185 results on '"Jennifer S. Savage"'
Search Results
2. Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial
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Lisa Bailey-Davis, Amy M. Moore, Melissa N. Poulsen, David A. Dzewaltowski, Stacey Cummings, Laina R. DeCriscio, Jennifer Franceschelli Hosterman, Daniel Huston, H. Lester Kirchner, Shawnee Lutcher, Carolyn McCabe, Gregory J. Welk, and Jennifer S. Savage
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Preschool-age ,Rural ,low-income ,Obesity ,Primary care ,Patient centered outcome ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Obesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour). Methods A total of 2,025 parents and their preschool-aged children (20–60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO—the Family Nutrition and Physical Activity (FNPA) risk assessment—from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child’s electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures. Discussion Study findings will inform health care systems’ choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors. Trial registration ClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.
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- 2022
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3. Sleep SAAF responsive parenting intervention improves mothers’ feeding practices: a randomized controlled trial among African American mother-infant dyads
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Erika Hernandez, Justin A. Lavner, Amy M. Moore, Brian K. Stansfield, Steven R. H. Beach, Jessica J. Smith, and Jennifer S. Savage
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Responsive parenting ,Prevention ,African American ,Infancy ,Feeding practices ,Childhood obesity ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background/Objective Parents shape children’s early experiences with food, influencing what is served, children’s food choices, and how much children eat. Responsive parenting (RP) interventions such as INSIGHT have improved maternal infant feeding practices, but have only been tested among predominantly White families. This secondary analysis of data from the Sleep SAAF (Strong African American Families) RCT tests the effects of an RP intervention designed to prevent rapid infant weight gain on African American mothers’ infant feeding practices. Methods Primiparous African American mother-infant dyads (n = 194) were randomized to an RP or safety control intervention delivered by community research associates at infant age 3 and 8 weeks. At 16 weeks, mothers completed the Babies Need Feeding questionnaire, the Infant Feeding Styles Questionnaire, and the Babies Need Soothing questionnaire. Logistic regression and general linear models examined the effect of study group on infant feeding practices. Moderation analyses explored whether effects varied by feeding mode (any breast milk versus exclusive formula), maternal age (≥ 20 years versus
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- 2022
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4. Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
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Awathif Dhanya Mackeen, Amanda J. Young, Shawnee Lutcher, Vonda Hetherington, Jacob W. Mowery, Jennifer S. Savage, Danielle Symons Downs, and Lisa Bailey‐Davis
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gestational weight gain ,nutrition counseling ,obesity ,pregnancy ,Internal medicine ,RC31-1245 - Abstract
Abstract Trial Design Excessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC). Methods A randomized controlled trial was conducted to improve healthy lifestyle behaviors to manage appropriate GWG. Consenting participants with prepregnancy obesity and singletons ≤17 weeks were randomized to (1) Usual Care (UC): usual written educational materials and counseling by obstetric provider or (2) Enhanced Care (EC): UC plus (a) personalized letter from physician detailing appropriate GWG; (b) access to individualized GWG chart; (c) ongoing counseling with registered dietitian/nutritionist (RDN). The primary outcome was proportion with GWG ≤9.1 kg, as this is upper limit recommended by Institute of Medicine (IOM). Total GWG and GWG as less than/within/greater than IOM recommendations (in aggregate and stratified by obesity class), and pregnancy/neonatal outcomes were evaluated as secondary outcomes. Results Analyses included 105 participants in EC and 109 in UC arms. The groups had similar demographics: 46% with class I obesity, 26% class II, and 28% class III. There were no group differences for any GWG, pregnancy, or neonatal outcomes when analyzed in aggregate. As compared to those randomized to the EC arm, participants in UC arm with class I obesity gained 1.4 kg less and those with class II obesity were significantly more likely to gain within IOM guidelines (14.8% vs. 40.0%, adjusted p = 0.04). Participants with class III obesity randomized to EC arm were more likely to gain within IOM guidelines as compared to participants randomized to UC arm (29.0% vs. 6.7%, adjusted p = 0.02). Conclusion There were no differences in GWG observed between groups when analyzing participants in aggregate. However, a physician's letter detailing appropriate GWG, patient portal access to a personalized GWG chart, and RDN consultation were helpful for encouraging GWG within IOM guidelines for women with prepregnancy class III obesity. Women with class I or II obesity had better GWG outcomes without these additional interventions.
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- 2022
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5. A mixed methods study of siblings’ roles in maternal feeding practices in early childhood: an application of the learning from experience process
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Cara F. Ruggiero, Amy M. Moore, Michele E. Marini, Stephen R. Kodish, Susan M. McHale, and Jennifer S. Savage
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Responsive feeding ,Siblings ,Family systems ,Mixed methods ,Infancy ,Toddlerhood ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Firstborn children have higher rates of obesity compared to secondborns, perhaps due, in part, to differential feeding practices. Despite the centrality of siblings in family life and potential for influence, almost nothing is known about the role of siblings in parent feeding practices in early childhood. Methods Participants (n = 117) were mothers of consecutively born siblings. Firstborns participated in an RCT that compared a responsive parenting intervention designed for primary prevention of obesity against a safety control. Secondborns participated in an observational cohort. Multilevel models tested whether and how firstborn characteristics (temperament, appetite, rapid weight gain) at 16 weeks and 1 year were associated maternal feeding practices of secondborns in infancy at 16 weeks, 28 weeks, and 1 year (food to soothe) and at ages 1, 2, and 3 years (structure-and control-based feeding practices). A purposive subsample (n = 30) of mothers also participated in semi-structured interviews to further illuminate potential sibling influences on maternal feeding practices during infancy and toddlerhood. Results Firstborn characteristics did not predict secondborn feeding in infancy (all ps > 0.05). Firstborn negative affect, however, predicted mothers’ less consistent mealtime routines (b (SE) = − 0.27 (0.09); p = 0.005) and more pressure (b (SE) = 0.38 (0.12); p = 0.001). Firstborn appetite predicted mothers’ less frequent use of food to soothe (b (SE) = − 0.16 (0.07); p = 0.02) when secondborns were toddlers. Firstborn surgency, regulation, and rapid weight gain, however, did not predict secondborn feeding practices during toddlerhood (all ps > 0.05). Interviews with mothers revealed three ways that maternal experiences with firstborns informed feeding practices of secondborns: 1) Use of feeding practices with secondborn that worked for the firstborn; 2) Confidence came from firstborn feeding experiences making secondborn feeding less anxiety-provoking; and 3) Additional experiences with firstborn and other factors that contributed to secondborn feeding practices. Conclusions Some firstborn characteristics and maternal experiences with firstborns as well as maternal psychosocial factors may have implications for mothers’ feeding practices with secondborns. Together, these mixed methods findings may inform future research and family-based interventions focused on maternal feeding of siblings in early childhood.
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- 2022
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6. Editorial: Healthy eating and parenting messages to prevent obesity
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Lisa Bailey-Davis and Jennifer S. Savage
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dietary guidelines ,parent feeding ,obesity prevention ,socioeconomic status ,policy ,Public aspects of medicine ,RA1-1270 - Published
- 2023
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7. Urinary cortisol is lower in pregnant women with higher pre-pregnancy BMI
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Emily E. Hohman, Joshua M. Smyth, Katherine M. McNitt, Abigail M. Pauley, Danielle Symons Downs, and Jennifer S. Savage
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pregnancy ,cortisol ,stress ,obesity ,intensive longitudinal data ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Background/objectivesAlthough cortisol levels increase during normal pregnancy, particularly high levels of cortisol or stress have been associated with adverse maternal/child outcomes. Obesity is associated with altered cortisol metabolism, but there is limited information on pregnancy-related changes in cortisol in pregnant women with overweight/obesity. The objective of this study was to examine weekly measures of urinary cortisol and perceived stress throughout ~10-36 weeks gestation, if levels differ by pre-pregnancy BMI categories, and whether concurrent measures of urinary cortisol and perceived stress are associated.MethodsLongitudinal observational data from Healthy Mom Zone, a gestational weight management intervention, and an ancillary fetal growth study were combined. Pregnant women with normal (n=7), overweight (n=11), or obese (n=14) pre-pregnancy BMI were recruited at >8 weeks gestation. Overnight urinary cortisol and Perceived Stress Scale were measured weekly from ~10-36 weeks gestation.ResultsHigher pre-pregnancy BMI was associated with overall lower urinary cortisol throughout gestation, but rate of increase in urinary cortisol across pregnancy was similar across weight status groups. Women with obesity reported higher levels of overall perceived stress than normal weight women. Regardless of weight status, perceived stress was not associated with gestational age or cortisol.ConclusionsAlthough women with obesity reported higher perceived stress, they had lower urinary cortisol than women with normal BMI, and gestation-related increases in cortisol were similar across weight groups and unrelated to perceived stress, suggesting that physiological factors that drive increases in cortisol as pregnancy may outweigh effects of stress and adiposity.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03945266, identifier (NCT03945266)
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- 2023
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8. Patient-reported outcome measures can advance population health, but is access to instruments and use equitable?
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Carolyn F. McCabe, G. Craig Wood, Jennifer Franceschelli-Hosterman, William J. Cochran, Jennifer S. Savage, and Lisa Bailey-Davis
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patient-reported outcome measure (PROM) ,pediatric care settings ,social determinansts of health ,healthcare factors ,individual-level factors ,Pediatrics ,RJ1-570 - Abstract
Patient reported outcome measures (PROM) can engage patients and clinicians to improve health outcomes. Their population health impact may be limited by systematic barriers inhibiting access to completion. In this analysis we evaluated the association between individual parent/child characteristics and clinic factors with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire. Participants included parent-child dyads who presented at 14 pediatric clinics for regularly scheduled well-child visits (WCV) prior to age 26 months. EHL items include feeding practices, diet, play time, screen exposure, and sleep. Completion was categorized at patient- (i.e., parent-child dyad) and clinic-levels. Parents completed the 15-item EHL in the patient portal before arrival or in the clinic; ninety-three percent of EHL questionnaires were completed in the clinic vs. 7% in the patient portal. High-completers completed EHL for half of WCVs; low-completers completed at least once; and non-completers never completed. Clinics were classified by EHL adoption level (% high completion): High-adoption: >50%; Moderate-adoption: 10%–50%; and Low-adoption: 1 clinic site for WCV (OR = 1.83 [1.34, 2.50]), non-White birth mother (OR = 1.78 [1.28, 2.47]), and body weight
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- 2022
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9. Nutritional Status Differs by Prescription Opioid Use among Women of Reproductive Age: NHANES 1999–2018
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Emily E. Hohman, Tammy E. Corr, Sarah Kawasaki, Jennifer S. Savage, and Danielle Symons Downs
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prescription opioids ,preconception ,women ,nutritional status ,biomarkers ,NHANES ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Prescription opioid use among pregnant women has increased in recent years. Prenatal exposure to opioids and poor nutrition can both negatively impact maternal–fetal outcomes. The objective of this study was to characterize the nutrition and health status of reproductive-age women taking prescription opioids, compared to women not taking opioids. Using NHANES 1999–2018 data, non-pregnant women aged 20–44 years were classified as taking a prescription opioid in the last 30 days (n = 404) or unexposed controls (n = 7234). Differences in anthropometric, cardiovascular, hematologic, and micronutrient status indicators between opioid-exposed and unexposed women were examined. Opioid-exposed women were older, had lower income and education, and were more likely to be non-Hispanic White, to smoke, and to have chronic health conditions compared to unexposed women. In unadjusted analyses, several nutrition and health markers were significantly different between opioid exposure groups. After controlling for covariates, women taking opioids had higher odds of Class II (OR = 1.6, 95% CI = 1.1–2.3) or III obesity (OR = 1.6, 95% CI = 1.1–2.5), and lower levels of serum folate, iron, and transferrin saturation. Reproductive-age women taking prescription opioids may be at risk for poorer nutritional and cardiometabolic health. Future research is needed to explore whether nutritional status impacts maternal–fetal outcomes for women exposed to opioids during pregnancy.
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- 2023
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10. Short Nighttime Sleep Duration and High Number of Nighttime Awakenings Explain Increases in Gestational Weight Gain and Decreases in Physical Activity but Not Energy Intake among Pregnant Women with Overweight/Obesity
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Abigail M. Pauley, Emily E. Hohman, Krista S. Leonard, Penghong Guo, Katherine M. McNitt, Daniel E. Rivera, Jennifer S. Savage, and Danielle Symons Downs
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pregnancy ,sleep ,energy balance ,gestational weight gain ,energy intake ,physical activity ,Medicine - Abstract
Pregnant women are at a high risk for experiencing sleep disturbances, excess energy intake, low physical activity, and excessive gestational weight gain (GWG). Scant research has examined how sleep behaviors influence energy intake, physical activity, and GWG over the course of pregnancy. This study conducted secondary analyses from the Healthy Mom Zone Study to examine between- and within-person effects of weekly sleep behaviors on energy intake, physical activity, and GWG in pregnant women with overweight/obesity (PW-OW/OB) participating in an adaptive intervention to manage GWG. The overall sample of N = 24 (M age = 30.6 years, SD = 3.2) had an average nighttime sleep duration of 7.2 h/night. In the total sample, there was a significant between-person effect of nighttime awakenings on physical activity; women with >1 weekly nighttime awakening expended 167.56 less physical activity kcals than women with
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- 2020
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11. Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices
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Lori A. Francis, Brandi Y. Rollins, Kathleen L. Keller, Robert L. Nix, and Jennifer S. Savage
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self-regulation ,appetitive traits ,food approach ,food avoidance ,childhood obesity ,food parenting practices ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance (e.g., satiety responsiveness, slowness in eating) and food approach (e.g., enjoyment of food, food responsiveness). Children's body mass index z-score (BMIz) was calculated from measured height and weight. Parents' BMI and food parenting practices were also measured. Four profiles were identified that characterized children with dysregulated behavior, higher food approach and lower food avoidance (16%), dysregulated behavior but lower food approach and higher food avoidance (33%), regulated behavior but highest food approach and lowest food avoidance (16%), and highly-regulated behavior, lowest food approach and highest food avoidance (35%). Children's BMIz was highest in the profile consisting of children with dysregulated behavior, higher food approach and lower food avoidance. BMI was similar in the profile with children with regulated behavior but highest food approach and lowest food avoidance; children in this profile also had parents who reported the highest levels of controlling food parenting practices, and the lowest levels of parental modeling of healthy eating. Compared to all other profiles, children in the profile characterized by highly-regulated behavior, lowest food approach and highest food avoidance had the lowest BMIz and had parents who reported food parenting practices characterized by the highest levels of child control in feeding and the lowest levels of pressure to eat. These findings provide evidence of differing patterns of relations between self-regulation across behavioral and eating domains, and children's obesity risk may vary based on these different patterns.
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- 2022
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12. Validation of a Classroom Version of the Eating in the Absence of Hunger Paradigm in Preschoolers
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Emily E. Hohman, Katherine M. McNitt, Sally G. Eagleton, Lori A. Francis, Kathleen L. Keller, and Jennifer S. Savage
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eating in the absence of hunger ,disinhibited eating ,children ,measure ,eating behavior ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Eating in the absence of hunger (EAH), a measure of children's propensity to eat beyond satiety in the presence of highly palatable food, has been associated with childhood obesity and later binge eating behavior. The EAH task is typically conducted in a research laboratory setting, which is resource intensive and lacks ecological validity. Assessing EAH in a group classroom setting is feasible and may be a more efficient alternative, but the validity of the classroom assessment against the traditional individually-administered paradigm has not been tested. The objective of this study was to compare EAH measured in a classroom setting to the one-on-one version of the paradigm in a sample of Head Start preschoolers. Children (n = 35) from three classrooms completed both classroom and individual EAH tasks in a random, counterbalanced order. In the group condition, children sat with peers at their classroom lunch tables; in the individual condition, children met individually with a researcher in a separate area near their classroom. In both conditions, following a meal, children were provided free access to generous portions of six snack foods (~750 kcal) and a selection of toys for 7 min. Snacks were pre- and post-weighed to calculate intake. Parents completed a survey of their child's eating behaviors, and child height and weight were measured. Paired t-tests and intraclass correlation coefficients were used to compare energy intake between conditions, and correlations between EAH intake and child BMI, eating behaviors, and parent feeding practices were examined to evaluate concurrent validity. Average intake was 63.0 ± 50.4 kcal in the classroom setting and 53.7 ± 44.6 in the individual setting, with no significant difference between settings. The intraclass correlation coefficient was 0.57, indicating moderate agreement between conditions. Overall, the EAH protocol appears to perform similarly in classroom and individual settings, suggesting the classroom protocol is a valid alternative. Future studies should further examine the role of age, sex, and weight status on eating behavior measurement paradigms.
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- 2022
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13. Infant Food Responsiveness in the Context of Temperament and Mothers' Use of Food to Soothe
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Holly A. Harris, Amy M. Moore, Cara F. Ruggiero, Lisa Bailey-Davis, and Jennifer S. Savage
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appetite ,emotional feeding ,food to soothe ,food responsiveness ,infant feeding ,low income ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Parents' use of food to soothe an infants' non-hunger related distress may impair an infants' development of appetite self-regulation. Parents tend to use food to soothe if their infant has more ‘difficult' temperamental tendencies. However, the role of infant appetite in this association is unclear. This study investigates the moderating effect of infant food responsiveness on cross-sectional and prospective associations between infant temperament and mothers' use of food to soothe. Mothers (n = 200) from low-income households reported their infants' temperament (i.e., surgency, negative affect and regulation) and food responsiveness at age 4 months, and their use of food to soothe at age 4 and 6 months. Temperament × food responsiveness interactions on mothers' use of food to soothe were examined using general linear models, adjusting for covariates. Cross-sectional associations showed that mothers used more food to soothe at 4 months for infants who were lower in negative affect and higher in food responsiveness (negative affect × food responsiveness interaction: p = 0.03). Prospective associations showed that mothers used more food to soothe at 6 months for infants who were lower in regulation and higher in food responsiveness (infant regulation × food responsiveness interaction: p = 0.009). Other interactions were not significant. Infant food responsiveness was consistently associated with mothers' use of food to soothe, independent of some temperamental dimensions. The findings highlight the salience of infant food responsiveness, both independent of and in association with temperament, on mothers' use of food to soothe.
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- 2022
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14. Sorry Parents, Children Consume High Amounts of Candy before and after a Meal: Within-Person Comparisons of Children’s Candy Intake and Associations with Temperament and Appetite
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Erika Hernandez, Amy M. Moore, Brandi Y. Rollins, Alison Tovar, and Jennifer S. Savage
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eating in the absence of hunger ,temperament ,appetite ,candy ,Pediatrics ,RJ1-570 - Abstract
Candy provides little nutritional value and contributes to children’s energy intake from added sugars. Factors influencing children’s candy intake remain largely unknown. This study describes children’s total candy intake (kcal) before and after a meal and examines associations of candy intake in both conditions with children’s temperament and appetite among a predominantly White, highly educated sample. Children (n = 38, age 5–8 years) were given free access to 11 candies (5 chocolate, 6 non-chocolate) and non-food alternatives during a pre-meal and a post-meal condition. Parents completed the Child Behavior Questionnaire and the Child Eating Behavior Questionnaire. Total candy intake was less when offered after a meal (209.3 kcal; SD = 111.25) than before a meal when still hungry (283.6 kcal; SD = 167.3), but not statistically different. Individual differences in candy intake between conditions was calculated to categorize children into three groups: “Better Regulators” consumed more candy before a meal (39%), “Consistent/Poorer Regulators” consumed similar amounts before and after a meal regardless of hunger (32%), and “Most Disinhibited” children consumed more candy after a meal when not hungry (29%). The “Better Regulators” group was lowest in negative affect and the “Consistent/Poorer Regulators” group was highest in food responsiveness. Children’s candy intake was high relative to daily energy needs both before and after a meal. Child negative affect and food responsiveness appear to be child characteristics that predispose children to poor self-regulation of candy intake before and after a meal.
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- 2022
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15. Ecological momentary assessment of using food to soothe during infancy in the INSIGHT trial
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Elizabeth L. Adams, Michele E. Marini, Timothy R. Brick, Ian M. Paul, Leann L. Birch, and Jennifer S. Savage
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Obesity prevention ,Responsive parenting ,Infant cry ,Infant fuss ,Infant feed ,Soothing strategies ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Use of food to soothe infant distress has been linked to greater weight in observational studies. We used ecological momentary assessment to capture detailed patterns of food to soothe and evaluate if a responsive parenting intervention reduced parents’ use of food to soothe. Methods Primiparous mother-newborn dyads were randomized to a responsive parenting intervention designed for obesity prevention or a safety control group. Responsive parenting curriculum included guidance on using alternative soothing strategies (e.g., swaddling), rather than feeding, as the first response to infant fussiness. After the initial intervention visit 3 weeks after delivery, mothers (n = 157) were surveyed for two 5–8 day bursts at infant ages 3 and 8 weeks. Surveys were sent via text message every 4 h between 10:00 AM-10:00 PM, with 2 surveys sent at 8:00 AM asking about nighttime hours. Infant fusses and feeds were reported for each 4-h interval. Food to soothe was defined as “Fed First” and “Not Fed First” in response to a fussy event. Use of food to soothe was modeled using random-intercept logistic regression. Results The control group had greater odds of having Fed First, compared to the responsive parenting group at ages 3 and 8 weeks (3 weeks: OR = 1.9; 95% CI = 1.4–2.7; p
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- 2019
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16. Underreporting of Energy Intake Increases over Pregnancy: An Intensive Longitudinal Study of Women with Overweight and Obesity
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Katherine M. McNitt, Emily E. Hohman, Daniel E. Rivera, Penghong Guo, Abigail M. Pauley, Alison D. Gernand, Danielle Symons Downs, and Jennifer S. Savage
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obesity ,gestational weight gain ,prenatal care ,eating behaviors ,stress ,mHealth ,Nutrition. Foods and food supply ,TX341-641 - Abstract
(1) Background: Energy intake (EI) underreporting is a widespread problem of great relevance to public health, yet is poorly described among pregnant women. This study aimed to describe and predict error in self-reported EI across pregnancy among women with overweight or obesity. (2) Methods: Participants were from the Healthy Mom Zone study, an adaptive intervention to regulate gestational weight gain (GWG) tested in a feasibility RCT and followed women (n = 21) with body mass index (BMI) ≥25 from 8–12 weeks to ~36 weeks gestation. Mobile health technology was used to measure daily weight (Wi-Fi Smart Scale), physical activity (activity monitor), and self-reported EI (MyFitnessPal App). Estimated EI was back-calculated daily from measured weight and physical activity data. Associations between underreporting and gestational age, demographics, pre-pregnancy BMI, GWG, perceived stress, and eating behaviors were tested. (3) Results: On average, women were 30.7 years old and primiparous (62%); reporting error was −38% ± 26 (range: −134% (underreporting) to 97% (overreporting)), representing an ~1134 kcal daily underestimation of EI (1404 observations). Estimated (back-calculated), but not self-reported, EI increased across gestation (p < 0.0001). Higher pre-pregnancy BMI (p = 0.01) and weekly GWG (p = 0.0007) was associated with greater underreporting. Underreporting was lower when participants reported higher stress (p = 0.02) and emotional eating (p < 0.0001) compared with their own average. (4) Conclusions: These findings suggest systemic underreporting in pregnant women with elevated BMI using a popular mobile app to monitor diet. Advances in technology that allow estimation of EI from weight and physical activity data may provide more accurate dietary self-monitoring during pregnancy.
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- 2022
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17. Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother–Infant Dyads
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Amy M. Moore, Jessica J. Smith, Brian K. Stansfield, Jennifer S. Savage, and Justin A. Lavner
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breastfeeding ,breast milk ,human milk ,infant feeding ,African American ,Sleep SAAF ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The health benefits of breast milk feeding have been well-established, yet disparities exist, with African American mothers having the lowest breast milk feeding rates in the United States. This prospective, longitudinal study examined infant feeding (breast milk and/or infant formula) from birth to age 16 weeks, predictors of any breast milk feeding by age 1 week, and predictors of cessation of any breast milk feeding by ages 3, 8, and 16 weeks among primiparous African American mothers. This secondary analysis included 185 mother–infant dyads from the Sleep SAAF (Strong African American Families) study, a randomized clinical trial testing a responsive parenting vs. child safety control intervention. Mothers reported sociodemographic and psychosocial characteristics at age 1 week and infant feeding practices at ages 1, 3, 8, and 16 weeks. Rates of any breast milk feeding decreased from 66.5% at 1 week to 23.3% at 16 weeks. Bivariate logistic regression models showed that prepregnancy BMI (OR = 1.09), working prepregnancy (OR = 2.25), and food insecurity (OR = 2.49) significantly increased the odds of mothers feeding any breast milk by 1 week, whereas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation (OR = 0.21) significantly decreased the odds. Bivariate logistic regression models showed that Supplemental Nutrition Assistance Program (SNAP) participation (OR = 2.86) and racial discrimination (OR = 2.14) significantly increased the odds of cessation of any breast milk feeding by 3 weeks. SNAP (OR = 2.33) and WIC (OR = 2.38) participation significantly increased the odds of cessation of any breast milk feeding by 8 weeks, whereas higher prepregnancy BMI (OR = 0.95) decreased the odds. Higher mother’s age (OR = 0.92) significantly decreased the odds of cessation of any breast milk feeding by 16 weeks. The findings can be used to inform targeted interventions to promote mothers feeding any breast milk and help reduce breast milk feeding disparities among African American mothers.
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- 2022
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18. Dieting is associated with reduced bone mineral accrual in a longitudinal cohort of girls
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Emily E. Hohman, Katherine N. Balantekin, Leann L. Birch, and Jennifer S. Savage
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Eating behavior ,Dieting ,Children ,Adolescence ,Bone ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Peak bone mass accrual occurs during adolescence, a time when dieting and related eating behaviors are common. Impaired bone mineral accrual is a known consequence of eating disorders in adolescents, but the effects of subclinical dieting behaviors on bone mineral content (BMC) have not been described in this age group. The goal of this analysis was to determine whether dieting behavior in preadolescence and adolescence is associated with bone mineral accrual in adolescent girls. Methods Non-Hispanic white girls (n = 139) were followed in a longitudinal cohort study. BMC was assessed at ages 9 and 15y. Dieting to lose weight was reported every 2 years, and dietary restraint and disinhibition, eating attitudes, weight concerns, and body esteem were assessed at age 11y. Girls were classified as “early dieters” if they first dieted by age 11y (31.7%), “adolescent dieters” if they first dieted after 11y (46.8%), or non-dieters if they did not report dieting by 15 y (21.6%). The effect of dieting related variables on BMC at 15y and change in BMC from 9 to 15y was assessed using linear regression, controlling for height, weight, BMI, physical activity, and pubertal status. Results Girls who first reported dieting to lose weight by age 11y had a 4.2% lower bone mineral accrual across adolescence (p = 0.02) and 3.1% lower BMC at age 15y (p = 0.005) than girls who first reported dieting after 11y or not at all. Number of weight control behaviors used, dietary restraint, and weight concerns were also negatively associated with BMC (p
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- 2018
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19. The Relative Reinforcing Value of Cookies Is Higher Among Head Start Preschoolers With Obesity
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Sally G. Eagleton, Jennifer L. Temple, Kathleen L. Keller, Michele E. Marini, and Jennifer S. Savage
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reinforcing value of food ,obesity ,energy density ,children ,low-income ,food insecurity ,Psychology ,BF1-990 - Abstract
The relative reinforcing value (RRV) of food measures how hard someone will work for a high-energy-dense (HED) food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED (cookies) to low-energy-dense (LED; fruit) food would be greater in children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics (i.e., age, sex, and reward sensitivity) and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached (breakpoint) for cookies (cookie Pmax) and fruit (fruit Pmax), the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined (RRV cookie), and response rates (responses per minute). Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson’s correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores (BMIZ). Statistical significance was defined as p < 0.05. Children with obesity (17%) had a greater cookie Pmax [F (1, 121) = 4.95, p = 0.03], higher RRV cookie [F (1, 121) = 4.28, p = 0.04], and responded at a faster rate for cookies [F (1, 121) = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ (r = 0.26, p < 0.01); and RRV cookie was positively associated with BMIZ for older children (5-year-olds: t = 2.40, p = 0.02) and boys (t = 2.55, p = 0.01), but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood.
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- 2021
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20. Child Weight Gain Trajectories Linked To Oral Microbiota Composition
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Sarah J. C. Craig, Daniel Blankenberg, Alice Carla Luisa Parodi, Ian M. Paul, Leann L. Birch, Jennifer S. Savage, Michele E. Marini, Jennifer L. Stokes, Anton Nekrutenko, Matthew Reimherr, Francesca Chiaromonte, and Kateryna D. Makova
- Subjects
Oral Microbiota ,Rapid Infant Weight Gain ,Linear Discriminant Analysis Effect Size (LEfSe) ,Diet-related Variables ,Microbiota Samples ,Medicine ,Science - Abstract
Abstract Gut and oral microbiota perturbations have been observed in obese adults and adolescents; less is known about their influence on weight gain in young children. Here we analyzed the gut and oral microbiota of 226 two-year-olds with 16S rRNA gene sequencing. Weight and length were measured at seven time points and used to identify children with rapid infant weight gain (a strong risk factor for childhood obesity), and to derive growth curves with innovative Functional Data Analysis (FDA) techniques. We showed that growth curves were associated negatively with diversity, and positively with the Firmicutes-to-Bacteroidetes ratio, of the oral microbiota. We also demonstrated an association between the gut microbiota and child growth, even after controlling for the effect of diet on the microbiota. Lastly, we identified several bacterial genera that were associated with child growth patterns. These results suggest that by the age of two, the oral microbiota of children with rapid infant weight gain may have already begun to establish patterns often seen in obese adults. They also suggest that the gut microbiota at age two, while strongly influenced by diet, does not harbor obesity signatures many researchers identified in later life stages.
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- 2018
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21. A patient-centered, coordinated care approach delivered by community and pediatric primary care providers to promote responsive parenting: pragmatic randomized clinical trial rationale and protocol
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Jennifer S. Savage, Samantha M. R. Kling, Adam Cook, Lindsey Hess, Shawnee Lutcher, Michele Marini, Jacob Mowery, Shannon Hayward, Sandra Hassink, Jennifer Franceschelli Hosterman, Ian M. Paul, Chris Seiler, and Lisa Bailey-Davis
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Early obesity prevention ,Responsive parenting ,Health information technology ,Coordination of care ,The special supplemental women ,Infants ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Economically disadvantaged families receive care in both clinical and community settings, but this care is rarely coordinated and can result in conflicting educational messaging. WEE Baby Care is a pragmatic randomized clinical trial evaluating a patient-centered responsive parenting (RP) intervention that uses health information technology (HIT) strategies to coordinate care between pediatric primary care providers (PCPs) and the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) community nutritionists to prevent rapid weight gain from birth to 6 months. It is hypothesized that data integration and coordination will improve consistency in RP messaging and parent self-efficacy, promoting shared decision making and infant self-regulation, to reduce infant rapid weight gain from birth to 6 months. Methods/design Two hundred and ninety mothers and their full-term newborns will be recruited and randomized to the “RP intervention” or “standard care control” groups. The RP intervention includes: 1) parenting and nutrition education developed using the American Academy of Pediatrics Healthy Active Living for Families curriculum in conjunction with portions of a previously tested RP curriculum delivered by trained pediatric PCPs and WIC nutritionists during regularly scheduled appointments; 2) parent-reported data using the Early Healthy Lifestyles (EHL) risk assessment tool; and 3) data integration into child’s electronic health records with display and documentation features to inform counseling and coordinate care between pediatric PCPs and WIC nutritionists. The primary study outcome is rapid infant weight gain from birth to 6 months derived from sex-specific World Health Organization adjusted weight-for-age z-scores. Additional outcomes include care coordination, messaging consistency, parenting behaviors (e.g., food to soothe), self-efficacy, and infant sleep health. Infant temperament and parent depression will be explored as moderators of RP effects on infant outcomes. Discussion This pragmatic patient-centered RP intervention integrates and coordinates care across clinical and community sectors, potentially offering a fundamental change in the delivery of pediatric care for prevention and health promotion. Findings from this trial can inform large scale dissemination of obesity prevention programs. Trial registration Restrospective Clinical Trial Registration: NCT03482908. Registered March 29, 2018.
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- 2018
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22. INSIGHT responsive parenting intervention and infant feeding practices: randomized clinical trial
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Jennifer S. Savage, Emily E. Hohman, Michele E. Marini, Amy Shelly, Ian M. Paul, and Leann L. Birch
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Obesity prevention ,Infancy ,Responsive parenting ,Feeding practices and styles ,Bottle-feeding and diet ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background What, when, how, how much, and how often infants are fed have been associated with childhood obesity risk. The objective of this secondary analysis was to examine the effect of a responsive parenting (RP) intervention designed for obesity prevention on parents’ infant feeding practices in the first year after birth. Methods Primiparous mother-newborn dyads were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study RP intervention or child safety control. Research nurses delivered intervention content at home at infant age 3–4, 16, 28, and 40 weeks, and at a research center at 1 year. RP feeding guidance advised feeding that was contingent (i.e., feed in response to hunger and satiety signs, alternatives to using food to soothe), and developmentally appropriate (i.e., delaying introduction of solids, age-appropriate portion sizes). Infant feeding practices (i.e., bottle use, introduction of solids, food to soothe) were assessed by phone interviews and online surveys and dietary intake was assessed using a food frequency questionnaire. Results RP mothers were more likely to use of structure-based feeding practices including limit-setting (p
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- 2018
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23. INSIGHT responsive parenting intervention reduces infant’s screen time and television exposure
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Elizabeth L. Adams, Michele E. Marini, Jennifer Stokes, Leann L. Birch, Ian M. Paul, and Jennifer S. Savage
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Obesity prevention ,Media use in children ,Infancy ,Tummy time ,Physical activity ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Sedentary behaviors, including screen time, in childhood have been associated with an increased risk for overweight. Beginning in infancy, we sought to reduce screen time and television exposure and increase time spent in interactive play as one component of a responsive parenting (RP) intervention designed for obesity prevention. Methods The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control intervention. Primiparous mother-newborn dyads (N = 279) were randomized after childbirth. Research nurses delivered intervention content at infant ages 3, 16, 28, and 40 weeks and research center visits at 1 and 2 years. As one component of INSIGHT, developmentally appropriate messages on minimizing screen time, reducing television exposure in the home, and promoting parent-child engagement through interactive play were delivered. Mothers self-reported their infant’s screen time at ages 44 weeks, 1, 1.5, 2 and 2.5 years; interactive play was reported at 8 and 20 weeks and 2 years. Results More RP than control parents reported their infants met the American Academy of Pediatrics’ no screen time recommendation at 44 weeks (53.0% vs. 30.2%) and at 1 year on weekdays (42.5% vs. 27.6%) and weekends (45.5% vs. 26.8%), but not after age 1 year. RP mothers and RP children had less daily screen time than controls at each time point (p ≤ 0.01). Fewer RP than control group mothers reported the television was ever on during infant meals (p
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- 2018
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24. Application of the multiphase optimization strategy to a pilot study: an empirical example targeting obesity among children of low-income mothers
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Kari C. Kugler, Katherine N. Balantekin, Leann L. Birch, and Jennifer S. Savage
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Factorial study design ,MOST ,Obesity ,Children ,Remotely delivered ,Low income ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Emerging approaches to building more efficient and effective behavioral interventions are becoming more widely available. The current paper provides an empirical example of the use of the engineering-inspired multiphase optimization strategy (MOST) to build a remotely delivered responsive parenting intervention to prevent obesity among children of low-income mothers with and without depressive symptoms. Methods Participants were 107 mothers with (n = 45) and without (n = 62) depressive symptoms who had a child aged 12 to 42 months participating in the Women, Infants and Children program. Participants were randomized to one of sixteen experimental conditions using a factorial design that included a combination of the following eight remotely delivered intervention components: responsive feeding curriculum (given to all participants), parenting curriculum, portion size guidance, obesogenic risk assessment, personalized feedback on mealtime routines, feeding curriculum counseling, goal setting, mobile messaging, and social support. This design enabled efficient identification of components with low feasibility and acceptability. Results Completion rates were high (85%) and did not statistically differ by depressive symptoms. However, mothers with depressive symptoms who received obesogenic risk assessment and personalized feedback on mealtime routines components had lower completion rates than mothers without depressive symptoms. All intervention components were feasible to implement except the social support component. Regardless of experimental condition, most participants reported that the program increased their awareness of what, when, and how to feed their children. Conclusions MOST provided an efficient way to assess the feasibility of components prior to testing them with a fully powered experiment. This framework helped identify potentially challenging combinations of remotely delivered intervention components. Consideration of how these results can inform future studies focused on the optimization phase of MOST is discussed.
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- 2016
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25. Caregiver’s Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families
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Lamis Jomaa, Muzi Na, Sally G. Eagleton, Marwa Diab-El-Harake, and Jennifer S. Savage
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food resource management ,food insecurity ,self-confidence ,nutrition education ,financial practices ,SNAP-Ed ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers’ self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.
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- 2020
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26. Gestational Weight Gain Intervention Impacts Determinants of Healthy Eating and Exercise in Overweight/Obese Pregnant Women
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Abigail M. Pauley, Emily Hohman, Jennifer S. Savage, Daniel E. Rivera, Penghong Guo, Krista S. Leonard, and Danielle Symons Downs
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Internal medicine ,RC31-1245 - Abstract
High gestational weight gain (GWG) in overweight/obese pregnant women increases maternal-fetal complications. We conducted a 6-week GWG intervention based on an energy balance model that includes theories of planned behavior (TPB) and self-regulation constructs to promote exercise and healthy eating motivation and behaviors. The purposes of this proof-of-concept feasibility study were to examine: (1) the energy balance model constructs over the intervention, and (2) pre-post intervention, weekly, and dose-response changes in study constructs. Methods. Overweight/obese pregnant women (N=17) were randomized to 1 of 6 conditions, increasing in intensity, and included varied combinations of components (exercise sessions, healthy eating demonstrations, etc.). Exercise and healthy eating TPB (attitude, subjective norm, perceived behavioral control, intention), and self-regulation (prospective, retrospective) constructs were collected weekly. Exercise behavior, energy intake, and GWG were collected daily. Results. We observed: (a) significant increases in exercise TPB constructs, healthy eating attitude (limit unhealthy foods), exercise/healthy eating retrospective self-regulation; (b) significant decrease in healthy eating subjective norm (limit unhealthy foods); (c) trending increases for healthy eating perceived behavioral control (limit unhealthy foods), healthy eating prospective self-regulation, and energy intake; (d) significantly higher active time, steps, and energy expenditure at W3 relative to other weeks; (e) no significant increase in GWG; and, (f) a dose response effect such that women in more intensive dosages had greater gains in exercise and healthy eating perceived behavioral control (eat healthy/limit unhealthy foods). Conclusion. Brief exposure to a theoretically-driven, GWG intervention resulted in changes to exercise and healthy eating TPB and self-regulation motivational determinants, no significant increase in GWG, and suggests intervention intensity can strengthen perceived ability to engage in exercise/healthy eating behaviors; offering initial proof-of-concept for the intervention to regulate GWG in overweight/obese pregnant women. Future research will test this intervention over the course of pregnancy to understand long-term impact on maternal-fetal health outcomes.
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- 2018
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27. Parents’ and Children’s Categorization of Candy are Similar: A Card Sort Protocol
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Jennifer S. Savage, Holly A. Harris, Julia A. Bleser, and Brandi Y. Rollins
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card sort ,candy intake ,children ,parents ,adults ,sweet snacks ,obesity prevention ,Nutrition. Foods and food supply ,TX341-641 - Abstract
American children frequently consume candy and, in excess, this may contribute to poor diets with attendant effects on obesity risk. Despite the ubiquity of candy in children’s diets, parental concern about children’s candy intake, and the diversity of confectionery products available, very little is known about how children and their parents conceptualize candy. Card sorting tasks offer a novel and visual technique to explore and compare an individuals’ perceptions of foods and are useful where literacy is limited (e.g. young children). This study aimed to understand and compare how young school-aged children and parents categorize various candy products using a photo card sorting task. In individual laboratory sessions, children (n = 42, 5 to 8 years old) and parents (n = 35) categorized 51 types of candy based on their similarity. A cluster analysis showed that parents created more categories of candies than children (11 versus 8). For example, parents distinguished between candied fruit and candied nuts, whereas children tended to collapse these categories. However, 7 clusters were virtually identical between parents and children (93% similarity). The findings from this study can inform the measurement of candy intake and the development of education materials targeted towards parent feeding around candy.
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- 2019
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28. Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial
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Jennifer S. Savage, Emily E. Hohman, Katherine M. McNitt, Abigail M. Pauley, Krista S. Leonard, Tricia Turner, Jaimey M. Pauli, Alison D. Gernand, Daniel E. Rivera, and Danielle Symons Downs
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pregnancy ,gestational weight gain intervention ,eating behavior ,restraint ,disinhibition ,uncontrolled and emotional eating ,fetal growth ,overweight and obesity ,generalized linear models ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Excess maternal weight gain during pregnancy elevates infants’ risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6–13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14–34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.
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- 2019
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29. System Identification Approaches for Energy Intake Estimation: Enhancing Interventions for Managing Gestational Weight Gain.
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Penghong Guo, Daniel E. Rivera, Jennifer S. Savage, Emily E. Hohman, Abigail M. Pauley, Krista S. Leonard, and Danielle S. Downs
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- 2020
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30. Effect of the INSIGHT Responsive Parenting Intervention on Parenting and Child Behavior at Ages 3 and 6 Years
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Sara Tauriello, Jennifer S. Savage, Juliana Goldsmith, Elizabeth Kubiniec, Ian M. Paul, and Stephanie Anzman-Frasca
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Pediatrics, Perinatology and Child Health - Published
- 2023
31. Optimizing behavioral interventions to regulate gestational weight gain with sequential decision policies using hybrid model predictive control.
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Penghong Guo, Daniel E. Rivera, Yuwen Dong, Sunil Deshpande, Jennifer S. Savage, Emily E. Hohman, Abigail M. Pauley, Krista S. Leonard, and Danielle Symons Downs
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- 2022
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32. Semi-physical identification and state estimation of energy intake for interventions to manage gestational weight gain.
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Penghong Guo, Daniel E. Rivera, Danielle S. Downs, and Jennifer S. Savage
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- 2016
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33. Development and Psychometric Properties of the Sleep Parenting Scale for Infants
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Susan Redline, Elsie M. Taveras, Kari C. Kugler, Jennifer S. Savage, Sebastien Haneuse, Brian Lo, Jess Haines, Kirsten K. Davison, and Melissa L. McTernan
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Psychiatry and Mental health ,Convergent validity ,Cronbach's alpha ,Scale (social sciences) ,Concurrent validity ,Measurement invariance ,Psychology ,Bedtime ,Applied Psychology ,Exploratory factor analysis ,Confirmatory factor analysis ,Developmental psychology - Abstract
Although infants' sleep behaviors are shaped by their interactions with parents at bedtime, few tools exist to capture parents' sleep parenting practices. This study developed a Sleep Parenting Scale for Infants (SPS-I) and aimed to (1) explore and validate its factorial structure, (2) examine its measurement invariance across mothers and fathers, and (3) investigate its reliability and concurrent and convergent validity. SPS-I was developed via a combination of items modified from existing scales and the development of novel items. Participants included 188 mothers and 152 mother-father dyads resulting in 340 mothers and 152 fathers; about half were non-Hispanic white. Mothers and fathers completed a 14-item SPS-I for their 12-month-old infant. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore and validate SPS-I's underlying structure. Multigroup CFA was used to examine measurement invariance across mothers and fathers. Reliability was examined using Cronbach's alpha. Concurrent validity was assessed using linear regressions examining associations between SPS-I factors and parent-reported infants nighttime sleep duration. Convergent validity was assessed using paired-sample t-tests to test whether the SPS-I subscale scores were similar between mothers and fathers in the same household. EFA and CFA confirmed a 3-factor, 12-item model: sleep routines, sleep autonomy, and screen media in the sleep environment. SPS-I was invariant across mothers and fathers and was reliable. Concurrent and convergent validity were established. SPS-I has good psychometric properties, supporting its use for characterizing sleep routines, sleep autonomy, and screen media in the sleep environment by mothers and fathers.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002799 .
- Published
- 2023
34. Direct sibling influence on eating behavior in early childhood: Siblings as role models and caregivers
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Cara F. Ruggiero, Amy M. Moore, and Jennifer S. Savage
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Pediatrics, Perinatology and Child Health - Published
- 2023
35. Sleep SAAF Responsive Parenting Intervention for Black Mothers Impacts Response to Infant Crying: A Randomized Clinical Trial
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Emily E. Hohman, Jennifer S. Savage, Brian K. Stansfield, and Justin A. Lavner
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Pediatrics, Perinatology and Child Health - Published
- 2023
36. Sleep parenting practices are associated with infant self-soothing behaviors when measured using actigraphy
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Elizabeth L. Adams, Lindsay Master, Orfeu M. Buxton, and Jennifer S. Savage
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Parenting ,Humans ,Infant ,Mothers ,Female ,General Medicine ,Wakefulness ,Sleep ,Actigraphy - Abstract
Night wakings are common during infancy, with variability in infant self-soothing or requiring parent involvement to fall back asleep. Reasons for variable soothing behaviors are unclear and may be influenced by early-life sleep parenting practices. The study applied a novel method using sleep actigraphy in mother-father-infant triads to quantify infant-only wake bouts (i.e., "self-soothing") and examined associations between sleep parenting practices from 6 to 24 weeks of age.Mother-father-infant triads (N = 20) wore sleep monitors for 1 week at infant ages 6, 15, and 24 weeks. Data were time-matched within families to quantify infant-only wake bouts (when infants woke in the night and parents remained asleep) to be indicative of infant self-soothing. Mothers reported on sleep parenting practices (e.g., feeding to sleep, putting infants to bed while awake) using the Brief Infant Sleep Questionnaire at each age. Mixed models tested associations between parenting practices and infant-only wake bouts.Most mothers (69.5%) reported typically feeding their infants to sleep at bedtime; 27.1% reported typically putting infants to bed while still awake. Parenting practices associated with a greater proportion and frequency of infant-only wake bouts included not typically feeding infants to sleep during night wakings, putting infants to bed while still awake (at 24 weeks of age), and using a greater proportion of low-, rather than high-, stimulus soothing strategies during night wakings.These data suggest parenting practices, such as putting infants to bed when drowsy but still awake, are important strategies for promoting infant self-soothing during night wakings.
- Published
- 2022
37. Hybrid model predictive control for sequential decision policies in adaptive behavioral interventions.
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Yuwen Dong, Sunil Deshpande, Daniel E. Rivera, Danielle S. Downs, and Jennifer S. Savage
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- 2014
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38. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions
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Asheley C. Skinner, Amanda E. Staiano, Sarah C. Armstrong, Shari L. Barkin, Sandra G. Hassink, Jennifer E. Moore, Jennifer S. Savage, Helene Vilme, Ashley E. Weedn, Janice Liebhart, Jeanne Lindros, and Eileen M. Reilly
- Subjects
Pediatrics, Perinatology and Child Health - Abstract
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are clinically based, effective treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori key questions.
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- 2023
39. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities
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Asheley C, Skinner, Amanda E, Staiano, Sarah C, Armstrong, Shari L, Barkin, Sandra G, Hassink, Jennifer E, Moore, Jennifer S, Savage, Helene, Vilme, Ashley E, Weedn, Janice, Liebhart, Jeanne, Lindros, and Eileen M, Reilly
- Subjects
Pediatrics, Perinatology and Child Health - Abstract
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are effective clinically based treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori Key Questions.
- Published
- 2023
40. Coordination between Primary Care and Women, Infants, and Children to Prevent Obesity for Infants from Low-Income Families: A Pragmatic Randomized Clinical Trial
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Jennifer S. Savage, Amy M. Moore, Samantha M.R. Kling, Michele Marini, Erika Hernandez, Jennifer Franceschelli Hosterman, Sandra Hassink, Ian M. Paul, and Lisa Bailey-Davis
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Nutrition and Dietetics ,Endocrinology, Diabetes and Metabolism ,Pediatrics, Perinatology and Child Health - Published
- 2022
41. Hybrid model predictive control for optimizing gestational weight gain behavioral interventions.
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Yuwen Dong, Daniel E. Rivera, Danielle S. Downs, Jennifer S. Savage, Diana M. Thomas, and Linda M. Collins
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- 2013
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42. A dynamical systems model for improving gestational weight gain behavioral interventions.
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Yuwen Dong, Daniel E. Rivera, Diana M. Thomas, Jesús Emeterio Navarro-Barrientos, Danielle S. Downs, Jennifer S. Savage, and Linda M. Collins
- Published
- 2012
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43. Sex Differences in Maternal Restrictive Feeding Practices in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study
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Alexis V. Hyczko, Ian M. Paul, Emily E. Hohman, Stephanie Anzman-Frasca, Leann L. Birch, Jennifer S. Savage, and Cara F. Ruggiero
- Subjects
CFQ ,business.industry ,Repeated measures design ,Intervention effect ,medicine.disease ,Childhood obesity ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Intervention (counseling) ,Pediatrics, Perinatology and Child Health ,medicine ,030212 general & internal medicine ,Analysis of variance ,business ,Infant feeding ,Body mass index ,Demography - Abstract
Background Intervention Nurses Start Infants Growing on Healthy Trajectories tested an early life responsive parenting (RP) intervention designed for obesity prevention. Body mass index z-score at age 3 years was lower for the RP group versus controls with a larger effect for girls than boys. We sought to determine if child sex was associated with differing maternal feeding practices and whether sex moderated intervention effects on feeding. Design/Methods Mothers (N = 279) completed the Infant Feeding Styles Questionnaire (IFSQ) at 28 weeks, the Structure and Control in Parent Feeding (SCPF) at 1, 2, and 3 years, and the Child Feeding Questionnaire (CFQ) at 3 years. Study aims were tested using 2-way analysis of variance and repeated measures. Results Mothers reported greater restriction (limiting food quantity) for boys at 28 weeks (IFSQ: 3.0 ± 1.1 vs 2.8 ± 1.0, P = .07) and across annual measurements from age 1 to 3 years (SCPF: P = .04). At age 3, the intervention group effect on restriction differed by sex (CFQ: P = .047) such that higher restriction was reported by RP group mothers of boys versus girls (3.4 ± 0.7 vs 3.0 ± 0.9, P = .002) with no control group sex difference (3.4 ± 0.8 vs 3.3 ± 0.9, P = .79). There were no sex differences or sex by intervention group interactions in other reported feeding practices at any assessment (ie, structure-based feeding, pressure). Conclusions Mothers of boys used more restrictive feeding through age 3. These findings may be partially explained by previously reported better self-soothing and self-regulation abilities of participating girls.
- Published
- 2021
44. Resource dilution in maternal feeding practices after birth of a secondborn
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Cara F. Ruggiero, Amy M. Moore, Michele E. Marini, Stephen R. Kodish, Damon E. Jones, Susan M. McHale, and Jennifer S. Savage
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Nutrition and Dietetics ,General Psychology - Abstract
Firstborn children have higher prevalence of obesity than secondborn siblings. The birth of a sibling typically results in resource dilution when mothers begin to divide their time and attention between two children. This mixed-methods analysis applies the family systems process of resource dilution to test the hypothesis that characteristics of the secondborn impact how parents feed the firstborn. Participants (n = 76) were mothers of consecutively born firstborn and secondborn siblings who participated in the INSIGHT trial and an observational cohort. Quantitative analyses involved multilevel models to test if characteristics of secondborns (temperament at 16 weeks, appetite at 28 weeks) were associated with maternal feeding practices of firstborns (structure and control-based feeding) at 1, 2, and 3 years, adjusting for firstborn child characteristics. A purposive subsample (n = 30) of mothers participated in semi-structured interviews to contextualize potential sibling influences on maternal feeding practices during infancy and toddlerhood. Quantitative data showed secondborn temperament and appetite were associated with how mothers fed their firstborn. Qualitative data explained maternal feeding practices in three primary ways: 1) Mothers explained shifting predictable meal and snack routines after birth of the secondborn, but did not perceive sibling characteristics as the source; 2) Family chaos following the secondborn's birth led to "survival mode" in feeding; and 3) Social support was protective against feeding resource dilution. The family systems process of resource dilution is a focus for future research and support for families during key transitions and a direction for efforts to reduce risk for child obesity.
- Published
- 2022
45. Variation in urine osmolality throughout pregnancy: a longitudinal, randomized-control trial among women with overweight and obesity
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Alysha Kelyman, Danielle Symons Downs, Emily E. Hohman, Celine Latona, Katherine M McNitt, Abigail M. Pauley, Alison D. Gernand, Krista S. Leonard, Jennifer S. Savage, Jason John, Asher Y. Rosinger, and Hilary J. Bethancourt
- Subjects
medicine.medical_specialty ,Birth weight ,Medicine (miscellaneous) ,Overweight ,Article ,law.invention ,Randomized controlled trial ,Pregnancy ,law ,medicine ,Humans ,Obesity ,Retrospective Studies ,Nutrition and Dietetics ,business.industry ,Obstetrics ,Osmolar Concentration ,Gestational age ,medicine.disease ,Gestational Weight Gain ,Pregnancy Complications ,Urine osmolality ,Gestation ,Female ,medicine.symptom ,business ,Weight gain - Abstract
PURPOSE: Water needs increase during pregnancy, and proper hydration is critical for maternal and fetal health. This study characterized weekly hydration status changes throughout pregnancy and examined change in response to a randomized, behavioral intervention. An exploratory analysis tested how underhydration during pregnancy was associated with birth outcomes. METHODS: The Healthy Mom Zone Study is a longitudinal, randomized-control trial intervention aiming to regulate gestational weight gain (GWG) in pregnant women with overweight/obesity (n=27). Fourteen women received standard of care; 13 women additionally received weekly guidance on nutrition, physical activity, water intake, and health-promoting behaviors. Hydration status was measured weekly via overnight urine osmolality (Uosm) from ~8–36 weeks gestation; underhydration was dichotomized (Uosm≥500 mOsm/kg). Gestational age- and sex-standardized birth weight and length z scores and percentiles were calculated. We used mixed-effect and linear regression models to test covariate-adjusted relationships. RESULTS: No differences existed in Uosm or other characteristics between control and intervention women at baseline. Significant interactions (p=0.01) between intervention and week of pregnancy on Uosm indicated intervention women maintained lower Uosm, whereas control women had a significant quadratic (inverse-U) relationship and greater Uosm in the second and early third trimesters. Results were consistent across robustness and sensitivity checks. Exploratory analyses suggest underhydration was associated with birth weight, but not length, in opposite ways in the second vs. third trimester. CONCLUSION: A multi-component behavioral intervention helped women with overweight/obesity maintain better hydration throughout pregnancy. Future studies should confirm birth outcome results as they have important implications for early life nutrition. Trial Registration ClinicalTrials.gov Identifier: NCT03945266; registered May 10, 2019 retrospectively
- Published
- 2021
46. Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity
- Author
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Krista S. Leonard, Daniel E. Rivera, Penghong Guo, Katherine M McNitt, Jennifer S. Savage, Abigail M. Pauley, Allen R. Kunselman, Emily E. Hohman, Danielle Symons Downs, and Christy Stetter
- Subjects
medicine.medical_specialty ,Psychological intervention ,Overweight ,Weight Gain ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,Intervention (counseling) ,medicine ,Humans ,Obesity ,030212 general & internal medicine ,Exercise ,mHealth ,General Psychology ,030505 public health ,business.industry ,medicine.disease ,Pregnancy Complications ,Psychiatry and Mental health ,Physical therapy ,Feasibility Studies ,Gestation ,Female ,Pregnant Women ,medicine.symptom ,Energy Intake ,0305 other medical science ,business ,Weight gain - Abstract
Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity: PA, energy intake: EI, theories of planned behavior/self-regulation constructs) compared to a usual care group. Pregnant women with overweight/obesity (N = 31) were randomized to a usual care control group or usual care + intervention group from 8 to 2 weeks gestation and completed the intervention through 36 weeks gestation. Intervention women received weekly evidence-based education/counseling (e.g., GWG, PA, EI) delivered by a registered dietitian in a 60-min face-to-face session. GWG was monitored weekly; women within weight goals continued with education while women exceeding goals received more intensive dosages (e.g., additional hands-on EI/PA sessions). All participants used mHealth tools to complete daily measures of weight (Wi-Fi scale) and PA (activity monitor), weekly evaluation of diet quality (MyFitnessPal app), and weekly/monthly online surveys of motivational determinants/self-regulation. Daily EI was estimated with a validated back-calculation method as a function of maternal weight, PA, and resting metabolic rate. Sixty-five percent of eligible women were randomized; study completion was 87%; 10% partially completed the study and drop-out was 3%. Compliance with using the mHealth tools for intensive data collection ranged from 77 to 97%; intervention women attended > 90% education/counseling sessions, and 68–93% dosage step-up sessions. The intervention group (6.9 kg) had 21% lower GWG than controls (8.8 kg) although this difference was not significant. Exploratory analyses also showed the intervention group had significantly lower EI kcals at post-intervention than controls. A theoretical, adaptive intervention with varied dosages to regulate GWG is feasible to deliver to pregnant women with overweight/obesity.
- Published
- 2021
47. Agreement in Infant Growth Indicators and Overweight/Obesity between Community and Clinical Care Settings
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Samantha M.R. Kling, Lisa Bailey-Davis, Holly A. Harris, Sandra G. Hassink, Jennifer S. Savage, Michele E. Marini, and Child and Adolescent Psychiatry / Psychology
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0301 basic medicine ,Male ,Percentile ,Pediatric Obesity ,Child Health Services ,030209 endocrinology & metabolism ,Standard score ,Overweight ,Weight Gain ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Child Development ,SDG 3 - Good Health and Well-being ,Medicine ,Humans ,Nutritionists ,Poverty ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Anthropometry ,Primary Health Care ,business.industry ,Body Weight ,Infant ,Secondary data ,General Medicine ,Pennsylvania ,medicine.disease ,Obesity ,Body Height ,Cross-Sectional Studies ,Categorization ,Electronic data ,Female ,Food Assistance ,medicine.symptom ,business ,Food Science ,Demography - Abstract
Background Infants from low-income backgrounds receive nutrition care from both community and clinical care settings. However, mothers accessing these services have reported receiving conflicting messages related to infant growth between settings, although this has not been examined quantitatively. Objective Describe the agreement in infant growth assessments between community (Special Supplemental Nutrition Program for Women, Infants, and Children) and clinical (primary care providers) care settings. Design A cross-sectional, secondary data analysis of infant growth measures abstracted from electronic data management systems. Participants and setting Participants included a convenience sample of infants (N = 129) from northeastern Pennsylvania randomized to the WEE Baby Care study from July 2016 to May 2018. Infants had complete anthropometric data from both community and clinical settings at age 6.2 ± 0.4 months. Average time between assessments was 2.7 ± 1.9 weeks. Main outcome measures Limits of agreement and bias in weight-for-age, length-for-age, weight-for-length, and body-mass-index-for-age z scores as well as cross-context equivalence in weight status between care settings. Statistical analysis performed Bland-Altman analyses were used to describe the limits of agreement and bias in z scores between care settings. Cross-context equivalence was examined by dichotomizing infants’ growth indicators at the 85th and 95th percentile cut-points and cross-tabulating equivalent and discordant categorization between settings. Results Strongest agreement was observed for weight-for-age z scores (95% limits of agreement –0.41 to 0.54). However, the limits of agreement intervals for growth indicators that included length were wider, suggesting weaker agreement. There was a high level of inconsistency for classification of overweight/obesity using weight-for-length z scores, with 15.5% (85th percentile cut-point) and 11.6% (95th percentile cut-point) discordant categorization between settings, respectively. Conclusions Infant growth indicators that factor in length could contribute to disagreement in the interpretation of infant growth between settings. Further investigation into the techniques, standards, and training protocols for obtaining infant growth measurements across care settings is required.
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- 2021
48. Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project
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Lori A Francis, Robert L Nix, Rhonda BeLue, Kathleen L Keller, Kari C Kugler, Brandi Y Rollins, and Jennifer S Savage
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Pharmacology ,General Medicine - Abstract
Background/Aims: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. Methods: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children’s healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children’s behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3–5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children’s body mass index and appetitive traits related to appetite regulation. Results: Four intervention components were developed, including three classroom curricula designed to increase preschool children’s nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. Conclusion: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.
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- 2023
49. Effects of a Responsive Parenting Intervention Among Black Families on Infant Sleep
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Justin A. Lavner, Emily E. Hohman, Steven R. H. Beach, Brian K. Stansfield, and Jennifer S. Savage
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General Medicine - Abstract
ImportanceBlack individuals in the US experience sleep disparities beginning in infancy and continuing throughout the lifespan, suggesting early interventions are needed to improve sleep.ObjectiveTo investigate whether a responsive parenting (RP) intervention for Black mothers improves infant sleep and increases responsive sleep parenting practices.Design, Setting, and ParticipantsThis is a post hoc secondary analysis of the Sleep SAAF (Strong African American Families) study, a randomized clinical trial comparing an RP intervention with a safety control condition over the first 16 weeks post partum. Data were collected between spring 2018 and summer 2021. Families were recruited from the mother-infant nursery at Augusta University Medical Center, Augusta, Georgia, and completed home visits at 1, 3, 8, and 16 weeks post partum. Primiparous Black mother-infant dyads were screened for eligibility using medical records. Results were analyzed on an intention-to-treat model. Data were analyzed from March 2022 to January 2023.InterventionsThe RP intervention curriculum focused on infant sleep, soothing and crying, and feeding. The control group received a safety intervention. Community research associates delivered the interventions during home visits at 3 and 8 weeks post partum.Main Outcomes and MeasuresThe primary end point was infant sleep duration at 16 weeks. Mothers reported on bedtime routine and sleep behaviors, infant sleep duration, and nighttime waking and feeding at 8 and 16 weeks post partum using questionnaires.ResultsA total of 212 Black mothers (mean [SD] age, 22.7 [4.5] years) were randomized, including 208 mothers (98.6%) who identified as non-Hispanic and 3 mothers (1.4%) who identified as Hispanic; 108 mothers were randomized to the RP group and 104 mothers were randomized to the control group. At 16 weeks post partum, infants in the RP group had longer reported nighttime sleep duration (mean difference, 40 [95% CI, 3 to 77] minutes), longer total sleep duration (mean difference, 73 [95% CI, 14 to 131] minutes), fewer nighttime wakings (mean difference, −0.4 [95% CI, −0.6 to −0.1] wakings), and greater likelihood of meeting guidelines of at least 12 hours of total sleep per day (risk ratio [RR], 1.4 [95% CI, 95% CI, 1.1 to 1.8]) than controls. Relative to controls, mothers in the RP group more frequently reported engaging in some RP practices, including giving the baby a few minutes to fall back asleep on their own (RR, 1.6 [95% CI, 1.0 to 2.6]) and being less likely to feed their baby as the last activity before bed (RR, 0.5 [95% CI, 0.3 to 0.8]).Conclusions and RelevanceThis secondary analysis of a randomized clinical trial found that an RP intervention for Black families improved infant sleep and increased some responsive sleep parenting practices.Trial RegistrationClinicalTrials.gov Identifier: NCT03505203
- Published
- 2023
50. Feasibility and user acceptability of Breezing™, a mobile indirect calorimetry device, in pregnant women with overweight or obesity
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Krista S. Leonard, Abigail M. Pauley, Penghong Guo, Emily E. Hohman, Daniel E. Rivera, Jennifer S. Savage, and Danielle Symons Downs
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Health Information Management ,Medicine (miscellaneous) ,Health Informatics ,Computer Science Applications ,Information Systems - Published
- 2023
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