Search

Background: The influx of Syrian refugees into Turkey has highlighted the importance of supporting breastfeeding practices among this vulnerable population. We aimed to evaluate the breastfeeding and infant feeding attitudes of Syrian mothers based on the observations of Syrian healthcare workers (HCWs). Methods: An online form including 31 questions was prepared in Turkish, Arabic, and English languages and distributed to HCWs, working in refugee health centers via e-mail, WhatsApp, or text message with the help of Ministry of Health in Turkey between January 2020 and March 2020. The questions were about HCWs' characteristics (occupation, region of employment, duration of employment, participation in breastfeeding counseling course) and about HCWs' observations of Syrian mothers' breastfeeding and infant feeding practices. Results: A total of 876 HCWs were included in the study; about 37.3% were physicians. Only 40.0% of HCWs reported that babies were predominantly fed with breast milk in the first three days after birth, 45.2% of HCWs indicated that mothers typically used sugary water as a prelacteal food, and 30.5% believed that breastfeeding was discontinued before 12 months. The main barriers to breastfeeding identified by HCWs included the lack of education, mental and physical health issues in the mother, food insecurity, low income, inadequate housing, lack of family planning, sociocultural environment, and limited access to quality health services. For complementary feeding, 28.0% of HCWs stated early introduction and 7.4% remarked delayed. HCWs believed grains, fruits and vegetables, and dairy products as top three foods for starting complementary food (59.5%, 47.8%, and 30.3% respectively). Healthcare challenges of Syrian pregnant and lactating mothers were reported to be associated primarily with "food, finance, and housing difficulties", low maternal education, and cultural and environmental issues. HCWs recommended various solutions, such as supporting breastfeeding, offering nutrition and health support, promoting family planning, improving healthcare systems through legislation, and addressing cultural barriers. Conclusions: To address breastfeeding issues among Syrian mothers, it is crucial to provide breastfeeding training to both HCWs and mothers. Expanding interventions that support breastfeeding-friendly practices, including community support and food aid for breastfeeding mothers, should also be considered to address the social determinants of breastfeeding. [ABSTRACT FROM AUTHOR]

BACKGROUND School settings offer an opportunity to impact student health and wellness. Quality wellness policies are important in establishing strong wellness environments, but current resources to support policy development, maintenance, and dissemination are lacking. The Building Healthy Schools Program aimed to develop capacity of school districts to improve the strength and comprehensiveness of wellness policies and sustain these activities. METHODS: Fifteen school districts in Pennsylvania participated in a program to facilitate the improvement of district wellness policies and practices. Program staff provided technical assistance to evaluate wellness policies before and after program implementation. Professional development and tailored training was provided for school personnel to create sustainability. Statistical analysis was performed to evaluate policy improvement. RESULTS: Thirteen of the 15 participating districts completed a policy revision. Median strength (p =.001) and comprehensiveness (p =.002) scores improved from baseline to post‐program and there were significant improvements in most assessment sub‐sections. Some districts were hesitant to make strong language improvements due to their limited capacity (ie, staff) for implementation. Champions (n = 13; 87%) reported confidence to revise wellness policy language independently in the future. CONCLUSIONS: Technical assistance provided to districts facilitated significant improvements to wellness policy language, especially in the implementation, evaluation, and communication; critical components for policy impact on school wellness environments. In addition, participant feedback suggested an ability to sustain activities in the future. Both external (ie, technical assistance) and internal resources are needed to facilitate school districts' ongoing wellness policy improvement and implementation, including improved model wellness policy language and enforcement within schools, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND School‐level implementation of district‐level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom‐specific LWPs implementation were examined. METHODS: An administrator survey (N = 756 schools; 24/24 districts) included 6 classrooms LWP best‐practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha =.71; elementary and middle/high examined separately) was used to examine associations with student body income (free‐and‐reduced priced meals (FARMS): ≤40%, 41‐75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district‐level clustering, with moderation examined. RESULTS: Classroom implementation scores were: elementary = 3.1 ± 1.8 (range: 0‐6/6 items) and middle/high = 2.3 ± 1.6 (range:0‐5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS‐eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed. CONCLUSIONS: Disparities in classroom‐specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low‐income students. [ABSTRACT FROM AUTHOR]

Aim: Children's intake of discretionary choices is excessive. This study aimed to develop a questionnaire measuring parents’ attitudes and beliefs towards limiting provision of discretionary choices, using the Health Action Process Approach model. Methods: The questionnaire items were informed by the Health Action Process Approach model, which extends the Theory of Planned Behaviour to include both motivational (intention) and volitional (post‐intention) factors that influence behaviour change. The questionnaire was piloted for content and face validity (expert panel, n = 5; parents, n = 4). Construct and predictive validity were examined in a sample of 178 parents of 4–7‐year‐old children who completed the questionnaire online. Statistical analyses included exploratory factor analyses, Cronbach's alpha and multiple linear regression. Results: Pilot testing supported content and face validity. Principal component analyses identified constructs that aligned with the eight constructs of the Health Action Process Approach model. Internal consistencies were high for all subscales, in both the motivational (Cronbach's alpha 0.77–0.88) and volitional phase (Cronbach's alpha 0.85–0.92). Conclusions: Initial results from validation tests support the development of a new questionnaire for measuring parent attitudes and beliefs regarding provision of discretionary choices to their 4–7‐year‐old children within the home. This new questionnaire can be used to gain greater insight into parents’ attitudes and beliefs that influence ability to limit discretionary choices provision to children. Further research to expand understanding of the questionnaires’ psychometric properties would be valuable, including confirmatory factor analysis and reproducibility. [ABSTRACT FROM AUTHOR]

Background: Parental self-efficacy (PSE) refers to beliefs of parents to effectively engage in behaviors that result in desired outcomes for their children. There are several instruments of PSE for promoting healthy dietary or physical activity (PA) behaviors in children. These measures typically assess PSE in relation to some quantity or frequency of behavior, for example, number of servings or times per week. However, measuring PSE in relation to contextual circumstances, for example, psychological states and situational demands, may be a more informative approach. The purpose of the present study was to develop and psychometrically evaluate a context-based PSE instrument. Methods: Swedish mothers of five-year-old children (n = 698) responded to the Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors in Preschoolers Scale (PDAP) and a questionnaire on dietary and PA behaviors in children. Interviews were conducted to explore participant perceptions of the quality of the PDAP items. Psychometric evaluation was conducted using exploratory and confirmatory factor analyses. Spearman correlations between PSE and child behaviors were examined. Results: Twenty-seven interviews were conducted with participants, who perceived the items as highly comprehensible, relevant and acceptable. A four-factor model of a revised 21-item version of the PDAP fitted the data, with different factors of PSE for promoting healthy dietary or PA behaviors in children depending on whether circumstances were facilitating or impeding successful performance. Internal consistency was excellent for total scale (Cronbach's a = .94), and good for factors (a =. 8 4-.88). Correlations were in the expected direction: positive correlations between PSE and healthy behaviors, and negative correlations between PSE and unhealthy behaviors (all rss ≤ .32). Conclusions: Psychometric evaluation of the PDAP provided preliminary support of construct validity and internal consistency. [ABSTRACT FROM AUTHOR]

The family and home environment are important in shaping the dietary patterns of children, yet research among low-income, minority groups is limited. We examined ethnic differences in the home food environment and parental practices among 706 low-income, African-American and Hispanic families of preschoolers. Questionnaires measured the access and availability of various foods in the home, parental practices, and meal consumption behaviors. Mixed model logistic regression and ANCOVA were used to assess ethnic differences. Unhealthy foods were available for both groups. Hispanic families were more likely to have fresh vegetables (AOR = 2.9, P ≤ 0.001), fruit (AOR = 2.0, P = 0.004), and soda available (AOR = 1.40, P = 0.001) compared to African-Americans. African-Americans families were more likely to restrict (AOR = 0.63, P ≤ 0.001) and reward with dessert (AOR = 0.69, P ≤ 0.001). Hispanic families consumed more family meals together ( P = 0.003) and less meals in front of the television ( P ≤ 0.006). Health promotion interventions should consider the behavioral differences between ethnicities. [ABSTRACT FROM AUTHOR]