Lila Asfour

Effect of a Child Care Center-Based Obesity Prevention Program on Body Mass Index and Nutrition Practices Among Preschool-Aged Children

This study examined the effect of an early childhood obesity prevention program on changes in Body Mass Index (BMI) z-score and nutrition practices. Eight child care centers were randomly assigned to an intervention or attention control arm. Participants were a multiethnic sample of children aged 2 to 5 years old (N = 307). Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake, decreased intake of simple carbohydrate snacks, and decreased screen time. Control centers received an attention control program. Height, weight, and nutrition data were collected at baseline and at 3, 6, and 12 months. Analysis examined height, weight, and BMI z-score change by intervention condition (at baseline and at 3, 6, and 12 months). Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group. Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants. Similarly, intervention children consumed less junk food, ate more fresh fruits and vegetables, drank less juice, and drank more 1% milk compared to children at control sites at 6 months post baseline. Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later. Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group.

An Application of the Complier Average Causal Effect Analysis to Examine the Effects of a Family Intervention in Reducing Illicit Drug Use among High‐Risk Hispanic Adolescents

The Complier Average Causal Effect (CACE) method has been increasingly used in prevention research to provide more accurate causal intervention effect estimates in the presence of noncompliance. The purpose of this study was to provide an applied demonstration of the CACE analytic approach to evaluate the relative effects of a family-based prevention intervention, Familias Unidas, in preventing/reducing illicit drug use for those participants who received the intended dosage. This study is a secondary data analysis of a randomized controlled trial designed to evaluate the relative efficacy of Familias Unidas with high-risk Hispanic youth. A total of 242 high-risk Hispanic youth aged 12-17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at baseline, 6 months and 12 months postbaseline. CACE models were estimated with a finite growth mixture model. Predictors of engagement were included in the CACE model. Findings indicate that, relative to the intent-to-treat (ITT) analytic approach, the CACE analytic approach yielded stronger intervention effects among both initially engaged and overall engaged participants. The CACE analytic approach may be particularly helpful for studies involving parent/family-centered interventions given that participants may not receive the intended dosage. Future studies should consider implementing the CACE analysis in addition to ITT analysis when examining the effects of family-based prevention programs to determine whether, and the extent to which, the CACE analysis has more power to uncover intervention effects.

Obesity Prevention Program in Childcare Centers: Two-Year Follow-Up.

Purpose: To assess the impact of an early childhood obesity prevention intervention “Healthy Caregivers–Healthy Children” (HC2) on dietary patterns and body mass index percentile (PBMI) over 2 school years. Design: Randomized controlled trial. Setting: Childcare centers. Participants: Low-income families. Intervention: Intervention centers (N = 12) received HC2 which consisted of (1) menu modifications, (2) a healthy eating and physical activity curriculum for children, and (3) a parent curriculum for healthy meal preparation, reinforced through a role-modeling curriculum. Control centers (N = 16) received an injury prevention/safety intervention. Measures: Child PBMI and parent report of child’s consumption of fruits/vegetables and unhealthy food. Analysis: Confirmatory factor analysis verified the psychometric properties of factor scores for children’s consumption of fruits/vegetables and unhealthy food. Growth curve analysis assessed the impact of HC2 on change in consumption of fruits/vegetables and unhealthy food and PBMI over 2 school years. Results: Children in the intervention group (n = 754) had a negative slope (β = −1.95, standard error [SE] = 0.97, P = .04), indicating less increase in PBMI versus control children (n = 457). Stratified analyses showed that obese children in the intervention arm had a significantly higher increase in fruit/vegetable consumption versus control group obese children (β = 0.24, SE = 0.08, P = .003). Conclusion: The HC2 intervention resulted in the maintenance of healthy PBMI over 2 preschool years among low-income multiethnic children. These findings support efforts to implement healthy weight programs in the childcare setting.

Ethnicity, Household Food Security, and Nutrition and Activity Patterns in Families With Preschool Children

OBJECTIVE This study evaluated the relationship between food security and child nutritional intake, sedentary behavior, and body mass index (BMI) and potential moderation by ethnic subgroup membership. DESIGN Cross-sectional data analysis from baseline data of a preschool intervention trial. SETTING Twenty-eight subsidized child care centers in Miami-Dade County, FL. PARTICIPANTS Children ages 2 to 5 (n = 1,211) and their caregivers. MAIN OUTCOME MEASURE The BMI percentile and the following 4 factors (via confirmatory factor analysis): food security, consumption of fruits/vegetables, consumption of unhealthy foods, and sedentary behaviors. ANALYSIS Separate linear mixed models tested relationships between food security and main outcome measures with an interaction term to test for possible moderation by ethnicity. RESULTS Results indicated a significant relationship (P < .05) between food security and child consumption of fruit/vegetables, consumption of unhealthy foods, and sedentary behavior, but not with BMI percentile. With greater food security, Haitians reported greater consumption of fruit/vegetables and sedentary behavior. With greater food security, Cubans and non-Hispanic whites reported less consumption of unhealthy foods, while Haitians reported greater consumption. CONCLUSIONS AND IMPLICATIONS Results showed higher food security was associated with higher consumption of fruit/vegetables, consumption of unhealthy foods, and sedentary behavior, but this was moderated by ethnicity. Implications for healthy weight interventions among low-income preschoolers should focus on the importance of food security and tailor intervention strategies for diverse ethnic groups accordingly.

Association Between Socio-Ecological Risk Factor Clustering and Mental, Emotional, and Behavioral Problems in Hispanic Adolescents

Compared to non-Hispanic whites, Hispanic adolescents in the U.S. report higher rates of several mental, emotional, and behavioral problems such as substance use, sexual risk behaviors, and internalizing and externalizing problems. There is evidence of common pathways in the development of mental, emotional, and behavioral problems with certain subgroups of Hispanic adolescents being at greater risk. In the present article, we report analysis of baseline data for 959 Hispanic adolescents who participated in one of two randomized controlled trials evaluating a family-based preventive intervention. Utilizing latent class analysis, we identified subgroups of Hispanic adolescents based on socio-ecological risk and protective factors (e.g., parent–adolescent communication, parental involvement in school). Three distinct socio-ecological risk subgroups (high, medium, and low risk) were identified and exhibited significant differences from each other across a majority of socio-ecological risk and protective factors. Adolescents in higher socio-ecological risk subgroups reported greater mental, emotional, and behavioral problems across all outcomes. Individual comparisons revealed significant differences between the low socio-ecological risk group and both the medium and high socio-ecological risk group in lifetime alcohol use, smoking, and sex, as well as internalizing and externalizing problems. Implications for intervention include focusing on specific risk subgroups and targeting shared risk and protective factors rather than specific mental, emotional, and behavioral outcomes.

Promoting Healthy Weight among Children with Developmental Delays.

An extensive body of research demonstrates a higher prevalence of obesity among children with developmental delays (DD) versus children without delays. This analysis examined the effectiveness of a randomized controlled trial to promote healthy weight in a subsample of preschool-age children with DD (n = 71) on the adoption of quality nutrition and increased physical activity habits versus controls. Child care centers (N = 28) randomized to the intervention group received a multilevel (parent, teacher, child) role modeling program and curriculum on obesity prevention. Results showed that children in the intervention group slightly decreased their junk food consumption while the control group increased their junk food consumption. In addition, among preschool-age children with DD, change in parent fruit and vegetable consumption significantly influenced change in their child’s consumption. Conversely, the greater the consumption of junk food by parents, the greater consumption by their children. Results imply that preschool-age children with DD may benefit from child care center–based healthy weight programs.

The Role of Physical Activity and Sedentary Behavior in Substance Use and Risky Sex Behaviors in Hispanic Adolescents

The purpose of our study was to investigate the potential relationships in Hispanic adolescents (n = 575) between substance use and/or risky sexual behaviors and (a) physical activity (PA) and (b) sedentary time and (c) the moderating effect of gender. PA levels and sedentary behaviors were assessed using the PA Questionnaire for Adolescents, while risky behaviors were assessed using items similar to those used in the national epidemiological study, Monitoring the Future. We found significant, positive associations between PA and smoking, drug use, and risky sex measures. Similar positive associations existed between sedentary time and risky behaviors. However, after stratifying by gender, most of the relationships remained significant only for males. Our study is among the first to examine these relationships in Hispanic adolescents. Given the emphasis on increasing PA and decreasing sedentary behavior in adolescents, more efforts should be dedicated to understanding the effect of these lifestyle habits on risky behaviors.