Search

To investigate whether higher levels of childhood family connection were associated with greater adult flourishing and if this association was present across levels of adverse childhood experiences (ACEs) and childhood socioeconomic disadvantage (SED). We pooled cross-sectional data from telephone and mailed surveys in the Midlife in the United States study that were collected from 2 nationally representative cohorts (2004–06 and 2011–14) of English-speaking, US adults, aged 25 to 74 years. Adult flourishing z score, standardized to the study population, was created from Ryff's 42-item Psychological Well-being Scale and quartiles of childhood family connection from a 7-item scale assessing parental attention, affection, and communication during childhood. Data were analyzed for the 4199 (72.0% of 5834) participants with complete data. The mean age of participants was 53.9 years and 85.4% were White. After adjusting for covariates, including adult chronic disease, ACEs, and childhood and current SED, mean (95% CI) flourishing z scores increased from the lowest to highest quartiles of family connection: −0.41 (−0.49, −0.33), −0.18 (−0.25, −0.12), −0.01 (−0.07, 0.06), and 0.25 (0.18, 0.32), respectively. For each 1 SD increase in the family connection score, there was a 0.25 (95% CI, 0.20, 0.29) unit increase in the adjusted flourishing z score. This positive association was also present across levels of ACEs and childhood SED. Greater childhood family connection was associated with greater flourishing in US adults across levels of childhood adversity. Supporting family connection in childhood may influence flourishing decades later, even with early adversity. [ABSTRACT FROM AUTHOR]

• Depression in early childhood education staff is common and can impair functioning. • Staff who report more frequent daily spiritual experiences report less depression. • The association persists across levels of adverse childhood experiences in staff. • Supporting staff spiritualty may reduce depression and improve children's learning. Depression is common among early childhood education (ECE) staff and can impair children's learning. Among adults, greater spirituality is associated with a lower risk of depression, while adverse childhood experiences (ACEs) are associated with a higher risk. The purpose of this study was to determine whether ECE staff who reported more frequent daily spiritual experiences had a lower prevalence of depression, and whether this association was present across a range of exposures to ACEs. In the 2012 Pennsylvania Head Start Staff Wellness Survey, we collected data from 2105 Head Start and Early Head Start staff on their daily spiritual experiences (Daily Spiritual Experience Scale [DSES] score), ACE scores (count of exposure to eight categories of childhood adversity), and depression (Center for Epidemiologic Studies Depression Scale score ≥16). Among survey participants, 97.1% were female and 56.0% were ≥40 years of age. Depression was reported by 24.4% and ≥3 ACEs by 22.8%. Across quartiles of daily spiritual experiences (DSES score) from lowest to highest, the prevalence of depression decreased significantly (32.7%, 27.2%, 20.1%, and 17.2%, respectively [ p <.001]), after adjusting for variables such as gender, age, race/ethnicity, education, and indicators of economic hardship. This inverse association was also present at each level of ACEs. For example, in the subgroup reporting ≥3 ACEs, the adjusted prevalence (95% confidence interval) of depression was 17.4% (27.2%, 7.7%) lower for those in the highest quartile of DSES scores compared to those in the lowest quartile. Among ECE staff working in Head Start, more frequent daily spiritual experiences were associated with a lower risk of depression across a range of exposures to ACEs. Supporting the spirituality of adults working in ECE may reduce their depressive symptoms, which could strengthen their relationships with children and families and improve children's outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine whether self-reported drowsy driving was associated with an evening chronotype, a biologically-based difference in circadian sleep-wake timing, and shorter school-night sleep duration in a sample of high school drivers.Study Design: Cross-sectional observational data were obtained from an online survey in spring 2015 of 431 drivers, age 15.5-18.7 years, attending Fairfax County (Virginia) Public schools. Drowsy driving was defined as having ever "driven a car or motor vehicle while feeling drowsy" in the last year. School-night sleep duration was calculated from school-night bedtime and wake time. Those with scores in the lower and upper tertiles of the Morningness-Eveningness Scale for Children were designated as having an evening or morning chronotype, respectively.Results: Among survey respondents, 63.1% drove at least several times a week and 47.6% reported drowsy driving. The covariate-adjusted prevalence of drowsy driving was 13.9% (95% CI 3.0%-24.9%) higher in students who slept <7 hours on school-nights than in those who slept 8 or more hours. Compared with those with a morning chronotype, the adjusted prevalence of drowsy driving was 15.2% (95% CI 4.5%-25.9%) higher among those with an evening chronotype.Conclusion: Among adolescent drivers, both an evening chronotype and shorter school-night sleep duration were associated with more frequent reports of drowsy driving. Interventions to improve the timing and duration of nighttime sleep in adolescents may reduce the occurrence of drowsy driving. [ABSTRACT FROM AUTHOR]

Objective: To determine whether preschool-aged children with earlier bedtimes have a lower risk for adolescent obesity and whether this risk reduction is modified by maternal sensitivity.Study Design: Data from 977 of 1364 participants in the Study of Early Child Care and Youth Development were analyzed. Healthy singleton-births at 10 US sites in 1991 were eligible for enrollment. In 1995-1996, mothers reported their preschool-aged (mean = 4.7 years) child's typical weekday bedtime, and mother-child interaction was observed to assess maternal sensitivity. At a mean age of 15 years, height and weight were measured and adolescent obesity defined as a sex-specific body-mass-index-for-age ≥95th percentile of the US reference.Results: One-quarter of preschool-aged children had early bedtimes (8:00 p.m. or earlier), one-half had bedtimes after 8:00 p.m. but by 9:00 p.m., and one-quarter had late bedtimes (after 9:00 p.m.). Children's bedtimes were similar regardless of maternal sensitivity (P = .2). The prevalence of adolescent obesity was 10%, 16%, and 23%, respectively, across early to late bedtime groups. The multivariable-adjusted relative risk (95% CI) for adolescent obesity was 0.48 (0.29, 0.82) for preschoolers with early bedtimes compared with preschoolers with late bedtimes. This risk was not modified by maternal sensitivity (P = .99).Conclusions: Preschool-aged children with early weekday bedtimes were one-half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity. [ABSTRACT FROM AUTHOR]

The quality of the relationships between teachers and young children affects children's social and emotional development and their academic success. Little is known, however, about whether the amount of workplace stress experienced by early childhood educators impacts the quality of their relationships with young children. The purpose of this study was to determine whether workplace stress was associated with poorer quality teacher–children relationships in Head Start. Across 37 Head Start programs in Pennsylvania, 1001 teachers completed an anonymous, web-based survey about workplace stress and the levels of conflict and closeness in their relationships with children in their classrooms. We examined the associations between teacher–children relationship quality and the level of three types of perceived workplace stress: high demands, low control, and low support. Findings indicated that more workplace stress was associated with more conflict in teacher–children relationships. Interventions to address workplace stress should be evaluated for their potential to impact teacher–children relationship quality and children's social–emotional development. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between prolonged bottle use and the risk of obesity at 5.5 years of age. Study design: Data from the Early Childhood Longitudinal Study, Birth Cohort were analyzed for 6750 US children born in 2001. The outcome was obesity (body mass index ≥95th percentile) at 5.5 years, and the exposure was parental report of the child using a bottle at 24 months. Results: The prevalence of obesity at 5.5 years was 17.6%, and 22.3% of children were using a bottle at 24 months. The prevalence of obesity at 5.5 years was 22.9% (95% CI, 19.4% to 26.4%) in children who at 24 months were using a bottle and was 16.1% (95% CI, 14.9% to 17.3%) in children who were not. Prolonged bottle use was associated with an increased risk of obesity at 5.5 years (OR, 1.33; 95% CI, 1.05 to 1.68) after controlling for potential confounding variables (sociodemographic characteristics, maternal obesity, maternal smoking, breastfeeding, age of introduction of solid foods, screen-viewing time, and the child’s weight status at birth and at 9 months of age). Conclusions: Prolonged bottle use was associated with obesity at 5.5 years of age. Avoiding this behavior may help prevent early childhood obesity. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine whether child maltreatment is associated with obesity in preschool children. Methods: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities. At 3 years of age, 2412 of these children had their height and weight measured, and mothers answered items on the Parent-Child Conflict Tactics Scales about three types of child maltreatment—neglect, corporal punishment, and psychological aggression. The frequency of each type of maltreatment behavior in the prior year was analyzed using categories—ever/never for neglect and quintiles for the other two types of maltreatment. Child obesity was defined as measured body mass index (kg/m2) ≥95th percentile. Results: Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment, and psychological aggression was 11%, 84%, and 93%, respectively. The odds of obesity were increased in children who had experienced neglect (odds ratio 1.56, 95% confidence interval, 1.14–2.14), after controlling for the income and number of children in the household, the mothers’ race/ethnicity, education, marital status, body mass index, prenatal smoking, and age, and the children''s sex and birth weight. Neither the frequency of corporal punishment nor psychological aggression was associated with an increased risk of obesity. Conclusions: In a sample of preschool children from 20 large US cities, maternal self-report of neglectful behavior was associated with an increased risk of childhood obesity, after controlling for birth weight, maternal obesity, and multiple socioeconomic factors. [Copyright &y& Elsevier]

Cross-sectional studies have suggested that food insecurity leads to obesity in women. The objective of this longitudinal study was to determine whether changes in women's food security status were associated with changes in their body weight. In 20 large U.S. cities, 1707 mothers of preschool children were followed for 2 y. At baseline (2001-2003) and follow-up (2003-2005), women's height and weight were measured and food security status was assessed with the US Household Food Security Survey Module. Those with no positive responses on the food security items were considered fully food secure and those with any positive responses were considered not fully food secure. Seventy-one percent were unmarried and 45% had incomes below the U.S. poverty threshold. At baseline, 41% were obese (BMI > or = 30 kg/m(2)) and 31% were not food secure. After adjusting for sociodemographic characteristics and baseline BMI, there were no significant differences in 2-y weight increases between 4 groups that differed in food security status: food secure at both time points (n = 1000), 1.7 kg (95% CI = 1.1-2.3); food secure at baseline, but not at follow-up (n = 183), 2.1 kg (95% CI = 0.7-3.5); not food secure at either time point (n = 257), 1.7 kg (95% CI = 0.5-2.9); and not food secure at baseline but food secure at follow-up (n = 267), 1.9 kg (95% CI = 0.7-3.0). In this population of urban women, changes in food security status over 2 y were not significantly associated with changes in weight. These findings do not support a causal association between food insecurity and obesity. [ABSTRACT FROM AUTHOR]

Background: Although dual-energy X-ray absorptiometry (DXA) is considered the most accurate measure of adiposity in children, it has rarely been used to examine the relation between infant feeding and adiposity during childhood. Objective: The objective was to ascertain whether adiposity at age 5 y was related to breastfeeding, to the timing of the introduction of complementary foods during infancy, or to both. Design: Body composition was measured in 313 children at age 5 y by using DXA. Data on breastfeeding, formula feeding, and the timing of the introduction of complementary foods were obtained from the mothers when the children were 3 y old. Regression analysis was used to examine the relation between infant feeding and fat mass after adjustment for lean body mass, sex, birth weight, maternal obesity, race, and other socio demographic variables. Results: Fifty-three percent of the children were boys, 80% were white, and 20% were black. There was no significant difference in adjusted fat mass between those ever breastfed and those never breastfed (x ± SE: 4.48 0.09 and 4.76 ± 0.17 kg, respectively; P = 0.17). Children who were breastfed for a longer duration and those who were breastfed without concurrent formula feeding did not have significantly lower fat mass than did those children who were never breastfed. Children did not differ significantly in fat mass if they were introduced to complementary foods before or after 4 mo of age (4.49 ± 0.12 and 4.63 ± 0.12 kg, respectively; P = 0.42). Conclusion: Neither breastfeeding nor the timing of the introduction of complementary foods was associated with adiposity at age 5 y. [ABSTRACT FROM AUTHOR]

Objective: To determine if viewing a documentary video, followed by facilitated group discussion, could alter the perceptions of those providing public health nutrition services about the barriers and solutions to addressing the problem of obesity in low-income preschoolers.Design: Before-after trial to determine how often study participants could identify any of the 17 barriers and seven solutions targeted in the video and during the facilitated group discussion.Subjects/setting: One hundred fifty-five attendees of the 2001 Kentucky Maternal and Child Health Conference participated in the study. Sixty percent were nurses, 24% were dietitians or nutritionists, and 64% had Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counseling experience.Intervention: Participants first viewed a 20-minute documentary video about three families enrolled in WIC. A 40-minute facilitated group discussion followed to highlight the 17 barriers (eg, WIC families are struggling with many demands in their lives that make nutrition a low priority and WIC health professionals “lecture” clients on what they “need to know”) and seven solutions (eg, adjusting WIC counseling to assess parenting skills and to increase sensitivity to clients’ life context and stresses).Main outcome measures/analyses: Participants responded before and after the intervention to the same two open-ended questions, one about barriers and one about solutions. Participant responses were coded to count instances of identifying any of the 17 barriers and seven solutions.Results: At baseline, 51% of participants were unable to record any of the barriers, and 91% could not identify any of the solutions. After the intervention, 37% could identify at least one more of the target barriers than they did at baseline, and 24% could identify at least one more of the target solutions.Conclusions: A documentary-style video, used with facilitated group discussion, can produce a short-term change in the perceptions of those providing public health nutrition services about addressing the problem of obesity in low-income preschool children. [Copyright &y& Elsevier]

In a previously reported randomized trial, we used both quantitative and qualitative methods to assess the impact of a professional development course, Enhancing Trauma Awareness, to increase trauma-informed care among preschool teachers in a large, urban, US school district. Although quantitative data from surveys showed no impacts of the course, the qualitative data from focus groups suggested that the course had positive, meaningful impacts on the teachers. These contrasting results are reconciled here by describing our experience of conducting and analyzing the focus group data. We explain how the course impacted the teachers and the implications of these mechanisms for implementing and evaluating approaches to increasing trauma-informed care. The course combined content about the effects of trauma with a key ingredient—a group-based relational process carried out over 12 weeks by two trainers. Through their engaged presence, the trainers allowed the course participants to feel emotionally safe. This safety allowed the participants to develop awareness and acceptance of trauma in their own lives and those of others. Teachers described the course as healing. They developed relational capacities manifested in their own engaged presence, characterized as a compassionate approach to addressing trauma experienced by children and families. [ABSTRACT FROM AUTHOR]

The quality of teachers' relationships with children is a key predictor of children's later social emotional competence and academic achievement. Interventions to increase mindfulness among teachers have focused primarily on the impacts on teachers' subjective well-being, but not on the quality of their relationships with children. Furthermore, none of these interventions have involved preschool teachers. To consider the potential of mindfulness-based interventions to improve the quality of teachers' relationships with preschool-aged children, we examined data from an online survey of 1001 classroom teachers in 37 Pennsylvania Head Start Programs. Using path analysis we investigated the association between teachers' dispositional mindfulness and the quality of their relationships with children (conflict and closeness). We further examined whether this association was mediated by teacher depressive symptoms and moderated by perceived workplace stress. Higher levels of dispositional mindfulness among teachers were associated with higher quality relationships with children (less conflict and greater closeness). The association between greater dispositional mindfulness and less conflict was partially mediated by lower depressive symptoms, and the conditional direct effect of mindfulness on conflict was stronger when perceived workplace stress was lower. These findings suggest that preschool teachers who have higher levels of dispositional mindfulness may experience higher quality relationships with children in their classrooms. Interventions to increase levels of dispositional mindfulness among early childhood educators may improve their well-being along with the quality of their relationships with children, potentially impacting children's educational outcomes. The potential impacts of such interventions may be even stronger if structural and systemic changes are also made to reduce workplace stress. [ABSTRACT FROM AUTHOR]

Abstract: Outdoor play is an important contributor to children''s physical activity and the prevalence, correlates, and environmental predictors of it among young children are not well characterized. This study aims to estimate the amount of time preschool-aged children attending Head Start spend playing outdoors at home and school, and whether aspects of the home and school environment are associated with greater outdoor play. We analyzed data (n=2529) collected in spring 2007 in the Head Start Family and Child Experiences Survey (FACES). Overall, 37.5% of children played outside at home >2h per weekday. Children who had a yard near home to play in or who had visited a park or playground or gone on a picnic with a family member in the last month were more likely to have >2h per weekday outdoor play at home, but having a playground within walking distance of the home was not related to home outdoor playtime. On average children played outdoors at Head Start for 36min per day. The amount of time children played outdoors at home was not related to school outdoor time. [Copyright &y& Elsevier]

Introduction: Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions (ILI) and metformin to prevent type 2 diabetes, no studies have tested their comparative effects in pragmatic settings. This study was designed to compare the real-world effectiveness of ILI, metformin, and standard care among Hispanic women (Latinas) with prediabetes.Study Design: RCT.Setting/participants: Ninety-two Latinas, who had a mean hemoglobin A1c of 5.9%, BMI of 33.3 kg/m2, and waist circumference of 97.4 cm (38.3 inches), were recruited from an urban community and randomly assigned to ILI, metformin, or standard care using 1:1:1 allocation. Data were collected from 2013-2015 and analyzed in 2016.Intervention: The 12-month ILI was adapted from the Diabetes Prevention Program's ILI and delivered by community health workers (promotoras) over 24 sessions. Metformin participants received 850 mg twice daily. Those randomized to standard care continued their regular medical care.Main Outcome Measures: Weight and secondary outcomes (waist circumference, blood pressure, hemoglobin A1c, fasting plasma glucose, insulin, and lipids) were assessed at baseline and 12 months.Results: ILI participants demonstrated significantly greater mean weight loss (-4.0 kg, 5.0%) than metformin (-0.9 kg, 1.1%) and standard care participants (+0.8 kg, 0.9%) (p<0.001). The difference in weight loss between metformin and standard care was not significant. The ILI group experienced a greater reduction in waist circumference than standard care (p=0.001), and a marginal improvement in hemoglobin A1c compared with metformin and standard care (p=0.063).Conclusions: In the first comparative effectiveness trial of diabetes prevention treatments, a 12-month ILI produced significantly greater weight loss than metformin and standard care among Latinas with prediabetes. These data suggest that ILI delivered by promotoras is an effective strategy for preventing diabetes in this high-risk group, which may be superior to metformin. Future pragmatic trials involving larger samples should examine differences in diabetes incidence associated with these treatments. [ABSTRACT FROM AUTHOR]

Promotora Effectiveness Versus Metformin Trial (PREVENT-DM) is a randomized comparative effectiveness trial of a lifestyle intervention based on the Diabetes Prevention Program delivered by community health workers (or promotoras), metformin, and standard care. Eligibility criteria are Hispanic ethnicity, female sex, age ≥ 20 years, fluent Spanish-speaking status, BMI ≥ 23 kg/m 2 , and prediabetes. We enrolled 92 participants and randomized them to one of the following three groups: standard care, DPP-based lifestyle intervention, or metformin. The primary outcome of the trial is the 12-month difference in weight between groups. Secondary outcomes include the following cardiometabolic markers: BMI, waist circumference, blood pressure, and fasting plasma glucose, hemoglobin A1C (HbA1c), total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and insulin. PREVENT-DM participants are socioeconomically disadvantaged Latinas with a mean annual household income of $15,527 ± 9922 and educational attainment of 9.7 ± 3.6 years. Eighty-six percent of participants are foreign born, 20% have a prior history of gestational diabetes, and 71% have a first-degree relative with diagnosed diabetes. At baseline, PREVENT-DM participants had a mean age of 45.1 ± 12.5 years, weight of 178.8 ± 39.3 lbs, BMI of 33.3 ± 6.5 kg/m 2 , HbA1c of 5.9 ± 0.2%, and waist circumference of 97.4 ± 11.1 cm. Mean baseline levels of other cardiometabolic markers were normal. The PREVENT-DM study successfully recruited and randomized an understudied population of Latinas with prediabetes. This trial will be the first U.S. study to test the comparative effectiveness of metformin and lifestyle intervention versus standard care among prediabetic adults in a “real-world” setting. [ABSTRACT FROM AUTHOR]

Abstract: Eating regular family meals is associated with a lower risk of obesity among preschool-aged children. Children in lower-income households are at higher risk for obesity, but there is little information about their mothers’ perceptions of family meals, and such information could improve nutrition counseling. To identify the perceived benefits and challenges of having family meals, four focus groups were conducted with 20 mothers of preschool-aged children living in low-income households in Philadelphia, PA. Three authors independently analyzed verbatim transcripts using an inductive method of open coding, and themes were established by consensus among all authors. Of the 20 mothers, 18 were black, 11 had education beyond high school, and 12 were living with an adult partner or husband. Mothers’ strong childhood memories of mealtimes, both negative and positive, motivated them to have family meals because of the opportunities afforded by mealtimes to build strong relationships with their children. However, mothers also described needing help, especially from other household adults, in preparing meals and establishing calm and order with their children during mealtimes. To identify what motivates the mothers of low-income, preschool-aged children to have family meals, registered dietitians can benefit from asking about the mothers’ own childhood experiences of family meals. Studies are needed to examine whether such an approach to identifying maternal motivations, when combined with practical advice about overcoming challenges with meal preparation and managing children’s mealtime behavior, could lead to more frequent and nutritious family meals in this population. [Copyright &y& Elsevier]

Present an abstract of the study `Why Don't Low-Income Mothers Worry About Their Preschoolers Being Overweight?,' by Anjali Jain, et al, which appeared in the 2001 issue of `Pediatrics.'