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Background Parental mindfulness may be a novel intervention target for child obesity prevention. Objective To examine associations between maternal mindfulness and child body mass index z-score (BMIz). Methods In a secondary data analysis of pre-intervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n=105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. Results Children were M=53.7 (SD 7.5) months old, and mothers were M=31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β=-0.02 (SE 0.01), p=.027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (p=.016) and BMI at the trend level (p=.0595) at the trend level. Conclusions Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.

Background With one in eight preschoolers classified as obese in the USA, childhood obesity remains a significant public health issue. This study examined rural–urban differences in low-income preschoolers’ body mass index z-scores (BMIz), eating behaviors, dietary quality, physical activity (PA) and screen time. Methods Pre-intervention data from 572 preschooler-parent dyads participating in a randomized, controlled obesity prevention trial in the Midwest USA were analyzed. We examined the associations among living in rural versus urban areas, child BMIz and child obesity-related behaviors, including eating behaviors, dietary quality, PA and screen time. Results Rural children had higher BMIz, more emotional overeating behaviors and more time spent playing outdoors compared with urban children. We found no associations between children living in rural versus urban areas and dietary quality and screen time. Conclusions The study found that rural–urban differences in BMIz may start as early as 3–4 years of age, if not earlier. To reverse the weight-related health disparities between rural and urban low-income preschoolers, structural changes in rural locations and family supports around coping skills may be needed.

This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF.

OBJECTIVE Disparities in childhood obesity necessitate identification of risk-protective and risk- augmenting factors for young children experiencing socioeconomic adversity born with perinatal risk. Temperamental reactivity is a biological marker of susceptibility to environmental characteristics. This study tested whether temperamental reactivity moderated the relation between socioeconomic risk and children's body mass index (BMI). METHOD This study examined 100 Head Start preschoolers (Mage = 4.07 years, SD = 0.56) with perinatal risk, defined as preterm birth (PT

The current study evaluated the effectiveness of a home-based psychotherapeutic Infant Mental Health Home Visiting (IMH-HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24-month old (M = 9.8, SD = 8.4), who were initiating IMH-HV services with community mental health-based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q-sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH-HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose-response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community-based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.

BACKGROUND Behaviour problems and obesity are related but research findings have been inconclusive regarding the direction of effects. OBJECTIVES This study examined the cross-lagged associations between behaviour problems, body mass index (BMI) and obesity in preschoolers, and whether sex modified these associations. METHODS Repeated measures of teacher-reported externalizing (EXT) and internalizing behaviour problems (clinically significant T scores were >90th percentile), BMI z-scores (BMI-Z) and obesity status (BMI ≥95th for age and sex) were assessed in the fall (T1) and spring (T2) of the school year in Head Start preschoolers (N = 423). Associations were examined with cross-lagged modelling. RESULTS Prospective paths from T1 clinically significant EXT to both T2 BMI-Z (β = .05) and obesity (β = .18) were significant. There was no evidence that T1 BMI-Z or obesity preceded T2 behaviour problems. However, sex-specific models indicated that T1 BMI-Z was prospectively associated with higher T2 EXT for boys (β = .13), but not girls. T1 EXT was predictive of subsequent BMI-Z (β = .09) and obesity (β = .33) at T2 for girls only. CONCLUSION Findings suggest that behaviour problems, particularly externalizing behaviours, are prospectively related to childhood obesity, and early prevention methods should reflect sex-specific modifications.

Although dispositional mindfulness has recently been linked to high quality teaching practices, there is limited work on how mindfulness is related to caregiving beliefs and practices with infants and toddlers. Based on survey responses from 618 preservice students enrolled in child development/early education classes at nine US universities, we examined associations between mindfulness and students’ beliefs, knowledge, and practices with infants and toddlers. Preservice students with greater self-reported mindfulness reported stronger beliefs about reflective practices and more mindful interactions with others, particularly interactions characterized by intentional kindness, greater child development knowledge, and more developmentally supportive responses to infants’/toddlers’ needs during common challenging situations. Results underscore the associations between mindfulness and developmentally supportive beliefs and practices and highlight burgeoning research on the role of mindfulness in high-quality early childhood teaching. Results also suggest the potential value of incorporating mindfulness training as part of professional development efforts related to early childhood teacher training.

Objective Assessment of pediatric behavior problems often requires rating scales from multiple reporters in different settings (eg, home and school); however, concordance between reporters may be low. Pediatricians must reconcile differences to inform treatment. We sought to examine characteristics predicting parent–teacher concordance on ratings of preschoolers' behavior problems. Methods Data from 562 preschoolers were used from the Growing Healthy study, an obesity prevention trial in Head Start programs (2011–2015). Parents and teachers completed the Eyberg Child Behavior Inventory (ECBI)/Student Behavior Inventory (SBI) and the Social Competence and Behavior–Evaluation (SCBE). Outcome variables were: parent–teacher concordance (teacher minus parent score on each subscale of ECBI/SBI and SCBE); teacher reports problem behavior, parent does not (children rated in the top quintile of challenging behavior by teacher but not parent); and parent reports problem behavior, teacher does not (children rated in the top quintile of challenging behavior by parent but not teacher). Multiple linear and logistic regression models were created for each subscale outcome, including the following covariates: child sex, child race/ethnicity, parent age, parent education, family structure, parent depressive symptoms, and parenting self-efficacy, and time of school year. Results Lower concordance was associated with child female sex, and child black or Hispanic race/ethnicity; parent older age, lower education, more depressive symptoms, and greater self-efficacy; and beginning of school year. Conclusions Low parent–teacher concordance may reflect different perceptions of child behavior. Pediatricians could consider parent depressive symptoms, culture, and implicit bias when interpreting differences in behavior ratings by parents and teachers.

Objective Excessive screen media exposure in childhood is associated with parent-reported self-regulation difficulties. No studies have used laboratory-based or teacher-reported measures of child self-regulatory behaviors. This study examines cross-sectional associations between preschooler screen media exposure and multiple measures of self-regulatory behaviors. Methods Preintervention data were used from 541 preschoolers in the Growing Healthy study, an obesity prevention trial (2011-2015). Screen media exposure was measured by daily screen media exposure (hr/d), television (TV) in the bedroom, frequency of background TV, and TV with meals (1 = rarely/never, 4 = frequently). Child self-regulatory behaviors were measured by the following: child ability to delay gratification, a standardized waiting paradigm; teacher-reported Social Competence and Behavior Evaluation; and parent-reported difficult temperament on the Child Behavior Questionnaire (CBQ). Multivariate regression analyses modeled screen media exposure predicting each self-regulatory measure, adjusting for child age, sex, parent age, education, marital status, income-to-needs ratio, number of adults in household, parent depressive symptoms, and sensitivity. Results Children were aged 4.1 years (SD = 0.5), parents were aged 29.6 years (SD = 6.8), 48% had high school education or less, and 67% were married. Daily screen media exposure and background TV were associated with weaker observed self-regulation (β: -10.30 seconds for each hr/d media, -12.63 seconds for 1-point increase, respectively). Background TV and TV with meals were associated with greater parent-reported difficult temperament (β: 0.04 and 0.05 CBQ, respectively, for 1-point increase). Conclusion Greater screen media exposure had small but significant associations with weaker observed and parent-reported, but not teacher-reported, self-regulatory behaviors. Longitudinal studies are needed to determine the directionality of associations.

Background Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake. Methods This was a cross-sectional analysis of baseline data from a randomized controlled trial to prevent obesity among 506 preschoolers attending Head Start. Parents completed questionnaires to assess picky eating and child temperament. Three 24-hour dietary recalls were collected to assess dietary intake. Multivariate regression models assessed child, parent, and family predictors of picky eating; additional models tested adjusted associations of picky eating with child BMIz, dietary quality (measured using the Healthy Eating Index-2010), and micronutrient intake. Results Picky eating was predicted by male sex, older child age, and more difficult temperament but not race/ethnicity, maternal body mass index, maternal depressive symptoms, household food insecurity, or single parent home. Picky eating was not associated with child BMIz or micronutrient deficiencies; it was inversely associated with total Healthy Eating Index-2010 score and servings of whole fruit, total vegetables, greens and beans, and total protein foods. Conclusions Pediatric providers should support parents in expanding the number of healthy foods the child eats to improve dietary quality, but reassure parents that picky eating is not associated with children's weight status or micronutrient deficiencies.

Background Childhood maltreatment and harsh parenting can have lasting effects on young children’s development, and home visiting interventions provide critical opportunities to mitigate this risk. Objective This study aimed to examine associations between participation in the Michigan Model of Infant Mental Health Home Visiting (IMH-HV) and both harsh parenting and child abuse potential. Participants and Setting Participants were 76 mothers and their infants/toddlers (M age = 9.9 months at baseline) receiving IMH-HV with Community Mental Health Service Provider agencies in Michigan. Methods Data were collected at baseline (shortly after initiation of services), and 3, 6, 9, and 12 months post baseline assessment. Mothers provided demographic information and completed several questionnaire measures including the Brief Child Abuse Potential Inventory (BCAP). Harsh parenting was rated by a trained research assistant using subscales from the Home Observation of Measurement of the Environment (HOME). Treatment dosage was collected from IMH-HV clinicians. Results Mothers with higher numbers of IMH-HV visits showed lower levels of observed harsh parenting over the three time points in the study (estimate = 0.050, p = 0.002) and higher cumulative societal factors associated with oppression (SFAO) predicted higher harsh parenting over the three time points. A higher number of IMH-HV visits also predicted lower child abuse potential across the time points of the study (estimate = −0.78, p = 0.043), controlling for SFAO. Conclusions Participation in the Michigan Model of IMH-HV, delivered in the community, is associated with reductions in both harsh parenting and child abuse potential.

Children living in households that have recently become food insecure may be particularly vulnerable to adverse weight and dietary changes, but longitudinal studies examining these associations are lacking. Using data from 501 Head Start preschoolers from Michigan (48% male) who were followed during one school year as a part of a randomized obesity prevention trial, we examined changes in children's adiposity indices and dietary quality according to changes in household food insecurity. Household food insecurity change status was categorized as persistently food secure, became food secure, persistently food insecure, or became food insecure. Linear mixed effects models were used to estimate relative changes in BMI-for-age z scores (BAZ), triceps skinfolds-for-age z scores (TAZ), or diet quality (assessed with the 2010 Healthy Eating Index) over the school year according to food insecurity category. We found that girls from households that became food insecure over the year had a 0.21 unit higher gain in BAZ than girls from households that were persistently food secure, after adjustment for potential confounders (95% CI 0.02 to 0.39, P = 0.03). Girls from households that became food secure had improvements in dietary quality over the year compared to girls from persistently food insecure households (adjusted difference in Healthy Eating Index score change = 9.1 points; 95% CI 3.0 to 15.0; p = 0.003). There were no statistically significant associations with changes in TAZ. Among boys, there were no associations between changes in household food insecurity and changes in BAZ, TAZ, or dietary quality. In summary, we found that BMI and diet quality changes of Head Start preschool girls were correlated with short-term changes in household food insecurity. Continued research efforts should focus on identifying the most effective ways to promote the health of children in food insecure households, especially those who may have recently transitioned or are transitioning into food insecurity.

Objective While obesity prevention efforts emphasize the importance of healthy family meals, few studies have addressed instrumental barriers to family meals as an obesity prevention strategy. Therefore, our study objectives are to: Phase 1 - test the additive effects of six intervention components reflecting differing levels of supports for family mealtimes; identify components associated with family meals and dietary outcomes in a Screening Phase and Phase 2 - evaluate the identified components as an intervention in a randomized controlled trial in a Confirming Phase. Description Phase 1 (n = 499 children from Head Start/parents) analyses indicated that the provision of healthy meals and cookware/dinnerware sets was most robustly associated with mealtime frequency and dietary quality. In Phase 2, participants in the treatment condition receive two prepared meals delivered weekly by Meals on Wheels for 12 weeks and a comprehensive set of cookware/dinnerware. We have enrolled 58 pilot parent-child dyads (Mage parents = 31.12 years, SD = 7.97; Mage children = 4.21 years, SD = 0.52) who reflect a racially diverse, low-income sample. 75% of parents/27% of children are overweight/obese and 57% of families were food insecure at enrollment. Recruitment for an additional 250 children/parents is underway. Evaluation Given the small pilot, we utilized descriptive analyses of pre-post changes in mean scores, with Cohen's d compared to the control condition noted. The pilot intervention showed pre-post increases in the frequency of eating meals together (d = 0.13), increases in efficacy in mealtime planning (d = 0.27) and decreases in time barriers regarding meal preparation (d = -0.36). Children's body mass index z-score decreased in the treatment and control groups. Conclusion and Implications Preliminary pilot results suggest the provision of healthy, prepared meals may be related to greater frequency of family meals eaten together and improvements in perceived barriers to planning and preparing meals. At the conclusion of Phase 2, study results are expected to inform policy (e.g. where limited resources may be best allocated) and interventions (e.g. supports most effective in promoting family meals).

This study examined whether children's representations of parenting (perceptions of authoritative discipline and empathy) moderated the association between harsh punishment—including corporal punishment (CP) and verbal punishment (VP)—and children's emotion regulation at the age of five years. Participants were 559 low-income mother-child dyads. Maternal self-reports and home observations were used to measure punishment. Children's representations were assessed using the MacArthur Story Stem Battery. Children's emotion regulation was assessed by observer rating via the Leiter International Performance Scale–Revised. Hierarchical multiple regressions revealed that children's authoritative disciplinary representations moderated the effects of both VP and CP on children's emotion regulation. Empathic representations moderated the effects of VP only on children's emotion regulation. The current findings highlight the role of children's internal representations as potential protective factors in the context of harsher forms of punishment.

OBJECTIVES: To determine the effect of an intervention to improve emotional and behavioral self-regulation in combination with an obesity-prevention program on the prevalence of obesity and obesity-related behaviors in preschoolers. METHODS: This was a cluster-randomized intervention trial in Head Start (HS) classrooms conducted in each of 4 academic years from 2011 to 2015. Participants (697 children; 49% boys; mean age: 4.1 ± 0.5 years; 48% white, 30% African American, 12% Hispanic) were randomly assigned by classroom to 1 of 3 intervention arms: (1) HS + Preschool Obesity Prevention Series (POPS) + Incredible Years Series (IYS) (HS enhanced by the POPS [program targeting evidence-based obesity-prevention behaviors] and the IYS [program to improve children’s self-regulation]), (2) HS+POPS, or (3) HS. Primary outcomes were changes in prevalence of obesity, overweight/obesity, BMI z score, and teacher-reported child emotional and behavioral self-regulation; secondary outcomes were dietary intake, outdoor play, screen time, and parent nutrition knowledge and nutrition self-efficacy. RESULTS: HS+POPS+IYS improved teacher-reported self-regulation compared with HS+POPS (P < .001) and HS (P < .001), but there was no effect on the prevalence of obesity (16.4% preintervention to 14.3% postintervention in HS+POPS+IYS versus 17.3% to 14.4% in HS+POPS [P = .54] versus 12.2% to 13.0% in HS [P = .33]). There was no effect of HS+POPS compared with HS alone (P = .16). There was no effect on other outcomes except for sugar-sweetened beverage intake (HS+POPS+IYS resulted in a greater decline than HS; P = .005). CONCLUSIONS: An intervention for parents and children to improve HS preschoolers’ emotional and behavioral self-regulation in combination with an obesity-prevention curriculum did not reduce obesity prevalence or most obesity-related behaviors.

Background High intake of added sugar and sodium is a public health concern for preschool-aged children living in the US. Externalizing behavior may predict higher consumption of added sugar and/or sodium; however, previous studies have mostly been cross-sectional. The aim was to evaluate whether externalizing behavior is prospectively related to added sugar and intake in a sex-specific manner among preschoolers. Methods This was a secondary analysis of 524 preschool children (48% male) from Michigan who participated in an obesity prevention trial that occurred during one school year from 2011 to 2015. Teacher-assessed externalizing behaviors and three 24-h dietary recalls were completed at baseline and follow-up. We used linear mixed effects regression to evaluate the association between externalizing behavior at baseline and added sugar (% of total Calories) and sodium intake (mg/1000 Calories) at follow-up. In adjusted analysis, we included baseline income-to-needs ratio, child race/ethnicity, and baseline overweight status. All models were adjusted for total energy intake and accounted for clustering by classroom. Results Baseline externalizing behavior was positively associated with added sugar intake at follow-up among boys; after adjustment for confounders, every 5 points lower externalizing T-score (corresponding to higher externalizing behavior) was associated with a 0.6 higher percentage of added sugar per total Calories (95% CI 0.2 to 1.1; P value = 0.004). In contrast, girls with higher levels of externalizing behavior had lower consumption of added sugars; after confounder adjustment, every 5 points lower externalizing T-score was related to 0.6 lower percentage intake (95% CI -1.0 to −0.1; P value = 0.01). Baseline externalizing behavior was inversely associated with sodium intake at follow-up among boys. After potential confounder adjustment, for every 5 points lower externalizing behavior T-score, there was a 22 mg/1000 Cal lower sodium intake (95% CI -45 to 1; P value = 0.06). In contrast, after adjustment for confounders, every 5 points lower externalizing T-score among girls was related to 24 mg/1000 Cal higher sodium intake (95% CI 1 to 46; P value = 0.04). Conclusions Externalizing behavior among preschool-aged children was prospectively related to added sugar and sodium intake in a sex-dependent manner. Trial registration NCT01398358 Registered 19 July 2011. Electronic supplementary material The online version of this article (10.1186/s12966-017-0591-y) contains supplementary material, which is available to authorized users.

Background Early child weight gain predicts adolescent and adult obesity, underscoring the need to determine early risk factors affecting weight status and how risk factors might be mitigated. Socioeconomic status, food insecurity, caregiver depressive symptomology, single parenthood, and dysfunctional parenting each have been linked to early childhood weight status. However, the associations between these risk factors and children's weight status may be moderated by caregiver feeding styles (CFS). Examining modifiable factors buffering risk could provide key information to guide early obesity intervention efforts. Methods This analysis used baseline data from the Growing Healthy project that recruited caregivers/child dyads (N = 626) from Michigan Head Start programs. Caregivers were primarily non-Hispanic white (62%) and African American (30%). After using latent class analysis to identify classes of familial psychosocial risk, CFS was tested as a moderator of the association between familial psychosocial risk class and child body mass index (BMI) z-score. Results Latent class analysis identified three familial psychosocial risk classes: (1) poor, food insecure and depressed families; (2) poor, single parent families; and (3) low risk families. Interactive effects for uninvolved feeding styles and risk group indicated that children in poor, food insecure, and depressed families had higher BMI z-scores compared to children in the low risk group. Authoritative feeding styles in low risk and poor, food insecure, and depressed families showed lower child BMI z-scores relative to poor, single parent families with authoritative feeding styles. Conclusions Uninvolved feeding styles intensified the risk and an authoritative feeding style muted the risk conferred by living in a poor, food-insecure, and depressed family. Interventions that promote responsive feeding practices could help decrease the associations of familial psychosocial risks with early child weight outcomes.

Maternal and/or child-feeding behaviors and food choices may be important contributors to childhood obesity. We aimed to compare food patterns and mealtime behaviors and to determine predictors of frequent intake of nutrient-dense and energy-dense foods of low-income African American (AA; n = 199) and non-Hispanic White (NHW; n = 200) mother-toddlers dyads using a cross-sectional study. Energy-dense foods were consumed frequently by AA than NHW mother-toddler dyads. Mealtime TV watching for AA and being single for NHW mothers predicted toddlers' frequency of nutrient-dense food intake. These findings have implications for culturally relevant interventions aimed at obesigenic food behavior in low-income parents of toddlers.

We examined differences in male and female caregivers’ behavioral styles, and their use of negative or positive touch in noncompliance episodes with preschool-aged children that occurred in public settings. Coders reliably coded adult caregiver behavioral style (authoritarian-type, authoritative-type, and permissive-type), positive and negative touch, and children’s latency to comply, as well as the child’s demeanor at the end of the noncompliance event. Surprisingly, almost a quarter of all children were touched negatively by adults during these public episodes. Contrary to expectations based on self-report and laboratory studies, male caregivers were more likely to use touch in noncompliance episodes with children, and more likely to use positive touch, than female caregivers. Adult caregiver behavioral style, and positive versus negative touch were each related to children’s responses in the noncompliance episodes. This work extends the findings of earlier studies about adult caregiver behavioral styles and highlights the use of positive versus negative touch as an important behavioral context for compliance requests of young children. Further, child demeanor is a crucial measure of the success of parenting behavior in noncompliance episodes because it indexes behavior occurring after compliance occurs, but which has the potential to be a significant influence on family harmony. The use of naturalistic observational methodology is a suggested as a critical step in validating findings on harsh discipline and corporal punishment that rely on methods in which social desirability may be a confound.

Objective To ascertain maternal expectations and experiences with mealtimes and feeding of toddlers among low-income African American mothers in two mid- to large-size cities in the United States. Design Qualitative focus group study. Setting Two Early Head Start programme sites in a Midwestern state which serve low income families. Method Twenty-seven low-income African American mothers took part in two focus groups which were conducted by a facilitator, according to a semi-structured topic guide. Focus group data were supplemented with demographic family data. Results Four major themes emerged: (1) maternal perceptions of healthy toddlers, (2) maternal food choices for toddlers, (3) maternal expectations about toddler autonomy and self-regulation of feeding, and (4) mealtime context and interaction. Conclusions and implications Data provided examples of maternal expectations and experiences, suggesting the development of healthy feeding patterns among some toddlers and provided evidence of less healthy feeding patterns in others. Evidence of less healthy feeding patterns included limiting toddler autonomy and food regulation, and misinterpretation of normative toddler behaviours. Because parenting practices and perceptions have been reported to contribute to social and environmental influences of obesity, this research could aid development of culturally sensitive nutrition education interventions.

The purpose of this study was to determine the perspectives of health professionals on assisting low income mothers with infant feeding. Low income mothers interact with a variety of health professionals through medical care and public health programs. Mothers indicate that health professionals are an important source of infant feeding information; however, they also report this information to be conflicting or difficult to follow. Five focus groups were conducted with 36 health professionals (pediatricians, nurses, WIC professionals, and Cooperative Extension nutrition educators). Individual interviews were also conducted with WIC professionals who were unavailable to meet as a group. Focus groups and interviews were audio taped, transcribed, and analyzed for common content categories. Six major content categories emerged from focus groups and individual interviews with health professionals: (1) Mothers’ sources of infant feeding information, (2) Helping mothers deal with multiple sources of infant feeding advice, (3) Use of infant feeding recommendations by health professionals and their clients (4) Reasons mothers introduce cereal early to their infants (5) Mothers feeding infants in poor mealtime environments, and (6) Ways of providing education to mothers on infant feeding. Conclusions: A better understanding of health professionals’ perspectives on working with low income mothers on infant feeding will inform nutrition education for these mothers, and may also inform strategies to improve communication between mothers and health professionals, subsequently improving infant health.

Forty-six low-income adolescent mother-infant pairs (M age = 17.2 years) were randomly assigned at birth to a control (C) or an experimental group (E). All dyads were videotaped in teaching, play, and feeding sessions at entry visit, 3-month post-program visit, and a follow-up visit at 5-6 months. E mothers received weekly home visits to enhance maternal skills and sensitivity and were interviewed in depth regarding their own family-of-origin experiences. Maternal reflectivity about her own past proved significantly associated with sensitive and more growth enhancing parenting practices, as well as increased responsivity to infant distress.

Despite numerous studies on parenting stress suggesting negative influences on parent–child interactions and children's development, the majority of these studies focus on mothers' parenting stress with little or no acknowledgement of fathers. Using data from the National Early Head Start Research and Evaluation Project, this study examined (i) the effects of fathers' parenting stress during toddlerhood on children's language and cognitive outcomes when children are 3 years old (ii) whether the effects of fathers' parenting stress on children's language and cognitive development vary by child gender? Results from mixed linear models showed fathers' parenting stress predicted children's lower cognitive scores, but there were no gender differences in the effects of fathers' parenting stress on children's cognitive outcomes. In the language domain, boys, not girls, were found to be more susceptible to the effects of fathers' parenting stress. These findings indicated that fathers, in addition to mothers, should be included in early parenting research and interventions. Copyright © 2016 John Wiley & Sons, Ltd.

To examine maternal demographic characteristics and depressive symptoms as predictors of TV viewing during mealtimes, and to investigate how mealtime TV viewing predicts mothers' and toddlers' food consumption. A prospective, cross-sectional survey design was employed with 199 African American and 200 Caucasian, low-income, mother-toddler dyads enrolled in eight Early Head Start programs in a Midwestern state. Mothers completed the Toddler-Parent Mealtime Behavior Questionnaire to assess toddler mealtime behavior. Data were analyzed using a three-step multiple regression: (a) step one was to determine what characteristics predicted family TV viewing during mealtime; (b) step two was to determine whether TV viewing during mealtime predicted maternal food consumption, and (c) step three was to determine whether TV viewing during mealtime predicted toddler food consumption. Direct and indirect effects of TV watching were explored via path models. Maternal race, education, and depressive symptoms predicted 8% of the variance in TV viewing during mealtime (Por = 0.001). African American mothers and mothers who had fewer years of schooling and exhibited more depressive symptoms tended to watch more TV during mealtime. More TV viewing during mealtime predicted mothers' intake of 'more' unhealthy foods. Mothers' food consumption was the single best predictor of toddlers' food consumption, while TV viewing during mealtime had an indirect effect through mothers' TV viewing. TV viewing practices affect mothers' food consumption and mealtime behaviors; this, in turn, impacts toddlers' food consumption. Practical interventions are needed to positively influence the nutritional habits of lower-income mothers. Reducing mothers' "unhealthy" food consumption while watching TV may offer one effective strategy.

The early introduction of solids to infants is a risk factor associated with later health problems including allergies, overweight, and diabetes. The Infant Feeding Series (TIFS), a newly designed curriculum that promotes the appropriate transition to solids through parenting education and behavior change among low-income mothers, used the Theory of Planned Behavior and the Transtheoretical Model of Change to develop TIFS curricular foci and activities. Using a pre-post design, pilot study results indicate that after exposure to the TIFS curriculum, mothers had significantly increased knowledge about appropriate infant feeding, could more accurately identify developmental indicators of infants’ readiness for solids, and reported greater feelings of self efficacy about initiating and maintaining healthy feeding practices. Editors’ Strategic Implications: Replication is necessary, but TIFS appears to be a promising prevention program based on short-term knowledge and long-term behavioral outcomes (i.e., healthy feeding practices).

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4-6 months of age (Kleinman, 2004). This study's purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed.

Objective: Evaluate effectiveness of the Healthy Babies (HB) intervention compared to a control group on maternal responsiveness, feeding style, and feeding practices, and compare infant feeding self-regulation and growth pattern of infants. Description: The HB Curriculum is a series of 6 in-home lessons and 3 follow-up telephone contacts, based on the Theory of Planned Behavior. Evaluation: Preliminary results (N 1⁄4 170) showed significant positive results related to pressuring to eat cereal, responding to infant fullness cues, and feeding knowledge. Conclusions and Implications: Preventive feeding interventions are necessary during age-appropriate transition to solid foods. Funding: USDA Grant # 2009-55215-05220. Other Funding/Support: Michigan State University (MSU), College of Nursing, MSU Families and Communities Together, MSUE EFNEP, and CSUE EFNEP.

Description: Five year, tri-state, quasi-experimental project. One control and one intervention community from each state are responsible for creating and implementing one nutrition and one physical activity program addressing overweight and obesity among 6th to 8th grade youth. Evaluation: Baseline environmental assessments were conducted in all communities. Focus groups were conducted in intervention communities. Data from baseline assessments and focus groups will be used to develop a questionnaire to capture youth health behaviors, determinants of behaviors, and youth engagement and empowerment. Conclusion and Implications: Identifying a potential framework for creating community-focused, sustainable and effective adolescent obesity prevention programs.

Objective: To evaluate a culturally sensitive healthful eating and activity program for Latinas based on a Health at Every Size (non-dieting) approach. Design, Setting and Participants: Single-group design. Participants were 72 females self-identifying as Latino/ Hispanic recruited at community sites. Seventy completed the program and provided post data; 62 provided follow-up data. Intervention: 8-weekly 1-hour classes in community settings, conducted in Spanish, including body image, healthful eating, physical activity, signs of hunger and fullness, self-confidence and social support. Outcome Measures and Analysis: Assessments, pre (week 0), post (week 9) and follow-up (week 18) included height and weight (BMI was calculated), daily cups of fruit and vegetables (FV) (NCI FV Screener), fat intake (NCI Fat Scan), minutes walking/week(IPAQ), cognitive restraint, emotional eating and uncontrolled eating subscales of the TFEQ. Data are presented for subjects completing followup. Repeated measures ANOVA was used with post-hoc comparisons between time points. Results: Mean age 3819 years; acculturation low (mean 1.4810.7; 5-point scale). BMI decreased (baseline mean 29.815.5; follow-up mean 29.215.2; p 0.001), fat intake decreased by 2% kcal (p 0.05), walking increased by 105 minutes/week (p 0.001), TFEQ uncontrolled eating decreased by 3.6% (p 0.001) and emotional eating decreased by 9.6% (p 0.001). TFEQ cognitive restraint increased at post but was not different from baseline at follow-up; FV intake was unchanged. Conclusions and Implications: This culturally sensitive program appeared to be effective in improving dietary and exercise behaviors as well as cognitive factors associated with eating which was reflected in a decrease in BMI among overweight Latinas. Supported by RI Ag. Experiment Station, grant #RH00131.

Background Nearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity. Methods/design The Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction. Discussion The Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children. Trial registration number Clinicaltrials.gov Identifier: NCT01398358

Background Poor feeding practices during infancy contribute to obesity risk. As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages. The Healthy Babies trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention is being conducted during the infant's first 6 months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior. Methods/Design We will describe our study protocol for a multisite randomized control trial being conducted in Colorado and Michigan with an anticipated sample of 372 economically and educationally disadvantaged African American, Hispanic, and Caucasian mothers with infants. Participants are being recruited by county community agency staff. Participants are randomly assigned to the intervention or the control group. The intervention consists of six in-home visits by a trained paraprofessional instructor followed by three reinforcement telephone contacts when the baby is 6, 8, and 10 months old. Main maternal outcomes include a) maternal responsiveness, b) feeding style, and c) feeding practices. Main infant outcome is infant growth pattern. All measures occur at baseline and when the infant is 6 and 12 months old. Discussion If this project is successful, the expected outcomes will address whether the home-based early nutrition education intervention is effective in helping mothers develop healthy infant feeding practices that contribute to improving infant health and development and reducing the risk of early-onset childhood obesity. Trial Registration Current Controlled Trials ACTRN126100000415000