Background:Obtaining estimates of food intake via the 24-h dietary recall is laborious and expensive. Simpler methods for estimating dietary quality are needed in clinical settings and for evaluating nutrition education interventions. Objectives:The objective of this study was to validate a simple, pictorial tool for assessing diet quality using vegetable variety as the indicator. Methods:The My Veggies tool, containing 28 pictures of vegetables and items about food preparation, eating at home, and eating fast food, was administered to 258 healthy adults aged 18-65 y. To assess convergent validity, 3 dietary recalls were used to calculate the Healthy Eating Index (HEI) 2015 and dietary energy density (DED), both of which serve as measures of diet quality. To determine criterion validity, height, weight, and body composition (as measured by dual-energy X-ray absorptiometry) were assessed. Using cluster analysis, responses to My Veggies generated 3 vegetable variety groups: high variety (HV; n = 84), medium variety (MV; n = 107), and low variety (LV; n = 67). Values for HEI, DED, body mass index (BMI) (in kg/m2), and body composition were compared across the variety groups to determine whether differences existed. Results:Demographic characteristics did not differ between the variety groups. The LV group had lower total HEI score (median = 54.4; IQR = 15.6) than HV (62.1; 17.3) and MV (68.0; 18.6) groups (P < 0.0001 for both). The LV variety group had a higher DED score (median = 2.6; IQR = 0.4) than the HV (2.2; 0.6) and MV (2.3; 0.5) groups (P < 0.0001 for both). Both HV and MV groups reported cooking from scratch more often than LV group (P < 0.0001), and HV and MV reported eating out and fast food less frequently than LV (analysis of variance, P < 0.0001; post hoc mean comparisons of HV and MV compared with LV, P < 0.0001). The LV group had higher BMI (P < 0.003) and body fat percentage (P < 0.005) than MV and HV groups. Conclusions:This study provides evidence of the convergent and criterion validity of a simple, pictorial assessment tool for evaluating diet quality based on vegetable variety. Overall, adults with lower vegetable variety scores had lower diet quality and higher body mass index and fat mass. My Veggies can be used by health professionals as an evaluation tool for community nutrition education interventions or as a screener for counseling in a clinical setting.This trial was registered at clinicaltrials.gov as NCT02367287.

BACKGROUND:Mi Niño a la Hora de Comer (Mi Niño) is a visually enhanced, Spanish-language, parent self-assessment tool designed to measure food parenting behaviors of low-income, Spanish-speaking caregivers of preschool-aged children. OBJECTIVE:The aim of this study was to evaluate the construct and convergent validity of Mi Niño. DESIGN:Videotaped mealtime behaviors at home were used to test for Mi Niño construct validity. Concurrent caregiver reports of general parenting styles and children's body mass index were used to test for convergent validity with Mi Niño scores. PARTICIPANTS/SETTING:Data were drawn from the Niños Sanos study collected between 2016-2017. Participants (N = 273) were recruited through Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children centers in the Sacramento, CA, metropolitan area and were eligible if they were at least 18 years old, the primary caregiver of a child between ages 3 and 5 years, declared Spanish as their preferred language, and were enrolled in Head Start or the Special Supplemental Nutrition Program for Women, Infants, and Children. Participants who completed Mi Niño, general parenting style surveys, and child anthropometric measurements (n = 199) were included in the current analysis. A subset of participants self-selected to complete a videotaped mealtime in their homes (n = 60). Video corruption occurred with 1 video, resulting in N = 59 final videotape sample. MAIN OUTCOME MEASURES:Parent-centered and child-centered parent mealtime behaviors obtained via observed mealtimes, child body mass index z scores, and self-reports of general parenting styles were used to assess the validity of Mi Niño scores. STATISTICAL ANALYSES PERFORMED:Two-way analysis of variance was used to assess differences in Mi Niño scores by observed mealtime behaviors, and linear regression was used to test associations between Mi Niño scores and child body mass index z scores and general parenting styles. RESULTS:Parent-centered Mi Niño scores were positively associated with the rate of observed parent-centered behaviors (F = 2.49; P < .05) and negatively with child body mass index z scores (r = -0.19; P < .01). Parent-centered Mi Niño scores were positively associated with parent self-assessments of authoritarian general parenting styles (r = 0.35; P < .01), and child-centered Mi Niño scores were positively associated with parent self-assessments of authoritative general parenting styles (r = 0.44; P < .01). CONCLUSIONS:Results provide partial support for construct and convergent validity of the Mi Niño self-assessment tool to assess food parenting behaviors with Spanish-speaking caregivers of young children who have low incomes.

The purpose is to examine validity and reliability for an obesity risk assessment tool developed in Spanish for immigrant families with children, 3–5 years old using an 8-week cross-sectional design with data collected over 1 year at Head Start and Special Supplemental Nutrition Program for Women, Infants and Children [WIC]. Parent/child dyads (206) provided a child obesity risk assessment, three child modified 24 h dietary recalls, three child 36+ h activity logs and one parent food behavior checklist. Main outcome measures were convergent validity with nutrients, cup equivalents, and diet quality and three assessments of reliability that included item difficulty index, item discrimination index, and coefficient of variation. Validity was demonstrated for assessment tool, named Niños Sanos. Scales were significantly related to variables in direction hypothesized [p ≤ 0.05]: Healthy Eating Index, fruit/vegetable cup equivalents, folate, dairy cup equivalents, vitamins D, β-carotene, fiber, saturated fat, sugar, time at screen/ sleep/physical activity and parent behaviors. Three measures of reliability were acceptable. The addition of nutrient values as an analytical validation approach adds strength and consistency to previously reported Niños Sanos validation results using children’s blood biomarkers and body mass index. This tool can be used by health professionals as an assessment of obesity risk in several capacities: (1) screener for counseling in a clinic, (2) large survey, (3) guide for participant goal setting and tailoring interventions, and (4) evaluation.

Background:Accurate measurement of food-related parenting practices is necessary to inform related interventions and program evaluation. Valid tools reflect cultural attributes that affect household food environments and feeding practices. Simple, unidirectional language adaptation approaches are insufficient to capture these attributes in assessment tools. My Child at Mealtime (MCMT) is a 27-item, validated, visually enhanced self-assessment tool to measure food-related parenting practices of low-income English-speaking parents of preschoolers.Objectives:The aim of this study was to describe the cross-cultural adaptation of MCMT into its Spanish version Mi Niño a la Hora the Comer (Mi Niño) and to establish its face validity, factor structure, and internal consistency.Methods:MCMT was adapted into its Spanish version after an iterative process that triangulated cognitive interviews with verification of conceptual equivalence by content experts to establish face validity and semantic equivalence. The resulting tool underwent confirmatory factor analysis to determine whether internal consistency was equivalent across the 2 versions.Results:Four rounds of cognitive interviews (n = 5, n = 6, n = 2, and n = 4, respectively) with Spanish-speaking women caregivers of children aged 3-5 y recruited from Head Start were conducted. Ten items were modified throughout the adaptation process. Modifications included improved clarity (6 items), comprehension (7 items), appropriateness (4 items), suitability (4 items), and usefulness (2 items) of text and/or accompanying visuals. Confirmatory factor analysis with a sample of Spanish-speaking caregivers (n = 243) resulted in 2 reliable factors representing "child-centered" (α = 0.82) and "parent-centered" (α = 0.87) food-related parenting practices.Conclusions:Face validity, semantic equivalence, and internal consistency of Mi Niño were established. This tool can be used in community settings to inform program content and measure changes in food-related parenting practices of Spanish-speaking parents and assist in setting food-related parenting goals. The next steps include exploring the correspondence of Mi Nino with mealtime behaviors observed through video recording.

Purpose: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. Methods: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. Results: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. Conclusion: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.

Literacy is a concern in the US, including California, with 22% to 23% of adults reading at the lowest level of literacy, referred to as below basic. 1 Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Findings of the National Adult Literacy Survey. 3rd ed. NCES 1993–275. Washington, DC: USDepartment of Education; 2002. https://nces.ed.gov/pubs93/93275.pdf. Accessed October 22, 2019. Google Scholar ,2 Pariona A. Average educational levels in the U.S.A. by state. https://www.worldatlas.com/articles/us-literacy-rate-by-state.html. Accessed October 16, 2019. Google Scholar Another 25% score in the next level of literacy, described as low. For these adults, literacy ranges from being unable to read and understand any written information in English to being able to locate easily identifiable information in short, commonplace prose text, but nothing more advanced. 1 Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Findings of the National Adult Literacy Survey. 3rd ed. NCES 1993–275. Washington, DC: USDepartment of Education; 2002. https://nces.ed.gov/pubs93/93275.pdf. Accessed October 22, 2019. Google Scholar ,2 Pariona A. Average educational levels in the U.S.A. by state. https://www.worldatlas.com/articles/us-literacy-rate-by-state.html. Accessed October 16, 2019. Google Scholar Educators delivering federal nutrition education programs in multiple languages to low-income communities serve a disproportionate number of program clients with limited literacy skills. 3 Townsend MS Patient-driven education materials: low-literate adults increase understanding of health messages and improve compliance. Nurs Clin North Am. 2011; 46: 367-378 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar

Background:Many families with young children practice nutrition, parenting, and lifestyle behaviors that set their children on trajectories for unhealthful weight gain. Potential adverse health effects of excessive body fat can result in the secretion of proinflammatory molecules and increased risk of inflammation and metabolic diseases. A pediatric obesity risk assessment tool named Healthy Kids (HK), demonstrated validity in a longitudinal study with child's measured BMI and 36-hour diet, screen, sleep, and activity logs. Our objective was to provide additional evidence of validity with low-income families with literacy issues using an inflammation index composed of four proinflammatory biomarkers. Methods:Parent/child pairs (n = 104) from Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided HK, blood samples, and measured heights/weights. Select child inflammatory markers were discretized into two groups of HK scores. Data were analyzed with a mixed model adjusted for children's age and BMI. Results:A significant HK-time interaction effect was shown for the child inflammation index with two data collection points 1 year apart (p(did) = 0.039). This index increased over 12 months in children with less healthful behaviors (p = 0.007), but not in children with more healthful profiles (p = 0.58). Conclusions:Children with less healthful HK scores had an elevated inflammation index indicating a low-grade chronic systemic inflammatory state. Taken together with our previously published findings, the HK tool has potential as a rapid and easy-to-administer assessment of the family environment and the child's obesity risk. HK can be useful for federal nutrition programs for evaluation, risk assessment, goal setting, and/or program planning in clinical and community environments.

Childhood ObesityVol. 16, No. S1 EditorialFree AccessUSDA Research Combats Childhood Obesity: A Collection of Projects that Integrate Research, Education, and Extension Targeting Low-Income, Ethnically Diverse Children and FamiliesMarilyn S. Townsend, Mical K. Shilts, and Deirdra ChesterMarilyn S. TownsendAddress correspondence to: Marilyn S. Townsend, PhD, Department of Nutrition, University of California at Davis, 1 Shields Avenue, Davis, CA 95616, USA E-mail Address: mstownsend@ucdavis.eduNutrition Department, University of California at Davis, Davis, CA, USA.Search for more papers by this author, Mical K. ShiltsDepartment of Family and Consumer Sciences, California State University at Sacramento, Sacramento, CA, USA.Search for more papers by this author, and Deirdra ChesterNational Institute of Food and Agriculture, U. S. Department of Agriculture, Washington, DC, USA.Search for more papers by this authorPublished Online:20 Aug 2020https://doi.org/10.1089/chi.2020.29006.mstAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The purpose of this supplement, “USDA Research to Combat Childhood Obesity,” is to showcase examples of recent projects to advance obesity prevention for the most vulnerable population, low-income children. The six included articles highlight a diversity of research projects, low-income target audiences, and settings.1–6These settings include medical clinics,1elementary,2 middle and high schools,3 Head Start,4,5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),4,5 Supplemental Nutrition Assistance Program - Education (SNAP-Ed),6 and Expanded Food and Nutrition Education Program (EFNEP).6 In addition, several studies in this issue examine intervention impact with a focus on the child and parent/family to address childhood obesity through infant feeding,1 school lunch participation,3 media literacy,6 school gardening, and physical activity.2 Two studies address development and validation of assessment tools for child obesogenic risk and food parenting practices.4,5Specifics about these six articles follows. Messito and colleagues examined the effectiveness of the Starting Early Program with 533 Hispanic pregnant and postpartum mothers in a randomized control trial.1 Implemented in the medical clinic setting, the intervention included nutrition counseling with nutrition and parenting support groups coordinated with pediatric medical clinic visits. Intervention mothers compared to mothers in the usual care control group were more likely to give breast milk and prioritize family meals. They were less likely to give juice or cereal in the bottle. Intervention mothers also exhibited lower pressuring, indulgent, and laissez-faire feeding styles. These findings demonstrate that the medical clinic is a viable intervention site and that childhood obesity prevention can and should start early in development.Articles by Townsend et al. and Ontai et al. advanced childhood obesity risk assessment in ethnically diverse families with preschool age children.4,5 Using child blood values and BMI data, Townsend and colleagues validated an assessment tool for limited literacy parents, meeting the new gold standard for validation using objective, in addition to subjective or self-report comparisons. Ontai and colleagues further explored parent food-related behaviors and children's BMI. Family-based behaviors were associated with lower BMI only when parents used fewer parent-centered behaviors. Both of the obesity risk assessment tools are available and images can be tailored to a specific ethnic group at this website http://healthykids.ucdavis.edu/.Austin and colleagues examined the effectiveness of a community-based program called FoodMania: Kids and Food in a Marketing-Driven World in three urban and two rural counties in Washington State.6 The controlled trial evaluated this family-centered, media literacy-oriented intervention delivered by EFNEP and SNAP-Ed with the intervention group showing improvements in parent and youth nutrition behaviors and media literacy skills.Two articles in this supplement implemented large scale interventions in school settings. Van den Berg and colleagues conducted a randomized controlled trial with 28 low-income elementary schools in Texas to examine the individual and combined impact of physical activity and garden based interventions.2 Both interventions showed impact on child BMI but combining the interventions did not result in BMI reduction possibly due to asking too much of schools and teachers to implement both interventions plus the existing Catch intervention. Learn, Grow, Eat & Go materials are available www.jmgkids.us/lgeg. Thompson and colleagues targeted adolescents in a multi-pronged intervention focused on improving school lunch participation in 24 urban middle and high schools in San Francisco, California.3 The intervention included cafeteria redesign, additional school lunch points-of-sale (mobile carts and vending machines), and teacher education. The intervention had a modest, but significant positive effect on school lunch participation among those who qualify for free or reduced price meals.Funding AgencyThe USDA National Institute of Food and Agriculture (NIFA) awards Agriculture and Food Research Initiative (AFRI) research, education, and extension grants that address key problems of national, regional, and multi-state importance.7 AFRI is the nation's leading competitive grants program for agricultural sciences. The long-term goal of the AFRI Childhood Obesity Prevention Challenge Area (AFRI COP) was to reduce the prevalence of obesity among children and adolescents ages 2–19 years.8 Childhood obesity is a critical nutrition problem in America with prevalence rates for obesity in children and adolescents aged 2–19 years remaining high for almost two decades.9,10 Low-income, ethnically diverse children bear an even greater obesity burden.11 AFRI COP also allows this program to support education and extension activities that deliver science-based knowledge to end users, allowing them to make informed, practical decisions. From 2011–2017 the USDA's AFRI program had a competitive grants program that provided funding for research, education, and extension projects directed to obesity prevention. Grants (n = 82) awarded produced over 550 peer-reviewed, published articles.Our ProcessIn March 2019, project directors who received grants from 2011 to 2017 were invited to submit a proposal to write a manuscript for this journal issue. This call for proposals led to 47 submissions with 12 selected to undergo the Childhood Obesity peer-review process. Ultimately, six articles were selected for this supplement portraying a wide range of projects, study designs, and settings. These six reflect research not previously published.1–6Projects funded by this USDA effort, collectively contributed to meeting the following 5 AFRI COP goals. In addition to the 6 projects featured in this supplement, we highlight 10 others here.Goal 1: Generation of new knowledge about behavioral, social, cultural, and environmental factors that influence excessive weight gain by children and adolescents.This goal was addressed by work conducted by Rose et al.,12 Qian et al.,13 Graziose et al.,14 as well as Ontai and colleagues in this supplement.4 An AFRI COP funded research project previously published by Rose and colleagues examined relations between patterns of dietary exposures at 9 months and infant weight status at 12 months for 1,807 mother-infant dyads. Infants in the high energy density dietary pattern were more likely to be overweight at 12 months.12 Qian and colleagues found neighborhood fast food density to have significant and positive effects on the BMI z-scores of Arkansas public schoolchildren.13 Cost effectiveness of nutrition education interventions in the elementary school setting was examined by Graziose et al. via a rigorous analysis.14 If Food, Health & Choices intervention was implemented in all New York City fifth-grade public school students over 1 year at an estimated cost of $8,500,000, obesity would be reduced by 289 males and 350 females in these schools. This effort would produce a savings of 1,599 quality-adjusted life-years (QALYs) and over $8,000,000 in direct medical costs.14Goal 2: Development of effective behavioral, social, and environmental interventions to meet US Dietary Guidelines.In addition to these four articles in the supplement,1,2,3,6 Natale and colleagues documented favorable changes in preschool-aged child BMI following a 2-year intervention in a childcare setting, which included menu modifications and child, parent, and teacher education.15Goal 3: The development of new, more effective evaluation tools, and/or incorporating Big Data.This goal was met by researchers Bekelman et al.16 and Townsend et al.17 in addition to a study in this supplement.5 Bekelman and colleagues developed and validated at Head Start/preschool centers a new method to document dietary intake, the remote food photography method.16 A vegetable behavioral tool, Focus on Veggies, was validated with Head Start and WIC center participants and demonstrated correspondence with vegetable cup equivalents and micronutrient intakes, BMI, and blood biomarkers.17Goal 4: Expansion of interventions that have proven effective and assessment of their impact.In addition to an article in this supplement,2 two other studies addressed this goal.18,19 The largest ARFI obesity prevention intervention and funding occurred in the islands of the Pacific Region. Novotny et al. reported that interventions communities produced significant improvements in overweight prevalence compared to control communities.18 Khan et al. demonstrated that a physical activity intervention improved cardiorespiratory fitness, reduced fat mass, and prevented accumulation of central fat mass in children with varying adiposity levels.19Goal 5: An increase in the number of parents, caretakers, educators, practitioners, and researchers who receive the training and effectively model behaviors necessary to address the complex problem of childhood obesity prevention.In this supplement, articles by Austin et al.,6 Messito et al.,1 van den Berg et al.,2 and Thompson et al.3 contain training components. AFRI COP funding supported university level training such as the Transdisciplinary Obesity Prevention (TOP) graduate certificate program20 and an online training certificate program for community family educators.21Although the challenge areas were eliminated and the Childhood Obesity Prevention Program has been sunset and replaced with the Sustainable Agriculture Systems Program, the breadth and depth of the articles in this issue and 550+ previously published significantly added to the childhood obesity prevention literature base. The research produced provides a solid foundation for community-based programming to better understand, address, and assess childhood obesity prevention.References1. Messito MJ, Katzow MW, Mendelsohn AL, et al. Starting Early Program impacts on infant feeding at 10 months old: A randomized controlled trial. Child Obes 2020;16:S4–S13. Google Scholar2. van den Berg A, Warren JL, McIntosh A, et al. Impact of a gardening and physical activity intervention in Title 1 schools: The TGEG study. Child Obes 2020;16:S44–S54. Link, Google Scholar3. Thompson HR, Gosliner W, Ritchie L, et al. The impact of a multipronged intervention to increase school lunch participation among secondary school students in an urban public school district. Child Obes 2020;16:S14–S22. Google Scholar4. Ontai LL, Sutter C, Sitnick S, et al. Parent food-related behaviors and family-based dietary and activity environments: Associations with BMI z-scores in low-income preschoolers. Child Obes 2020;16:S55–S63. Google Scholar5. Townsend MS, Shilts MK, Lanoue LL, et al. Healthy Kids study among 3–5 years olds: Validation with biomarkers of low-grade chronic inflammation. Child Obes 2020;16:S23–S32. Google Scholar6. Austin EW, Austin B, Kaiser K, et al. A media literacy-based nutrition program fosters parent–child food marketing discussions, improves home food environment and youth consumption of fruits and vegetables. Child Obes 2020;16:S33–S43. Google Scholar7. USDA NIFA. Agriculture and research initiative. https://www.nifa.usda.gov/program/agriculture-and-food-research-initiative-afri (last accessed July 26, 2020). Google Scholar8. USDA NIFA. AFRI challenge areas. https://nifa.usda.gov/afri-challenge-areas (last accessed July 26, 2020). Google Scholar9. Ogden CL, Fryar CD, Hales CM, et al. Differences in obesity prevalence by demographics and urbanization in US children and adolescents, 2013–2016. JAMA 2018;319:2410–2418. Crossref, Medline, Google Scholar10. Skinner AC, Ravanbakht SN, Skelton JA, et al. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics 2018;141:e20173459. Crossref, Medline, Google Scholar11. Pan L, Blanck HM, Sherry B, et al. Trends in the prevalence of extreme obesity among US preschool-aged children living in low income families,1998–2010. JAMA 2012;308:2563–2565. Crossref, Medline, Google Scholar12. Rose C, Savage JS, Birch LL. Patterns of early dietary exposures have implications for maternal and infant weight outcomes. Obesity 2015;24:430–438. Crossref, Medline, Google Scholar13. Qian Y, Thomsen MR, Nayga Jr. RM, et al. The effect of neighborhood fast food on children's BMI: Evidence from a sample of movers. B.E. Journal of Economic Analysis and Policy 2017;17:20160251. Google Scholar14. Graziose MM, Koch PA, Wang YC, et al. Cost-effectiveness of a nutrition education curriculum intervention in elementary schools. JNEB 2017;49:684–691. Google Scholar15. Natale R, Messiah SE, Asfour LA, et al. Obesity prevention program in childcare centers: Two year follow up. Am J Health Promot 2017;31:502–510. Crossref, Medline, Google Scholar16. Bekelman T, Bellows LL, McCloskey ML, et al. Assessing dinner meals offered at home among low-income preschoolers with remote food photography method. Ped Obes 2019;14:e12558. Medline, Google Scholar17. Townsend MS, Shilts MK, Styne D, et al. Vegetable behavioral tool demonstrates validity with MyPlate vegetable cups and carotenoid and inflammatory biomarkers. Appetite 2016;107: 628–638. Crossref, Medline, Google Scholar18. Novotny R, Davis J, Butel J, et al. Effect of the Children's Healthy Living program on young child overweight, obesity and acanthosis nigricans in the US affiliated Pacific region: A randomized controlled trial. JAMA Network Open 2018;1:E183896. Crossref, Medline, Google Scholar19. Khan NA, Raine LB, Drollette ES, et al. Impact of the FITKids physical activity intervention on adiposity in prepubertal children. Pediatrics 2014;133:875–883. Crossref, Google Scholar20. Jensen BS, Anderson-Knott M, Bowne M, et al. Innovation and collaboration: Creating a transdisciplinary childhood obesity prevention (TOP) graduate certificate program. Health and Interprofessional Practice 2017;3:eP1125. Crossref, Google Scholar21. Eck K, Alleman GP, Quick V, et al. Evaluation of a childhood obesity prevention online training certification program for community family educators. J Comm Health 2016; 4:1187–1195. Crossref, Google ScholarFiguresReferencesRelatedDetails Volume 16Issue S1Aug 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Marilyn S. Townsend, Mical K. Shilts, and Deirdra Chester.Childhood Obesity.Aug 2020.S-1-S-3.http://doi.org/10.1089/chi.2020.29006.mstPublished in Volume: 16 Issue S1: August 20, 2020PDF download

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

Background: In early childhood, the family dietary and activity environment and parent food-related practices have been found to be important predictors of children's weight. However, few studies account for both of these factors, or the interaction between the 2, when assessing BMI in early childhood. This study aims to examine the association between the family-based dietary and activity environment (including intake, physical activity, and structure) and children's BMI z-scores in the context of parent food-related behaviors in low-income families during the preschool years. Methods: Parents (n = 111) completed questionnaires assessing the family-based dietary and activity environment, including diet, physical activity, screentime and sleep, and their use of parent food-related behaviors including parent-centered (i.e., controlling) and child-centered (i.e., autonomy supportive) practices. Children's BMI z-scores were calculated from researcher-measured height and weight. Results: Parent-centered food-related behaviors were directly related to children's BMI z-scores and moderated the association between the family-based dietary and activity environment and children's BMI z-scores. Family-based behaviors were associated with lower BMI only when parents used fewer parent-centered behaviors. Conclusions: Findings indicate that programs working with low-income families to prevent child obesity should stress both the creation of a healthy home environment and the use of positive parent food-related behaviors with preschool aged children.

ObjectiveCollecting 'before' and 'after' ratings at the time of post-testing for program evaluation, reduces the likelihood of response-shift bias with a resulting increase in reliability. This method may be promising for program evaluation, especially where overestimation of initial behaviors are likely with a resulting improvement in intervention outcomes. Applying qualitative methods, the objective is to determine client preferences for retrospective approach and format, and implement those results in two tools of varying length.DescriptionThe Nutrition Education Evaluation Model (NEEM) was used to guide selection of approach and development of format for a non-traditional retrospective evaluation. Cognitive interviews were conducted at a food bank in 2006 and at Head Start and EFNEP sites, 2011-2018. Participants were low-income, English or bilingual Spanish speaking and available for an immediate interview. Several strategies were employed: concurrent and retrospective think alouds, paraphrasing probes, response format options and restating text. EFNEP educators offered opinions in unstructured discussions.EvaluationStudy participants and EFNEP educators recommended one of four approaches: the Post then Pre. They preferred the format featuring each question on row along with two sets of response options flanking the centered question, use of a visual to portray each question, use of color to guide tool instructions, and presence of icons to support 'before/then' and 'after/now' concepts.Conclusion and ImplicationsTwo examples of the visual retrospective method were produced: Focus of Sweet Drinks…Now and Then for an English speaking low-income audience and Focus on Veggies…Now and Then for a Spanish speaking low-income audience. This qualitative method and the study results can be utilized by other researchers and practitioners. Collecting 'before' and 'after' ratings at the time of post-testing for program evaluation, reduces the likelihood of response-shift bias with a resulting increase in reliability. This method may be promising for program evaluation, especially where overestimation of initial behaviors are likely with a resulting improvement in intervention outcomes. Applying qualitative methods, the objective is to determine client preferences for retrospective approach and format, and implement those results in two tools of varying length. The Nutrition Education Evaluation Model (NEEM) was used to guide selection of approach and development of format for a non-traditional retrospective evaluation. Cognitive interviews were conducted at a food bank in 2006 and at Head Start and EFNEP sites, 2011-2018. Participants were low-income, English or bilingual Spanish speaking and available for an immediate interview. Several strategies were employed: concurrent and retrospective think alouds, paraphrasing probes, response format options and restating text. EFNEP educators offered opinions in unstructured discussions. Study participants and EFNEP educators recommended one of four approaches: the Post then Pre. They preferred the format featuring each question on row along with two sets of response options flanking the centered question, use of a visual to portray each question, use of color to guide tool instructions, and presence of icons to support 'before/then' and 'after/now' concepts. Two examples of the visual retrospective method were produced: Focus of Sweet Drinks…Now and Then for an English speaking low-income audience and Focus on Veggies…Now and Then for a Spanish speaking low-income audience. This qualitative method and the study results can be utilized by other researchers and practitioners.

ObjectivesTo validate two pediatric obesity risk assessment tools for low-income Spanish speaking parents and one diet quality tool; determine the feasibility of EFNEP embedded in a medical clinic; coordinate an AFRI obesity grant program journal supplement.DescriptionThe focus of year four (Y4) was to complete participant data collection and entry to validate assessment tools. Enrollment for the EFNEP intervention concluded with post surveys and in-person interviews administered after each of 21 intervention rounds.EvaluationHispanic (> 99%) parents (n = 239) from WIC or Head Start completed the five data collection points and a blood sample (n = 169 children). Children were classified as being overweight (10%) or obese (16%). Children in the highest BMI percentile-for-age quartile have significantly higher lipid (229 ± 82), and metabolic (118 ± 33) indices, and larger waist circumference (58.8 ± 5.7) than children in the lowest BMI percentile-for-age quartile (188 ± 95, 95 ± 38, 49.9 ± 2.6, respectively). A sample of 60 families were videotaped at mealtime and all of the videotapes have been coded for parent behaviors and 20% for child behaviors. One-hundred and five parents attended at least one EFNEP session who were referred by their child's pediatrician. All parents engaged in setting nutrition and parenting goals and 71 parents were interviewed to assess the relevance of Motivational Modeling & feasibility of attending EFNEP intervention. In addition, cultural adaptation and design were completed for Mis Vegetales, a vegetable variety tool to measure diet quality. The HK website was also updated to include Spanish language versions of Healthy Kids (HK) and My Child at Meal Time and the newly validated HK 19-item tool http://healthykids.ucdavis.edu/. Journal supplement planning began with communication to project directors and three journals were contacted for comparison bids.Conclusion and ImplicationsProducts and findings can support efforts to reduce childhood obesity risk in low-income Spanish-speaking families by providing valid tools to identifying risky nutrition and parenting behaviors and illustrating their utility in expanding EFNEP's reach to medical clinics. To validate two pediatric obesity risk assessment tools for low-income Spanish speaking parents and one diet quality tool; determine the feasibility of EFNEP embedded in a medical clinic; coordinate an AFRI obesity grant program journal supplement. The focus of year four (Y4) was to complete participant data collection and entry to validate assessment tools. Enrollment for the EFNEP intervention concluded with post surveys and in-person interviews administered after each of 21 intervention rounds. Hispanic (> 99%) parents (n = 239) from WIC or Head Start completed the five data collection points and a blood sample (n = 169 children). Children were classified as being overweight (10%) or obese (16%). Children in the highest BMI percentile-for-age quartile have significantly higher lipid (229 ± 82), and metabolic (118 ± 33) indices, and larger waist circumference (58.8 ± 5.7) than children in the lowest BMI percentile-for-age quartile (188 ± 95, 95 ± 38, 49.9 ± 2.6, respectively). A sample of 60 families were videotaped at mealtime and all of the videotapes have been coded for parent behaviors and 20% for child behaviors. One-hundred and five parents attended at least one EFNEP session who were referred by their child's pediatrician. All parents engaged in setting nutrition and parenting goals and 71 parents were interviewed to assess the relevance of Motivational Modeling & feasibility of attending EFNEP intervention. In addition, cultural adaptation and design were completed for Mis Vegetales, a vegetable variety tool to measure diet quality. The HK website was also updated to include Spanish language versions of Healthy Kids (HK) and My Child at Meal Time and the newly validated HK 19-item tool http://healthykids.ucdavis.edu/. Journal supplement planning began with communication to project directors and three journals were contacted for comparison bids. Products and findings can support efforts to reduce childhood obesity risk in low-income Spanish-speaking families by providing valid tools to identifying risky nutrition and parenting behaviors and illustrating their utility in expanding EFNEP's reach to medical clinics.

My Child at Mealtime (MCMT) is a visually enhanced, self-assessment tool designed to measure parent food related behaviors of low-income caregivers of preschool-aged children. The current study examined the factor structure of MCMT and the correspondence between MCMT parent- and child-centered food related behaviors with observed behaviors during a mealtime with their preschool aged child. Caregivers (N = 175) completed MCMT, and a subsample (n = 60) had a mealtime videotaped in their home. Exploratory and confirmatory factor analysis supported a two-factor structure resulting in parent-centered and child-centered MCMT subscales. There was a significant association between parent-centered MCMT scores and observed parent-centered behaviors at mealtime. Behavioral correspondence of MCMT child-centered behaviors was generally weaker. Overall, the findings suggest that caregivers' MCMT responses provide a valid measure of parent food related behaviors.

ABSTRACT Previous research suggests obesity is negatively related to cognitive functioning and academic outcomes in addition to physical health. However, not much is known about this association in early childhood or potential physiological underpinnings. Biomarkers related to obesity have been associated with cognition, in particular the adipokine leptin, and pro‐inflammatory cytokines including interleukin‐6 (IL‐6), tumor necrosis factor‐alpha (TNF‐alpha) and C‐reactive protein (CRP). These associations may be further exacerbated for children who experience early life stress. With a sample of low‐income preschoolers, the current study examined associations between obesity‐related biomarkers and aspects of behavioral and cognitive school readiness. Partial correlations controlling for child age show hypothesized negative associations between pro‐inflammatory cytokines and school readiness, while leptin was positively associated with cognitive school readiness and body mass index (BMI) z ‐score. Findings suggest connections between obesity, physiology, and school readiness need further examination, but may have implications for early childhood education and health interventions.

To reduce the risk of pediatric obesity, behaviorally-focused parental education is needed. This study examined the feasibility of guided goal setting in a pediatric obesity prevention intervention for low-income parents of young children. Parents from Head Start participated in a six-week nutrition, activity, and parenting intervention that included guided goal setting (N = 47). At each session, data were collected on goal selection, effort, and attainment. Pre- and postintervention data were collected on nutrition, activity, and child feeding behaviors (n = 24). A subset of parents completed in-depth interviews (n = 20). Parents reported a high level of goal effort (88%) and achievement (79%) and a preference for goal personalization and a list of goals from which to choose. In general, parents did not find the goal contract or weekly tracking as motivating as goal personalization. Pre- and postintervention assessment showed significant changes in the dietary energy density (p = .008) and vegetable behavior (p = .04) subscales with a marginal change in the snacking subscale (p = .08). Guided goal setting was a feasible behavioral strategy for the parents in this study since parents engaged in the process and demonstrated changes in serving more vegetables and fewer energy-dense foods.

Previous research suggests obesity is negatively related to cognitive functioning and academic outcomes in addition to physical health. However, not much is known about this association in early childhood or potential physiological underpinnings. Biomarkers related to obesity have been associated with cognition, in particular the adipokine leptin, and pro-inflammatory cytokines including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP). These associations may be further exacerbated for children who experience early life stress. With a sample of low-income preschoolers, the current study examined associations between obesity-related biomarkers and aspects of behavioral and cognitive school readiness. Partial correlations controlling for child age show hypothesized negative associations between pro-inflammatory cytokines and school readiness, while leptin was positively associated with cognitive school readiness and body mass index (BMI) z -score. Findings suggest connections between obesity, physiology, and school readiness need further examination, but may have implications for early childhood education and health interventions.

Objective: Demonstrate validity and reliability for an obesity risk assessment tool for young children targeting families' modifiable home environments. Design: Longitudinal design with data collected over 100 weeks. Setting: Head Start and the Special Supplemental Nutrition Program for Women, Infants, and Children. Participants: Parent-child pairs (n = 133) provided food behavior assessments; 3 child-modified, 24-hour dietary recalls; 3 >= 36-hour activity logs; and measured heights and weights. Main Outcome Measure: Five measures of validity and 5 of reliability. Results: Validity was excellent for the assessment tool, named Healthy Kids, demonstrating an inverse relationship with child body mass index percentile-for-age (P = .02). Scales were significantly related to hypothesized variables (P <= .05): fruit or vegetable cup equivalents; folate; vitamins A, C, and D; (beta-carotene; calcium; fiber; sugar; screen, sleep, and physical activity minutes; and parent behaviors. Measures of reliability were acceptable. Conclusions and Implications: Overall, children with higher Healthy Kids scores had a more healthful profile as well as lower body mass index percentiles-for-age 1.5 years later. Healthy Kids has potential for use by nutrition professionals as a screening tool to identify young children most at risk for excess weight gain, as an evaluation to assess intervention impact, and as a counseling tool to tailor intervention efforts. Future research should include validation in other settings and with other populations.

Objectives: The long term goal of this project is to evaluate the efficacy and feasibility of an integrated approach to reduce pediatric obesity in low income Spanish speaking families with preschool age children by validating two obesity risk assessment tools and one diet quality tool and determining the feasibility of EFNEP embedded in a medical clinic. Description: Participant recruitment and data collection (parental surveys; 24-hour dietary, sleep, activity logs; anthropometric and biomarker measures; and mealtime video recordings) to validate the tools continued to be the focus of year 3 (Y3). Pilot testing of the medical clinic kiosk commenced to stimulate parent interest and physician referrals to the EFNEP classes. Evaluation: One hundred parent-child pairs from 12 Head Start and WIC sites were enrolled in Y3 for a total of 210 participants enrolled. More than 30% of the children were overweight. Children with higher BMI percentiles-for-age had significantly higher plasma cholesterol, LDL-C and nonHDL-C levels compared to children with lower BMI-percentiles for age. Twenty-one new videotapes were collected to assist with validation of the parenting tool. Content and face validity of the Spanish diet quality tool were achieved after applying a multistep, iterative process that included four rounds of cognitive interviews. Twelve iPad kiosk pilot testing sessions were completed demonstrating the need for clinic wait times of >5 minutes and handing the iPad directly to the parent to enhance usage. Physicians (n = 81) generated 425 patient referrals, of which 227 were in Y3. Thirty-one parents were enrolled in the EFNEP intervention in Y3 for a total 69 parents with 83% completing 5 or more classes. Parents (84%) identified physician referral as an important reason for enrolling. Conclusions and Implications: Obesity risk assessment and diet quality tools for Spanish speaking families are being validated and an iPad kiosk and EFNEP intervention are being implemented in several medical clinics. These outcomes are intended to promote clinical intervention before children become overweight to establish a new trajectory of weight gain. Funding: 2015-68001-23280. The following is the supplementary data to this article: Download .pdf (4.78 MB) Help with pdf files Poster

Produce final versions of two validated obesity risk assessment tools for Spanish speaking parents; assess feasibility of these tools to the child's physician; develop and validate a diet quality tool; and determine feasibility of an EFNEP intervention in a medical clinic. Protocol development, enrollment and data collection commenced in year 2 to validate the Spanish obesity risk assessment tools using: parental surveys; 24-hour dietary, sleep, activity logs; anthropometric and biomarker measures; and mealtime video recordings. The 23-item diet quality tool in English and Spanish was tested for face and content validity. The EFNEP intervention protocol, education materials including motivational modeling were finalized, a bilingual educator was trained, and an information kiosk is ready for pilot testing. To date, recruitment has focused on eight Head Start sites with a total of 110 Spanish speaking parent-child pairs enrolled with a sub-sample (n=24) completing mealtime videotaping. Preliminary analyses of the glucose and lipid profiles show that the child metabolic data are positively associated with BMI percentile. Physicians (n=38) from four medical clinics have generated 198 patient referrals for the EFNEP intervention. Parents (n=39) have been enrolled in the intervention which required 584 phone calls and 368 texts. Sixty-five percent of parents stated that the physician referral was an important reason for enrolling and most parents and physicians report value from the intervention. Validation of two pediatric obesity risk assessment tools and one diet quality tool are underway. An EFNEP intervention is demonstrating feasibility at a medical clinic site yet challenges remain in garnering physician referrals. Outcomes may contribute to the identification of young children more likely to become obese.