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Objective: In youth, a preoccupation with weight and the desire to be thinner, or drive for thinness, might persist into adulthood and predict reward-based compulsive eating and greater weight status.Methods: A total of 623 women were enrolled from a prospective cohort study starting at 10 years old and assessed up to 20 years later. Drive for thinness was measured five times during adolescence. In adulthood (mean age = 39.5), drive for thinness, reward-based eating drive, and BMI were measured.Results: Structural equation modeling found cumulative adolescent drive for thinness predicted higher scores for both adult drive for thinness and reward-based eating drive. Youth drive for thinness was not directly associated with adult BMI but rather indirectly through adult drive for thinness. Reward-based eating drive was not associated with adult BMI.Conclusions: Drive for thinness during the critical developmental years may exert long-term effects on adulthood eating behaviors tied to greater weight gain, potentially reflecting an important early target of intervention. [ABSTRACT FROM AUTHOR]

Summary: Background: Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration. Objectives: Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12. Methods: We analyzed 204 mother‐child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood. Results: Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z‐score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z‐score compared to those who persistently lived in highly food secure households. Conclusions: Changes in food security status and duration of food insecurity were associated with changes in children's growth. [ABSTRACT FROM AUTHOR]

BACKGROUND: The National School Lunch and Breakfast Programs help to reduce food insecurity and improve nutrition. The Community Eligibility Provision (CEP) enables high‐poverty schools to offer breakfast and lunch at no cost to all students. This study examines associations between CEP and participation among students eligible for free or reduced‐price meals ("FRPM"), possibly eligible ("near‐cutoff"), or ineligible ("full‐price"). METHODS: Using data from the 2013‐2015 Healthy Communities Study, we compared school breakfast and lunch participation between 842 students in K‐8 at 80 CEP schools and 1463 students at 118 schools without CEP. Cross‐sectional difference‐in‐difference (DID) models compared meal participation among near‐cutoff and full‐price groups to that in the FRPM group. RESULTS: Overall, FRPM students had high participation in school lunch and breakfast at both types of schools. In adjusted DID models, lunch participation among near‐cutoff students was 12 points higher in CEP versus comparison schools (p <.05). Among full‐price students, breakfast participation was 20 points higher and lunch participation 19 points higher in CEP than comparison schools (p <.001). CONCLUSIONS: Community Eligibility Provision improves access to school breakfast and lunch in high‐poverty schools, particularly for students who are near or above the cutoff for FRPM eligibility. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess associations between neighborhood typologies classified across multiple neighborhood domains and cardiometabolic pregnancy outcomes and determine variation in effectiveness of a mindfulness-based stress-reduction intervention on outcomes across neighborhood types.Methods: Neighborhoods of participants in the Maternal Adiposity Metabolism and Stress (MAMAS) intervention (n = 208) were classified across dimensions of socioeconomic, food, safety, and service/resource environments using latent class analysis. The study estimated associations between neighborhood type and three cardiometabolic pregnancy outcomes-glucose tolerance (GT) during pregnancy, excessive gestational weight gain, and 6-month postpartum weight retention (PPWR)-using marginal regression models. Interaction between neighborhood type and intervention was assessed.Results: Five neighborhood types differing across socioeconomic, food, and resource environments were identified. Compared with poor, well-resourced neighborhoods, middle-income neighborhoods with low resources had higher risk of impaired GT (relative risk [RR]: 4.1; 95% confidence Interval [CI]: 1.1, 15.5), and wealthy, well-resourced neighborhoods had higher PPWR (beta: 3.9 kg; 95% CI: 0.3, 7.5). Intervention effectiveness varied across neighborhood type with wealthy, well-resourced and poor, moderately resourced neighborhoods showing improvements in GT scores. PPWR was higher in intervention compared with control groups within wealthy, well-resourced neighborhoods.Conclusions: Consideration of multidimensional neighborhood typologies revealed important nuances in intervention effectiveness on cardiometabolic pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Neighbourhood opportunity, measured by poverty, income and deprivation, has been associated with preterm birth, however little is known about the contribution of early-life and life-course neighbourhood opportunity to preterm birth risk and racial-ethnic disparities. We examined maternal early-life and adult neighbourhood opportunity in relation to risk of preterm birth and racial-ethnic disparities in a population-based cohort of women under age 30.Methods: We linked census tract poverty data to 2 generations of California births from 1982-2011 for 403 315 white, black, or Latina mothers-infant pairs. We estimated the risk of preterm birth, and risk difference (RD) comparing low opportunity (≥20% poverty) in early life or adulthood to high opportunity using targeted maximum likelihood estimation.Results: At each time point, low opportunity was related to increased preterm birth risk compared to higher opportunity neighbourhoods for white, black and Latina mothers (RDs 0.3-0.7%). Compared to high opportunity at both time points, risk differences were generally highest for sustained low opportunity (RD 1.5, 1.3, and 0.7% for white, black and Latina mothers, respectively); risk was elevated with downward mobility (RD 0.7, 1.3, and 0.4% for white, black and Latina mothers, respectively), and with upward mobility only among black mothers (RD 1.2%). The black-white preterm birth disparity was reduced by 22% under high life-course opportunity.Conclusions: Early-life and sustained exposure to residential poverty is related to increased PTB risk, particularly among black women, and may partially explain persistent black-white disparities. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We examined whether prenatal mindfulness training was associated with lower depressive symptoms through 18‐months postpartum compared to treatment as usual (TAU). Method: A controlled, quasi‐experimental trial compared prenatal mindfulness training (MMT) to TAU. We collected depressive symptom data at post‐intervention, 6‐, and 18‐months postpartum. Latent profile analysis identified depressive symptom profiles, and multinomial logistic regression examined whether treatment condition predicted profile. Results: Three depressive symptom severity profiles emerged: none/minimal, mild, and moderate. Adjusting for relevant covariates, MMT participants were less likely than TAU participants to be in the moderate profile than the none/minimal profile (OR = 0.13, 95% CI = 0.03‐0.54, p = .005). Conclusions: Prenatal mindfulness training may have benefits for depressive symptoms during the transition to parenthood. [ABSTRACT FROM AUTHOR]

Introduction Few studies have examined prenatal mood as a means to identify women at risk for negative childbirth experiences. We explore associations between prenatal mood and birth perceptions in a socioeconomically diverse, American sample. Methods We conducted a prospective study of 136 predominantly low-income and ethnic minority women of mixed parity. Prenatal measures of perceived stress, pregnancy-related anxiety, and depressive symptoms were used to predict maternal perceptions of birth experiences 1 month postpartum, using the childbirth experience questionnaire ( CEQ; 1). Results After adjusting for sociodemographic variables and mode of delivery, higher third-trimester stress predicted worse CEQ total scores. This association was predominantly explained by two CEQ domains: own capacity (e.g., feelings of control and capability), and perceived safety. Pregnancy-related anxiety and depressive symptoms correlated with perceived stress, though neither independently predicted birth experience. An unplanned cesarean delivery was associated with a worse CEQ total score. Vaginal delivery predicted greater perceived safety. Altogether, sociodemographic covariates, mode of delivery, and prenatal mood accounted for 35 percent of the variance in birth experience ( p < 0.001). Discussion Our finding that prenatal stress explains a significant and likely clinically meaningful proportion of the variance in birth experience suggests that women perceive and recall their birth experiences through a lens that is partially determined by preexisting personal circumstances and emotional reserves. Since childbirth perceptions have implications for maternal and child health, patient satisfaction, and health care expenditures, these findings warrant consideration of prenatal stress screening to target intervention for women at risk for negative birth experiences. [ABSTRACT FROM AUTHOR]

Objective: To determine whether adding mindfulness-based eating and stress management practices to a diet-exercise program improves weight loss and metabolic syndrome components.Methods: In this study 194 adults with obesity were randomized to a 5.5-month program with or without mindfulness training and identical diet-exercise guidelines. Intention-to-treat analyses with multiple imputation were used for missing data. The primary outcome was 18-month weight change.Results: Estimated effects comparing the mindfulness to control arm favored the mindfulness arm in (a) weight loss at 12 months, -1.9 kg (95% CI: -4.5, 0.8; P = 0.17), and 18 months, -1.7 kg (95% CI: -4.7, 1.2; P = 0.24), though not statistically significant; (b) changes in fasting glucose at 12 months, -3.1 mg/dl (95% CI: -6.3, 0.1; P = 0.06), and 18 months, -4.1 mg/dl (95% CI: -7.3, -0.9; P = 0.01); and (c) changes in triglyceride/HDL ratio at 12 months, -0.57 (95% CI: -0.95, -0.18; P = 0.004), and 18 months, -0.36 (95% CI: -0.74, 0.03; P = 0.07). Estimates for other metabolic risk factors were not statistically significant, including waist circumference, blood pressure, and C-reactive protein.Conclusions: Mindfulness enhancements to a diet-exercise program did not show substantial weight loss benefit but may promote long-term improvement in some aspects of metabolic health in obesity that requires further study. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence of food insecurity on women's stress, disordered eating, dietary fat intake, and weight during the postpartum period. Methods The association between marginal food security and food insecurity-measured during pregnancy and postpartum-and stress, disordered eating, dietary fat intake, and weight at 3 and 12 months postpartum was estimated using multivariate linear regression, controlling for demographic and socioeconomic characteristics and health behaviors. Effect modification between level of food insecurity and prepregnancy weight status was assessed, hypothesizing a stronger association would be found among women who started pregnancy with overweight or obesity. Results Food insecurity status during pregnancy was strongly associated with higher levels of stress, disordered eating, and dietary fat intake at 3 and 12 months postpartum; during the postpartum period, food insecurity was associated with these measures at 12 months postpartum. A significant interaction was found between level of food insecurity and prepregnancy weight status; food insecurity was associated with greater weight and BMI at 12 months only among women with overweight or obesity. Conclusions In order to return to one's prepregnancy weight, women with overweight and obesity who face household food insecurity may need multipronged assistance that not only addresses having enough high-quality food, but also include stress reduction and eating behavior interventions. [ABSTRACT FROM AUTHOR]

Objective. To determine the relative importance of familial, dietary, behavioral, psychological and social risk factors for predicting body mass index (BMI) change, and onset of overweight and obesity among adolescent girls. Methods. Data from the NHLBI Growth and Health Study (n = 2 150), a longitudinal cohort of girls, were used to identify the most important predictors of change in BMI percentile between the ages of 9 and 19 years, and second, risk for becoming overweight and obese. Forty-one baseline predictors were assessed using a tree-based regression method (Random forest) to rank the relative importance of risk factors. Results. The five factors that best predicted change in BMI percentile (p < 0.05) were related to family socio-economic position (income and parent education) and drive to restrict eating and weight (body dissatisfaction, drive for thinness and unhappiness with physical appearance). The factors that were statistically significant (p < 0.05) predictors of both onset of overweight and obesity were income, ineffectiveness and race. Conclusions. Family socio-economic position and emotion regulation appeared as the top predictors of both BMI change and onset of overweight and obesity. Our results build upon prior findings that policies to prevent the onset of obesity during adolescence be targeted towards girls from lower socio-economic position households. Our findings also suggest several novel psychological factors including ineffectiveness as predictors of obesity during adolescence. These predictive findings offer a direction for future inquiry into adolescent obesity etiology using causal methods. [ABSTRACT FROM AUTHOR]

Birth records are an important source of data for examining population-level birth outcomes, but questions about the reliability of these vital records exist. We sought to assess the reliability of birth certificate data by comparing them with data from a large prospective cohort. Pregnancy, Infection, and Nutrition cohort study participants were matched with their birth certificates to assess agreement for maternal demographics, health behaviours, previous pregnancies and major pregnancy events. Agreement among categorical variables was assessed using percentage agreement and kappa statistics; for continuous variables, Spearman's correlations and concordance correlation coefficients were used. The majority of variables had high agreement between the two data sources, especially for maternal demographic and birth outcome variables. Variables measuring anaemia, gestational diabetes and alcohol consumption showed the lowest correlations. Number of cigarettes smoked and number of previous pregnancies differed by education categories. For most variables, birth records appear to be a good source of reliable information. With the exception of a few variables that differed by education, most variables did not differ by stratum of race or education. Our research further supports the use of birth certificates as a reliable source of population-level data. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the association of pregravid weight status, previous dietary restraint, and psychosocial factors during pregnancy. We used data from the Pregnancy, Infection, and Nutrition study, which recruited 2,006 women at prenatal clinics before 20 weeks' gestation who were >16 years and English speaking. Institute of Medicine BMI cut points of underweight (<19.8), normal weight (19.8–26.0), overweight (>26.0–29.0), obese (>29.0–34.9), and an additional category extremely obese (≥35.0), were used to categorize weight status. Eight psychosocial measures and dietary restraint were assessed with regard to BMI; perceived stress, trait anxiety, depressive symptoms, internal locus of control (LOC), chance LOC, powerful others LOC, self-esteem, and mastery. Linear regression was used to estimate associations, controlling for potential confounders. A significant trend was found between increasing pregravid weight categories and increasing scores for perceived stress, trait anxiety, depressive symptoms, powerful others LOC and dietary restraint, and decreasing scores for self-esteem and mastery. In adjusted models, pregravid obesity was independently associated with perceived stress, trait anxiety, and depressive symptoms. Extreme obesity was independently associated with all measures except internal LOC. A strong linear association was found between increasing weight categories and dietary restraint. In conclusion, as pregravid weight increased, pregnant women were at greater risk of reporting higher scores on negative psychosocial state and dietary restraints, and reporting lower score on positive personal dispositions.Obesity (2009) 17 3, 550–558. doi:10.1038/oby.2008.585 [ABSTRACT FROM AUTHOR]

Residential context has received increased attention as a possible contributing factor to race/ethnic and socio-economic disparities in birth outcomes in the United States. Utilising vital statistics birth record data, this study examined the association between neighbourhood deprivation and the risk of a term small-for-gestational-age (SGA) birth among non-Hispanic whites and non-Hispanic blacks in eight geographical areas. An SGA birth was defined as a newborn weighing <10th percentile of the sex- and parity-specific birthweight distribution for a given gestational week. Multi-level random intercept logistic regression models were employed and statistical tests were performed to examine whether the association between neighbourhood deprivation and SGA varied by race/ethnicity and study site. The risk of term SGA was higher among non-Hispanic blacks (range 10.8-17.5%) than non-Hispanic whites (range 5.1-9.2%) in all areas and it was higher in cities than in suburban locations. In all areas, non-Hispanic blacks lived in more deprived neighbourhoods than non-Hispanic whites. However, the adjusted associations between neighbourhood deprivation and term SGA did not vary significantly by race/ethnicity or study site. The summary fully adjusted pooled odds ratios, indicating the effect of one standard deviation increase in the deprivation score, were 1.15 [95% CI 1.08, 1.22] for non-Hispanic whites and 1.09 [95% CI 1.05, 1.14] for non-Hispanic blacks. Thus, neighbourhood deprivation was weakly associated with term SGA among both non-Hispanic whites and non-Hispanic blacks. [ABSTRACT FROM AUTHOR]

There is extensive literature showing that psychosocial factors, income, being black, being single, and having children are the strongest predictors of household food insecurity. We examined these factors in a vulnerable sample of 201 first-time African-American mothers with 3 month old infants and mostly single (88%). Fifty-four percent of the women were food secure, 33% were marginally food secure, and 12% were food insecure. Using these categories as outcomes, we ran a multinomial logistic regression model to assess how maternal age, education, work status, living with child's grandmother, father, or other household members, and maternal depression (Center for Epidemiological Studies Depression Scale) influence household food security status. Compared to food secure households, living with the child's grandmother decreased the risk of food insecurity (Relative Risk Ratio (RRR): 0.12 [95% CI: .02, .72]) but living with the father (RRR: 3.73 [95% CI: 1.27, 10.96]) and having depressive symptoms (RRR: 4.98 [95% CI: 1.69, 14.75]) increased the risk of food insecurity. Compared to food secure households, living with an extended family (RRR: 0.73 [95% CI: .56, .96]) appeared to be protective against marginal food security. These findings suggest that living with the child's grandmother may be how a first-time mother copes with the difficulties of being single and having a young infant. These results also stress the importance of financial and emotional support for these mothers especially in the postpartum period. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined prenatal mood as a means to identify women at risk for negative childbirth experiences. We explore associations between prenatal mood and birth perceptions in a socioeconomically diverse, American sample., Methods: We conducted a prospective study of 136 predominantly low-income and ethnic minority women of mixed parity. Prenatal measures of perceived stress, pregnancy-related anxiety, and depressive symptoms were used to predict maternal perceptions of birth experiences 1 month postpartum, using the childbirth experience questionnaire (CEQ; 1)., Results: After adjusting for sociodemographic variables and mode of delivery, higher third-trimester stress predicted worse CEQ total scores. This association was predominantly explained by two CEQ domains: own capacity (e.g., feelings of control and capability), and perceived safety. Pregnancy-related anxiety and depressive symptoms correlated with perceived stress, though neither independently predicted birth experience. An unplanned cesarean delivery was associated with a worse CEQ total score. Vaginal delivery predicted greater perceived safety. Altogether, sociodemographic covariates, mode of delivery, and prenatal mood accounted for 35 percent of the variance in birth experience (p < 0.001)., Discussion: Our finding that prenatal stress explains a significant and likely clinically meaningful proportion of the variance in birth experience suggests that women perceive and recall their birth experiences through a lens that is partially determined by preexisting personal circumstances and emotional reserves. Since childbirth perceptions have implications for maternal and child health, patient satisfaction, and health care expenditures, these findings warrant consideration of prenatal stress screening to target intervention for women at risk for negative birth experiences., (© 2016 Wiley Periodicals, Inc.)