Parent and household influences on calcium intake among early adolescents.

Background Calcium intake during early adolescence falls short of requirements for maximum bone accretion. Parents and the home food environment potentially influence children’s calcium intakes. This study aimed to quantify parental psychosocial factors (PSF) predicting calcium intakes of Asian, Hispanic, and non-Hispanic white (NHW) early adolescent children from a parental perspective. Methods This was a cross-sectional study involving the administration of a validated calcium-specific food frequency questionnaire to a convenience sample of children aged 10–13 years and the primary individual responsible for food acquisition in the child’s household. Based on Social Cognitive Theory, parental factors potentially associated with children’s calcium intake were also assessed via parent questionnaires. The total study sample consisted of 633 parent-child pairs (Asian = 110, Hispanic = 239, NHW = 284). Questionnaires were completed at community-based centers/sites. Outcome measures were the association between parent-child calcium (mg), milk (cups/day), and soda (cans/day) intakes and the predictive value of significant parental PSF towards calcium intakes of their children. Sex-adjusted linear regression and multivariate analyses were performed. Results Calcium intakes of parent-child pairs were positively associated among all ethnic groups (r = 0.296; P < 0.001). Soda intakes were positively associated among Hispanic parent-child pairs only (r = 0.343; P < 0.001). Home availability of calcium-rich foods (CRF), parental rules and expectations for their child’s intake of beverages, and parents’ calcium intake/role modeling were positively associated with children’s calcium intake and overwhelmed all other PSF in multivariate analyses. Significant cultural differences were observed. Parental role modeling was a significant factor among Hispanic dyads only. Multivariate models explained 19–21% of the variance in children’s calcium intakes. Conclusions Nutrition interventions to improve children’s calcium intakes should focus on parents and provide guidance on improving home availability of CRF and increasing rules and expectations for the consumption of CRF. Among Hispanic families, interventions promoting parental modeling of desired dietary behaviors may be most successful

Effect of a text intervention during pregnancy on birth weight in participants of the WIC program in Hawaii.

ObjectivesThere are limited studies testing the effect of a pregnancy educational intervention on infants’ birth weight. This study investigated the effect of a short message service (SMS), or text message, intervention for promoting adequate gestational weight gain on infants’ birth weight in a sample of pregnant women in Hawai‘i.MethodsA randomized clinical trial was conducted among women participating in the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) program in Hawai‘i (n = 83). The intervention group (n = 42) received weekly SMS about appropriate energy intake and physical activity and the control group (n = 41) received weekly SMS about general health issues for 4 months during pregnancy. Weight and length at birth were obtained from the participant's chart in WIC and compared between groups. Birthweight was categorized as small (SGA), appropriate (AGA) or large (LGA) for gestational age.ResultsWomen were age 27.7 ± 5.3y on average, 65.5% were Native Hawaiian, Pacific Islander or American Indian, 54.8% had some college or more and 37.8% were employed. Infant birth weight was similar in the intervention (3431 ± 682 g) and control groups (3232 ± 599 g; P > 0.05). Mothers in the control group had higher odds of having a SGA baby (OR: 2.21; 95% CI 0.40, 12.2) but similar risk of having a LGA baby (0.27; 95% CI 0.07, 1.05) compared to the intervention group. After adjusting for mothers’ age, education level and employment status, results were similar for SGA (OR: 2.34; 95% CI 0.43, 14.7) and LGA (OR: 0.35; 95% CI 0.08, 1.49).ConclusionsThere was no significant difference in birth weight between groups in mothers from the WIC program in Hawai‘i. More intensive educational interventions may be needed to observe an impact on birth weight

Examining plausibility of self-report energy intake data: considerations for method selection.

Self-reported dietary intake data contain valuable information and have long been used in the development of nutrition programs and policy. Some degree of measurement error is always present in such data. Biological plausibility, assessed by determining whether self-reported energy intake (rEI) reflects physiological status and physical activity level, must be examined and accounted for before drawing conclusions about intake. Methods that may be used to account for plausibility of rEI include crude methods such as excluding participants reporting EIs at the extremes of a range of intake and individualized methods such as statistical adjustment and applying cutoffs that account for the errors associated with within-participant variation in EI and total energy expenditure (TEE). These approaches allow researchers to determine how accounting for under- and overreporting affects study results and to appropriately address misreporting in drawing conclusions with data collected and in interpreting reported research. In selecting a procedure to assess and account for plausibility of intake, there are a number of key considerations, such as resources available, the dietary-report instrument, as well as the advantages and disadvantages of each method. While additional studies are warranted to recommend one procedure as superior to another, researchers should apply one of the available methods to address the issue of implausible rEI. If no method is applied, then at minimum, mean TEE or rEI/TEE should be reported to allow readers to ascertain the degree of misreporting at a gross level and better interpret the data and results provided

Effect of a short message service intervention on excessive gestational weight gain in a low-income population: a randomized controlled trial

Objectives: The objective of this trial was to investigate the effect of educational short message service (SMS), or text messages, on excessive gestational weight gain (GWG) in a low-income, predominantly overweight/obese population. Methods: Participants (n = 83) were mostly overweight/obese women recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics on the island of O’ahu, Hawai’i at 15–20 weeks gestational age. The intervention group received SMS on nutrition and physical activity during pregnancy designed to help them meet Institute of Medicine (IOM) guidelines for GWG and American College of Obstetricians and Gynecologists guidelines for exercise, respectively. The control group received SMS about general health topics during pregnancy, excluding nutrition and physical activity. Both groups received one text message per week for eighteen weeks. GWG was defined as the difference between the last self-reported weight taken before delivery and participants’ self-reported weight before pregnancy. Differences between study groups were examined using t-tests and Chi-square tests. Linear regression models were used to examine association of GWG with study group and other factors. Results: GWG was similar (p = 0.58) in the control group (14.1 ± 11.4 kg) and the intervention group (15.5 ± 11.6 kg). The percentage of participants exceeding IOM guidelines for GWG was similar (p = 0.51) in the control group (50.0%, n = 17) and the intervention group (60.5%, n = 23). Conclusions: GWG was not significantly different between intervention and control groups. Trials that begin earlier in pregnancy or before pregnancy with longer intervention durations and varying message frequency as well as personalized or interactive messages may be needed to produce significant improvements

Associations between gestational weight gain and rate of infancy weight gain in Hawaii and Puerto Rico WIC participants.

Background Excessive gestational weight gain and rapid infancy weight gain (RIWG) are associated with increased susceptibility to childhood obesity. Since low-income and minority children are particularly at risk, investigation of the associations between gestational weight gain and rate of infancy weight gain may inform childhood obesity prevention. This study investigated the associations between gestational weight gain and rate of infancy weight gain during the first four to six months postpartum in participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Hawai‘i and Puerto Rico. Methods This was a cross-sectional secondary data analysis from a text message-based intervention in WIC participants in Hawai‘i and Puerto Rico. The analysis included 80 mother/infant pairs from the control group who completed the follow-up visit when infants were four to six months old. Maternal weight, height, and gestational weight gain were self-reported. Infant weight was measured at baseline and follow-up. A proportional odds model was used to investigate the association between gestational weight gain and infancy weight gain rate (rapid or extremely rapid, on-track, or slow), adjusting for maternal age, pregravid body mass index (BMI) status, parity, and being up-to-date with infant vaccinations. Results In comparison to recommended gestational weight gain, excessive and inadequate (under the recommended amount) gestational weight gain was associated with 77% decreased (adjusted odds ratio [AOR] = 0.23; 95% confidence interval [CI] = 0.08, 0.70; p = 0.01) and 71% decreased (AOR = 0.29; 95% CI = 0.09, 0.94; p = 0.04) odds of RIWG versus on-track or slow infant weight gain, respectively. In comparison to women with one child, women with two children (AOR = 0.31; 95% CI = 0.11, 0.87; p = 0.03) or three or four children (AOR = 0.24; 95% CI = 0.07, 0.88; p = 0.03) had significantly lower odds of RIWG versus on-track or slow infancy weight gain. Conclusions Women with excessive or inadequate gestational weight gain had lower proportional odds of RIWG and were more likely to have slower infant weight gain than women who gained the recommended amount of weigh

Validation of a collaboration readiness assessment tool for use by Supplemental Nutrition Assistance Program Education (SNAP-Ed) agencies and partners.

To evaluate content and face validity of a collaboration readiness assessment tool developed to facilitate collaborative efforts to implement policy, systems, and environment changes in Supplemental Nutrition Assistance Program–Education (SNAP-Ed).Evaluation of the validity of the tool involved 2 steps. Step 1 was conducted with 4 subject matter experts to evaluate content validity. Step 2 used an iterative cognitive testing process with 4 rounds and 16 SNAP-Ed staff and community partners to evaluate face validity.Subject matter experts found that survey items appropriately matched the content area indicated and adequately covered collective efficacy, change efficacy, and readiness. Cognitive testing with SNAP-Ed staff and partners informed modifications and resulted in adequate face validity.The ability to measure collaboration readiness will allow agencies and community partners that implement SNAP-Ed to target areas that facilitate collaboration efforts needed for policy, systems, and environment change and collective efficacy. Further cognitive testing of the tool with other populations is needed to ensure its applicability and usefulness. Evaluation of the reliability of the tool with a broad range of SNAP-Ed programs and community agencies is also recommended

Association between cognitive restraint, uncontrolled eating, emotional eating and BMI and the amount of food wasted in early adolescent girls.

Understanding of behavioral factors associated with obesity is of importance in addressing this issue. This study examined the association between cognitive restraint, uncontrolled eating, emotional eating and body mass index (BMI) and amount of food plated, consumed, leftovers, and leftover food thrown into the trash (food wasted) in early adolescent girls nine to 13 years in O'ahu, Hawai'i (n = 93). Food plated, consumed, leftovers, and food wasted were estimated using a three-day mobile food record™ (mFR). Weight and height were measured to compute BMI (kg/m 2). The three-factor eating questionnaire provided a score from 0 to 100 for cognitive restraint, uncontrolled eating, and emotional eating. Higher scores are indicative of greater cognitive restraint, uncontrolled eating, and emotional eating. Pearson's correlations were computed to examine the relationship between three factor eating scores and BMI. General linear models were conducted to examine the effect of each of three-factor eating scores on food plated, consumed, leftovers, and food wasted. Cognitive restraint was positively correlated with BMI (r = 0.36, p < 0.001) and with BMI z-score (r = 0.40, p < 0.001). There were no associations between three-factor eating scores and food plated, consumed, leftovers, and food wasted at lunch. However, at dinner, total energy plated, left over, and food wasted increased by 4.24 kcal/day (p = 0.030), 1.67 kcal/day (p = 0.002), and 0.93 kcal/day (p = 0.031), respectively, with a unit increase in uncontrolled eating score. Similarly, total energy plated and energy left over at dinner increased by 3.40 kcal/day (p = 0.045) and 1.51 kcal/day (p = 0.001), respectively, with a unit increase in emotional eating score. Additional research should examine the specific roles of cognitive restraint, uncontrolled eating, emotional eating and food waste in the development of obesity in adolescents

Amount, preparation and type of formula consumed and its association with weight gain in infants participating in the WIC Program in Hawaii and Puerto Rico.

The aim of this study was to assess the association between amount (below or above recommendations), preparation (liquid vs. powder), and type (regular vs. hydrolysate) of infant formula consumed and weight in infants participating in the Women, Infant and Children (WIC) Program in Hawaii (HI) and Puerto Rico (PR). This was a secondary analysis of 162 caregivers with healthy term 0-2-month-old infants. Socio-demographics, infant food frequency questionnaires, and weight and length were assessed at baseline and after four months. Infant feeding practices were associated with weight-for-length z-scores using multivariable logistic regression. In total, 37.7% were exclusively breastfed and 27.2% were exclusively formula-fed. Among formula users, regular (63.6%) and powder (87.0%) formula were the most common; 43.2% consumed formula above recommendations. Most infants had rapid weight gain (61.1%). Infants fed regular formula had higher odds of overweight after four months (adjusted OR = 8.77, 95% CI: 1.81-42.6) and higher odds of rapid weight gain (adjusted OR = 3.10, 95% CI: 1.12, 8.61). Those exclusively formula fed had higher odds of slow weight gain (adjusted OR = 4.07, 95% CI: 1.17-14.2). Formula preparation and amount of formula were not associated with weight. These results could inform the WIC program's nutrition education messages on infant feeding. Studies with longer follow-up are needed to confirm these results

Acceptability of a text message-based intervention for obesity prevention in infants from Hawaii and Puerto Rico WIC.

Background: Low-income and minority children are at increased risk for obesity. Text messaging offers advantages for delivering education, but few studies have assessed the acceptability of text messaging in interventions aimed at preventing excessive weight gain in infants. This study investigated the acceptability of a text message-based intervention for prevention of excessive weight gain in infants from Hawai'i and Puerto Rico WIC clinics. Methods: The four-month text message based intervention designed to improve infant feeding practices and reduce excessive weight gain was a randomized controlled trial that included mothers with infants ages 0-2 months at baseline. Participants in the intervention arm received 18 text messages (1/week) promoting breastfeeding and appropriate complementary feeding. Acceptability of the intervention was assessed from participant retention, satisfaction, and evidence of behavior change in a sequential multimethod approach, quantitatively from questions sent via text and qualitatively during the in-person exit interview. The final analysis included 80 mother-infant pairs from the intervention arm. Results: When asked about messages liked and disliked the most, the majority of responses via text indicated that they liked all messages. From the qualitative analyses, most participants reported that all messages were useful and that the messages led them to make changes in the way they fed their infants. Participant retention was good at 78.4%. Conclusions: The intervention was acceptable to participants based upon participant retention, measures of satisfaction, and reports of behavior change. Results may inform development of mobile health programs for minority childhood obesity prevention