Mildred A. Horodynski

Increasing Nutrition Literacy: Testing the Effectiveness of Print, Web site, and Game Modalities

OBJECTIVE To examine the effectiveness of three modalities for delivery of nutrition education. DESIGN Between-subjects, repeated-measures design. SETTING Data were collected at community agencies or during home visits. PARTICIPANTS Low-income, European American and African American mothers (N = 155). INTERVENTION Participants were exposed to nutrition education material in 1 of 3 modalities (a computer game, The Fantastic Food Challenge; Web site; or pamphlet). Likeability, nutrition knowledge, intention to use, and demographic measures followed the intervention at T1 and T2. MAIN OUTCOME MEASURES 5-point Likert-type scales measured likeability (5 items), and 33 multiple-choice questions measured knowledge. ANALYSIS Data were analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) procedures using SPSS version 15.0 (SPSS Inc., Chicago, IL) software, P < .05. RESULTS Overall, the Web site was liked more than the other conditions with this audience of women. Significant differences in attention, understanding, and intent to use the information existed across modalities. The Web site performed better than other modalities on knowledge outcomes, with no differences in knowledge retention from T1 to T2. CONCLUSIONS AND IMPLICATIONS The Web site modality performed best with this audience of women, indicating that interactive computer games may not confer greater benefits than traditional modes of information delivery for all audiences, particularly those with low computer skills.

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors.

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4–6 months of age (Kleinman, 2004). This studys 1 purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed. 1Funded by the Michigan Department of Community Health and Michigan State University.

Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study.

BackgroundNearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity.Methods/designThe Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction.DiscussionThe Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children.Trial registration numberClinicaltrials.gov Identifier: NCT01398358

Health professionals' perspectives on the infant feeding practices of low income mothers.

The purpose of this study was to determine the perspectives of health professionals on assisting low income mothers with infant feeding. Low income mothers interact with a variety of health professionals through medical care and public health programs. Mothers indicate that health professionals are an important source of infant feeding information; however, they also report this information to be conflicting or difficult to follow. Five focus groups were conducted with 36 health professionals (pediatricians, nurses, WIC professionals, and Cooperative Extension nutrition educators). Individual interviews were also conducted with WIC professionals who were unavailable to meet as a group. Focus groups and interviews were audio taped, transcribed, and analyzed for common content categories. Six major content categories emerged from focus groups and individual interviews with health professionals: (1) Mothers’ sources of infant feeding information, (2) Helping mothers deal with multiple sources of infant feeding advice, (3) Use of infant feeding recommendations by health professionals and their clients (4) Reasons mothers introduce cereal early to their infants (5) Mothers feeding infants in poor mealtime environments, and (6) Ways of providing education to mothers on infant feeding. Conclusions: A better understanding of health professionals’ perspectives on working with low income mothers on infant feeding will inform nutrition education for these mothers, and may also inform strategies to improve communication between mothers and health professionals, subsequently improving infant health.

The Healthy Toddlers Trial Protocol: An Intervention to Reduce Risk Factors for Childhood Obesity in Economically and Educationally Disadvantaged Populations

BackgroundThe number of overweight children in America has doubled to an estimated 10 million in the past 20 years. Establishing healthy dietary behaviors must begin early in childhood and include parents. The Healthy Toddlers intervention focuses on promoting healthy eating habits in 1- to 3-year-old children utilizing the Social Cognitive Theory and a learner-centered approach using Adult Learning principles. This Healthy Toddlers Trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mothers of toddlers. The intervention focuses on: (a) promoting healthy eating behaviors in toddlers while dietary habits are forming; and (b) providing initial evidence for the potential of Healthy Toddlers as a feasible intervention within existing community-based programs.Methods/DesignThis describes the study protocol for a randomized control trial, a multi-state project in Colorado, Michigan, and Wisconsin with economically and educationally disadvantaged mother-toddler dyads; toddlers are between 12 and 36 months. The Healthy Toddlers intervention consists of eight in-home lessons and four reinforcement telephone contacts, focusing on fruit, vegetable, and sweetened beverage consumption and parental behaviors, taught by paraprofessional instructors. Healthy Toddlers uses a randomized, experimental, short-term longitudinal design with intervention and control groups. In-home data collection (anthropometric measurements, feeding observations, questionnaires, 3-day dietary records) occurs at baseline, immediately following the intervention, and 6 months after the intervention. Main toddler outcomes include: a) increased fruit and vegetable consumption and decreased sweetened beverage consumption; and b) improved toddler-eating skills (self-feeding and self-serving). Main parent outcomes include: a) improved psychosocial attributes (knowledge, attitudes, self-efficacy, feeding style) related to child feeding; b) provision of a more positive mealtime physical environment (turning off the TV); and c) creation of a more positive mealtime social environment (sitting down together for meals).DiscussionIf this project is successful, the expected outcomes are that the intervention will be effective in helping toddlers develop healthy eating skills that contribute to improve overall health and development and to the prevention of obesity.Trial registrationCurrent Controlled Trials ACTRN12610000981022

Healthy babies through infant-centered feeding protocol: an intervention targeting early childhood obesity in vulnerable populations

BackgroundPoor feeding practices during infancy contribute to obesity risk. As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages. The Healthy Babies trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention is being conducted during the infants first 6 months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior.Methods/DesignWe will describe our study protocol for a multisite randomized control trial being conducted in Colorado and Michigan with an anticipated sample of 372 economically and educationally disadvantaged African American, Hispanic, and Caucasian mothers with infants. Participants are being recruited by county community agency staff. Participants are randomly assigned to the intervention or the control group. The intervention consists of six in-home visits by a trained paraprofessional instructor followed by three reinforcement telephone contacts when the baby is 6, 8, and 10 months old. Main maternal outcomes include a) maternal responsiveness, b) feeding style, and c) feeding practices. Main infant outcome is infant growth pattern. All measures occur at baseline and when the infant is 6 and 12 months old.DiscussionIf this project is successful, the expected outcomes will address whether the home-based early nutrition education intervention is effective in helping mothers develop healthy infant feeding practices that contribute to improving infant health and development and reducing the risk of early-onset childhood obesity.Trial RegistrationCurrent Controlled Trials ACTRN126100000415000

Key Theoretical Frameworks for Intervention: Understanding and Promoting Behavior Change in Parent–Infant Feeding Choices in a Low-Income Population

The early introduction of solids to infants is a risk factor associated with later health problems including allergies, overweight, and diabetes. The Infant Feeding Series (TIFS), a newly designed curriculum that promotes the appropriate transition to solids through parenting education and behavior change among low-income mothers, used the Theory of Planned Behavior and the Transtheoretical Model of Change to develop TIFS curricular foci and activities. Using a pre-post design, pilot study results indicate that after exposure to the TIFS curriculum, mothers had significantly increased knowledge about appropriate infant feeding, could more accurately identify developmental indicators of infants’ readiness for solids, and reported greater feelings of self efficacy about initiating and maintaining healthy feeding practices. Editors’ Strategic Implications: Replication is necessary, but TIFS appears to be a promising prevention program based on short-term knowledge and long-term behavioral outcomes (i.e., healthy feeding practices).

Toddler feeding: Expectations and experiences of low-income African American mothers

Objective To ascertain maternal expectations and experiences with mealtimes and feeding of toddlers among low-income African American mothers in two mid- to large-size cities in the United States. Design Qualitative focus group study. Setting Two Early Head Start programme sites in a Midwestern state which serve low income families. Method Twenty-seven low-income African American mothers took part in two focus groups which were conducted by a facilitator, according to a semi-structured topic guide. Focus group data were supplemented with demographic family data. Results Four major themes emerged: (1) maternal perceptions of healthy toddlers, (2) maternal food choices for toddlers, (3) maternal expectations about toddler autonomy and self-regulation of feeding, and (4) mealtime context and interaction. Conclusions and implications Data provided examples of maternal expectations and experiences, suggesting the development of healthy feeding patterns among some toddlers and provided evidence of less healthy feeding patterns in others. Evidence of less healthy feeding patterns included limiting toddler autonomy and food regulation, and misinterpretation of normative toddler behaviours. Because parenting practices and perceptions have been reported to contribute to social and environmental influences of obesity, this research could aid development of culturally sensitive nutrition education interventions.

Improving self-regulation for obesity prevention in head start: A randomized controlled trial

A preschool-based intervention to improve children’s self-regulation improves self-regulation but has no effect on child BMI or obesity-related behaviors. OBJECTIVES: To determine the effect of an intervention to improve emotional and behavioral self-regulation in combination with an obesity-prevention program on the prevalence of obesity and obesity-related behaviors in preschoolers. METHODS: This was a cluster-randomized intervention trial in Head Start (HS) classrooms conducted in each of 4 academic years from 2011 to 2015. Participants (697 children; 49% boys; mean age: 4.1 ± 0.5 years; 48% white, 30% African American, 12% Hispanic) were randomly assigned by classroom to 1 of 3 intervention arms: (1) HS + Preschool Obesity Prevention Series (POPS) + Incredible Years Series (IYS) (HS enhanced by the POPS [program targeting evidence-based obesity-prevention behaviors] and the IYS [program to improve children’s self-regulation]), (2) HS+POPS, or (3) HS. Primary outcomes were changes in prevalence of obesity, overweight/obesity, BMI z score, and teacher-reported child emotional and behavioral self-regulation; secondary outcomes were dietary intake, outdoor play, screen time, and parent nutrition knowledge and nutrition self-efficacy. RESULTS: HS+POPS+IYS improved teacher-reported self-regulation compared with HS+POPS (P < .001) and HS (P < .001), but there was no effect on the prevalence of obesity (16.4% preintervention to 14.3% postintervention in HS+POPS+IYS versus 17.3% to 14.4% in HS+POPS [P = .54] versus 12.2% to 13.0% in HS [P = .33]). There was no effect of HS+POPS compared with HS alone (P = .16). There was no effect on other outcomes except for sugar-sweetened beverage intake (HS+POPS+IYS resulted in a greater decline than HS; P = .005). CONCLUSIONS: An intervention for parents and children to improve HS preschoolers’ emotional and behavioral self-regulation in combination with an obesity-prevention curriculum did not reduce obesity prevalence or most obesity-related behaviors.

Theory of Dependent-Care in Research With Parents of Toddlers: The NEAT Project:

This paper contains a description of the use of the theory of dependent-care in the Nutrition Aimed at Toddlers project, a nursing intervention study with parents of toddlers, and discusses the research and practice utility of the theory of dependent-care, a corollary theory to Orem’s self-care theory. In particular, the concepts of dependent-care, dependent-care agency, therapeutic self-care demand and an educative-supportive nursing system are discussed within the context of the Nutrition Aimed at Toddlers project.