Publications by authors named "Cody D Neshteruk"

10 Publications

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Weight-Related Behaviors of Children with Obesity during the COVID-19 Pandemic.

Child Obes 2021 Apr 26. Epub 2021 Apr 26.

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.

During the coronavirus disease 2019 (COVID-19) pandemic, children and families have had to adapt their daily lives. The purpose of this study was to describe changes in the weight-related behaviors of children with obesity after the onset of the COVID-19 pandemic. Semistructured interviews ( = 51) were conducted from April to June 2020 with parents of children with obesity. Families were participants in a randomized trial testing a clinic-community pediatric obesity treatment model. During interviews, families described their experience during the COVID-19 pandemic, with a particular emphasis on children's diet, physical activity, sleep, and screen time behaviors. Rapid qualitative analysis methods were used to identify themes around changes in children's weight-related behaviors. The mean child age was 9.7 (±2.8) years and the majority of children were Black (46%) or Hispanic (39%) and from low-income families (62%). Most parent participants were mothers (88%). There were differences in the perceived physical activity level of children, with some parents attributing increases in activity or maintenance of activity level to increased outdoor time, whereas others reported a decline due to lack of outdoor time, school, and structured activities. Key dietary changes included increased snacking and more meals prepared and consumed at home. There was a shift in sleep schedules with children going to bed and waking up later and an increase in leisure-based screen time. Parents played a role in promoting activity and managing children's screen time. The COVID-19 pandemic has created unique lifestyle challenges and opportunities for lifestyle modification. Clinical Trials ID: NCT03339440.
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http://dx.doi.org/10.1089/chi.2021.0038DOI Listing
April 2021

Implementation of a workplace physical activity intervention in child care: process evaluation results from the Care2BWell trial.

Transl Behav Med 2021 Apr 17. Epub 2021 Apr 17.

Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Care2BWell was designed to evaluate the efficacy of Healthy Lifestyles (HL), a worksite health promotion intervention to increase child care workers' physical activity. The purpose of this study was to use process evaluation to describe the implementation of HL and determine if different levels of implementation are associated with changes in workers' physical activity. Data were collected from 250 workers randomized to HL, a 6 month, multilevel intervention that included an educational workshop followed by three 8 week campaigns that included self-monitoring and feedback, raffle incentive, social support, and center director coaching. Process evaluation data collection included direct observation, self-reported evaluation surveys, website analytics and user test account data, tracking databases and semi-structured interviews. Implementation scores were calculated for each intervention component and compared at the center and individual levels. Nearly a third of workers never self-monitored and few (16%) met self-monitoring goals. Only 39% of centers engaged with the social support component as intended. Raffle and social support components were perceived as the least useful. Implementation varied widely by center (25%-76%) and individual workers (0%-94%). No within- or between-group differences for high compared to low implementation groups for change in physical activity were evident. Interview themes included limited sustainability, competing priorities, importance of social support, and desire for a more intensive, personalized intervention. Wide variation in implementation may explain limited effects on intervention outcomes. Future worksite interventions designed for child care workers can use these findings to optimize health promotion in this setting.
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http://dx.doi.org/10.1093/tbm/ibab034DOI Listing
April 2021

The association between neighborhood quality, youth physical fitness, and modifiable cardiovascular disease risk factors.

Ann Epidemiol 2021 May 14;57:30-39. Epub 2021 Feb 14.

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, NC. Electronic address:

Purpose: Striking disparities persist in cardiovascular disease risk factors among minority youth. We examined the association between multiple indicators of neighborhood quality and minority youth fitness.

Methods: The primary exposure was the Child Opportunity Index (COI), a measure comprised of indicators that facilitate healthy child development. Outcome data were drawn from the 2018-2019 Fit2Play Study (Miami-Dade County, FL). Hotspot analysis evaluated COI spatial clustering. Generalized linear mixed models examined cross-sectional COI-fitness associations.

Results: The sample included 725 youth (53% Black, 43% Hispanic; 5-17 years). Significant neighborhood quality spatial clusters were identified (Gi* = -4.85 to 5.36). Adjusting for sociodemographics, walkability was associated with lower percentiles in body mass index (BMI) and diastolic blood pressure percentiles (DBP) (β = -5.25, 95% CI: -8.88, -1.62 and β = -3.95, 95% CI: -7.02, -0.89, respectively) for all, lower skinfold thickness (β = -4.83, 95% CI: -9.97, 0.31 and higher sit-ups (β = 1.67, 95% CI: -0.17, 3.50) among girls, and lower systolic blood pressure percentiles (SBP) (β = -4.75, 95% CI: -8.99, -0.52) among boys. Greenspace was associated with higher BMI (β = 6.17, 95% CI: 2.47, 9.87), SBP (β = 3.47, 95% CI: -0.05, 6.99), and DBP (β = 4.11, 95% CI: 1.08, 7.13).

Conclusions: COI indicators were positively associated with youth fitness. Disparities in youth cardiovascular disease risk may be modifiable through community interventions and built environment initiatives targeting select neighborhood factors.
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http://dx.doi.org/10.1016/j.annepidem.2021.02.004DOI Listing
May 2021

Understanding the Role of Fathers in Children's Physical Activity: A Qualitative Study.

J Phys Act Health 2020 05 1;17(5):540-547. Epub 2020 May 1.

Background: Parents are influential in supporting children's physical activity, but relatively little is known about the role of fathers in children's physical activity.

Methods: Semi-structured interviews (n = 24) were conducted with low-active and active fathers of children 3-11 years old. Deductive thematic analysis was used to identify fathers' physical activity practices and understand how fathers interact with their children around physical activity.

Results: All fathers demonstrated coparticipation in physical activity with their children. Other physical activity practices commonly used by fathers included as follows: facilitation of active opportunities, modeling, involvement through coaching or teaching, and encouragement. In addition, fathers viewed physical activity as an opportunity to spend time with their children to bond and develop shared interests. Finally, fathers perceived their role in children's physical activity to be different compared with mothers. Regarding father activity level, active fathers discussed modeling more frequently and tended to engage in a variety of different activities compared with low-active fathers.

Conclusions: Fathers play an important role in their children's physical activity, suggesting that physical activity may be one context in which to prompt paternal involvement, foster father-child relationships, and strengthen paternal parenting.
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http://dx.doi.org/10.1123/jpah.2019-0386DOI Listing
May 2020

Identifying patterns of physical activity and screen time parenting practices and associations with preschool children's physical activity and adiposity.

Prev Med Rep 2020 Jun 20;18:101068. Epub 2020 Feb 20.

Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Although physical activity and screen time parenting practices influence children's behaviors, little work has examined how these practices work in combination. The purpose of this study was to identify patterns of physical activity and screen time parenting practices, and examine differences in preschool children's physical activity, sedentary behavior, and adiposity among the identified patterns. Data were collected in 2009-2012 from 319 parent-child dyads enrolled in a randomized trial testing a parent-focused obesity prevention intervention. At baseline, physical activity and screen time parenting practices were assessed using a validated self-report survey. Children's physical activity and sedentary behavior were measured using accelerometers and child anthropometrics were objectively measured. Latent profile analyses identified patterns of physical activity and screen time parenting practices. Differences in child outcomes were tested among the identified classes. Three parent classes were identified: Rewarders ( = 165), Activity Supportive ( = 98), and Screen Time Permissive ( = 56). Rewarder parents were characterized by the highest scores on using physical activity and screen time to reward or control children's behavior. Activity Supportive parents generally had the highest scores on practices to promote physical activity, while Screen Time Permissive parents had the highest scores on practices facilitating screen time. There were no differences in the mean child physical activity, sedentary behavior or BMI z-score among the three classes. Findings revealed distinct classes of parents that could provide modifiable targets for family-based physical activity promotion, but more work is needed examining the influence of these patterns longitudinally and in different populations.
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http://dx.doi.org/10.1016/j.pmedr.2020.101068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058893PMC
June 2020

Means of Optimizing Physical Activity in the Preschool Environment: A Commentary on Coe (2019).

Am J Lifestyle Med 2020 Jan-Feb;14(1):28-31. Epub 2019 Oct 14.

Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina (DSW).

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http://dx.doi.org/10.1177/1559827619881126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933566PMC
October 2019

HomeSTEAD's physical activity and screen media practices and beliefs survey: Instrument development and integrated conceptual model.

PLoS One 2019 31;14(12):e0226984. Epub 2019 Dec 31.

Center for Health Promotion and Disease Prevention, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.

The home environment has a significant influence on children's physical activity and obesity risk. Our understanding of this environment is limited by current measurement tools. The Home Self-administered Tool for Environmental assessment of Activity and Diet addresses this gap. This paper describes the development and psychometric testing of its family physical activity and screen media practices and beliefs survey.

Methods: Survey development was guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework and informed by a literature review, expert opinion, and cognitive interviews. Parents of children ages 3-12 years (n = 129) completed the HomeSTEAD survey three times over 12-18 days. Additionally, parents reported on child behaviors and trained staff measured parent and child height and weight. Five exploratory factor analyses were conducted after categorizing items into: control of physical activity, control of screen media, explicit modeling, implicit modeling, and perceived barriers and facilitators. Scales with 3 or more items underwent scale reduction. Psychometric testing evaluated internal consistency (Chronbach's alphas), test-retest reliability (analysis of variance and intraclass correlations (ICC)), and construct validity (correlations with child BMI, physical activity, screen time). An integrated conceptual model of parent physical activity and screen media practices and beliefs was developed based on recent literature to aid in the identification and naming of constructs.

Results: Final scales demonstrated good internal consistency (median Cronbach's alpha = 0.81, IQR = 0.74-0.85), test-retest reliability (median ICC = 0.70, IQR = 0.66-0.78), and construct validity (with correlations between scale score and children's behaviors generally in the expected direction). Comparison with the integrated conceptual model showed that most identified constructs were captured.

Conclusions: The family physical activity and screen media practices survey advances the measurement of the home environment related to children's physical activity, screen time, and weight. The integrated conceptual model provides a useful framework for researchers studying both physical activity and screen media parenting practices.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226984PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938346PMC
April 2020

The influence of fathers on children's physical activity: A review of the literature from 2009 to 2015.

Prev Med 2017 Sep 24;102:12-19. Epub 2017 Jun 24.

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Parents are influential in promoting children's physical activity. Yet, most research has focused on how mothers influence children's activity, while little empirical attention has been devoted to understanding how fathers may influence children's activity. The purpose of this review was to summarize observational studies from 2009 to 2015 examining the influence of fathers on children's physical activity. A publicly available database, from a prior systematic review, containing information on 667 studies of parenting and childhood obesity from 2009 to 2015 was searched for potential studies. Studies were eligible if: 1) fathers were included as participants, 2) results were presented for fathers separate from mothers, 3) fathers' physical activity or physical activity parenting was assessed, and 4) child physical activity was measured. Ten studies met eligibility criteria. All studies were rated as fair quality. The majority of studies (n=8) assessed the relationship between father and child physical activity. Of 27 associations tested, 14 (52%) were significant, indicating a modest, positive relationship between father and child activity. Of the studies examining fathers' physical activity parenting (n=3), there were three significant associations out of 15 tested (20%) and no consistency among measured constructs. No differences were observed in the influence of mothers vs. fathers on children's physical activity. Limited evidence was available to examine moderating effects of child sex or age. Few studies have examined the effect of fathers on child physical activity and this relationship remains unclear. Future studies should target fathers for research and investigate specific pathways through which fathers can influence child activity.
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http://dx.doi.org/10.1016/j.ypmed.2017.06.027DOI Listing
September 2017

Low-Income Women's Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study.

Matern Child Health J 2016 12;20(12):2510-2517

Department of Foods and Nutrition, The University of Georgia, 176 Dawson Hall, Athens, GA, 30602-3632, USA.

Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the "one size fits most" approach. Lastly, mothers reported relying on their "instincts" and that "all babies are different" when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother-child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.
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http://dx.doi.org/10.1007/s10995-016-2076-zDOI Listing
December 2016