EVALUATING THE MULTIVARIATE RELATIONSHIP BETWEEN BREASTFEEDING, EARLY CHILDHOOD OBESITY, ASTHMA, AND MENTAL ILLNESS IN DALLAS, TX

The aim of this study was to examine the associations between breastfeeding, asthma and mental illness in North Texas children aged two to five years, and to explore whether these associations are explained by the presence of obesity. The study population comprised of 1,174 children whose caregivers responded to a 2015 survey administered by Children’s Health and the Health & Wellness Alliance for Children. Information on breastfeeding, BMI, asthma, and mental illness were self-reported by primary caregivers. Of the 1,174 children, 61% were breastfed, 13% had asthma, and 17% had a mental illness. The odds of having asthma were 2.28 times higher among children who were obese compared to non-obese children (95% CI: 1.37-3.79; p-value= 0.001). There were no statistically significant relationships between breastfeeding, obesity, or mental health illness. Children living in a household where the caregivers had more than a college education (OR: 2.07, p-value= 0.007) or a household income of $50,000 to$100,000 (OR: 1.80, p-value= 0.006) were more likely to have been breastfed. Obesity was not found to be a statistically significant mediator in the relationship between breastfeeding, asthma, and mental illness. This study hopes to inform future studies about the complex relationship among breastfeeding, early childhood obesity, asthma, and mental illness

Cluster randomized trial of the impact of an obesity prevention intervention on child care center nutrition and physical activity environment over two years

Objective: The prevalence of obesity among preschool-aged children in the United States remains unacceptably high. Here we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a child care center (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over two school years. Design: This was a cluster randomized trial with 12 CCC receiving the HC2 intervention arm and 12 in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over two school years (Fall-2015, Spring-2016 and Spring-2017). Changes in EPAO physical activity and nutrition score were analyzed via a (1) random effects mixed models and (2) mixed models to determine the effect of HC2 versus control. Setting: The study was conducted in 24 CCCs serving low-income, ethnically diverse families in Miami-Dade County. Participants: Intervention CCCs received (1) teachers/parents/children curriculum; (2) snack, beverage, physical activity, and screen time policies; and (3) menu modifications. Results: Two-year EPAO nutrition score changes in intervention CCCs were almost twice that of control CCCs. The EPAO physical activity environment scores only slightly improved in intervention CCCs versus control CCCs. Intervention CCCs showed higher combined EPAO physical activity and nutrition scores compared to control CCCs over the 2-year study period (β=0.09, P=0.05). Conclusions: Obesity prevention programs can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCCs may need consistent support to improve the physical activity environment to ensure the policies remain intact

Effect of in-utero polysubstance exposure on adolescent cardiovascular disease risk: Results from the Maternal Lifestyle Study

Polysubstance use during pregnancy typically includes use of one or more illicit substances in addition to tobacco and/or alcohol. Rates of polysubstance use during pregnancy range from 5 to 10% and continue to rise. However, to date, there are no studies using longitudinal data exploring cardiovascular disease risk in adolescents exposed to polysubstances in utero. The objective of this analysis was to discover the possible association between maternal substance use and cardiovascular disease risk (i.e., increased blood pressure) in adolescence. The National Institute on Drug Abuse (NIDA)-funded Maternal Lifestyle Study (MLS) cohort was used for this analysis. Briefly, in 1993 MLS enrolled mothers by substance use during pregnancy status (Y/N) at four US locations (Detroit, MI; Miami, FL; Providence, RI; and Memphis, TN) and followed offspring until 2011. Generalized linear modeling assessed cardiovascular disease risk in offspring via systolic blood pressure (mm Hg) at age 16 comparing those prenatally exposed and unexposed to maternal substance use. The most prevalent singular substance used during pregnancy in this sample (n = 910) was alcohol (n = 121, 16%), while the most common polysubstance used during pregnancy was a combination of tobacco, alcohol, and cocaine (n = 123, 16%). Those born normal birthweight (≥2500 g) and exposed to tobacco, alcohol, and opioids in utero had 22 mm Hg higher systolic blood pressure at age 16 compared to those not exposed to any substances (β coefficient = 22.44, 95% CI: 10.53–34.35). Singularly, tobacco, alcohol, and opioids are among the most used during pregnancy and when used in combination, pose great risk for cardiovascular disease in offspring. Given its recent rise and high prevalence, targeting maternal substance use is critical for cardiovascular disease prevention. •Drug use during pregnancy often involves use of two or more substances.•Maternal drug use can harm fetal health and offspring health in childhood.•The most common combination of polysubstance use was tobacco, alcohol, and cocaine.•In-utero exposure to polysubstance use leads to elevated blood pressure in adolescence.•Maternal drug use may be a risk factor for CVD in offspring adulthood

Longitudinal effect of prenatal polydrug use and birthweight status on pediatric growth

Maternal drug use causes low birthweight but less is known about longer-term pediatric growth. The purpose of this analysis was to longitudinally measure anthropometric growth among children exposed to drugs in utero. We used data from the National Institute on Drug Abuse (NIDA)-funded Maternal Lifestyle Study (MLS). Mixed effects piecewise regression longitudinally assessed BMI percentile from 2-16 years. Those born low birthweight prenatally exposed to poly tobacco/opioid use had lower pediatric BMI percentiles than those unexposed from 2-16 years. Specific combinations of drug use appear to delay or accelerate growth across childhood at different points for those born low birthweight

Parent concerns regarding paediatric obesity in community‐based programmes serving children with developmental disabilities

Background Previous studies show a higher prevalence of obesity among preschool‐age children with developmental disabilities (DDs) versus children who are typically developing (TD). Little is known about parent concerns about obesity in young children with DD. The purpose of this study was to examine concerns regarding paediatric obesity among parents who had a preschool‐age child with DD compared with parents with a child who is TD. Methods A cross‐sectional analysis occurred at baseline entry into one of three community‐based programmes. Parents of a child with DD (n = 815) or TD (n = 563) were asked obesity‐related questions about their child and in general. Multinomial and logistic regression unadjusted and adjusted models were run to generate the odds of obesity concerns based on disability status. Results The average child age was 38 months. Parent concerns about paediatric obesity differed by disability status. Unadjusted odds of parents ‘doing anything to control their child's weight’ was 38% lower among parents of a child with DD versus TD (OR: 0.62, 95% CI: 0.48, 0.82). The adjusted odds of perceiving that their child was underweight was 83% higher among parents of a child with DD compared with parents of a child who is TD (aOR: 1.83, 95% CI: 1.27, 2.64). Parents of a child with DD were 179% more likely to believe that childhood obesity is a public health problem (aOR: 2.79, 95% CI: 1.88, 3.96). The models were adjusted for age, sex and race/ethnicity. Conclusions Findings indicate that parents of preschool‐age children with DD are more likely to acknowledge that obesity is a public health concern. Because some parents of children with DD are concerned about their child's weight, families of preschool‐age children with DD may be receptive to the delivery of healthy weight strategies in community‐based programs