Publications by authors named "Kirsten K Davison"

79 Publications

Marketing to Children Inside Quick Service Restaurants: Differences by Community Demographics.

Am J Prev Med 2021 May 11. Epub 2021 May 11.

Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Introduction: In the U.S., children regularly consume foods from quick-service restaurants, but little is known about the marketing strategies currently used inside quick-service restaurants. This study aims to validate a child-focused Environmental Assessment Tool for quick-service restaurants, evaluate marketing strategies inside and on the exterior of quick-service restaurants, and examine differences by community race/ethnicity or income.

Methods: The inter-rater and test-retest reliability of the Environmental Assessment Tool were assessed across the top 5 national quick-service restaurant chains. Marketing techniques in 165 quick-service restaurants (33 per national chain) in socioeconomically and racially/ethnically diverse communities throughout New England were examined in 2018-2019. Mixed methods ANOVA examined the differences in marketing techniques in 2020.

Results: The inter-rater and test-retest reliability of the Environmental Assessment Tool were high (Cohen's κ>0.80). Approximately 95% of quick-service restaurants marketed less healthy foods, whereas only 6.5% marketed healthy options. When examining the differences by community demographics, there were significantly more price promotion advertisements inside and on the exterior of quick-service restaurants in lower-income communities. In addition, there was a greater number of child-directed advertisements with cartoon or TV/movie characters as well as fewer healthy entrée options and more sugar-sweetened beverage and dessert options on the children's menu inside quick-service restaurants in communities with higher minority populations.

Conclusions: Environmental Assessment Tool is a valid tool to evaluate marketing inside quick-service restaurants. Results suggest that there is a substantial amount of unhealthy food and beverage marketing inside quick-service restaurants, with differences in the number and types of techniques used in lower-income and minority communities. Policies that limit quick-service restaurant marketing to children should be considered.
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http://dx.doi.org/10.1016/j.amepre.2021.01.035DOI Listing
May 2021

Promoting Sleep and Balanced Screen Time among School-Aged Children with Neurodevelopmental and Mental Health Disorders: A Parent Perspective.

Child Obes 2021 Apr 20. Epub 2021 Apr 20.

Boston College School of Social Work, Chestnut Hill, MA, USA.

Children with neurodevelopmental and mental health disorders (N/MHD), such as autism spectrum, mood disorders, and anxiety, are more likely to engage in excessive screen time, receive insufficient sleep, and to have obesity than neurotypical peers. However, little is known about how parents of these children approach promoting sleep and balanced screen time. We conducted semistructured interviews with 24 parents of children aged 8-15 years with a diagnosis of N/MHD to assess barriers and facilitators to promoting sleep and balanced screen time. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11. Many parents described children's chronic sleep challenges, often compounded by screen use and no clear solutions. When feeling overwhelmed, some parents reluctantly reported co-sleeping or allowing gaming devices in bed. Nearly all participants reported chronic, occasionally severe, conflict when managing children's screen time, with some parents experiencing opposition and physical aggression. Parents struggled to weigh the benefits of screen use (, behavior management, learning, and social connection) with the costs (, reduced self-care and limited physical activity). To combat barriers, parents described firm routines (, "screens off" time and consistent bedtime on weekdays and weekends), moderating access (, shutting down internet and no device in bedroom), verbal priming, and coping strategies (, music and books). Parents of children with N/MHD face unique challenges in promoting sleep and balanced screen time. Given these behaviors may impact weight status and mental health, future interventions should examine ways to support parents in reducing conflict while promoting healthy habits.
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http://dx.doi.org/10.1089/chi.2020.0335DOI Listing
April 2021

Summer Weight Gain Among Preschool-Aged Children With Obesity: An Observational Study in Head Start.

Prev Chronic Dis 2021 Mar 18;18:E25. Epub 2021 Mar 18.

Boston College School of Social Work, Chestnut Hill, Massachusetts.

School-aged children gain weight most rapidly in summer, but few studies have investigated summer weight gain among preschool-aged children. We fit continuous linear spline mixed models to test for accelerated summer weight gain among 2,044 children attending 16 Boston-area Head Start programs between fall 2016 and spring 2019. Academic year and summer rates of change in modified body mass index z-score differed (P < .001), with accelerated summer weight gain most pronounced among children with obesity. As with school-aged children, increased focus on the summer is warranted for promoting healthy weight among children in Head Start.
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http://dx.doi.org/10.5888/pcd18.200532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986969PMC
March 2021

Changes in Fathers' Body Mass Index, Sleep, and Diet From Prebirth to 12 Months Postbirth: Exploring the Moderating Roles of Parenthood Experience and Coparenting Support.

Ann Behav Med 2021 Mar 1. Epub 2021 Mar 1.

School of Social Work, Boston College, Chestnut Hill, MA, USA.

Background: While research has examined prenatal to postnatal changes in women's weight, sleep, and diet, much less is known about these changes among fathers.

Purpose: This study aimed to (a) examine changes in fathers' body mass index (BMI), sleep, and diet from 1 month before birth to 5-6 months following birth, and from 5-6 months to 11-12 months following birth and (b) explore the moderating roles of parenthood experience and coparenting support.

Methods: 169 fathers (mean age 35.5 years, 58.9% White) participated. Fathers completed an intake survey shortly after their infant's birth to recall their height and weight, nighttime sleep hours, fruit and vegetable intake, soda intake, and fast food intake for the month prior to birth. When their child was 6 and 12 months old, fathers reported their weight, sleep, and diet again for the past 4 weeks (i.e., 4 week periods spanning 5-6 months and 11-12 months following birth). Generalized estimating equations were used to answer our research questions.

Results: Fathers reported higher BMI (Δ = 0.22 kg/m2; 95% confidence interval [CI] = 0.06, 0.38; p = .008) and less nighttime sleep duration (Δ = -0.21 hr; 95% CI = -0.38, -0.05; p = .012) at 5-6 months following birth compared to 1 month prior to birth. Fathers' diet remained stable over the three timepoints. No evidence was found to support the moderating roles of parenthood experience and coparenting support on fathers' weight and behavior changes.

Conclusions: 5-6 months following birth may be an important point of intervention for fathers to promote a return to prebirth BMI and sleep levels.
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http://dx.doi.org/10.1093/abm/kaab013DOI Listing
March 2021

Acceptability and appropriateness of a novel parent-staff co-leadership model for childhood obesity prevention in Head Start: a qualitative interview study.

BMC Public Health 2021 01 22;21(1):201. Epub 2021 Jan 22.

Boston College School of Social Work, McGuinn Hall 106K, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.

Background: Peer leadership can be an effective strategy for implementing health programs, benefiting both program participants and peer leaders. To realize such benefits, the peer leader role must be appropriate for the community context. Also, peer leaders must find their role acceptable (i.e., satisfactory) to ensure their successful recruitment and retention. To date, parent peer leaders have seldom been part of early childhood obesity prevention efforts. Moreover, parents at Head Start preschools have rarely been engaged as peer leaders. The aim of this study is to evaluate the appropriateness and acceptability of an innovative model for engaging parents as peer leaders for this novel content area (early childhood obesity prevention) and setting (Head Start).

Methods: Parents Connect for Healthy Living (PConnect) is a 10-session parent program being implemented in Head Start preschools as part of the Communities for Healthy Living early childhood obesity prevention trial. PConnect is co-led by a parent peer facilitator who is paired with a Head Start staff facilitator. In the spring of 2019, 10 PConnect facilitators participated in a semi-structured interview about their experience. Interview transcripts were analyzed by two coders using an inductive-deductive hybrid analysis. Themes were identified and member-checked with two interviewees.

Results: Themes identified applied equally to parent and staff facilitators. Acceptability was high because PConnect facilitators were able to learn and teach, establish meaningful relationships, and positively impact the parents participating in their groups, although facilitators did express frustration when low attendance limited their reach. Appropriateness was also high, as PConnect provided adequate structure and support without being overly rigid, and facilitators were able to overcome most challenges they encountered.

Conclusions: The PConnect co-facilitation model was highly acceptable and appropriate for both the parent facilitators (peer leaders) and the staff facilitators. Including parents as peer leaders aligns to Head Start's emphasis on parent engagement, making it a strong candidate for sustained implementation in Head Start. The insights gained about the drivers of peer leadership appropriateness and acceptability in this particular context may be used to inform the design and implementation of peer-led health programs elsewhere.

Trial Registration: clinicaltrials.gov, NCT03334669 (7-11-17).
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http://dx.doi.org/10.1186/s12889-021-10159-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825243PMC
January 2021

Development and Validation of a Parental Health-Related Empowerment Scale with Low Income Parents.

Int J Environ Res Public Health 2020 11 20;17(22). Epub 2020 Nov 20.

Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, State University of New York, Albany, NY 12144, USA.

Objectives: Consistent with empowerment theory, parental empowerment acts as a mechanism of change in family-based interventions to support child health. Yet, there are no comprehensive, validated measures of parental health-related empowerment to test this important perspective. Informed by empowerment theory and in the context of a community-based obesity intervention, we developed a self-report measure of parental health-related empowerment and tested its preliminary validity with low-income parents.

Methods: The Parental Empowerment through Awareness, Relationships, and Resources (PEARR) is a 21-item scale designed to measure three subdimensions of empowerment including resource empowerment, critical awareness, and relational empowerment. In the fall of 2017 or the fall of 2018, low-income parents (n = 770, 88% mothers) from 16 Head Start programs in Greater Boston completed the PEARR. The resulting data were randomly split into two equal samples with complete data. The factorial structure of the PEARR was tested in the first half of the sample using principal component analysis (PCA) and exploratory factor analysis (EFA) and subsequently confirmed with the second half of the sample using confirmatory factor analysis (CFA). Internal consistency coefficients were calculated for the final subscales.

Results: Results from the PCA and EFA analyses identified three component factors (eigenvalues = 8.25, 2.75, 2.12) with all items loading significantly onto the hypothesized subdimension (β > 0.59 and < 0.01). The three-factor model was subsequently confirmed with the second half of the sample using CFA (β > 0.54 and < 0.01). Fit indices met minimum criteria (Comparative Fit Index = 0.95, Root Mean Square Error of Approximation = 0.05 (0.05, 0.06), Standardized Root-Mean-Square Residual = 0.05). Subscales demonstrated strong internal consistency (α= 0.83-0.90).

Conclusions: Results support initial validity of a brief survey measuring parental empowerment for child health among Head Start parents. The PEARR can be utilized to measure changes in parental empowerment through interventions targeting empowerment as a mechanism of change.
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http://dx.doi.org/10.3390/ijerph17228645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699877PMC
November 2020

Modifications to Communities for Healthy Living trial design resulting from COVID-19.

Contemp Clin Trials 2020 12 2;99:106205. Epub 2020 Nov 2.

Harvard T.H. Chan School of Public Health, Dept of Biostatistics, Boston, MA 02115, United States of America.

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http://dx.doi.org/10.1016/j.cct.2020.106205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605818PMC
December 2020

Communities for Healthy Living (CHL) A Community-based Intervention to Prevent Obesity in Low-Income Preschool Children: Process Evaluation Protocol.

Trials 2020 Jul 23;21(1):674. Epub 2020 Jul 23.

Boston College School of Social Work, McGuinn Hall Room 115, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.

Background: Process evaluation can illuminate barriers and facilitators to intervention implementation as well as the drivers of intervention outcomes. However, few obesity intervention studies have documented process evaluation methods and results. Community-based participatory research (CBPR) requires that process evaluation methods be developed to (a) prioritize community members' power to adapt the program to local needs over strict adherence to intervention protocols, (b) share process evaluation data with implementers to maximize benefit to participants, and (c) ensure partner organizations are not overburdened. Co-designed with low-income parents using CBPR, Communities for Healthy Living (CHL) is a family-centered intervention implemented within Head Start to prevent childhood obesity and promote family well-being. We are currently undertaking a randomized controlled trial to test the effectiveness of CHL in 23 Head Start centers in the greater Boston area. In this protocol paper, we outline an embedded process evaluation designed to monitor intervention adherence and adaptation, support ongoing quality improvement, and examine contextual factors that may moderate intervention implementation and/or effectiveness.

Methods: This mixed methods process evaluation was developed using the Pérez et al. framework for evaluating adaptive interventions and is reported following guidelines outlined by Grant et al. Trained research assistants will conduct structured observations of intervention sessions. Intervention facilitators and recipients, along with Head Start staff, will complete surveys and semi-structured interviews. De-identified data for all eligible children and families will be extracted from Head Start administrative records. Qualitative data will be analyzed thematically. Quantitative and qualitative data will be integrated using triangulation methods to assess intervention adherence, monitor adaptations, and identify moderators of intervention implementation and effectiveness.

Discussion: A diverse set of quantitative and qualitative data sources are employed to fully characterize CHL implementation. Simultaneously, CHL's process evaluation will provide a case study on strategies to address the challenges of process evaluation for CBPR interventions. Results from this process evaluation will help to explain variation in intervention implementation and outcomes across Head Start programs, support CHL sustainability and future scale-up, and provide guidance for future complex interventions developed using CBPR.

Trial Registration: ClinicalTrials.gov, NCT03334669 . Registered on October 10, 2017.
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http://dx.doi.org/10.1186/s13063-020-04571-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376736PMC
July 2020

Antenatal dietary concordance among mothers and fathers and gestational weight gain: a longitudinal study.

BMC Public Health 2020 Jul 6;20(1):1071. Epub 2020 Jul 6.

Massachusetts General Hospital, Division of Academic Pediatrics, 125 Nashua Street, Boston, MA, 02114, USA.

Background: Parent-child dietary concordance is associated with child diet, but the clinical implications of mother-father dietary concordance during pregnancy are unknown. This study evaluates antenatal mother-father dietary concordance and associations with gestational weight gain (GWG).

Methods: Mother-father (n = 111) dyads with low income reported their fruit/vegetable (FV), fast food (FF), and sugar-sweetened beverage (SSB) consumption frequency during the first trimester of pregnancy. From electronic health records, we collected height and self-reported pre-pregnancy weight and calculated pre-pregnancy body mass index (BMI). The primary outcome was excessive GWG for pre-pregnancy BMI. Dyads were categorized as healthy or unhealthy concordant (consuming similarly high or low amounts of FV, FF, or SSB), or mother-healthy or father-healthy discordant (consuming different amounts of FV, FF, or SSB). Multivariable and logistic regressions analyzed associations between dietary concordance and GWG.

Results: Mothers were Hispanic (25%), 43% White, 6% Black, and 23% Asian or Other. Most mothers were employed (62%) making <$50,000/year (64%). Average maternal GWG was 11.6 kg (SD = 6.40), and 36% had excessive GWG. Mothers in the mother-healthy discordant FV group (OR = 4.84; 95% CI = 1.29, 18.22) and the unhealthy concordant FF group (OR = 7.08; 95% CI = 2.08, 24.12) had higher odds for excessive GWG, compared to healthy concordant dyads. SSB concordance was associated with higher GWG in unadjusted, but not adjusted models.

Conclusions: Mothers had higher risk for excessive GWG when both partners had unhealthy FF consumption frequency, and when fathers had unhealthy FV consumption frequency. These findings imply that fathers should be involved in educational opportunities regarding dietary intake during pregnancy.
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http://dx.doi.org/10.1186/s12889-020-09182-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339503PMC
July 2020

Fathers' food parenting: A scoping review of the literature from 1990 to 2019.

Pediatr Obes 2020 10 16;15(10):e12654. Epub 2020 May 16.

Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Champaign, Illinois, USA.

Background: While food parenting is a robust area of inquiry, studies have largely focused on mothers. Given the diversity of family structures today and increases in fathers' engagement in caregiving, fathers' food parenting warrants attention.

Objective: We present a scoping review of research on fathers' food parenting (1990-2019). Eligible studies included peer-reviewed research published in English documenting fathers' food parenting and presenting results for fathers separate from mothers.

Results: Seventy-seven eligible studies were identified. Most studies were based in the U.S (63.6%) and utilized a cross-sectional design (93.5%). Approximately half of studies used a validated measure of food parenting (54.5%) and slightly less than 30% utilized theory (28.6%). Many studies did not report information on fathers' residential status (37.7%) or their relationship to the target child (biological vs social) (63.6%). Content analysis of study findings showed that: fathers are involved in food parenting, but at lower levels than mothers; there are few consistent mother-father differences in food parenting practices; and fathers' controlling food parenting is linked with negative nutrition outcomes in children while responsive food parenting is linked with positive child outcomes.

Conclusion: To better inform family interventions to prevent childhood obesity, future food parenting research with fathers should recognize the diversity of family structures and utilize prospective, theory-based, designs.
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http://dx.doi.org/10.1111/ijpo.12654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010159PMC
October 2020

Biography of Leann L Birch, PhD, 25 June 1946 - 26 May 2019.

J Nutr 2020 06;150(6):1343-1347

Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA.

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http://dx.doi.org/10.1093/jn/nxaa127DOI Listing
June 2020

The Role of Parents and Children in Meal Selection and Consumption in Quick Service Restaurants.

Nutrients 2020 Mar 11;12(3). Epub 2020 Mar 11.

Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA.

Children regularly consume foods from quick service restaurants (QSRs) in the United States, but little is known about how ordering decisions are made and the impact on selection and consumption. A total of = 218 parents dining with a child (ages 4-16 years) inside a participating QSR completed interviews and demographic surveys and provided their child's leftover foods at the end of the meal. Children's meal consumption was measured using plate-waste methodology. The majority of children selected their meal without parental involvement (80%) and decided what to order prior to entering the QSR (63%). Using mixed-model analysis of variance, children selected and consumed significantly fewer calories and less total fat and sodium when a parent ordered the meal compared with when the child ordered the meal alone. There were no significant differences in selection or consumption when a parent and child ordered the meal together. Approximately one-third of the children consumed foods that were shared. In conclusion, because children primarily select foods without parental involvement and prior to entering QSRs, innovative strategies are needed to influence ordering decisions inside QSRs toward healthier options. Additionally, because food is frequently shared, policies that only focus on children's menus may not be as effective in impacting children's dietary intake.
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http://dx.doi.org/10.3390/nu12030735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146225PMC
March 2020

The Obesity Parenting Intervention Scale: Factorial Validity and Invariance Among Head Start Parents.

Am J Prev Med 2019 12;57(6):844-852

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Introduction: Obesity affects 15.7% of U.S. preschoolers, with higher rates among low-income and Spanish-speaking populations. Food, physical activity, and sleep parenting practices, referred to collectively as obesity-related parenting practices, are linked with children's risk of obesity and are a common target in family-based obesity interventions. Yet, there is no brief, validated measure of obesity-related parenting practices that is appropriate for use in intervention studies and for diverse audiences. This study tests the factorial validity of a brief measure of obesity-related parenting and measurement invariance of the English and Spanish versions of the scale, as well as among mothers and fathers.

Methods: Parents of children enrolled in Head Start (n=578; 500 mothers and 78 fathers) completed a brief survey of food (7 items), physical activity (5 items), and sleep parenting (3 items) in fall of 2017 and 2018. Scale items were drawn from existing measures and the evidence base, initially drafted in English, and then translated to Spanish. One parent per family completed the scale independently in English (n=448) or Spanish (n=130). A confirmatory factor analysis framework was adopted to test a 3-factor model for the total sample. Multi-group structural equation modeling was used to assess measurement invariance of the scale by the language of administration (English or Spanish) and among mothers and fathers separately.

Results: Results supported a 3-factor model of obesity parenting with a single factor each for food, physical activity, and sleep parenting. There was statistically significant measurement invariance across all groups (p<0.05). Internal consistency was adequate across factors (α=0.65-0.80).

Conclusions: This brief obesity-parenting scale demonstrates adequate factorial validity in English and Spanish and among mothers and fathers. This measure has been integrated into an intervention, and future work will test sensitivity to change.
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http://dx.doi.org/10.1016/j.amepre.2019.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167826PMC
December 2019

Shaping healthy habits in children with neurodevelopmental and mental health disorders: parent perceptions of barriers, facilitators and promising strategies.

Int J Behav Nutr Phys Act 2019 06 26;16(1):52. Epub 2019 Jun 26.

Harvard T.H. Chan School of Public Health, Boston, USA.

Objective: Prevalence of pediatric neurodevelopmental and mental health disorders (ND/MHD) is increasing in the United States and globally. ND/MHD are associated with higher risk of poor dietary, physical activity (PA), screen, and sleep habits in youth, contributing to elevated lifetime chronic disease risk. ND/MHD symptoms can present unique challenges to parenting, create competing parenting priorities, and may decrease parental capacity to instill healthy habits. Unfortunately, literature characterizing parenting of health habits in youth with ND/MHD is sparse. The objective of this study was to describe barriers to, facilitators of, and practical strategies for parenting healthy lifestyle habits in children and teens with ND/MHD.

Methods: We conducted semi-structured interviews with parents whose children with diagnosed ND/MHD were attending a Boston-area therapeutic day school serving K-10th grade. Interviews allowed parents to focus on parenting PA, diet, sleep, and/or screen habits as context for questions. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11.

Results: We interviewed 24 parents; average age of their child with ND/MHD was 11.2 years (range: 8-15). Most had a son (75%) with multiple ND/MHD (88%); diagnoses included autism spectrum disorder (50%), attention deficit-hyperactivity disorder (67%), anxiety (67%), and other mood disorders (58%). Major barriers to parenting all types of health habits included depleted parent resources, child dysregulation, lack of supportive programming available to children with ND/MHD, and medication side effects. Major facilitators included participation in specialized therapeutic options, adaptive community programs and schools, as well as parents' social capital. Effective parenting strategies included setting clear, often structural boundaries, using positive reinforcement, allowing agency by presenting healthy choices, and use of role modeling to promote healthy habits. Almost one third of parents extensively discussed the role of pets or therapy animals as key to establishing and maintaining healthy routines, particularly PA and screen-time management.

Conclusions: Parenting healthy habits in children with ND/MHD is difficult and is undermined by competing demands on parenting resources. To reduce chronic disease disparities and promote health in this population, future research must better adapt existing health promotion materials and programs to more practically support parents in multiple settings including home, schools and community organizations.
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http://dx.doi.org/10.1186/s12966-019-0813-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595579PMC
June 2019

Emergence of racial/ethnic differences in infant sleep duration in the first six months of life.

Sleep Med X 2019 Dec 18;1:100003. Epub 2019 May 18.

Department of Nutrition, Harvard Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA.

Objective: Examine the emergence of differences in sleep duration between infants from different racial/ethnic backgrounds and extent to which differences are explained by socioeconomic status (SES) and sleep continuity.

Methods: Sleep duration and continuity (number of night wakings and longest nighttime stretch of sleep) were assessed for 394 infants in the Rise & Sleep Health in Infancy & Early Childhood (SHINE) birth cohort at one- and six-months using the Brief Infant Sleep Questionnaire (BISQ). Multivariable regression was used to estimate associations of race/ethnicity with sleep duration adjusting for individual-level covariates, SES, and sleep continuity.

Results: The sample was 40% non-Hispanic white, 33% Hispanic, 11% Black, and 15% Asian. Mean (SD) durations for daytime, nighttime, and total sleep at one-month were 6.3 (2.0), 8.9 (1.5), and 15.2 (2.7) hours, respectively. Corresponding durations at six-months were 3.0 (1.4), 9.9 (1.3), and 13.0 (1.9) hours. At one-month, Hispanic infants had shorter nighttime sleep than white infants [β: -0.44 h (95% CI: -0.80, -0.08)]. At six-months, Hispanic [β: -0.96 h (-1.28, -0.63)] and Black [β: -0.60 h (-1.07, -0.12)] infants had shorter nighttime sleep than white infants. The near 1-h differential in night sleep among Hispanics resulted in shorter total sleep [β: -0.66 h (-1.16, -0.15)]. Associations across all racial/ethnic groups were attenuated after adjustment for SES at one- and six months. Sleep continuity attenuated associations with nighttime and total sleep duration by 20-60% for Hispanic infants at six-months.

Conclusions: Differences in sleep duration emerge early in life among racial/ethnic groups and are in part explained by SES and sleep continuity.
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http://dx.doi.org/10.1016/j.sleepx.2019.100003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041110PMC
December 2019

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies.

Obesity (Silver Spring) 2019 04;27(4):525-533

Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.

Objective: Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days.

Methods: The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement.

Results: Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics.

Conclusions: Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.
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http://dx.doi.org/10.1002/oby.22395DOI Listing
April 2019

Autonomous motivation, sugar-sweetened beverage consumption and healthy beverage intake in US families: differences between mother-adolescent and father-adolescent dyads.

Public Health Nutr 2019 04 11;22(6):1010-1018. Epub 2019 Feb 11.

1Department of Nutrition,Harvard T.H. Chan School of Public Health,655 Huntington Avenue,Boston,MA 02115,USA.

Objective: To assess interdependent effects of autonomous motivation to limit sugar-sweetened beverage (SSB) consumption in relation to SSB and healthy beverage (HB) intake in mother-adolescent and father-adolescent dyads.

Design: Adopting a dyadic cross-sectional design, the actor-partner interdependence modelling (APIM) approach was used to construct and analyse two APIM for mother-adolescent and father-adolescent dyads. The first model assessed actor effects (individual's autonomous motivation associated with his/her own beverage intake) and partner effects (individual's autonomous motivation associated with another family member's beverage consumption) of autonomous motivation on SSB consumption. The second model assessed actor and partner effects of autonomous motivation on HB intake.

Setting: Two Internet-based surveys were completed in participant households.ParticipantsData from a demographically representative US sample of parent-adolescent dyads (1225 mother-adolescent dyads, 424 father-adolescent dyads) were used.

Results: In the first model (autonomous motivation on SSB consumption), actor effects were significant for adolescents, but not for parents. Partner effects were significant for mother-adolescent, but not father-adolescent dyads. In the second model (autonomous motivation on HB intake), actor effects were significant for adolescents and parents in all dyadic combinations. Regarding partner effects, adolescent autonomous motivation had a significant effect on HB intake for mothers and fathers. In addition, maternal autonomous motivation had a significant effect on adolescent HB intake. No partner effects for HB were identified for fathers.

Conclusions: We found significant interdependent effects of autonomous motivation in relation to SSB and HB intake in mother-adolescent and father-adolescent dyads for eleven out of sixteen pathways modelled.
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http://dx.doi.org/10.1017/S136898001800383XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676308PMC
April 2019

Communities for healthy living (CHL) - A family-centered childhood obesity prevention program integrated into Head Start services: Study protocol for a pragmatic cluster randomized trial.

Contemp Clin Trials 2019 03 7;78:34-45. Epub 2019 Jan 7.

Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States. Electronic address:

Background: Childhood obesity is highly prevalent and carries substantial health consequences. Childhood obesity interventions have had mixed results, which may be partially explained by the absence of theory that incorporates broader family context and methods that address implementation challenges in low-resource settings. Communities for Healthy Living (CHL) is an obesity prevention program for Head Start preschools designed with careful focus on theory and implementation. This protocol paper outlines the design, content, implementation, and evaluation of CHL.

Methods/design: CHL integrates a parenting program co-led by Head Start staff and parents, enhanced nutrition support, and a media campaign. CHL content and implementation are informed by the Family Ecological Model, Psychological Empowerment Theory, and Organizational Empowerment Theory. The intervention is directed by community-based participatory research and implementation science principles, such as co‑leadership with parents and staff, and implementation in a real world context. CHL is evaluated in a three-year pragmatic cluster-randomized trial with a stepped wedge design. The primary outcome is change in child Body Mass Index z-score. Secondary outcomes include children's weight-related behaviors (i.e., diet, physical activity, screen use, and sleep), parenting practices targeted at these behaviors (e.g., food parenting), and parent empowerment. The evaluation capitalizes on routine health data collected by Head Start (e.g., child height and weight, diet) coupled with parent surveys completed by subsamples of families.

Discussion: CHL is an innovative childhood obesity prevention program grounded in theory and implementation science principles. If successful, CHL is positioned for sustained implementation and nationwide Head Start scale-up.
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http://dx.doi.org/10.1016/j.cct.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487308PMC
March 2019

Inclusion of Sleep Promotion in Family-Based Interventions To Prevent Childhood Obesity.

Child Obes 2018 Nov/Dec;14(8):485-500. Epub 2018 Aug 15.

1 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, MA.

Sleep promotion in childhood may reduce the risk of obesity, but little is known of its inclusion in family-based interventions. This study examines the proportion and context of family-based interventions to prevent childhood obesity that promote child sleep. We drew on data from a recent systematic review and content analysis of family-based interventions for childhood obesity prevention published between 2008 and 2015, coupled with new data on sleep promotion strategies, designs, and measures. Out of 119 eligible family-based interventions to prevent childhood obesity, 24 (20%) promoted child sleep. In contrast, 106 (89%) interventions targeted diet, 97 (82%) targeted physical activity, and 63 (53%) targeted media use in children. Most interventions that promoted sleep were implemented in clinics (50%) and home-based settings (38%), conducted in the United States (57%), and included children 2-5 years of age (75%). While most interventions utilized a randomized controlled design (70%), only two examined the promotion of sleep independent of other energy-balance behaviors in a separate study arm. Sleep was predominately promoted by educating parents on sleep hygiene (e.g., age-appropriate sleep duration), followed by instructing parents on responsive feeding practices and limiting media use. One intervention promoted sleep by way of physical activity. A large number promoted sleep by way of bedtime routines. Most interventions measured children's sleep by parent report. Results demonstrate that sleep promotion is underrepresented and variable in family-based childhood obesity interventions. While opportunities exist for increasing its integration, researchers should consider harmonizing and being more explicit about their approach to sleep promotion.
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http://dx.doi.org/10.1089/chi.2017.0235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422003PMC
September 2019

Changes in the nutritional quality of fast-food items marketed at restaurants, 2010 v. 2013.

Public Health Nutr 2018 08 27;21(11):2117-2127. Epub 2018 Mar 27.

4Department of Medical Ethics & Health Policy,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA.

Objective: To examine the nutritional quality of menu items promoted in four (US) fast-food restaurant chains (McDonald's, Burger King, Wendy's, Taco Bell) in 2010 and 2013.

Design: Menu items pictured on signs and menu boards were recorded at 400 fast-food restaurants across the USA. The Nutrient Profile Index (NPI) was used to calculate overall nutrition scores for items (higher scores indicate greater nutritional quality) and was dichotomized to denote healthier v. less healthy items. Changes over time in NPI scores and energy of promoted foods and beverages were analysed using linear regression.

Setting: Four hundred fast-food restaurants (McDonald's, Burger King, Wendy's, Taco Bell; 100 locations per chain).

Subjects: NPI of fast-food items marketed at fast-food restaurants.

Results: Promoted foods and beverages on general menu boards and signs remained below the 'healthier' cut-off at both time points. On general menu boards, pictured items became modestly healthier from 2010 to 2013, increasing (mean (se)) by 3·08 (0·16) NPI score points (P<0·001) and decreasing (mean (se)) by 130 (15) kJ (31·1 (3·65) kcal; P<0·001). This pattern was evident in all chains except Taco Bell, where pictured items increased in energy. Foods and beverages pictured on the kids' section showed the greatest nutritional improvements. Although promoted foods on general menu boards and signs improved in nutritional quality, beverages remained the same or became worse.

Conclusions: Foods, and to a lesser extent, beverages, promoted on menu boards and signs in fast-food restaurants showed limited improvements in nutritional quality in 2013 v. 2010.
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http://dx.doi.org/10.1017/S1368980018000629DOI Listing
August 2018

Food parenting and child snacking: a systematic review.

Int J Behav Nutr Phys Act 2017 11 3;14(1):146. Epub 2017 Nov 3.

Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA.

Background: While the role of parenting in children's eating behaviors has been studied extensively, less attention has been given to its potential association with children's snacking habits. To address this gap, we conducted a systematic review to describe associations between food parenting and child snacking, or consuming energy dense foods/foods in between meals.

Methods: Six electronic databases were searched using standardized language to identify quantitative studies describing associations of general and feeding-specific parenting styles as well as food parenting practices with snacking behaviors of children aged 2-18 years. Eligible peer-reviewed journal articles published between 1980 and 2017 were included. Data were extracted using a standard protocol by three coders; all items were double coded to ensure consistency.

Results: Forty-seven studies met inclusion criteria. Few studies focused on general feeding (n = 3) or parenting styles (n = 10). Most studies focused on controlling food parenting practices (n = 39) that were not specific to snacking. Parental restriction of food was positively associated with child snack intake in 13/23 studies, while pressure to eat and monitoring yielded inconsistent results. Home availability of unhealthy foods was positively associated with snack intake in 10/11 studies. Findings related to positive parent behaviors (e.g. role modeling) were limited and yielded mixed results (n = 9). Snacking was often assessed using food frequency items and defined post-hoc based on nutritional characteristics (e.g. energy-dense, sugary foods, unhealthy, etc.). Timing was rarely included in the definition of a snack (i.e. chips eaten between meals vs. with lunch).

Conclusions: Restrictive feeding and home access to unhealthy foods were most consistently associated with snacking among young children. Research is needed to identify positive parenting behaviors around child snacking that may be used as targets for health promotion. Detailed definitions of snacking that address food type, context, and purpose are needed to advance findings within the field. We provide suggested standardized terminology for future research.
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http://dx.doi.org/10.1186/s12966-017-0593-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668962PMC
November 2017

Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis.

Int J Behav Nutr Phys Act 2017 08 24;14(1):113. Epub 2017 Aug 24.

Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, SPH-2 655 Huntington Avenue, Boston, 02115, USA.

Background: A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base.

Methods: Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook.

Results: More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented.

Conclusions: The limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.
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http://dx.doi.org/10.1186/s12966-017-0571-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571569PMC
August 2017

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

Obesity (Silver Spring) 2017 07;25(7):1159-1166

Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, Massachusetts, USA.

Objective: To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]).

Methods: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site.

Results: Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111).

Conclusions: The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.
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http://dx.doi.org/10.1002/oby.21866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506684PMC
July 2017

Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project.

Obesity (Silver Spring) 2017 07;25(7):1175-1182

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Objective: To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls.

Methods: MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention.

Results: Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01).

Conclusions: This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.
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http://dx.doi.org/10.1002/oby.21867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488705PMC
July 2017

Childhood obesity prevention in the women, infants, and children program: Outcomes of the MA-CORD study.

Obesity (Silver Spring) 2017 07;25(7):1167-1174

Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, USA.

Objective: To examine the extent to which a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) intervention improved BMI z scores and obesity-related behaviors among children age 2 to 4 years.

Methods: In two Massachusetts communities, practice changes in WIC were implemented as part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) initiative to prevent obesity among low-income children. One WIC program was the comparison. Changes in BMI z scores pre and post intervention and prevalence of obesity-related behaviors of WIC participants were assessed. Linear mixed models were used to examine BMI z score change, and logistic regression models were used to examine changes in obesity-related behaviors in each intervention site versus comparison over 2 years.

Results: WIC-enrolled children in both intervention sites (vs. comparison) had improved sugar-sweetened beverage consumption and sleep duration. Compared to the comparison WIC program (n = 626), no differences were observed in BMI z score among children in Intervention Site #1 (n = 198) or #2 (n = 637). In sensitivity analyses excluding Asian children, a small decline was observed in BMI z score (-0.08 units/y [95% confidence interval: -0.14 to -0.02], P = 0.01) in Intervention Site #2 versus comparison.

Conclusions: Among children enrolled in WIC, the MA-CORD intervention was associated with reduced prevalence of obesity risk factors in both intervention communities and a small improvement in BMI z scores in one of two intervention communities in non-Asian children.
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http://dx.doi.org/10.1002/oby.21865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600510PMC
July 2017

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

Lessons Learned by Community Stakeholders in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Project, 2013-2014.

Prev Chronic Dis 2017 01 26;14:E08. Epub 2017 Jan 26.

Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115 MA. Email:

Introduction: Childhood obesity is a multifaceted disease that requires sustainable, multidimensional approaches that support change at the individual, community, and systems levels. The Massachusetts Childhood Obesity Research Demonstration project addressed this need by using clinical and public health evidence-based methods to prevent childhood obesity. To date, little information is known about successes and lessons learned from implementing such large-scale interventions. To address this gap, we examined perspectives of community stakeholders from various sectors on successes achieved and lessons learned during the implementation process.

Methods: We conducted 39 semistructured interviews with key stakeholders from 6 community sectors in 2 low-income communities from November 2013 through April 2014, during project implementation. Interviews were audio-recorded, transcribed, and analyzed by using the constant comparative method. Data were analyzed by using QSR NVivo 10.

Results: Successes included increased parental involvement in children's health and education, increased connections within participating organizations and within the broader community, changes in organizational policies and environments to better support healthy living, and improvements in health behaviors in children, parents, and stakeholders. Lessons learned included the importance of obtaining administrative and leadership support, involving key stakeholders early in the program planning process, creating buffers that allow for unexpected changes, and establishing opportunities for regular communication within and across sectors.

Conclusion: Study findings indicate that multidisciplinary approaches support health behavior change and provide insight into key issues to consider in developing and implementing such approaches in low-income communities.
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http://dx.doi.org/10.5888/pcd14.160273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268744PMC
January 2017

Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012-2014.

Prev Chronic Dis 2017 01 12;14:E03. Epub 2017 Jan 12.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Introduction: Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts' capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing "Eat Well and Keep Moving" and "Planet Health" behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts.

Methods: The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability.

Results: MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district's staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers.

Conclusion: Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.
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http://dx.doi.org/10.5888/pcd14.160381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234440PMC
January 2017

Correlates of Resource Empowerment among Parents of Children with Overweight or Obesity.

Child Obes 2017 Feb 22;13(1):63-71. Epub 2016 Nov 22.

2 Department of Nutrition, Harvard School of Public Health, Harvard University , Boston, MA.

Background: Few studies have examined correlates of resource empowerment among parents of children with overweight or obesity.

Methods: We studied baseline data of 721 parent-child pairs participating in the Connect for Health randomized trial being conducted at six pediatric practices in Massachusetts. Parents completed the child weight management subscale (n = 5 items; 4-point response scale) of the Parent Resource Empowerment Scale; items were averaged to create a summary empowerment score. We used linear regression to examine the independent effects of child (age, sex, and race/ethnicity), parent/household characteristics (age, education, annual household income, BMI category, perceived stress, and their ratings of their healthcare quality), and neighborhood median household income, on parental resource empowerment.

Results: Mean (SD) child age was 7.7 years (2.9) and mean (SD) BMI z-score was 1.9 (0.5); 34% of children were white, 32% black, 22% Hispanic, 5% Asian, and 6% multiracial/other. The mean parental empowerment score was 2.95 (SD = 0.56; range = 1-4). In adjusted models, parents of older children [β -0.03 (95% CI: -0.04, -0.01)], Hispanic children [-0.14 (-0.26, -0.03)], those with annual household income less than $20,000 [-0.16 (-0.29, -0.02)], those with BMI ≥30.0 kg/m [-0.17 (-0.28, -0.07)], and those who reported receiving lower quality of obesity-related care [-0.05 (-0.07, -0.03)] felt less empowered about resources to support their child's healthy body weight.

Conclusions: Parental resource empowerment is influenced by parent and child characteristics as well as the quality of their obesity-related care. These findings could help inform equitable, family-centered approaches to improve parental resource empowerment.
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http://dx.doi.org/10.1089/chi.2016.0136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278806PMC
February 2017

Fathers' Perspectives on Coparenting in the Context of Child Feeding.

Child Obes 2016 12 16;12(6):455-462. Epub 2016 Sep 16.

1 Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University , Boston, MA.

Background: In a diverse sample of fathers, this study examined coparenting dynamics specific to (1) how fathers managed responsibilities for food parenting with the child's mother and (2) the extent to which their food parenting practices were co-operative versus conflicting with those of the mother.

Methods: Semistructured interviews were conducted with 37 fathers (38 ± 9.1 years) using a piloted interview guide. Interview questions focused on the division of responsibility in food parenting practices, experiences of consistent versus conflicting practices, and the source and consequences of conflicting practices. The data were analyzed in QSR NVivo 10 using thematic analysis.

Results: Sixty-two percent (N = 23) of fathers reported sharing food parenting responsibilities with the child's mother. Among the remaining fathers, approximately half reported being solely responsible for food parenting (N = 6) and half reported that the mother was solely responsible (N = 8). Fathers reported using a variety of approaches to manage planning, procuring, and preparing food with mothers. Cooperative food parenting practices were reported by approximately half of the fathers in this sample. A large percentage of fathers (40%) also reported instances of conflicting food parenting practices. Conflicting practices typically focused on access to energy-dense, nutrient-poor snacks and introducing variety into the diet. Dissimilarities in practices were driven by differences in parental eating habits, feeding philosophies, and concern for child health, and often resulted in child tantrums or refusal to eat.

Conclusions: This study identifies potential sources of inconsistencies in components of coparenting that would be important to address in future interventions.
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http://dx.doi.org/10.1089/chi.2016.0118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445205PMC
December 2016