commentary: A commentary on this article appears in this issue on page 821.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.7838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557658PMC
June 2019

Commentary: Reflecting on Holmbeck (2002): Making Advanced Quantitative Methods Approachable in Pediatric Psychology.

J Pediatr Psychol 2019 Aug;44(7):813-815

Department of Pediatrics, University of Maryland School of Medicine.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpepsy/jsz035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6655387PMC
August 2019

Featured Article: Bidirectional Effects of Sleep and Sedentary Behavior Among Toddlers: A Dynamic Multilevel Modeling Approach.

J Pediatr Psychol 2019 04;44(3):275-285

Department of Pediatrics, University of Maryland School of Medicine.

Objective: To examine the bidirectional effects of objectively measured nighttime sleep and sedentary activity among toddlers.

Method: Actical accelerometer data were analyzed for 195 toddlers participating in an obesity prevention trial (mean age = 27 months). Toddlers wore the accelerometers for up to 7 consecutive days. Nighttime sleep was defined as the number of minutes asleep between the hours of 8 pm and 8 am the following morning. Sedentary behavior (in minutes) was defined using previously established Actical cut points for toddlers. Variables were lagged and parsed into latent within- and between-person components, using dynamic structural equation modeling (DSEM).

Results: Toddlers spent an average of 172 min (∼3 hr) in sedentary activity and slept an average of 460 min (∼8 hr) per night. An autoregressive cross-lagged multilevel model revealed significant autoregression for both sleep and sedentary activity. Cross-lagged values revealed that decreased sleep predicted increased next-day sedentary activity, and sedentary activity predicted that night's sleep. For 89% of the sample, the within-person standardized cross-lagged effects of sleep on sedentary were larger than the cross-lagged effects of sedentary on sleep.

Conclusions: Results suggest that, on average, nighttime sleep is a stronger predictor of subsequent sedentary behavior (compared with the reverse), and this is the case for the majority of toddlers. Findings highlight the importance of interindividual associations between sleep and sedentary activity. The present study is an example of how DSEM methods can be used to ask questions about Granger-causal cross-lagged relations between variables, both within and between individuals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpepsy/jsy089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551589PMC
April 2019

Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers.

Child Obes 2018 Aug/Sep;14(6):403-411

3 Department of Pediatrics, University of Maryland School of Medicine , Baltimore, MD.

Background: Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers.

Methods: A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores.

Results: Response rate was 40% (n = 610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B = 0.26, p < 0.001; B = 0.26, p = 0.001, respectively); policies with foods served (B = 0.22, p = 0.002); and policies, provider training, and feeding environment with physical activity (B = 0.19, p = 0.001; B = 0.24, p = 0.010; B = 0.38, p < 0.001).

Conclusions: Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/chi.2018.0085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150935PMC
September 2019

Perceived Toddler Sleep Problems, Co-sleeping, and Maternal Sleep and Mental Health.

J Dev Behav Pediatr 2018 04;39(3):238-245

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.

Objective: Childhood sleep problems are associated with insufficient parental sleep and adverse maternal mental health symptoms, which may be exacerbated when mothers/toddlers co-sleep (i.e., bed/room sharing). This study examines maternal sleep duration as a mechanism linking perceived toddler sleep problems with maternal mental health and examines whether these associations vary by co-sleeping, in addition to exploring alternative models.

Methods: Low-income mothers of toddlers (n = 280) (age 12-32 months) recruited from Women, Infants, and Children and pediatric clinics provided demographic information and completed questionnaires on their toddler's sleep and their own sleep duration and mental health symptoms (depressive symptoms, anxiety, and stress). Indirect and conditional indirect models were conducted to examine the relation between perceived toddler sleep problems and maternal mental health.

Results: Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping (mean = 6.1 h). Maternal sleep duration mediated the relation between perceived toddler sleep problems and maternal symptoms of depression, anxiety, and stress for co-sleeping mothers. Maternal sleep duration did not mediate relations between maternal mental health symptoms and perceived toddler sleep problems.

Conclusion: This study provides a conceptual model by which parent and child sleep is related to parental mental health. Practitioners might consider alternatives to co-sleeping when discussing sleep arrangements with parents. Future studies should replicate results longitudinally and examine whether reducing co-sleeping improves maternal sleep duration and reduces perceptions of toddler sleep problems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DBP.0000000000000535DOI Listing
April 2018

BMI and disordered eating in urban, African American, adolescent girls: The mediating role of body dissatisfaction.

Eat Behav 2018 04 28;29:59-63. Epub 2018 Feb 28.

University of Maryland Baltimore School of Medicine, Department of Pediatrics, 737 West Lombard Street, Baltimore, MD 21201, United States; RTI International, Research Triangle Park, NC 27709, United States. Electronic address:

Objective: This study examined the mediating role of body dissatisfaction between Body Mass Index (BMI) and subsequent disordered eating (e.g. dieting and restricting/purging) among early adolescent African American girls.

Study Design: Participants included 701 African American girls in 6th and 7th grades in urban schools serving low-income communities, mean age 12.15 (SD = 0.72) years. Participants were assessed at baseline and approximately 6 months later. Objectively measured height and weight were used to calculate BMI z-score. Participants completed questionnaires on body size dissatisfaction and recent dieting and restricting/purging behaviors.

Results: At baseline, 51.5% of participants were overweight/obese, and 60.4% expressed body dissatisfaction and a desire to be smaller. Path analytic analyses revealed change in body dissatisfaction significantly mediates the relation between initial BMI z-score and increases in dieting behaviors (B = 0.924, SE = 0.280, p = 0.001) but not restricting/purging behaviors (p = 0.05).

Conclusions: Body dissatisfaction explains some associations between excess body weight and subsequent disordered eating symptoms among early adolescent, African American girls. Body dissatisfaction, identified by screening, may be an indicator of further negative consequences, including disordered eating behaviors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eatbeh.2018.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935573PMC
April 2018

Building Healthy Development and Behavior Among WIC Participants.

J Dev Behav Pediatr 2017 06;38(5):347-348

*Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; †RTI International.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DBP.0000000000000451DOI Listing
June 2017

Temporal Associations Between Sleep and Physical Activity Among Overweight/Obese Youth.

J Pediatr Psychol 2016 Jul 22;41(6):680-91. Epub 2016 Jan 22.

Department of Clinical and Health Psychology, University of Florida and.

Objective: Examine average interindividual and temporal intraindividual associations between time of sleep onset (sleep onset), total sleep time (TST), and minutes in moderate-to-very-vigorous physical activity per hour (MVPA/h) among overweight/obese youth.

Methods: Overweight/obese youth (n = 134; 7-12 years) wore an accelerometer for 16+ hr/day, 5-7 days, which provided daily objective estimates of MVPA/h, TST, and sleep onset.

Results: Multilevel models revealed an intraindividual effect of TST, such that nights with longer TST preceded less MVPA/h during the midnight-to-midnight monitoring period; a significant random effect qualified this relationship. Average interindividual TST did not predict mean MVPA/h, whereas sleep onset significantly predicted mean MVPA/h.

Conclusions: Later time of sleep onset (as opposed to TST) was the strongest predictor of group-level decreased physical activity. At the individual level, longer TST than usual predicted less MVPA/h than usual. Results suggest the need for more person-centered research and a greater focus on sleep timing among youth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpepsy/jsv167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6080488PMC
July 2016

Park Density Impacts Weight Change in a Behavioral Intervention for Overweight Rural Youth.

Behav Med 2015 ;41(3):123-30

a University of Florida.

Currently, over 30% of youth are overweight or obese. Limited access to parks and recreational facilities is related to physical inactivity and obesity. Environmental factors may also impact the effectiveness of pediatric weight management interventions. Most research concerning the built environment and child weight status has been conducted in urban settings, despite rural children being disproportionately overweight and obese compared to their urban peers. The current study examined the relationship between park density and weight change among 93 overweight rural youth (ages 8-14) participating in a randomized controlled trial examining the effectiveness of a behavioral family weight management intervention. Results revealed that increased park density was associated with decreases in BMI z-score over time for youth in the behavioral family weight management intervention, but not those in the wait-list control group. In rural communities it is important to consider the environmental context when designing prevention and treatment programs addressing childhood obesity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08964289.2015.1029428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725197PMC
June 2016

Distance as a predictor of treatment attendance in a family based pediatric weight management program in rural areas.

J Rural Health 2015 15;31(1):19-26. Epub 2014 Jul 15.

Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida.

Purpose: The primary aim of this study was to determine whether demographic variables and distance to treatment were significant predictors of treatment attendance in a family based healthy lifestyle intervention program held in rural counties.

Methods: Two hundred forty-nine children aged 8-12 who were overweight or obese and their parents participated in a 21-session healthy lifestyle intervention. Measures were obtained at baseline, and attendance included the number of the first core 12 sessions attended. Hierarchical linear regression analyses were conducted to identify variables that significantly predicted treatment attendance, and exploratory moderation analyses were conducted to examine if demographic variables moderated effects of distance to treatment site predicting group attendance.

Findings: Results support significant inverse relationships between distance to treatment and treatment attendance. Additionally, parents' marriage status significantly moderated the relationship between distance to treatment and treatment attendance.

Conclusions: These results expand the literature to a rural sample and indicate the importance of marital status for treatment attendance. Knowledge of these barriers to treatment provides information to tailor interventions to improve attendance in the future. Possible strategies include addressing cultural norms, providing resources to overcome time and travel barriers, and implementing e-health interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jrh.12078DOI Listing
October 2016

The role of overweight perception and depressive symptoms in child and adolescent unhealthy weight control behaviors: a mediation model.

J Pediatr Psychol 2014 Apr 15;39(3):340-8. Epub 2013 Dec 15.

MS, Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610, USA.

Objective: Children who are overweight or obese are at risk for depression and development of unhealthy weight control behaviors (UWCBs), including using diet pills, purging, or fasting. Explications of pathways leading to UWCBs are needed to prevent the associated negative health outcomes.

Methods: Participants were 106 children/adolescents 8-17 years of age at a pediatric clinic. Measures included child body mass index, the Child Depression Inventory-Short Form, and questionnaires assessing perception of overweight and UWCBs used in the past year. Depression was hypothesized to mediate the relationship between perception of overweight and UWCBs.

Results: A bootstrapped mediation model revealed that depressive symptoms mediated the relationship between youth perception of overweight and UWCBs accounting for youth body mass index z-score. The total model explained 24% of the variance in UWCBs. Discussion This study presents a potential mechanism by which youth perception of overweight may influence UWCBs. Longitudinal research is needed to further elucidate the directionality of these relationships.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpepsy/jst091DOI Listing
April 2014

Integrating mediation and moderation to advance theory development and testing.

J Pediatr Psychol 2014 Mar 30;39(2):163-73. Epub 2013 Oct 30.

Department of Psychology, The College of Wooster, Wooster, OH 44691, USA.

Objective: The concepts and associated analyses of mediation and moderation are important to the field of psychology. Although pediatric psychologists frequently incorporate mediation and moderation in their theories and empirical research, on few occasions have we integrated mediation and moderation. In this article, conceptual reasons for integrating mediation and moderation are offered.

Method: We illustrate a model that integrates mediation and moderation.

Results: In our illustration, the strength of an indirect or a mediating effect varied as a function of a moderating variable.

Conclusions: Clinical implications of the integration of mediation and moderation are discussed, as is the potential of integrated models to advance research programs in pediatric psychology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpepsy/jst080DOI Listing
March 2014

Predictors of maternal encouragement to diet: a moderated mediation analysis.

Matern Child Health J 2014 Aug;18(6):1480-7

Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610, USA,

Maternal encouragement to diet has been linked to child disordered eating, overweight and obesity, and negative psychosocial outcomes. A limited amount of research has examined variables that may contribute to maternal encouragement to diet. The current study examined the relationship between child BMI, parent BMI, maternal concern about child weight status, and maternal encouragement to diet. 80 youths, aged 8-17, and their mothers were administered questionnaires to assess maternal weight concern and child perception of maternal encouragement to diet. Data were analyzed using a bootstrapped moderated mediation model. Higher child BMI predicted increased maternal weight concern, which in turn was related to increased encouragement to diet. Mothers of overweight and obese youth were more likely to be concerned about their child's weight if mothers themselves were overweight or obese. Overweight or obese girls (but not boys) with an overweight or obese mother were more likely to be encouraged to diet. The model accounted for 48% of the variance in maternal encouragement to diet. Results indicate a potential mechanism by which encouragement to diet occurs and highlight the relevance of maternal weight and child gender in the prediction of encouragement to diet.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10995-013-1388-5DOI Listing
August 2014

Differentiating the effects of maternal and peer encouragement to diet on child weight control attitudes and behaviors.

Appetite 2012 Dec 7;59(3):723-9. Epub 2012 Aug 7.

University of Florida, Department of Clinical Health Psychology, PO Box 100165, Gainesville, FL 32610, USA.

Obese and overweight youth are more at risk for engaging in frequent dieting, unhealthy weight control behaviors and report more body dissatisfaction than their normal weight peers. Previous research has indicated that peer and maternal encouragement to diet is predictive of unhealthy weight related behaviors and attitudes. The current study aims to examine if maternal and peer encouragement to diet equally mediate the relationship between youth BMI z-score and (a) unhealthy weight control behaviors, (b) diet frequency and (c) body dissatisfaction in a sample of racially diverse boys and girls. Participants were 94 children/adolescents between the ages of 8-17. Results were stratified by gender. Three bootstrapped multiple mediation models were conducted to examine each outcome variable. Results indicated that maternal encouragement to diet mediated the relationships predicting unhealthy weight control and diet frequency for girls, but not for boys. Peer encouragement to diet significantly mediated the relationship predicting unhealthy weight control behaviors, with increased peer encouragement associated with fewer unhealthy weight control behaviors for girls. Peer encouragement to diet was not a significant mediator for any of the outcomes for boys. Results suggest that maternal encouragement to diet may play a larger role than peer encouragement to diet in predicting unhealthy weight attitudes and behaviors for girls.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.appet.2012.06.022DOI Listing
December 2012

Parenting behavior, child functioning, and health behaviors in preadolescents with type 1 diabetes.

J Pediatr Psychol 2011 Oct 9;36(9):1052-61. Epub 2011 Aug 9.

Children's National Medical Center, Washington, DC 20010, USA.

Objective: To examine the association of critical parenting behaviors with preadolescent reported depressive symptoms, self-efficacy, and self-care behaviors in youth with type 1 diabetes (T1D).

Method: A total of 84 youth with T1D, ages 9-11 years, completed the Diabetes Family Behavior Checklist, Child Depression Inventory, Self-Efficacy for Diabetes scale, and Self-Care Inventory during a baseline assessment for a randomized controlled trial of an intervention to promote adherence.

Results: Preadolescents who reported more critical parenting behaviors reported more depressive symptoms and lower self-efficacy. The relationship between critical parenting and self-efficacy was partially mediated by depressive symptoms. In a second model, depressive symptoms were associated with lower self-efficacy and fewer self-care behaviors. The relationship between depressive symptoms and self-care was fully mediated by self-efficacy.

Conclusions: Critical parenting behaviors are associated with preadolescents' psychological well-being, which has implications for self-care. Clinical implications include decreasing critical parenting behaviors and monitoring preadolescents with T1D for depressive symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpepsy/jsr039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173745PMC
October 2011

Correlates of self-worth and body size dissatisfaction among obese Latino youth.

Body Image 2011 Mar 26;8(2):173-8. Epub 2011 Feb 26.

Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20001, USA.

The current study examined self-worth and body size dissatisfaction, and their association with maternal acculturation among obese Latino youth enrolled in a community-based obesity intervention program. Upon entry to the program, a sample of 113 participants reported global self-worth comparable to general population norms, but lower athletic competence and perception of physical appearance. Interestingly, body size dissatisfaction was more prevalent among younger respondents. Youth body size dissatisfaction was associated with less acculturated mothers and higher maternal dissatisfaction with their child's body size. By contrast, although global self-worth was significantly related to body dissatisfaction, it was not influenced by mothers' acculturation or dissatisfaction with their own or their child's body size. Obesity intervention programs targeted to Latino youth need to address self-worth concerns among the youth as well as addressing maternal dissatisfaction with their children's body size.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bodyim.2010.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072832PMC
March 2011