Publications by authors named "Brittany R Schuler"

12 Publications

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The mediating effect of parenting stress and couple relationship quality on the association between material hardship trajectories and maternal mental health status.

J Affect Disord 2021 May 1;290:31-39. Epub 2021 May 1.

Department of Research, Cizik School of Nursing, University of Texas Health Science Center, 6901 Bertner Avenue, 591, Houston, TX 77030, United States.

Background: Household material hardships could have a negative impact on maternal mental health. Understanding mechanisms by which material hardship trajectories affect maternal depression and anxiety could aid health care professionals and researchers to design better interventions to improve mental health outcomes among mothers.

Methods: The study identified family-level mechanisms by which material hardship trajectories affect maternal depression and anxiety using Fragile Families and Child Wellbeing Study data (n = 1,645). Latent growth mixture modelling was used to identify latent classes of material hardship trajectories at Years-1, -3, and -5. Parenting stress and couple relationship quality was measured at Year-9. The outcome measures included maternal depression and generalized anxiety disorder (GAD) at Year-15 based on the Composite International Diagnostic Interview - Short Form.

Results: Parenting stress mediated the association between low-increasing hardship (b = 0.020, 95% confidence interval (CI):0.003, 0.043) and maternal depression. Parenting stress also mediated the association between high-increasing hardship (b = 0.043, 95% CI:0.004, 0.092), high decreasing hardship (b = 0.034, 95% CI=0.001, 0.072), and low-increasing (b = 0.034, 95% CI:0.007, 0.066) and maternal GAD. In all models, current material hardship was directly related to maternal depression (b = 0.188, 95% CI:0.134, 0.242) and GAD (b = 0.174, 95% CI:0.091, 0.239).

Limitations: Study results need to be interpreted with caution as the FFCWS oversampled non-marital births as part of the original study design.

Conclusions: While current material hardship appears to be more related to maternal mental health, prior material hardship experiences contribute to greater parenting stress which places mothers at risk for experiencing depression and GAD later on.
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http://dx.doi.org/10.1016/j.jad.2021.04.058DOI Listing
May 2021

Independent and combined associations of intimate partner violence and food insecurity on maternal depression and generalized anxiety disorder.

J Anxiety Disord 2021 Apr 27;81:102409. Epub 2021 Apr 27.

University of Texas Health Science Center, Cizik School of Nursing, 6901 Bertner Avenue, Houston, TX, 77030-3901, United States. Electronic address:

While research has investigated intimate partner violence (IPV) and food insecurity (FI) as independent experiences on mental health, research is lacking on the possible longitudinal associations of combined experiences of IPV and FI on maternal depression and generalized anxiety disorder (GAD). The study examined the independent and combined associations of IPV and FI that mothers experienced 3-5 years after child's birth on major depression and GAD at Year-15. The study utilizes the Fragile Families and Child Wellbeing study data (n = 2,311). Five mutually exclusive dichotomous variables were created based on IPV and FI experiences during Year-3 and Year-5. Major depression and GAD measured at Year-15 using the Composite International Diagnostic Interview-Short Form. According to the covariate-adjusted logistic regression models, none of the IPV and FI categories predicted depression at Year-15. Mothers who experienced only FI (OR = 3.79, p = 0.017) and those experiencing both IPV and FI concurrently (OR = 3.40, p = 0.021) had greater odds of having GAD at Year-15. Compared to the independent effect of IPV, the combined effect of concurrent IPV and FI experiences was highly associated with maternal mental health. Using a trauma-informed approach to counseling in combination with food assistance programs might be an effective strategy in preventing maternal GAD symptoms.
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http://dx.doi.org/10.1016/j.janxdis.2021.102409DOI Listing
April 2021

The early effects of cumulative and individual adverse childhood experiences on child diet: Examining the role of socioeconomic status.

Prev Med 2021 Apr 3;145:106447. Epub 2021 Feb 3.

Department of Sociology, Temple University, 1115 Polett Walk, Gladfelter Hall 7(th) floor, Philadelphia, PA 19122, USA. Electronic address:

Adverse Childhood Experiences (ACEs) have been associated with detrimental long-term health outcomes, including obesity risk. Existing research has yet to examine whether early life ACEs are associated with diet in early childhood within socioeconomic subgroups. Data were drawn from the Early Childhood Longitudinal Study-Birth Cohort (2001-2002). Mother-child dyads (n = 7000) were recruited when children were 9-months old, and followed longitudinally at 2 years, and 4 years. Mothers reported children's exposure to five ACEs at 9-months and 2 years and children's daily intake of fruits, vegetables, sweet snacks, and sugar-sweetened beverages (SSBs) at 4 years. Weighted multiple linear regression models tested the effect of cumulative and individual ACEs on child diet in full, low-, and high-SES samples. Cumulative ACE score was inversely associated with frequency of fruit intake in full (b = -0.08, p = 0.005) and low-SES samples (b = -0.10, p < 0.001). Domestic violence was associated with less frequent fruit intake in full (b = -0.21, p = 0.01) and low-SES samples (b = -0.29 p = 0.008). In the full sample, incarceration was associated with less frequent fruit intake (b = -0.24, p = 0.02), and domestic violence was associated with higher sweet snack (b = 0.22, p = 0.01) and SSB intake (b = 0.27, p = 0.009). Results provide preliminary evidence on the association between cumulative and specific ACEs and child diet, and how this relationship varies by SES context. Future research is needed to understand the complex multi-level mechanisms operating along this pathway in order to inform interventions supporting behavior change and to build evidence for policies that may reduce diet-related disparities in ACE exposure.
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http://dx.doi.org/10.1016/j.ypmed.2021.106447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956050PMC
April 2021

The association between adverse childhood experiences and childhood obesity: A systematic review.

Obes Rev 2021 Jul 27;22(7):e13204. Epub 2021 Jan 27.

College of Public Health, Temple University, Philadelphia, PA, USA.

Adverse childhood experiences (ACEs) are associated with numerous physical and mental health issues in children and adults. The effect of ACEs on development of childhood obesity is less understood. This systematic review was undertaken to synthesize the quantitative research examining the relationship between ACEs and childhood obesity. PubMed, PsycInfo, and Web of Science were searched in July 2020; Rayyan was used to screen studies, and the Newcastle-Ottawa Scale was used to assess risk of bias. The search resulted in 6,966 studies screened at title/abstract and 168 at full-text level. Twenty-four studies met inclusion criteria. Study quality was moderate, with greatest risk of bias due to method of assessment of ACEs or sample attrition. Findings suggest ACEs are associated with childhood obesity. Girls may be more sensitive to obesity-related effects of ACEs than boys, sexual abuse appears to have a greater effect on childhood obesity than other ACEs, and co-occurrence of multiple ACEs may be associated with greater childhood obesity risk. Further, the effect of ACEs on development of childhood obesity may take 2-5 years to manifest. Considered collectively, findings suggest a need for greater attention to ACEs in the prevention and treatment of childhood obesity.
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http://dx.doi.org/10.1111/obr.13204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192341PMC
July 2021

Economic hardship and child intake of foods high in saturated fats and added sugars: the mediating role of parenting stress among high-risk families.

Public Health Nutr 2020 10 27;23(15):2781-2792. Epub 2020 Jul 27.

Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI48109, USA.

Objective: Economic hardship (EH) may link to poorer child diet, however whether this association is due to resource limitations or effects on family functioning is unknown. This study examines whether parenting stress mediates the association between EH and child consumption of foods high in saturated fats and added sugars (SFAS).

Design: Data were collected from the Fragile Families and Child Wellbeing study. EH was assessed using eight items collected when children were between 1-9 years old. Mothers reported parenting stress and frequency of child consumption of high SFAS foods when children were 9 years old. Latent growth curve modelling (LGCM) and structural equation modelling tested direct associations between the starting level/rate of change in EH and high SFAS food consumption, and parenting stress as a mediator of the association.

Setting: Twenty US cities.

Participants: Mothers/children (n 3846) followed birth through age 9 years, oversampled 'high-risk', unmarried mothers.

Results: LGCM indicated a curvilinear trend in EH from ages 1-9, with steeper increases from ages 3-9 years. EH did not directly predict the frequency of high SFAS foods. Average EH at 3 and 5 years and change in EH from ages 1-9 predicted higher parenting stress, which in turn predicted more frequent consumption of high SFAS foods.

Conclusions: Findings suggest it may be important to consider parenting stress in early prevention efforts given potential lasting effects of early life EH on child consumption of high SFAS foods. Future research should explore how supports and resources may buffer effects of EH-related stress on parents and children.
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http://dx.doi.org/10.1017/S1368980020001366DOI Listing
October 2020

Stability and Change in Early Life Economic Hardship Trajectories and the Role of Sex in Predicting Adolescent Overweight/Obesity.

J Youth Adolesc 2020 Aug 6;49(8):1645-1662. Epub 2020 May 6.

Department of Research, Cizik School of Nursing, University of Texas Health Science Center, 6901 Bertner Avenue, Houston, TX, 77030, USA.

There is evidence that poverty is related to adverse child health outcomes. Yet, evidence is lacking on how economic hardship experiences during early childhood are related to adolescent obesity, how the relationship may differ by child sex, in addition to the potential child and maternal behavioral factors that link economic hardship and adolescent obesity. The purpose of the current study was to address this gap by using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 1814). The analytic sample included 50.5% girls, 20% experiencing overweight status, and 19% experiencing obesity. Majority of the adolescents were born to non-Hispanic black (49%), U.S. born (86%), married/cohabitating mothers (61%) with high school or greater level of education (75%). The economic hardship trajectory classes were determined using the latent growth mixture modeling approach and supported a 4-class trajectory model, with 5% of the adolescents in the high-increasing economic hardship trajectory class. The children in the high-increasing economic hardship class had increased odds of developing overweight/obesity in adolescence compared to those in low-stable class. This association was significantly moderated by child sex (i.e., relationship was significant for adolescent boys). Parenting stress and child snacking behaviors did not significantly mediate the association between economic hardship classes and overweight/obesity. Economic hardships that increase through early childhood need to be recognized as an obesity risk factor particularly for adolescent boys.
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http://dx.doi.org/10.1007/s10964-020-01249-3DOI Listing
August 2020

Social work and toddler overweight risk: Identifying modifiable child and parent factors across the socioeconomic gradient.

Soc Work Health Care 2019 Nov-Dec;58(10):952-969. Epub 2019 Oct 31.

School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA.

: Childhood obesity is associated with long-term health consequences, yet little is known about the prevalence of child and parent risk factors of overweight across the socioeconomic gradient in early life. This exploratory study documents the prevalence of risk factors that contribute to overweight among toddlers within and across socioeconomic status (SES). : Obesity risk factors were examined within and across SES quintiles in a nationally representative sample. Data were collected from 5,100 mothers and 2-year-old children. Weighted regression models assessed child and parent characteristics that predict toddler weight status in a national sample and samples stratified by SES quintiles. : Higher rates of overweight were observed in Q1 (29.2%) and reduced with each successive SES quintile (16.9%-Q5), suggesting a gradient effect. Results indicated factors unique within quintiles, distinct from the full national sample: Q1-motor development; Q2-motor and mental development, maternal BMI, breastfeeding, bottle feeding, introduction of solid foods; Q3-breastfeeding; and Q4-5-introduction of solid foods. : Findings further existing knowledge of toddler obesity by uncovering risks relevant for specific SES groups. Results yield implications for social workers to refine strategies for improving toddler health and preventing overweight/obesity.
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http://dx.doi.org/10.1080/00981389.2019.1680478DOI Listing
April 2020

Building Blocks for Healthy Children: Evaluation of a Child Care Center-Based Obesity Prevention Pilot Among Low-Income Children.

J Nutr Educ Behav 2019 09 19;51(8):958-966. Epub 2019 Jun 19.

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; Distinguished Fellow, RTI International, Research Triangle Park, NC.

Objective: To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children.

Design: A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted.

Setting: A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).

Participants: Children aged 18-71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff).

Intervention(s): A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers.

Main Outcome Measure(s): Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns.

Analysis: Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers.

Results: Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.

Conclusions And Implications: Curriculum-driven training and implementation support improved nutritional policies and practices and staff-child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.
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http://dx.doi.org/10.1016/j.jneb.2019.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736706PMC
September 2019

Barriers and Enablers to the Implementation of School Wellness Policies: An Economic Perspective.

Health Promot Pract 2018 11 18;19(6):873-883. Epub 2018 Jan 18.

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

Background: Local wellness policies (LWPs) are mandated among school systems to enhance nutrition/physical activity opportunities in schools. Prior research notes disparities in LWP implementation. This study uses mixed methods to examine barriers/enablers to LWP implementation, comparing responses by student body income.

Method: Schools ( n = 744, 24 systems) completed an LWP implementation barriers/enablers survey. Semistructured interviews ( n = 20 random subsample) described barriers/enablers. Responses were compared by majority of lower (≥50% free/reduced-price meals; lower income [LI]) versus higher income (HI) student body.

Results: In surveys, LI and HI schools identified common barriers (parents/families, federal/state regulations, students, time, funding) and enablers (school system, teachers, food service, physical education curriculum/resources, and staff). Interviews further elucidated how staffing and funding served as enablers for all schools, and provide context for how and why barriers differed by income: time, food service (HI schools), and parents/families (LI schools).

Conclusions: Findings support commonalities in barriers and enablers among all schools, suggesting that regardless of economic context, schools would benefit from additional supports, such as physical education and nutrition education resources integrated into existing curricula, additional funding, and personnel time dedicated to wellness programming. LI schools may benefit from additional funding to support parent and community involvement.
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http://dx.doi.org/10.1177/1524839917752109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095820PMC
November 2018

Child Development and the Community Environment: Understanding Overweight across the Income Gradient.

Child Obes 2017 Dec 31;13(6):479-489. Epub 2017 Jul 31.

2 School of Social Work, College of Health Sciences, Boise State University , Boise, ID.

Background: Childhood obesity is associated with increased risk of long-term health consequences. Despite the wealth of research, prevalence rates are still high, particularly among lower-income groups. Little is known about variations in risk of overweight/obesity across income gradients and the adolescent developmental stage. This study examines the association between distal community factors and adolescent weight status across income gradients and whether this association is moderated by age.

Methods: Using a nationally representative sample of 33,096 adolescents drawn from the National Survey of Children's Health (NSCH), this study assesses how age interacts with community factors and weight (overweight/obese vs. normal weight) after controlling for individual-level factors (gender, race/ethnicity, household composition, parental employment, education) in subsamples stratified by income quartile (according to federal poverty guidelines). Community factors include community risk (comprising community safety, school safety, neighborhood cohesion, and detracting neighborhood elements) and four neighborhood amenities (sidewalks, parks, recreation centers, libraries).

Results: Adolescents with low community risk in quartiles 1 and 3 had lower odds of overweight/obesity (by 32% and 35%, respectively) compared with the high community risk group. Age interacted with access to recreational centers in quartile 1 and sidewalks in quartile 4, indicating a decrease in odds of overweight/obesity (by 17% and 9%, respectively) with access to these amenities as youth age.

Conclusions: Findings suggest that predictors of overweight/obesity can be diverse within income groups, and future research and interventions should address distinct features of each community. This includes reducing detracting elements and enhancing amenities and cohesion in lower quartiles, as well as improving walkability in the highest quartile.
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http://dx.doi.org/10.1089/chi.2017.0025DOI Listing
December 2017

Health Perceptions and Quality of Life among Low-Income Adults.

Health Soc Work 2015 Aug;40(3):225-32

Marginalized populations may be predisposed to poor health outcomes due to health dis parities. Although much of the research on health and quality of life is from the perspective of the impact of clinical diagnosis, there is a need for more diverse inquiries and recognition of the individuals' perceptions and preferences. The present study examined the importance of an individual's perception of his or her current health in predicting quality of life over and beyond the presence of physical or mental health conditions. The sample included 150 low-income adults, of which 84.7 percent were African American and 15.4 percent were of another minority race or ethnicity. Participants had an average monthly income of $703. Having a better perception of health was significantly associated with increased quality of life scores. Subjective perceptions of current health were a better predictor of quality of life than the presence of a serious physical or mental health condition. The article ends with a discussion of appropriate interventions to improve health perceptions in similar populations predisposed to poor health outcomes.
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http://dx.doi.org/10.1093/hsw/hlv045DOI Listing
August 2015