Bridget Armstrong

BMI and disordered eating in urban, African American, adolescent girls: The mediating role of body dissatisfaction

OBJECTIVEnThis study examined the mediating role of body dissatisfaction between Body Mass Index (BMI) and subsequent disordered eating (e.g. dieting and restricting/purging) among early adolescent African American girls.nnnSTUDY DESIGNnParticipants included 701 African American girls in 6th and 7th grades in urban schools serving low-income communities, mean age 12.15 (SDu202f=u202f0.72) years. Participants were assessed at baseline and approximately 6u202fmonths later. Objectively measured height and weight were used to calculate BMI z-score. Participants completed questionnaires on body size dissatisfaction and recent dieting and restricting/purging behaviors.nnnRESULTSnAt baseline, 51.5% of participants were overweight/obese, and 60.4% expressed body dissatisfaction and a desire to be smaller. Path analytic analyses revealed change in body dissatisfaction significantly mediates the relation between initial BMI z-score and increases in dieting behaviors (Bu202f=u202f0.924, SEu202f=u202f0.280, pu202f=u202f0.001) but not restricting/purging behaviors (pu202f=u202f0.05).nnnCONCLUSIONSnBody dissatisfaction explains some associations between excess body weight and subsequent disordered eating symptoms among early adolescent, African American girls. Body dissatisfaction, identified by screening, may be an indicator of further negative consequences, including disordered eating behaviors.

Cortisol reactivity and weight gain among adolescents who vary in prenatal drug exposure: Cortisol and adolescent weight gain

Low inhibitory control is linked with weight gain among youth. Inhibitory problems are associated with disruption to the hypothalamic–pituitary–adrenal axis cortisol response. Increased cortisol predicts appetite and weight gain (though may be gender specific). This study hypothesized that cortisol reactivity explains the association between inhibition and weight gain while considering the moderating factors of early stressors to the hypothalamic–pituitary–adrenal axis (e.g. prenatal‐drug exposure) and gender.

Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers

BACKGROUNDnChild care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Marylands child care centers.nnnMETHODSnA survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores.nnnRESULTSnResponse rate was 40% (nu2009=u2009610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (Bu2009=u20090.26, pu2009<u20090.001; Bu2009=u20090.26, pu2009=u20090.001, respectively); policies with foods served (Bu2009=u20090.22, pu2009=u20090.002); and policies, provider training, and feeding environment with physical activity (Bu2009=u20090.19, pu2009=u20090.001; Bu2009=u20090.24, pu2009=u20090.010; Bu2009=u20090.38, pu2009<u20090.001).nnnCONCLUSIONSnNutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.

Perceived Toddler Sleep Problems, Co-sleeping, and Maternal Sleep and Mental Health

Objective: Childhood sleep problems are associated with insufficient parental sleep and adverse maternal mental health symptoms, which may be exacerbated when mothers/toddlers co-sleep (i.e., bed/room sharing). This study examines maternal sleep duration as a mechanism linking perceived toddler sleep problems with maternal mental health and examines whether these associations vary by co-sleeping, in addition to exploring alternative models. Methods: Low-income mothers of toddlers (n = 280) (age 12–32 months) recruited from Women, Infants, and Children and pediatric clinics provided demographic information and completed questionnaires on their toddlers sleep and their own sleep duration and mental health symptoms (depressive symptoms, anxiety, and stress). Indirect and conditional indirect models were conducted to examine the relation between perceived toddler sleep problems and maternal mental health. Results: Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping (mean = 6.1 h). Maternal sleep duration mediated the relation between perceived toddler sleep problems and maternal symptoms of depression, anxiety, and stress for co-sleeping mothers. Maternal sleep duration did not mediate relations between maternal mental health symptoms and perceived toddler sleep problems. Conclusion: This study provides a conceptual model by which parent and child sleep is related to parental mental health. Practitioners might consider alternatives to co-sleeping when discussing sleep arrangements with parents. Future studies should replicate results longitudinally and examine whether reducing co-sleeping improves maternal sleep duration and reduces perceptions of toddler sleep problems.

Building healthy development and behavior among WIC participants

Maureen M. Black, PhD,*† Bridget Armstrong, PhD* The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides healthy food, nutrition education, and referrals to women during pregnancy and to children from birth through the first 5 years of life for approximately 8 million low-income participants annually, thereby serving as a “safety net.” The goal of the WIC Program is to safeguard the health of lowincome women, infants, and children during the critical periods of early growth and development. Under the guidance of the United States Department of Agriculture (USDA), WIC has implemented participant-centered nutrition education approaches that focus on participant engagement based on theories of behavior change. WIC providers are trained to incorporate principles of responsive feeding, developmental readiness, and caregiver–child communication into their nutrition counseling and to use participant-centered strategies, such as motivational interviewing. Evaluations have shown that not only are these techniques effective, but WIC participants express satisfaction and confidence with WIC providers and with the education they receive. Thus, it is not surprising that participants readily share concerns about their children’s development and behavior with their WIC providers, as reported in this issue. Development and behavior problems commonly occur among young children, ranging from transitional issues typical of development to disabilities and serious disorders that can have lifelong consequences. Early intervention can be effective and often lessen the negative consequences of potential problems. However, early intervention referrals are often delayed, particularly among children from low-income and racialethnic minority families, such as the WIC population. Referral delays mean that children with disabilities or disorders may miss opportunities for therapeutic intervention during critical developmental periods or that transitional problems may become chronic, particularly when they are associated with maladaptive parent–child interactions. The issue raised by Zuckerman et al. is WIC’s role in recognizing children with development and behavior problems and providing appropriate referrals. WIC providers are neither funded nor trained to conduct developmental screening. Implementing unfunded activities could threaten WIC providers’ ability to complete mandated activities. Screening in the absence of training runs the risk of either not recognizing a problem when one exists or incorrectly identifying typical development and behavior as problematic. The former situation could cause caregivers not to seek an evaluation and services that may be helpful; the latter situation could introduce undue caregiver anxiety and expense if caregivers seek unnecessary evaluations and services. In addition, WIC providers raised concerns about their awareness of appropriate referral sources. WIC providers can be instrumental in identifying caregivers’ development and behavior concerns about their children, playing a complementary role with primary health care providers. Screening is included in primary care guidelines. Development and behavior problems span multiple aspects of a child’s health care profile and are typically managed by health care providers. Just as WIC participants sometimes express concerns about the consistency of feeding advice between WIC providers and health care providers, an optimal outcome for families would be consistency in the advice and referrals that they receive from WIC providers and health care providers, rather than either in isolation. There are several potential options to take advantage of WIC participants’ willingness to express concerns to WIC providers and WIC providers’ sensitivity to potential concerns related to children’s development and behavior. One option is to train WIC providers to help parents communicate with their health care provider regarding development and behavior concerns. This strategy was demonstrated by an externally funded collaboration between pediatricians and WIC providers that resulted in developing a curriculum and training more than 500 WIC providers. Another option is to utilize emerging technologies to facilitate communication between health care providers and WIC providers. With appropriate funding, WIC could expand their recently developed online nutrition education services to include a validated developmental screening tool based on parental report, such as Parents’ Evaluation of Developmental Status: Developmental From the *Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; †RTI International.