Marsha Spence

The Effects of an Energy Density Prescription on Diet Quality and Weight Loss: A Pilot Randomized Controlled Trial

Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6 years, body mass index [BMI; calculated as kg/m(2)] 34.8±4.8, 81.8% women, and 93.2% white) were recruited between December 2009 and March 2010 and randomly assigned to: Low ED (consume ≥10 foods ≤1.0 kcal/g dietary ED and ≤2 foods ≥3.0 kcal/g dietary ED per day (n=15); Low-Energy, Low-Fat (1,200 to 1,500 kcal/day, ≤30% energy from fat (n=15); or Low-ED, Low-Energy, Low-Fat (n=14). Participants received 12 weekly group sessions led by a research interventionist. Dietary intake (measured by 3-day food records), self-reported physical activity, and weight were measured at baseline and 3 months. Intent-to-treat analyses showed all conditions reduced dietary ED and energy intake (P<0.001). Low-ED and Low-ED, Low-Energy, Low-Fat interventions increased fruit consumption (P<0.05). All conditions increased self-reported physical activity (P<0.001), with no difference between conditions. Although participants in all conditions lost weight (P<0.001), those in the Low-ED condition lost more (P<0.05) than those in the Low-ED, Low-Energy, Low-Fat condition (Low-ED -20.5±7.0 lb, Low-Energy, Low-Fat -16.9±10.1 lb, and Low-ED, Low-Energy, Low-Fat -12.5± 6.5 lb). A diet prescription that lowered ED increased fruit intake and enhanced weight loss compared with other weight loss prescriptions.

Youth Can! Results of a Pilot Trial to Improve the School Food Environment

OBJECTIVE This study evaluated the potential of youth partnerships to improve the school environment and child nutrition. METHODS A quasi-experimental trial was conducted with 2 intervention and 3 control schools. Intervention schools selected student leaders to participate in youth-led interventions in their schools. Students (n = 104) were included in the evaluation if they were in the fourth grade at baseline and had complete baseline and follow-up data. The intervention trained student leaders in research, advocacy, and nutrition. Leaders implemented interventions appropriate to their schools. Changes in childrens reported dietary intake were examined. Data were analyzed using multivariable regression. RESULTS Childrens diets changed in response to the interventions offered at the schools, although the dietary changes differed by the types of interventions selected. CONCLUSIONS AND IMPLICATIONS Partnering with youth, even at the elementary school level, is a promising avenue for developing tailored interventions for schools.

Remote Lactation Consultation A Qualitative Study of Maternal Response to Experience and Recommendations for Survey Development

Background: Use of videoconferencing technology for healthcare intervention and support is an area of tremendous potential, especially in regard to application in rural or underserved communities. Potential for cost-savings, time-savings, and increased access to care are the ultimate driving force behind use of this technology, for both providers and recipients of healthcare services. Recently, the Federal Government has initiated rulings to support the increased use of computer technology in underserved areas. Therefore, exploring novel applications of the technology of videoconferencing is timely. Remote lactation consultation may be one such novel application. Objectives: The primary objective of this pilot study was to describe the maternal experience of lactation consultation by means of videoconferencing, compared with standard face-to-face care, using grounded theory for model development. Methods: Twelve mothers participated in both a videoconferencing and a face-to-face consultation during one visit to the study site. Using grounded theory methods, responses to an in-depth phone interview occurring 3 days post-consultation were analyzed for major themes and a theoretical model proposed. Results: Three major themes emerged including maternal characteristics and interaction with technology, accuracy and trust determines acceptability for consultation type and, conditional acceptance of remote consultation use. Conclusions: Emergent themes were grounded in existing literature, and potential scales were identified to assist with development of a future tool to test the theoretical model. Responses to the videoconferencing experience were positive, but preferred use of the technology was situational.

Using grounded theory methodology to conceptualize the mother–infant communication dynamic: Potential application to compliance with infant feeding recommendations

Excessive, rapid weight gain in early infancy has been linked to risk of later overweight and obesity. Inappropriate infant feeding practices associated with this rapid weight gain are currently of great interest. Understanding the origin of these practices may increase the effectiveness of interventions. Low-income populations in the Southeastern United States are at increased risk for development of inappropriate infant feeding practices, secondary to the relatively low rates of breastfeeding reported from this region. The objective was to use grounded theory methodology (GTM) to explore interactions between mothers and infants that may influence development of feeding practices, and to do so among low-income, primiparous, Southeastern United States mothers. Analysis of 15 in-depth phone interviews resulted in development of a theoretical model in which Mother-Infant Communication Dynamic emerged as the central concept. The central concept suggests a communication pattern developed over the first year of life, based on a positive feedback loop, which is harmonious and results in the maternal perception of mother and infant now speaking the same language. Importantly, though harmonious, this dynamic may result from inaccurate maternal interpretation of infant cues and behaviours, subsequently leading to inappropriate infant feeding practices. Future research should test this theoretical model using direct observation of mother-infant communication, to increase the understanding of maternal interpretation of infant cues. Subsequently, interventions targeting accurate maternal interpretation of and response to infant cues, and impact on rate of infant weight gain could be tested. If effective, health care providers could potentially use these concepts to attenuate excess rapid infant weight gain.

Knowledge and learning claims in blog conversations: a discourse analysis in social psychology (DASP) perspective

This paper explores how discourse analysis in social psychology (DASP) can provide CSCL researchers with insights regarding how students perform knowing and learning. We investigated what counted as knowledge and learning as students in a large undergraduate lecture course shared their understandings of dietary supplements through blog conversations.

Incorporating the life course model into MCH nutrition leadership education and training programs.

Life course perspective, social determinants of health, and health equity have been combined into one comprehensive model, the life course model (LCM), for strategic planning by US Health Resources and Services Administration’s Maternal and Child Health Bureau. The purpose of this project was to describe a faculty development process; identify strategies for incorporation of the LCM into nutrition leadership education and training at the graduate and professional levels; and suggest broader implications for training, research, and practice. Nineteen representatives from 6 MCHB-funded nutrition leadership education and training programs and 10 federal partners participated in a one-day session that began with an overview of the models and concluded with guided small group discussions on how to incorporate them into maternal and child health (MCH) leadership training using obesity as an example. Written notes from group discussions were compiled and coded emergently. Content analysis determined the most salient themes about incorporating the models into training. Four major LCM-related themes emerged, three of which were about training: (1) incorporation by training grants through LCM-framed coursework and experiences for trainees, and similarly framed continuing education and skills development for professionals; (2) incorporation through collaboration with other training programs and state and community partners, and through advocacy; and (3) incorporation by others at the federal and local levels through policy, political, and prevention efforts. The fourth theme focused on anticipated challenges of incorporating the model in training. Multiple methods for incorporating the LCM into MCH training and practice are warranted. Challenges to incorporating include the need for research and related policy development.

Predictors of body mass index in female parents whose children participate in a competitive, creative, problem-solving program

Background Recent findings from our research indicate that children participating in a creative afterschool program exhibit overall healthier lifestyle practices compared to the average US pediatric population. This observation led us to investigate the prevalence of overweight/obesity and lifestyle practices of their parents. Objective To determine the strongest predictors of weight status for female parents whose children were participating in such creative afterschool program. Design Surveyed subjects were parents of children who competed in the 2008 and 2009 Destination ImagiNation® Global Finals in Knoxville, Tennessee. A total of 4,608 children participated in data collection, with parental consent. For the combined 2 years, 1,118 parents, 87% of whom were females (n=1,032) completed online questionnaires, which were based on the Behavioral Risk Factor Surveillance System and included self-reported height, weight, dietary intake, physical activity, and socioeconomic status. The majority of this population was white, and less than 5% were African American or Hispanic. Results We report here results obtained for the female parents. Only 45.2% of these female parents were overweight/obese, compared to a national average of 64.1% reported by the National Health Nutrition Examination Surveys for 2007—2008. Furthermore, this population was significantly more physically active compared to national average. Most parents (76%) had completed a college degree and reported high incomes. Parents with the lowest income were the most obese in this population. Finally, we found a significant association between parent and child weight status. Conclusions These studies demonstrate that female parents of children who have healthy lifestyles were physically active, which likely accounts for the parents’ lower overweight/obesity rates. In addition to physical activity, income and percentage of calories from fat were all predictors of weight status.

Use of Body Mass Index and Body Mass Index Growth Charts for Assessment of Childhood Weight Status in the United States: A Systematic Review

Childhood obesity has greatly increased in the United States over the previous decades and has become a public health priority. Children at high risk for becoming and who are overweight/obese should be identified early, so that appropriate intervention strategies can be implemented. As monitoring growth is an essential component of well-child care and may help prevent excess weight gain during childhood, it is recommended in pediatric guidelines that practitioners regularly assess weight status in children. In 1998, and again in 2007, the Expert Committee on Obesity Evaluation and Treatment (Expert Committee) released recommendations for physicians, nurse practitioners, and nutritionists in the United States to use the growth charts that were to be released in 2000 by the Centers for Disease Control and Prevention (CDC) to assess weight status in children. These charts included a newly developed body mass index (BMI)-for-age growth chart. The use of BMI (weight in kilograms divided by the square of height in meters [kg/m]) as a measure of adiposity has been supported by the International Task Force on Obesity and the Expert Committee since 1994. Unlike adults, the absolute BMI value is not directly applicable to children for identifying weight status because of the adiposity rebound. The release of the BMI-for-age growth charts finally allowed practitioners in the United States to assess weight status in children using the BMI standard. Thus, in the United States a recommendation has been in place for more than a decade for practitioners to assess weight status in children using the BMI-for-age charts, and these charts have been available to practitioners for most of that same time period. Therefore, the primary objective of this systematic review was to summarize research conducted since 2000 regarding pediatric health care providers’ calculation of BMI and use of the BMIfor-age growth charts to assess weight status in children.

Use of Videoconferencing for Lactation Consultation: An Online Cross-Sectional Survey of Mothers’ Acceptance in the United States

Background: Suboptimal breastfeeding duration and exclusivity rates are a public health concern. Therefore, there is a need for identifying effective tools for use in interventions targeting specific barriers to optimal breastfeeding outcomes. Research aim: This study aimed to assess the relationship between acceptance of remote lactation consultation using videoconferencing and (a) maternal demographic factors, (b) technology acceptance subscales, (c) maternal learning style preferences, and (d) other potentially explanatory maternal factors. Methods: This was a cross-sectional, online study. English-speaking mothers of at least 18 years of age, with an infant age 4 months or younger, and who reported initiating breastfeeding were eligible to participate. Mothers were recruited from 27 randomly selected states. One hundred one mothers completed the survey, resulting in a response rate of 71%. The main outcome was acceptance of videoconferencing use for lactation consultation. Results: No significant differences were found in acceptance by maternal demographic factors or learning style preferences. Acceptance was significantly related to perceived ease of use (r = .680, p < .001), perceived usefulness/extrinsic motivation (r = .774, p < .001), intrinsic motivation (r = .689, p < .001), desire for control of privacy (r = –.293, p < .01), and mother’s perception of the infant father’s/maternal partner’s acceptance of videoconferencing for lactation consultation (r = .432, p < .001). Only perceived usefulness/extrinsic motivation and maternal age remained in the final regression model (R2 = .616, p < .001). Although perceived usefulness/extrinsic motivation was positively associated with acceptance, maternal age was inversely related. Conclusion: This sample of mothers indicated general acceptance of videoconferencing for lactation consultation, with younger mothers and those perceiving it to be more useful demonstrating greater acceptance.